Behavioral healthcare for children and adolescents is more critical than ever in the United States. According to the American Academy of Pediatrics (AAP), nearly 20% of children aged 3-17 have been diagnosed with a mental, emotional, or behavioral disorder. Factors such as academic pressures, social media influences, family dynamics, and broader societal anxieties all impact the mental well-being of young people. The AAP has reported increased rates of depression and anxiety diagnoses since the COVID-19 pandemic. As the availability of child and adolescent mental health services struggles to keep up with the rising demand, the AAP, Children’s Hospital Association (CHA), and American Academy of Child and Adolescent Psychiatry declared the situation a national emergency in 2023.
Meeting the increasing need for child and adolescent mental health services means addressing the insufficient capacity and ineffective environments in existing facilities. Healthcare providers require the support of physical environments that are designed appropriately to facilitate healing for young patients. Updating existing facilities and creating new spaces requires balancing complex design factors and stakeholder views. By considering the unique needs and developmental stages of children and adolescents, the thoughtful design of mental health facilities helps to address the national crisis.
Why the Need is Urgent
Escalating Demand
The increase in demand for child and adolescent mental health services since the pandemic has strained health systems. The CHA reported that mental health-related emergency department visits increased by 50% for children aged 3-18 from 2016 to 2022. This has resulted in extended wait times for young patients experiencing a mental health crisis. According to the National Institute of Mental Health, the rate of child and adolescent patients waiting more than two nights for a mental health unit bed to become available increased by 76% from 2019 to 2022. In response, many hospitals, such as Allegheny Health Network’s Forbes Hospital, have elected to designate portions of their emergency departments for accommodating patients with urgent mental health needs.
Systemic Gaps
Today’s children and adolescents face insufficient mental health services in the places they spend most of their time as well as the places they turn to for care. Schools are often able to observe changes in behavior and identify signs of mental illness. However, they are frequently lacking the resources and personnel to properly manage the mental health needs of their students. Similarly, many hospitals are missing the specialized environments and staff needed to provide inpatient and outpatient mental health services, leading to ineffective care and extended stays for child and adolescent patients.
Consequences of Inaction
If children and adolescents receive care that is insufficient or stay in an unsuitable environment, they may experience trauma that worsens their condition. Delayed access to appropriate care can exacerbate existing mental health conditions and cause more severe issues in the future. MedCentral reported that serious mental illness in adolescents, if left untreated, can have an exponential effect impacting emergency department visits, academic performance, encounters with the criminal justice system, and social and environmental consequences as they enter adulthood. Children and adolescents whose mental health needs go unmet often require more intensive and costly treatment later in life, further burdening hospitals. Failure to address this crisis puts the well-being of young people at risk and strains our health systems.
Current Infrastructure is Failing Our Youth
The facilities that currently serve children and adolescents with mental health needs are often outdated or unsuitable for supporting the healing process. Traditional environments lack the sense of familiarity and comfort that helps reduce anxiety in young patients, making facilities feel institutional and sterile. Harsh overhead lighting, long hallways, and stark color palettes can contribute to overstimulation and agitation, hindering progress. A common and less expensive solution for health systems is to adapt existing facilities for a mental healthcare function. However, this introduces additional challenges related to modifying an environment that was not designed to accommodate young patients with mental health needs. These spaces often prevent healthcare providers from creating an optimal environment for healing and meeting best practices for design, such as strong sightlines, access to natural light, and security measures.
Outdated mental health facilities typically prioritize security at the cost of patient comfort. Particularly for children and adolescents, the healthcare environment directly impacts treatment and healing progress. Existing facilities that feel restrictive and frightening to young patients can slow healing and even cause mental health conditions to worsen. The safety of patients, staff, and the community is paramount; a facility’s design must consider staff sightlines and egress paths, controlled access and elopement risk, and potential for misuse of finishes. However, security measures should be integrated without compromising the healing environment. Through comprehensive planning and design, health systems can implement solutions that seamlessly balance security with patient dignity and comfort.
Designing for Healing: What Children and Teens Actually Need
Developmentally Appropriate Design
As young children transition into adolescents, their needs and abilities evolve. The mental healthcare environment should support the distinct needs of each age group, including by integrating code-mandated separations and design elements. Young patients must be separated by age and gender, and the Americans with Disabilities Act (ADA) has special codes for spaces primarily occupied by children aged 12 and under. Mental health environments for young children should emphasize opportunities for play and positive sensory input like cheerful colors and artwork. Furniture and fixtures should be scaled appropriately to encourage independence and comfort. Meanwhile, adolescents in their teens benefit from more privacy and freedom of choice. Security solutions should ensure safety while promoting autonomy for adolescent patients.
Identity and Control
Young patients experience a loss of identity when they enter an inpatient mental health facility, as most personal items must be removed to ensure their safety. Mental health environments should introduce opportunities to personalize a patient’s surroundings, especially for adolescents. Private bedrooms, customizable lighting, and artwork give young patients ownership over their experience. These solutions return some agency to the patient, helping them feel more at home and receptive to the healing process.
Sensory Considerations
Traditional mental health environments are typically characterized by small windows, neutral color palettes, and sparse furnishings, making them feel institutional and unwelcoming for young patients. Mental health facilities should incorporate solutions that contribute to a positive sensory experience that balances engaging and calming features. Children respond more positively to colorful and playful environments, while adolescents prefer muted, calming tones and a variety of spaces to choose from. Open areas, natural light, access to the outdoors, and home-like finishes work together to soothe anxious minds, aiding in the healing process.
Trauma-Informed Approaches
Mental healthcare facilities should integrate spaces and features that minimize negative responses and help young patients de-escalate. Trauma-informed design solutions avoid constrictive spaces and limited visibility, promoting a sense of safety and control for children and adolescents. Areas dedicated to de-escalation, such as quiet rooms with soft lighting and tactile features, provide a safe space for young patients to soothe their emotions and learn how to manage crises. These design approaches give children and teens the resources to grow and heal.
The Role of Stakeholders in Driving Change
The child and adolescent mental health crisis demands increased capacity for treatment services and environments that effectively support healing. Communities need more facilities dedicated to these services, but the success of new facilities hinges on the support of providers, payers, educators, parents, and the community. Achieving these goals begins with developing mutual trust between the client and architect and establishing priorities for planning and design. Comprehensive collaboration is critical to addressing the needs and concerns of all stakeholders. Facility designs should instill confidence in parents who must entrust health systems with the care of their children. The physical environment should support the important work of clinicians, facilitating improved treatment outcomes and promoting staff recruitment and retention.
Trust and collaboration are crucial on a broader scale as well. Local authorities and surrounding communities are often wary of new facilities due to the stigma and lack of knowledge about mental healthcare. Health systems and architects should work together to shed light on the life-changing services these facilities provide, and the direct benefit to children and families in the community. Securing funding is also crucial to bringing new mental health facilities to fruition. Health systems often depend on investment at the state or federal level in addition to private donations to make projects possible. The expansion of mental health services for children and adolescents relies on the support of stakeholders from every group, requiring careful coordination to navigate the design and construction process.
Case Study: Designing the Pittsburgh Region’s First Behavioral Health Hospital Solely for Children and Adolescents
Our designers at IKM Architecture (IKM) are committed to furthering behavioral health design and bringing best practices to fruition for the benefit of our clients and their patients. Roger Hartung, Principal, and Marissa Kohler, Associate, recently collaborated with Acadia Healthcare to expand the Pittsburgh campus of Southwood Children’s Behavioral Healthcare (Southwood) with a new inpatient hospital. This facility adds 108 much-needed inpatient beds dedicated to children aged 4 to 10 and adolescent patients up to age 18. IKM’s design exemplifies the ways that strategic solutions can ensure patient and staff safety, while creating an environment where children can heal and grow.
Inviting Exterior
The façade of the new three-story hospital features brightly colored panels that welcome patients and families to the campus, reflecting the playful interior environment catered to young patients and conveying the empathetic care offered here.
To prioritize safety and sensitivity, an internal sallyport was integrated at the patient admissions entrance to prevent elopement without the intimidating appearance of an external, cage-like structure. In addition, the visitor entrance features a simplified secure vestibule as a less intimidating option for loved ones coming to see admitted patients.
Separation by Age Group
Six inpatient units are organized to satisfy code requirements and create dedicated environments for children and adolescents. Patients are separated by age and gender, with children aged 4 to 10 on the top floor, and adolescents up to age 18 on the two lower floors. Adolescent patients are further separated by gender, with one floor designated for females and one floor for males.
Open Social Space
An open common area was created on each floor by removing the wall between the social noisy space and the corridor. This eliminates the constrictive feel of a four-walled room and creates a welcoming environment for social interaction. Adolescent patients are free to access the space without express permission, providing a safe space outside their bedrooms.
The adjacent nurse station monitors the social noisy space and corridor, extending the open environment the entire length of the floor. This layout encourages children to explore the unit freely and interact with staff at the nurse station.
Nurse Stations
Laminated safety glass at each nurse station ensures the physical safety of staff while facilitating clear communication through gaps in the panes. The frameless panes break down the barrier between patients and staff by visually occupying the same shared space.
A dedicated egress path inside the secured nurse station gives staff the ability to retreat into the nurse work area without reentering the unit in the event of violence.
Door Hardware
Locking systems were installed on doors in the social spaces, comfort rooms, and patient bedrooms that allow them to be accessed freely during the day, giving adolescent patients a sense of independence. These doors can also be locked as needed by staff to prevent the misuse of space.
Bathrooms in each patient bedroom are accessed through flexible magnetized doors, providing a non-lockable, tear-away solution that upholds patient privacy while ensuring unobstructed access for staff in case of an emergency.
Patient Rooms
Several interior design solutions were integrated that give young patients ownership of their space, including colored “door mats” in the flooring and a light fixture outside each patient’s room to mimic stoops along a street.
Marker boards serve as signage for each bedroom, encouraging patients to create their own identifications and artwork.
Play Areas
Dedicated activity zones separate from therapy areas encourage play and support young patients’ development. An indoor play area mirrors the outdoor space, allowing for year-round use.
Chalk-friendly blacktop, pick-proof turf for safe sensory play, and a meandering track provide healthy outlets for energy. Safety features include a netted ceiling in the indoor play area, out of patients’ reach to protect fixtures from damage, and an anti-climb fence enclosing the outdoor space to prevent elopement.
In the planning stages of the new inpatient mental health hospital, IKM and Southwood leadership established a common understanding of the goals for the facility and communicated the challenges in achieving them. This early collaboration established a relationship of trust and honesty among the project team. Southwood trusted the IKM team to develop a solution that balances code requirements, best practices for mental health environments, and budget. We were able to select finishes that contribute to a home-like environment while saving cost and labor in the long run. In behavioral health environments, regular abuse of materials means that life cycle costs impact return on investment more than up-front costs.
Together, IKM and Southwood advocated for the value of this project, illuminating the essential care that the new facility provides to families in the immediate community and beyond. By communicating directly with local authorities and community members, the project team received unanimous support for its construction. As a result, Southwood Children’s Behavioral Healthcare is now able to provide critical mental health services to 108 additional child and adolescent patients on their campus.
IKM Architecture is proud to serve organizations that make a profound difference in their communities. Mental health is an area of care that reaches more child and adolescent patients every year as demand for services continues to rise. As expert partners, we guide our clients in comprehensive discussions to address the myriad factors that impact child and adolescent mental health design. We develop evidence-based solutions that are tailored to each client’s stakeholders and needs. The environments we create support the delivery of critical services, facilitate healing, and promote patient and staff well-being.
Editor: Ashley Poore; Graphic Designer: Jessica Sandy; Contributors: Madeline Oppelt, Roger Hartung, Marissa Kohler