Designing for Empathy and Resilience in Mental and Behavioral Health

  • Rachael Farrell
  • David Vincent
  • Erin Peavey
  • Deborah Wingler, PhD
  • Hannah Shultz
  • Nathan Howell

Access to high-quality mental and behavioral health care is more essential than ever. With a global pandemic threatening the mental health of millions across the globe, it is crucial to act swiftly to improve access to care for all individuals across the growing care continuum. Creating environments that address cultural biases and support  varied mental health conditions can help transform stigmas and usher in a more human-centered approach for the patients, families, and staff who deliver care. 

Disparity of Adults and Children with Mental Health and Substance Use Disorders Receiving Necessary Treatment in the United States

Original graphic. Content derived from: 1. Substance Abuse and Mental Health Services Administration. (2018). Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health. 2. National Alliance on Mental Illness. (2019). Mental Health By the Numbers. Retrieved from

Recent statistics show that approximately 19% of adults and 17% of children experience a mental illness or disorder each year. However, only about half of these individuals receive treatment due to lack of resources and access to care, as well as stigma around seeking care. Across the board, these individuals are at greater risk for a range of negative health and quality of life outcomes from cardiovascular disease, unemployment, and substance use disorders.  COVID-19 has had a remarkable impact on our mental health, with 45% of Americans reporting its negative effects. As many struggle to adapt, many health experts see a rise in the need for mental health services in the coming years. 

To implement positive change, we are committed to seeing the whole person through a culture of empathy and activism while leveraging data, our research expertise, and a steadfast focus on safety and wellbeing. We also believe that design is a platform to advocate for change across the health care system. We collaborate with partners including manufacturers, legislators, and community coalitions to create greater access to care and ultimately, improve community health and resilience. 

  • Provide an integrative research approach. Our in-house research team includes PhD researchers, anthropologists and data analysts to offer our clients evidence-based insights to improve health outcomes. 
  • Form coalitions with providers and community stakeholders. Our cross pollination of expertise helps us to maintain a reading on the heartbeat of this issue. We want to surround ourselves with the people that care most about this matter, so we can deliver spaces that support meaningful, measurable, and sustained healing.  
  • Meet with state lawmakers. We actively participate in the reviewing, proposing, and supporting of new architectural code amendments. We want to see legislation adopt and support Crisis Stabilization Units, to offset unnecessary hospital admissions.  
  • Challenge manufacturers. We find deficiencies in the products at our disposal, and we sketch options and solutions to help work toward improvements of the hardware, doors, windows, ceilings and finishes we employ to support patient and staff safety, successful installation, longevity and sustainability. 

Just as clinicians work to create resilience in individuals, we understand the importance of creating resilient environments that facilitate recovery, reduce stigma, support staff recruitment and retention, are safe, secure, and flexible for whatever may come.

Facilitate Recovery

One of the core tenets of theNational Alliance on Mental Illnessis recovery. Design and planning can help facilitate this by providing opportunities for patients to engage in therapeutic experiences and practice life skills in a safe, supportive environment. In addition to the programs provided, the facility itself can help reduce stress, provide phased levels of family and community integration, and support the care model. 

Patients and their families are greeted by bold and uplifiting imagery upon reception at Cincinnati Children’s College Campus Hill.

Reduce Stigma

The stigma of mental illness is a primary roadblock to patients and families in seeking treatment. Creating a therapeutic environment that honors the person is an important step in reducing stigma. In practice, this means creating a welcoming entry, using artwork and décor and finding ways to support privacy and choice as possible to support a sense of personal security. Having a place that is well-maintained can increase pride in the environment and reduce further property destruction. 

INTEGRIS Arcadia Trails Center Addiction Recovery in Edmond, Oklahoma provide a safe haven for patient recovery, with a warm palette and luxe furnishings to make each resident feel at home.

Improve Safety and Security

Planning and designing environments that reduce stress for occupants can help patients feel and be safer, minimize the risk of patients harming themselves or others, and support staff safety. Access to a variety of therapeutic spaces can promote behavioral improvement, reduce violent incidents, and reduce stress. 

Safe access to expansive courtyards from the patient unit was a high priority at San Antonio State Hospital. Exterior stairs, equipped with unobtrusive digital security devices, were designed to provide clear sight lines from the relaxing walking trails to the care station on the facility's second level.

Support Staff Recruitment and Retention

Staff shortages are a major concern for health systems. A facility with well-designed areas that are safe, secure, and attractive can increase recruitment and retention. The design should include areas of respite for staffand create an environment that improves their workflow. 

Design for Resilience

Resilienceis increasingly a project driver in a changing mental health environment. The facility design should be able to accommodate different care models than originally planned or provide services to different groups of patient types. 


As we navigate through the complexities associated with the rise of mental and behavioral health needs and the COVID-19 pandemic threatens the wellbeing of our communities, we must take a more all-inclusive approach to mental and behavioral health care. Our comprehensive approach  supports all building typologies and acuities of care, adapting as necessary throughout an organization’s evolution. The patients of the future need a resilient care environment that can transform with the ever-evolving social, environmental, and biological variables of our world. Through intentional design, community partnering and advocacy, we design care environments that enable people with mental or behavioral health conditions to be treated with empathy, dignity, and human-centered care.  

This was project was completed as a part of HKS’ Research Incubator program. This annual initiative empowers practitioners throughout the firm to invest focused time and energy into exploring topics that encourage innovation and a culture of curiosity. To learn more about this program, please contact us at

Rachael Farrell

Rachael Farrell is a Senior Medical Planner of both acute care and mental/behavioral health facilities. She is an integral part of the HKS mental and behavioral health thought leadership team. She specializes in complex, high-tech projects and incorporates user-experience insights to deliver well-planned health care spaces.

David Vincent

David Vincent is a Principal and Director of Health at HKS. As a programmer and functional planner, he effectively defines the specific challenges unique to each project. He has a special interest in emergency and behavioral health facilities and is a celebrated mentor of young architects recognized for teaching the next generation of leaders.

Erin Peavey

Erin Peavey is an Architect and Design Researcher at HKS. She bridges the gap between research and practice, with a focus on design for health and wellbeing. Erin has been named a Rising Star by Healthcare Design Magazine and Healthcare Design's Best Under 40 by the AIA-AAH.

Deborah Wingler, PhD

Dr. Deborah Wingler is the Health Research Lead at HKS. She works with HKS' research and design teams to develop and implement initiatives that achieve meaningful, measurable outcomes. As the mother of a pediatric cancer care survivor, Deborah understands that we must design health care environments that support the health and well-being of all.

Hannah Shultz

Hannah Shultz is an Architectural Designer at HKS, working alongside design teams within the Health studio. A recipient of the 2019 HKS Health Fellowship, Hannah has studied mental and behavioral crisis care environments during the one-year fellowship term. She is also a participant in the firm’s Research Incubator, which supports practice-based research.

Nathan Howell

Nathan Howell is an Architect at HKS. As a Project Manager and Medical Planner in the mental and behavioral health sector, he understands the unique nuances needed to create healing environments. Nathan is a distinguished thought leader who works to advance research and design practices around the built environment.