The Future of Mental Health Design: How Design, Choice, and Agency Shape Mental Health Environments

How Design, Choice, and Agency Shape Behavioral Health Environments

When was the last time you truly experienced a space—not as a professional, but as a human?

We walk into treatment centers, hospitals, offices every day, often seeing them through the lens of our roles—designer, clinician, architect, administrator. But what if we stripped those titles away and just felt a space? Would it be welcoming? Empowering? Or would it feel institutional, more focused on containment than care?

Reimagining Behavioral Health Through Agency and Choice

Francis Pitts, one of the leading voices in behavioral health architecture in the U.S., has spent decades considering this very question. He believes that the key to environments that promote healing—not just housing—is grounded in agency and choice. Two fundamental human needs that are often overlooked in behavioral health design.

This shift in mindset pushes us beyond compliance and minimum safety standards. Because real safety isn’t just about preventing harm—it’s about creating spaces where people can regain control of their lives.

Shaping Behavior, Not Just Managing Risk

Historically, behavioral health facilities have prioritized physical safety above all else. While safety is crucial, an overemphasis can result in sterile, depersonalized spaces that leave individuals feeling powerless.

Early in his career, Pitts observed young people in secure psychiatric units and noticed how they naturally gravitated to spaces where they could feel safe—but not scrutinized. That led to a powerful concept: “places in between”—spaces that offer individuals control over how much interaction they want, rather than forcing them into isolation or constant observation.

We all engage in these behaviors. We choose a seat facing the door at a restaurant. We hover near an exit at a crowded event. These are subconscious choices that help us manage our own safety and comfort. And yet, in many behavioral health settings, people are stripped of those same instincts and freedoms.

What if we created spaces that supported those natural behaviors? What if instead of sterile corridors and locked-down dayrooms, we offered environments where people had the freedom to choose their level of engagement?

Moving Beyond Compliance

Too often, behavioral health design focuses on meeting minimum safety codes. But is that really enough?

In a recent episode of the Care on Air podcast, Francis Pitts posed a compelling question: “What’s merely important, compared to what’s absolutely essential?” While compliance is important, what’s essential is helping someone progress on their recovery journey.

Take the layout of traditional inpatient units—double-loaded corridors lined with bedrooms, all designed for maximum visibility from the nurses’ station. Functional? Yes. But it can also feel impersonal and institutional.

At Worcester Recovery Center and Hospital in Massachusetts, Pitts and the team at architecture+ took a different approach. Instead of long, institutional corridors, they designed smaller, household-style clusters that felt more like shared homes than hospital wards. The result? Spaces that empowered residents, encouraged community, and supported smoother transitions back into everyday life.

Designing with Mental Health in Mind—Everywhere

Behavioral health doesn’t exist in a vacuum. Mental health crises occur in ERs, schools, police stations, and workplaces. So why are most public spaces designed in ways that escalate distress instead of calming it?

Forward-thinking healthcare systems in the U.S. are beginning to address this—replacing the outdated “psych-safe room” model with universally adaptable patient spaces. That means calm color palettes, residential-style finishes, flexible layouts—all designed to maintain dignity and comfort, while still ensuring safety.

Because mental health isn’t a separate issue—it’s part of the full human experience. And our environments should reflect that.

Designing for Dignity

Early in his career, Pitts worked on monastery designs—and found a surprising parallel to behavioral health spaces. Monasteries emphasize structured freedom: quiet, reflective spaces for solitude, communal areas for connection, and a natural ebb and flow of activity.

At Worcester Recovery Center, this principle was put into practice. A 30-bed unit was broken down into three distinct “households.” Instead of large, impersonal lounges, there were cozy nooks—places where people could be alone but not isolated. It created space for group dynamics to unfold naturally, respecting where someone was in their recovery journey.

The goal wasn’t just to keep people safe. It was to help them heal. And healing happens in environments where people feel respected, trusted, and empowered.

Rethinking What Safety Really Means

In behavioral health, safety is often framed in black-and-white terms: someone is either safe, or they’re not. But in reality, true safety is relational—and it includes agency, trust, and connection.

Out in the real world, we all make micro-decisions that protect our wellbeing. But in clinical settings, those decisions are often made for the individual. Pitts makes a strong case for creating options rather than restrictions.

• Instead of 24/7 observation, offer environments that allow passive supervision without invading someone’s space.

• Instead of locked doors, design rooms that feel secure without feeling restrictive.

• Instead of rigid protocols, empower clinicians with flexible, human-centered spaces.

Because when someone feels safe because they’re in control, not because someone else has taken control away—that’s when healing begins.

Looking Ahead

So what’s next?

The future of behavioral health design isn’t just about better buildings. It’s about a new mindset.

• It’s about asking: How can this space promote recovery, not just risk management?

• It’s about recognizing that design impacts every aspect of someone’s experience—from trauma response to social reintegration.

• And most of all, it’s about placing dignity, autonomy, and personhood at the center of everything we create.

As Pitts says: “To not pay attention is a waste of time.”

So the next time you walk into a space—whether it’s a behavioral health unit or a public waiting room—ask yourself:

“Am I just building a space, or am I shaping a place where someone can truly live?”

Because in the end, good design isn’t about bricks and mortar.
It’s about people.

📩 Interested in talking more about behavioral health design? Contact us today!