Children in Crisis Need More Than Emergency Departments Can Offer

In June of 2021, 33 children and adolescents experiencing a mental health crisis were boarding in NH emergency departments (ED).* The state of their condition has created safety concerns within their own homes and transferring to an available child-focused inpatient psychiatric bed can take weeks or longer. A child whose world is out of proportion requires a thoughtfully designed space that encourages a sense of emotional and physical safety.

According to the National Alliance on Mental Illness (NAMI), 1 in 6 youth aged 6-17 experience a mental health disorder each year. 50% of all lifetime mental illness begins by age 14, and 75% by age 24. Suicide is the second leading cause of death among people aged 10-34.

The ongoing surge of pediatric patients seeking care within emergency departments shines a light on the fact that EDs lack the infrastructure to provide the specialized care children in crisis require. Extended waiting periods can also hinder the recovery process due to additional stress and unknown care plans. More specialized child and adolescent psychiatric units will enable patients to access the care they need in a safe and age-appropriate environment.

The child-focused design approach explores opportunities to see space beyond the protective value by incorporating all stakeholders – patients, family, and clinical staff. Treatment centers are looking to provide more choices within a built design; colors that stimulate the senses or evoke calmness dictated by the intended functionality of the space and framed artwork or interactive walls help patients explore their emotions. Functional furnishings also provide a feeling of belonging and security. Staff can incorporate intuitive design strategies into their physical and occupational therapies. Everything is purposeful and can be adapted for more than one use.

Christina Mellor, IIDA, NCIDQ, LEED, AP, Associate, Senior Interior Designer with Lavallee Brensinger Architects has worked on many behavioral health interior design projects. She is currently working with Cambridge Health Alliance (CHA) on their quest to renovate two floors within the Somerville Hospital to treat children and adolescents in need of mental health care. When asked what the most important detail to consider throughout the design process of an appropriate space for children or adolescent patients she replied,

“The details come from understanding the balance between how to create a safe environment but not a sterile environment, making sure it is geared toward the population that is using it, children and adolescents – safety always being your guide.”

Children walking into unfamiliar circumstances, knowing they will be separated from their parents, need to be presented with calm surroundings. Their emotional environment needs to include a feeling of belonging, security, and assurance that they can navigate their treatment program. The use of texture and colors in the main area along with curved shaped lights and organic patterns on floor tiles made of durable soft materials add to an overall welcoming feel. Rounded furniture presents a soft image. Artwork creates a sense of wonder and distraction. Everything within the physical structure is designed as an element of their care, to promote trust, and aid in their treatment and return home. Every area within a unit is designed for multiple uses.

First impressions are extremely important to a parent experiencing emotional anguish as they bring their child to a psychiatric hospital. Their emotional environment needs to project a perceived level of care and access to their child’s information and clinical team. They want and need to feel assured that their child will be safe, treated with kindness, empathy, and dignity. Parents/advocates need to trust that their child has proper psychiatric care combined with a sense of compassion and security. The environment needs to feel welcoming, calm, respectful, and not sterile. Meeting spaces, private consult rooms, and areas where they can comfortably visit their child are important to them.

Clinical Staff
The clinical staff is foremost responsible for the successful treatment of their patients, while never forgetting about the safety of both patients and the staff. When the setting has been designed to help mitigate some of those safety concerns, the staff can focus on treatment. Allowing for space for staff to focus behind the scenes, but nearby, helps to reduce errors. An engagement center is an option to supplement the nurse’s station within the milieu. This welcoming and comfortable design will allow staff and patients to interact in a relaxed but safe manner, while keeping a watchful eye on the surrounding activities.

The Design Experience
As the doors open into CHA’s art-filled lobby on the newly designed children’s unit, parents and patients are greeted with a colorful open space designed with rounded lights and organic floor patterns. Â The curve of the wall complements the curved furniture while projecting a cocoon-like ambience. These details create a space that is welcoming, warm, and comfortable for child and staff interaction and is reassuring to parents.

Transitional spaces between common areas and bedrooms create a sense of security and belonging within the child. The colors on the floor curve as they set intuitive boundaries and flow like a stream leading to uniquely colored bedroom entrances. Next to each bedroom door is a storage locker for personal belongings. A child entering their bedroom is greeted with natural light cascading over a comfortable-looking bed situated on top of a floor pattern that simulates an area rug. A desk area alongside a whiteboard communicates the day’s activities and provides the child with a sense of control of their day. One full wall in each patient room is finished with a mural to provide the child with an avenue to self-soothe. The totality of these design choices can help the child feel as though their bedrooms were specially designed just for them, providing a safe place to retreat when needed as well as a sense of privacy and comfort.

The need for more beds within appropriate child-focused psychiatric units is more important than ever. Healthcare designers work directly with providers and clinicians to integrate emotional wellbeing with physical needs while maintaining safety for patients and clinical staff and provide reassurance for parents. Allowing Healthcare organizations to reduce emergency room boarding by providing thoughtfully designed psychiatric units.

Continue the conversation with our Psychiatric Services Design Specialists!

Joan Eagleson, RA | Principal |
Christina Mellor, IIDA, NCIDQ, LEED AP | Associate |

*National Association of Mental Illness. (n.d.). Mental Health by the Numbers. Nami.Org. Retrieved June 24, 2021, from