Ease of Wayfinding and Circulation Cues

Wayfinding helps patients and visitors navigate a facility with minimal assistance and no confusion. Flooring color can identify room types and patterns to guide people toward their destination.

According to the VA design guide for behavioral and mental health facilities, “Design can support elements by using color to identify program areas. For example, a consistent color can identify all staff off-stage areas. Patient units can be identified by distinct and different color palettes. Group Rooms may be identified with consistent color.”³¹

FGI Guidelines speak to pattern and color contrast research. Patterns and contrast research suggest that flooring with a medium-sized pattern (1 to 6 inches wide, or 2.54 to 15.24 centimeters wide) was associated with more falls than floors with no design or a small pattern (less than 1 inch wide, or 2.54 centimeters wide), or a large pattern (wider than 6 inches). High-contrast patterns with large geometric or swirling designs on floor surfaces have been associated with more patient falls. These patterns can distract and potentially confuse persons with visual acuity issues.

Minimal Contrast Between Types of Flooring

In the United States, 8 percent of the population (26.M), and 1:5 who are over sixty-five are visually impaired. Similar values between different flooring materials help minimize transitions between different types of flooring and may reduce fall risk. Smooth transitions should be provided between different flooring materials. Flush thresholds should be used to reduce tripping hazards. Some flooring types, such as resilient flooring (e.g., rubber, luxury vinyl tile, sheet vinyl) and carpet, should include transition strips that minimize trip hazards.

Slip Resistance

The slip-resistance ratings of flooring surfaces should be appropriate for the area of use—for dry or wet conditions and use on ramps and slopes.

According to FGI 2022 Guidelines for Design & Construction of Hospitals: Wet conditions are common in areas such as kitchens and bathing areas, entries from exterior to interior space, and areas where water is used for patient services. Slip resistance is also an important consideration for ramps and stairways. In dry areas, soft flooring (e.g., carpet, cushioned flooring) can reduce the risk of falls and the impact of associated injuries.

Compatible with Wheeled Devices

Floor surfaces should allow easy movement of all wheeled equipment in the facility. Portable lifting equipment without powered wheels may require more exertion by staff than ceiling-mounted equipment to move an elevated patient around and through a space. The exertion required by staff may increase with the use of carpet; however, different types and brands of carpet may have significantly different levels of resistance to wheeled devices. Installation of a mock-up to test hybrid flooring materials with wheeled equipment and devices used in a facility is recommended. Carpet should not be automatically discounted as inappropriate due to this challenge, as it has significant advantages over hard-surface flooring in terms of noise reduction and acoustics.

Floor Reflectivity and Glare

Finished floors with a high gloss value cause glare that may compromise patient vision by being misinterpreted as a pool of water on the floor or a hole in the floor surface, disrupting the balance. The use of no floor finish flooring eliminates glare. Where a floor finish is required, smooth flooring surfaces should be sealed with a matte finish to reduce surface glare. A minimum LRV of 30 is recommended between floors and walls (wall bases should match the walls) to help define the space.

Sound Attenuation (Reduce Impact Sound)

Reducing impact sound requires specifying the right product for the right space. Acoustic floors should be selected with consideration of sound reduction properties to help preserve sleep and to protect privacy and accuracy of communication in support of HIPAA compliance and medical error reduction.

According to the Veterans Administration’s “Design Guide for Inpatient Mental Health & Residential Rehabilitation Treatment Program Facilities”:³²

A mental health facility requires special attention to sound control. Acoustic isolation shall be provided from the units to other areas in the hospital and inside each patient and resident room to preserve privacy/confidentiality and to reduce excessive noise. Excessive noise can negatively impact a therapeutic environment for the patient/resident and the staff. It may affect one’s ability to hear or be heard in a normal speaking tone, which detracts from a calm, nonthreatening environment. Excessive noise may heighten some patients’ fear and anxiety levels.

Impact Resistance and Durability

Patients in behavioral and mental health settings may become violent. Such incidents potentially cause more impact on flooring in these spaces than in traditional healthcare settings. This calls for the highest level of impact-resistant and durable flooring.

Durability Considerations for Spaces in Continual Use

Flooring that does not need to be stripped, waxed, and recoated is most beneficial for a BMH center. The noise associated with maintenance protocol could negatively impact the serene ambiance at the heart of healing. Even more disruptions occur if the flooring needs replacing. A no-finish floor and durable flooring sustain the rigor of the setting, reduce the associated person-hours to maintain, and mitigate noise.

Solutions for Healing: A Person-Centered approach to Why the Floor Matters in the Behavioral Mental Healthcare Environment

Photo courtesy of Tarkett

A well-designed BMH facility includes many spaces for socializing.

Michael Garron Hospital (MGH), an East Toronto landmark for generations serving 400,000 residents, recently unveiled one of the largest redevelopment projects in the hospital's history. Empathy, understanding, transparency, and communication across the project teams resulted in a campus transformation.

To design the Center, MGH partnered with B+H, a global architectural firm. B+H shared that their approach was to actively use design to promote healing, recovery, and well-being to contribute to the health of patients, staff, and the larger community to which it belongs.

To foster inclusivity, an integral part of the eight-story Thomson Patient Care Centre included two inpatient mental health units. From the ground up, the floor matters in fostering a healing, therapeutic, safe environment.

Susan Roman, Senior Associate, Healthcare Interiors with B+H, shared that their role was not to influence a flooring selection but to inform the hospital of the qualities and options of homogeneous flooring products on the market and help them evaluate the options. A high-quality homogeneous vinyl flooring system was the basis of the design, and the manufacturer was awarded the project based on the flooring system’s inherent lifelong performance characteristics.

Roman went on to share how the flooring specification checked all the boxes for why the floor matters:

Q: When designing for the local community, how is this new hospital providing a modern level of care?
A: Part of our strategy was providing neutral wayfinding and floor color with a contrasting border for accessibility for the visually and cognitively impaired.

Q: What were the best practices for mental health design that you applied, specific to the flooring selection, regarding the vision and design for these two new mental health units?
A: Best practices included:

• We chose a 2mm homogeneous, seamless, resilient floor with an integral flash cove base.
• To provide aesthetically safe, welcoming, calming, and de-institutionalized flooring, we chose a homogeneous vinyl flooring system to foster soothing colors and mitigate the institutional elements to help blend into the background.
• To minimize busy or complex patterns, we used an “entry mat” accent color at patient-facing doorways and an “area rug” accent color to highlight destination points, such as care desks.

Q: What guidance did the hospital provide to B+H in terms of the design it hoped to see in these two new mental health units? What was the vision?
A: Key decision drivers were ease of maintenance, durability, safety, and longevity. In addition to exceptional durability, the flooring features technology that requires no floor finish for the life of the floor. It also demonstrates superior infection control and is certified asthma and allergy-friendly, ensuring good indoor air quality.

Q: What flooring design features help to make the patient experience more positive? A: We specified three flooring colors: one as the neutral field, one as a neutral accent, and one as a color accent. These are used across the new facility.

Q: Who were the key decision makers?
A: Multiple cross-disciplinary user groups, patient representatives, consultants, and hospital executives. Integral to the design of our healthcare facilities is a focus on patient-centered care guided by evidence-based design. B+H understands that community and private healthcare institutions require flooring solutions that anticipate changing demands. Healthcare clients around the globe currently share common concerns: to address aging populations and cope with increasingly complex and resilient illnesses with higher acuity. The principles of wellness and community care advocate for spaces that are clinical and practical yet comfortable and healing and integrated with our social and technological future. Our partnership with Tarkett supported the basis of design with a flexible, acuity-adaptable flooring solution.

CONCLUSION

A debt of gratitude is owed to architects, designers, and care centers for normalizing the patient experience in behavioral and mental healthcare settings.

The VA Design Guide Mental Health Facilities Design Guide identifies key criteria in the selection of interior finishes, and those also apply to flooring selection, such as aesthetic value, therapeutic attributes, maintainability, durability, infection control sustainability, and safety and security.

The Advisory Board notes that inequities in behavioral healthcare impact the financial outcomes of healthcare organizations. Despite high and growing demand, access to reliable behavioral health services is challenging. Provider shortages, stigma, and limited reimbursement create significant barriers to timely, cost-effective behavioral healthcare.

They go on to share that improving behavioral health has the potential to significantly improve clinical outcomes and healthcare costs. Behavioral health conditions are prevalent. Approximately 70 percent of patients with a behavioral health condition have a medical comorbidity. Additionally, “deaths of despair” (from alcohol, drugs, or suicide) have more than doubled since 1999. Despite the prevalence of behavioral health conditions, they often go untreated. Less than half of patients receive treatment.

By many accounts, behavioral and mental healthcare and acuity levels continue to increase. Mental health experts interviewed by Forbes³³ listed some areas of increase: social media-induced anxiety, work burnout, eating disorders, and neurodivergent conditions affecting mental health. For NAMI, the National Alliance on Mental Illness, three future goals³⁴ stand out: 1) To help people get help sooner, 2) to help them get the best care possible, and 3) to detach mental healthcare needs from law enforcement. All signs point to an overarching need for more spaces for those with mental and behavioral health challenges and those who care for them. This is why the floor matters: as a foundation for therapeutic care that allows patients to heal and transition back to whole, healthy lives in a society that supports their healing.

ENDNOTES