Veterans Affairs Inpatient Mental Health and Residential Rehabilitation Treatment Program Design Guide

The US Department of Veterans Affairs is the largest healthcare system in the nation and has the largest population of mental health patients, serving veterans at more than 1,200+ facilities around the country. To ensure the highest level of care is available, VA tasked SmithGroup mental health design experts to help develop detailed standards for all future construction and renovation of these specialized facilities.

These standards define VA’s principles for best practices in healthcare planning and design and illustrate concepts that support those principles. Over the years, SmithGroup has helped develop several design guides for VA, from polytrauma to pharmacy, surgical services and many more. The design standards are updated periodically and made available to the public via VA’s Technical Information Library. Because of VA’s reputation for superior mental healthcare, the new Design Guide serves as a valuable reference for other public and private healthcare facilities and is publicly available on their website. As a result, these standards have a significant influence on the nation’s mental healthcare system.

Expanding and updating the Design Guide began with an extensive nationwide tour of existing VA as well as private and state facilities. SmithGroup and the VA team conducted more than 30 on-site visits to study inpatient and residential rehabilitation treatment programs. These visits provided invaluable insights into the design strategies that help to create a safe and healing environment. Expanding hallways, for example, can soften stress-inducing acoustics, de-escalate conflict, and give patients more options for socialization while remaining within sight of staff. Open-hub nursing stations can be designed to maximize safety for patients and staff while retaining the dignity of face-to-face interaction. Providing ample outdoor space with access to  and views of nature is a positive contributor to patient outcomes, illustrated conceptually in the design guide. These and numerous other design strategies were examined against the backdrop of existing research to verify evidence-based solutions.

The team also held a two-day charrette with over 40 mental healthcare experts from VA and the private sector, which involved rapid prototyping and test fits of room configurations. A follow-up survey of VA staff provided additional feedback. A review of the mental health literature helped validate best practices and dispel common misperceptions about the effectiveness of different design concepts. This comprehensive approach underscored the therapeutic value of providing autonomy and choice to patients whenever possible.

By gathering and synthesizing information from a variety of sources, the team developed facility and space standards that identify and codify best practices in the planning and design of inpatient mental health and residential rehabilitation treatment. It effectively communicates the design strategies that will best serve veterans, their families and providers, and ensures that VA facilities continue to set the standard for safe, effective, compassionate care.