Staff and resident perceptions of mental and behavioural health environments

The purpose of this study was to explore clinical staff and resident perceptions regarding the importance, as well as effectiveness, of environmental qualities and features in mental and behavioural health (MBH) facilities. The study evaluated inadequacies in environmental attributes, as perceived by staff and residents, in four MBH facilities in the United States. The Psychiatric Staff Environmental Design tool and the Psychiatric Patient Environmental Design tool were used to capture perceptions and facility assessments. We examined the importance of various environmental attributes, the differences between the importance and how effectively these attributes were achieved, and the differences between psychiatric staff and resident responses. The most important qualities for residents were a well-maintained environment and suicide resistance. For staff, the most important qualities were staff safety and security and suicide resistance. Rated across all facilities, staff reported significant differences between importance and effectiveness of environmental attributes (p < .0001) whereas residents did not report differences. Significant differences were found between staff and patient ratings of existing facilities (p = .004), with staff reporting more inadequacies than residents. Findings suggest a strong need for more supportive physical MBH environments, particularly from the perspective of staff. Though residents reported fewer inadequacies, more evidence-based design guidelines for MBH environments are needed.