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Lighting design for behavioral health facilities

healthcare lighting design behavioral health facilities

Natural and artificial light play a crucial part in establishing a safe, stable environment for people with behavioral health conditions. Patients suffering from bipolar disorder, clinical depression and other illnesses are deeply affected by the intensity, brightness and color of light.

“Lighting is a huge component of behavioral health care,” said Carol Parke, RN, chief nursing operations, education, credentialing and utilization review officer at Mercy Health—Behavioral Health Institute. “We are shifting away from the historical sickness model and instead moving toward treating patients in a wellness model. Being thoughtful about natural and artificial light is integral to creating a comfortable, supportive environment that helps our patients heal.”

In many ways, behavioral health patients have needs similar to the general population, but their response to lighting stimuli is heightened. For example, natural light provides a more homelike feel and helps all patients feel more at ease in a clinical setting. In patient rooms, artificial light attuned to people’s circadian rhythms helps promote a natural response to the transition from day to night. But not addressing these items can have disastrous effects for patients suffering from behavioral health illnesses.

“People with behavioral health conditions can be especially sensitive,” Parke said. “For example, circadian rhythm is an important consideration for everyone, but we have to be particularly careful to ensure our lights aren’t too bright during the day. As the sun begins to set, our facility experiences gradual changes in light levels. Subtlety is key.” 

Are certain behavioral health patient populations more deeply affected by lighting? 

“April tends to be our busiest month at the Institute,” said Larry Graham, MD, president and chief clinical officer of Mercy Health—Behavioral Health Institute. “Here in Ohio, the sun starts shining in the spring. That triggers a negative response in people with manic conditions such as bipolar disorder.”

Bright sunlight can be harmful, but in healthy doses, natural light can have a healing effect. In one study, the positive impact of daylight reduced the length of stay for patients with clinical depression. In the study, 174 patients stayed in either sunlit or dimly lit rooms. Patients in the sunlit rooms went home, on average, 2.6 days more quickly than patients in the dimly lit rooms (NIH).

Lighting can, in some cases, make or break the patient experience for this population. If psychotic patients are already agitated, the wrong lighting might produce episodes that cause injuries to patients or staff. Other factors, such as age, may also play a role. For example, geriatric patients, especially those with cataracts, are better able to function and navigate in environments with blue or cool lighting versus red or warm lighting.

What are recommended lighting design strategies for hospitals and behavioral health facilities? 

Exposure to daylight and outside views are central to creating an optimal environment for behavioral health patients, because they provide sensory stimulation and reinforce the rhythm of a normal day outside the facility. At Mercy’s Behavioral Health Institute, every patient room has a window, and natural light from treatment spaces spills into interior corridors. However, it is important to control the amount and intensity of sunlight to avoid excessive heat or glare.

Mixing the levels and types of artificial light and incorporating lighting controls to enable adjustments also support a healthy patient experience.

“We use a blend of light fixtures and a range of intensities,” Parke said. “Each area of a behavioral health facility might call for different lighting throughout the day, and achieving the ideal lighting scheme requires careful calibration.”

The Behavioral Health Institute thinks about the needs of different patient groups and situations when determining lighting. Panel lighting, which can create a cold, commercial feel, has been replaced by residential-style, recessed downlights with integrated lighting controls to calm those suffering from bipolar disorder. In contrast, lighting in the Institute’s wound care and similar areas convey a more clinical atmosphere.

Cool hues are recommended for behavioral health facilities; research shows blue light reduces violence and agitation and promotes healthy sleep patterns. Amber lights are often used for nighttime illumination in other healthcare settings, but blue is preferred for behavioral health patients.

“We’re all taught as children that red, amber and orange – warm colors – mean ‘danger’ or ‘stop,’ Parke said. “Blue is less intimidating for patients suffering from behavioral health conditions. It creates a calming effect, reduces hallucinations and assists wayfinding.”

The intensity of artificial light is also particularly important for behavioral health patients, and its effect is closely tied to wall color. The walls of the Behavioral Health Institute are painted certain colors based on the presence of natural light, hallway light and overhead lighting to create an environment that limits agitation.

“All of our patient rooms are painted in shades of purple, green or blue,” Parke said. “The ideal lighting intensity for a purple or blue room is different than for a green room.”

Lighting controls play a key role, too. For example, if a room is typically well lit during the day but a patient becomes agitated, Behavioral Health Institute staff can override the system and decrease or turn off the light source to immediately decrease stimulation.

“Lighting controls support our ability to provide the best possible care to patients,” Parke said. “Physicians and nursing staff are trained to make real-time lighting adjustments based on time of day, level of agitation, patient condition and other factors.”

What’s next for Mercy’s Behavioral Health Institute?

Leaders at the Behavioral Health Institute say that in a relatively short time, they have already seen the benefit of the building and lighting design on patient care.

“In one of our locations, we experienced an 80 percent decrease in the use of restraints and seclusion after one year in the new space,” Parke said. “We’ve also seen a 50 percent reduction in injuries to our inpatient unit staff over a four-year period.

“While there are undoubtedly other factors at play, this is an encouraging sign. We look forward to taking the principles we’ve applied and implementing them elsewhere in the system.”

Parke says Mercy Health is looking at how lighting design can help patients in the emergency department. In the next three to five years, they will evaluate and potentially rework lights, colors and finishes with the goal of reducing violence among these patients.

“It is an ongoing process, but we believe it is well worth the time and effort,” Dr. Graham said. “We owe it to our patients and staff to design and build the best, most comfortable environments for healing.”

The Lighting reSource