Lighting for Behavioral Health by Lauren Roberts and Brienne Willcock

2. Designers Light Forum
Lighting for Behavioral
Health
Lauren Roberts, LC, EDAC, IES
Brienne Willcock, LC, MIES
March 28th 2017

3. Credit(s) earned on completion of
this course will be reported to AIA
CES for AIA members. Certificates of
Completion for both AIA members
and non-AIA members are available
upon request.
This course is registered with AIA CES
for continuing professional
education. As such, it does not
include content that may be deemed
or construed to be an approval or
endorsement by the AIA of any
material of construction or any
method or manner of
handling, using, distributing, or
dealing in any material or product.
___________________________________________
Questions related to specific materials, methods, and
services will be addressed at the conclusion of this
presentation.

4. This presentation is protected by US and International Copyright laws.
Reproduction, distribution, display and use of the presentation without written
permission of the speaker is prohibited.
© Visa Lighting 2017
Copyright Materials

5. In the next 3 years 14% of construction will be placed
into specialty hospitals. At the top of the list is
Behavioral Health among other project types, which
will account for 46% of the total construction. The
Affordable Care Act is also driving the trend toward
outpatient construction as patient experience
becomes more closely tied to reimbursement in a
hospital than ever before. This presentation will help
you understand about the types of patients, staff and
family in these areas, their special needs and how to
appropriately light for them. We need to change the
institutional public perception of mental health
illnesses and creating beautiful deserving spaces is
one step in the right direction.
Course
Description

6. Learning
Objectives
1. Understand the behavioral health population and construction needs.
2. Review codes, guidelines and relevant resources one should use when designing behavioral health
spaces.
3. Show examples of successful designs and review case studies.
4. Critically review lighting trends such as circadian lighting and possible risks and benefits in behavioral
health spaces.
5. Develop strategies for the implementation of lighting quality factors to promote emotional well-being.
At the end of the this course, participants will be able to:

7. Understanding
• The people
• History
• Construction
needs
Resources
• Codes
• Guidelines
• Where to
look & who
to lean on
Design
• Case
Studies
• Examples of
what works
Trends
• Risks and
Benefits
lighting
• Circadian
thinking
Strategies
• Implement
• Advocacy
of the
“right light”

8. Behavioral Health Stigma
Understanding
Self and Public
stigma: Inaccurate
portrayals of mental
illness

9. • She has spent over 365 days in her lifetime,
cumulatively, in inpatient behavioral health
care in 5 different hospitals.
• When asked about light:
– I wish I had more control.
– It feels punishing.
– I wish my food looked better.
– The lighting affects my mood, I think, I’m not very
optimistic when it’s too dark.
Understanding

10. Understanding

11. Serious Mental Illness (SMI):
– Diagnosable mental, behavioral, or emotional disorder
that in the past year has resulted in serious functional
impairment
Understanding

12. Diagnosis and variations:
• anxiety disorders
• attention deficit hyperactivity disorder
• autism spectrum disorders
• bipolar disorder
• borderline personality disorder
• depression
• eating disorders
• prevention
• Schizophrenia
• Substance abuse
• suicide prevention
Understanding

13. Understanding

14. Inpatient vs. Outpatient
treatment:
SMI divided by
Global Assessment of
Functioning (GAF)
Understanding
(2009 National Survey on Drug Use and Health 2009, Substance Abuse and Mental Health Services Administration)

15. • ACA was the largest expansion
in behavioral health coverage in
a generation.
• Every year, about 1 in 5
American adults suffers from
some mental illness, enduring
conditions such as depression,
bipolar disorder or
schizophrenia.
Understanding

16. Behavioral Health Building Types
• Psychiatric Hospitals
• Psychiatric Units in a General Hospital
• Alcohol and Addiction Treatment Facilities
• Behavioral Health Clinics and ED’s with psychiatric specialties
Understanding

17. Construction Shortages
• Lack of inpatient beds in all psychiatric hospital settings
• Patients have no where to go but the ED
– Where would YOU go??
• As a result psychiatric bed shortages and
• Increased use of EDs for acute episodes
Understanding

18. Construction Outcomes
• Outpatient facilities provide a lower cost and community integration
– Helps to change the stigma!
• Tele psychiatry is filling gaps
• Less patients have to go to the ED
• 23 Hour observation units in psychiatric EDs are becoming more common
– This allows clinicians to determine if the patient should be admitted for care
• Crisis stabilization units are emerging as a solution to acute psychiatric needs
– Diverting psychiatric or crisis cases away from EDs.
– Keeping adults from jail and juveniles from detention centers.
Understanding

19. 2017 Hospital Construction Survey
• The survey comprised more than 240 hospitals nationwide, about evenly split
among rural, urban and suburban facilities.
• Nearly one-third of the survey’s respondents are undertaking specialty hospital
construction projects
• 50 % of those say they are building or are planning to build behavioral health
centers/psychiatric hospitals in the next 3 years
Understanding

20. 2017 Hospital Construction Survey
http://www.hfmmagazine.com/articles/2750-hospital-construction-survey
Understanding

21. Understanding
• The people
• History
• Construction
needs
Resources
• Codes
• Guidelines
• Where to
look & who
to lean on
Design
• Case
Studies
• Examples of
what works
Trends
• Risks and
Benefits
lighting
• Circadian
thinking
Strategies
• Implement
• Advocacy
of the
“right light”

22. Existing Guidelines
– Patient Safety standards, material and systems guidelines
• Recommended by the New York State Office of Mental Health
– Design Guide for the Build Environment of Behavioral Health Facilities
• Distributed by the National Association of Psychiatric Health Systems
– Mental Health Facilities
• VA Design Guide
– FGI Guidelines
– IES Handbook
Resources

23. Codes Needed
• Impact resistance standards
– For walls we have ASTM standards but what about for lighting fixtures and
polycarbonate?
– Is ¼” really necessary if stronger 1/8” thick polycarbonate exists?
– How about if we bend the poly and make it more rigid, then what?
– How tough is tough enough and how is that measured?
• Should fixtures fall under certain safety standards?
Resources

24. Resources
Culmination of 115 articles:
• Relevant to BH facility design
• Clear research methodology
• Post 1960 data
• Published in peer –reviewed journals

25. Understanding
• The people
• History
• Construction
needs
Resources
• Codes
• Guidelines
• Where to
look & who
to lean on
Design
• Case
Studies
• Examples of
what works
Trends
• Risks and
Benefits
lighting
• Circadian
thinking
Strategies
• Implement
• Advocacy
of the
“right light”

26. Design
Patient Participation: Critical to treatment success:
“ …environmental psychologists agree that the physical
environment can reinforce and encourage appropriate behavior.”
In 2012 a study showed these design attributes can decrease patient
aggression:
• Availability of private rooms
• Better acoustics
• Window views & nature art
• Higher daylight exposure
• “Home-like design”
• Visibility of staff from common areas

27. Design
Luminaire Design Priorities – Narrow selections
• Anti ligature – fixed, and load release
• Tamper resistant
• IP65 common (not required)
• Color clarity – CRI, TM30
• Color consistency – Luminaire to Luminaire
– Homogenous feel between the color of patient rooms
and color of patient gathering areas
• Static color (more later)

28. Design
Care zones
• Patient Area Priority
– Safety
– Security
– Cleanliness
– Perception & Quality (visual comfort) and balance

29. Design
Care zones
• Staff Area Priority
– Task accuracy
– Productivity and alertness
– Color quality & consistency
– Cleanliness

30. Designing Forward
• Creating “normalized” environments
• Flexibility and multipurpose treatment spaces
• Community spaces to be flexible, open and social
• Design to promote patients participation in therapeutic activities and reduce the amount of time
spent alone in their rooms
• Access to outdoor spaces, view to outdoors and access to natural light
• Patients to have control of the environment including furniture and lighting as much as possible.
Design

31. Suggested Light Levels
• Bedroom
– General – 5FC
– Desk – 40FC
– Bathrooms – 30FC Grooming
– Bed Headboard Reading – 20FC
• Seclusion Rooms
– Cleaning 30FC
– Observation 10FC
• Group Therapy/Education
– General - 20FC
– Table Lighting - 50FC
• Hallway – 5FC
Design

32. Case Study
Swedish Ballard Behavioral Health Unit, Seattle
ZGF Architects
Design

33. • Patients do not have
access to the outdoors
• Communal space was a
the focus for this lighting
concept and to help bring
people together
• Circadian lighting that
mimics the sky that allude
to relationships of nature
• Finishes and lighting that
grounds patients with a
familiar sense of
orientation
• Lighting with intent to
improve sleep, mood and
increase pharmaceutical
efficacy
• Positive nurse feedback
has been received since
opening
Case Study
Swedish Ballard Behavioral Health Unit, Seattle
ZGF Architects
Design

34. Understanding
• The people
• History
• Construction
needs
Resources
• Codes
• Guidelines
• Where to
look & who
to lean on
Design
• Case
Studies
• Examples of
what works
Trends
• Risks and
Benefits
lighting
• Circadian
thinking
Strategies
• Implement
• Advocacy
of the
“right light”

35. Light & Color
• Color Temperature – The color of light at a certain temperature
• Black body locus – A physical body (like iron) that absorbs all incident electromagnetic radiation or light. It emits
a spectrum that is determined by the temperature.
Trends

36. Daylight
Trends

37. Blue Light
– From 380nm to 500nm
– Boosts alertness
– Heightens reaction times
– Helps memory and cognitive function
– Elevates mood
– Increases feeling of well being
– Suppresses melatonin
– Short, High energy wavelength – can cause
glare
– Sources include the sun, digital screens,
electronic devices, FLR and LED Lighting
– Can cause eyestrain, headaches and mental
fatigue if over exposed
– Can cause retinal damage
Trends

38. Red/Amber Light
• Does not disrupt sleep cycle
• Increases alertness without suppressing
melatonin
• Which means red/amber lighting will not
disrupt shiftwork or their work
Trends

39. Our body clock
Trends

40. Circadian Lighting:
Lighting for Behavioral Health is different.
• “How circadian lighting can improve health, sleep and mood”
– “Thanks to advancements in color tuning and lighting control technology, it is now
possible to imitate the complex nature of daylight indoors.”
• “The Health Benefits of Human-Centric Lighting Using LEDs”
– “At a more sophisticated level, HCL-focused custom LED systems have been installed in
hospitals and assisted-living facilities to help maintain patients’ natural sleep cycles,
reduce anxiety during examinations, and aid recovery by providing warmer or cooler
white light as appropriate.”
• “How Lighting Affects Mood”
– “Research reveals that even light color can affect our emotions and circadian
rhythms...”
DesignTrends

41. Dose, Duration, Direction
DesignTrends

42. Circadian Stimulus
• What can you do?
– Request the SPD of the light sources under consideration (rely on more than CCT)
• Higher CCTs (5000-6500K) may generally provide greater CS – but there’s exceptions.
• Two light sources rated for the same CCT might provide very different CS values depending
on their SPDs.
• Design for vertical illuminance at the eye, not just horizontal illuminance on the work plane.
• Choose luminaires that provide the best vertical to horizontal balance
• Research & Collaborate.
(reference: http://www.lrc.rpi.edu/resources/newsroom/LD+A_CircadianStimulus_Oct2016.pdf)
DesignTrends

43. Light & Health
What we know:
– Light impacts performance by enabling performance of visual tasks
– Can assist with circadian stimulus – but we need more research on the impact in Behavioral
Health Units
– Affects mood and perception
– Impacts critical chemical reactions in the body
Free Download - https://www.healthdesign.org/sites/default/files/CHD_Issue_Paper2.pdf
Trends

44. Light & Health
Studies show:
– Higher light levels link to better performance of visual tasks
• Light requirements increase with age
• Reduced medication dispensing errors in pharmacies
– Controlling the circadian system in hospitals (general)
• Reduces depression
• Decreases length of stay
• Improves sleep
• Less agitation among dementia patients
• Eases pain
• Improves nigh-shift work among staff
Trends

45. Understanding
• The people
• History
• Construction
needs
Resources
• Codes
• Guidelines
• Where to
look & who
to lean on
Design
• Case
Studies
• Examples of
what works
Trends
• Risks and
Benefits
lighting
• Circadian
thinking
Strategies
• Implement
• Advocacy
of the
“right light”

46. Behavioral Health Today
Strategies

47. Strategies
Lighting for Behavioral Health is different: Overview
• Tunable White isn’t prescriptive: Dynamic white not
synonymous with “health” or “well-being” in all environments
• Lighting beyond aesthetics: Consider the population, the
outcome, and the potential risks
• Consider nuances of sleep patterns, length of stay, purpose of
stay and other key design elements:
– Food, Socialization, Visualization of Self Image, Autonomy,
Medication Side Effects
• Utilize research-based design techniques and talk with
practitioners

48. Consider Sleep: First do no harm?
Consider the role of sleep independently from circadian or tunable lighting systems and design to
impact:
• Sleep problems are more likely to affect patients with psychiatric disorders than people in the
general population.
• Sleep problems may increase risk for developing particular mental illnesses, as well as result from
such disorders.
• Treating the sleep disorder may help alleviate symptoms of the mental health problem.
(reference: http://www.health.harvard.edu/newsletter_article/Sleep-and-mental-health)
Strategies

49. Strategies
Lighting for Behavioral Health is different: Specification
• Select luminaires based on safety, security & guidelines
• Consider the emotional and aesthetic impact of lighting as it relates to other design
features

50. • Population statistics: http://www.newsweek.com/nearly-1-5-americans-suffer-mental-illness-each-year-230608
• ACA & Mental Health Coverage: https://www.mentalhealth.gov/get-help/health-insurance/
• Sleep and Light: http://healthysleep.med.harvard.edu/healthy/science/how/external-factors
• Decision Making: http://www.medicalnewstoday.com/articles/273064.php
• IES Guidelines:
• Design Guide for the Build Environment of Behavioral Health Facilities: Distributed by the National Association of Psychiatric Health Systems
• Mental Health Facilities - VA Design Guide
• Mental Health in America Report - http://www.mentalhealthamerica.net/issues/mental-health-america-printed-reports?sid=160893
• National Alliance on Mental Illness https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers
• Guidelines for Psychiatric Hospitals http://array-architects.com/revisions-to-the-2014-guidelines-for-psychiatric-hospitals/
• Design Guide for Behavioral Health https://www.fgiguidelines.org/wp-content/uploads/2016/04/DesignGuideBH_7.1_1604.pdf
• Research: Behavioral Health https://www.healthdesign.org/system/files/chd428_researchreport_behavioralhealth_1013-_final_0.pdf
• Design for Behavioral Health Facilities https://www.healthdesign.org/chd/knowledge-
repository/design_research_and_behavioral_health_facilities
• Healthcare Magazine: http://www.hfmmagazine.com/articles/1449-behavioral-health-design-regulations
• Healthcare Magazine: http://www.healthcaredesignmagazine.com/projects/natural-remedy-biophilic-design-supports-behavioral-health/#slide-
5
References

51. This concludes The American Institute of Architects Continuing
Education Systems Course

52. Designers Light Forum
Lighting for Behavioral
Health
Lauren Roberts, LC, EDAC, IES
lroberts@visalighting.com
Brienne Willcock, LC, MIES
bwillcock@illuminart.net
March 28th 2017