Mental and behavioral health settings: Importance & effectiveness of environmental qualities & features as perceived by staff Mardelle McCuskey Shepley a, * , Angela Watson b , Francis Pitts c , Anne Garrity b , Elizabeth Spelman b , Andrea Fronsman a , Janhawi Kelkar a a Cornell University, Ithaca, NY, USA b Shepley Bulfinch, Boston, MA, USA c Architectureþ, Troy, NY, USA article info Article history: Received 18 May 2016 Received in revised form 28 December 2016 Accepted 24 January 2017 Available online 27 January 2017 Keywords: Behavioral health Mental health Psychiatric facility design Tools Survey abstract This paper describes research on the design of behavioral and mental health facilities. Using input from clinical staff, the purpose of the study was four-fold: to develop and test a tool for the evaluation of mental and behavioral health (MBH) facilities, to evaluate the importance and effectiveness of specific environ- mental qualities and features, to generate design guidelines for MBH facilities, and to make recommen- dations for future research. A draft version of a tool that was intended to measure the importance and effectiveness of environmental qualities and features in MBH facilities was developed using a multi- methods approach. This survey, the Psychiatric Staff Environmental Design (PSED) tool, was distributed to psychiatric nursing organization members (N ¼ 134). The researchers determined that the PSED was suitable for future research with minor modifications. Other findings included staff support for private patient rooms, staff recognition of the critical role of positive distraction, and the importance of aesthetics. © 2017 Elsevier Ltd. All rights reserved. Providing appropriate physical environments for patients and staff in mental and behavioral health (MBH) facilities is a critical contemporary issue (Papoulias, Csipke, Rose, McKellar, & Wykes, 2014). Although the need to support these populations is clear and new facilities are being developed, research to inform the design process is limited (Chrysikou, 2013; Ulrich, Bogren & Lundin, 2014). Studies on non-psychiatric acute care settings are more common (e.g., Chaudhury, Mahmood, & Valente, 2009), but the operational goals of these settings are different from MBH facilities relative to patient length of stay, delivery of care, medication and treatment protocols and staff-patient interaction. Fortunately, the emergent use of evidence-based design strategies in healthcare settings has opened the door for dialogue and research. This paper describes the development and testing of a survey on mental and behavioral health (MBH) environments. Mental health and behavioral health are terms that are often used interchange- ably (Torres & Estrine, 2015). The U.S. Department of Health & Human Services (1999) describes mental health as a condition demonstrating “successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and an ability to adapt to change and to cope with adver- sity.” Torres and Estrine (2015) define behavioral health as mental, emotional and physical states influenced by individual choices. For this study. the ambiguity in definitions suggested coupling the terms to cover a spectrum of integrated conditions. While several instruments have been used to evaluate patient and staff experiences in mental and behavioral health (MBH) fa- cilities, the scope of these tools and a focus on the development of content is often limited. Predecessor tools are helpful regarding specific topics such as safety (e.g., The Safety Risk Assessment (Center for Health Design, 2015) and the Mental Health Environ- ment of Care Checklist (Watts et al., 2012)), or specific building typologies such as substance abuse (e.g., Timko, 1996). Others address physical healthcare environments more broadly (e.g., NHS Estates, 2008) or deal with the physical environment tangentially relative to the psychosocial and operational environment (e.g., Moos & Houts, 1968; Rice, Berger, Klett, Sewall, & Lemkau, 1963). However, to our knowledge no tool has been developed that seeks to address the full range of important MBH physical environmental issues. The tool described in this paper overcomes the limitations of other tools by identifying the spectrum of critical topics while * Corresponding author. Department of Design & Environmental Analysis, 3429 Martha Van Rensselaer Hall, Cornell University, Ithaca, NY, 14853, USA. E-mail address: mshepley@cornell.edu (M.M. Shepley). Contents lists available at ScienceDirect Journal of Environmental Psychology journal homepage: www.elsevier.com/locate/jep http://dx.doi.org/10.1016/j.jenvp.2017.01.005 0272-4944/© 2017 Elsevier Ltd. All rights reserved. Journal of Environmental Psychology 50 (2017) 37e50