How designing for mental and behavioral health strengthens architectural practice

In the United States, more than one in five adults and one in seven adolescents experience mental illness each year. As diagnoses rise and public awareness grows, health systems and policymakers are struggling to keep pace by providing adequate services and spaces. 

Architecture plays an essential role in how communities respond to rising mental health challenges. Architects and designers specializing in mental and behavioral health design are helping health systems rethink how the built environment can support safety, dignity, emotional regulation, and long-term recovery.

AIA’s Academy of Architecture for Health (AAH) has helped elevate this work by celebrating exemplary mental and behavioral health projects, supporting research, and amplifying the voices of practitioners who shape spaces with the intention of improving holistic well-being outcomes. For Mental Health Awareness Month, AIA spoke with Pierce McVey, AIA, and Rachael Rome about how design for mental and behavioral health has evolved, what makes the work meaningful, and what architects across all sectors can learn from behavioral health design. McVey is the 2026 president of the AAH and a healthcare design principal at NAC Architecture, and Rome is the global director of mental and behavioral health design at HKS as well as a 2019 AAH Miller Knoll Scholarship recipient. 

What drew you to mental and behavioral health design, and what keeps you committed to this work?

Pierce McVey, AIA: For me, the work resonates because it serves a very real and urgent need. During the last 12 years, I’ve noticed behavioral health ramp up as a genuine practice area in architecture, and I’ve worked on projects spanning public and private as well as inpatient and ambulatory spaces. I’ve seen how profoundly the built environment affects people who are often at their most vulnerable. The challenge is in creating spaces that are both deeply humane and safe, and that challenge is significant, but the reward is knowing you’re contributing to a more just world. 

Rachael Rome: I came to this work through a deep fascination with human behavior and a belief that the spaces around us can profoundly shape how we feel, heal, and connect. During my tenure in academia, I studied healthcare architecture alongside clinicians and psychologists and ultimately took steps toward a second graduate degree in counseling and psychology because the need for compassion, healing, and hope felt so immense. Ultimately, behavioral health design became the place where those worlds converged for me.

In mental and behavioral health environments, architecture is never neutral. Space can heighten fear and dysregulation, or it can quietly restore calm, dignity, and hope. People often enter these environments during some of the most vulnerable moments of their lives, and I believe our responsibility as architects is to create places that remind people of their humanity, worth, and capacity for healing.

How has the field of mental and behavioral health design shifted in recent years?

McVey: The biggest shift has been awareness, both within the profession and amongst the public. We’re seeing more emphasis on equity of access, especially with increased intersections of homelessness and mental health crises in cities across the country. There’s also growing recognition that environments must support staff, whose well-being is essential to care delivery.

Rome: The field has evolved dramatically. Historically, many psychiatric environments were designed almost entirely around risk mitigation, observation, and containment. Today, trauma-informed care, neurodiversity, sensory regulation, and staff well-being are central to the conversation.

We are also designing across a much broader continuum of care, from pediatric outpatient and crisis stabilization to inpatient, forensic, and substance use environments. Behavioral health is no longer siloed from the rest of healthcare. Health systems increasingly recognize mental health as inseparable from physical health, and clients are advocating for spaces that feel more humane, hospitality inspired, and emotionally supportive while still meeting complex safety and operational needs.

So how do you balance clinical safety requirements with the need for environments that feel dignified, calming, and non-institutional?

McVey: It’s one of the hardest parts. Safety often implies surveillance, and that can undermine dignity. The challenge is to embed safety quietly through materials, detailing, and planning without making the environment feel restrictive. Material innovation has helped tremendously. For example, creating a warm, wood look environment used to be nearly impossible due to durability concerns, but new products allow us to achieve that warmth while meeting safety standards.

Rome: I often say that safety is the baseline, not the goal. The challenge is creating environments that are clinically safe without making people feel controlled, punished, or dehumanized. 

The best behavioral health environments integrate safety strategies into the architecture in ways that feel quiet and thoughtful rather than overt. But before designing solutions, we must deeply understand the patient population, operational philosophy, and long-term vision of the organization. 

Many facilities being replaced today are decades old, so we are designing not only for current care models but for how behavioral healthcare may continue evolving over the next several decades. That requires flexibility, empathy, and a willingness to think far beyond immediate needs.

What does effective collaboration look like with health systems, clinicians, staff, and people living with mental and behavioral health challenges?

McVey: Empathy is essential. These projects require educating the public, destigmatization, and building trust with communities who may fear what these facilities represent. Collaboration means listening closely to clinicians and staff who are operating in extremely challenging conditions. Their insights shape everything from planning to material choices.

Rome: Trust and listening are foundational to the process. We spend a tremendous amount of time in stakeholder workshops, mockups, simulations, and conversations with clinicians, staff, family advocates, and people with lived experience. Those perspectives are critical because they reveal operational realities and emotional experiences architects alone would never fully understand. 

In behavioral health environments, small details can have enormous implications for safety, dignity, staffing, and patient experience. There is also significant innovation happening in products and materials, many of which are highly specialized. These decisions are deeply important to our clients, and collaborative evaluation through mockups, testing, and shared dialogue allows teams to thoughtfully align safety, durability, operational needs, and the human experience.

Looking ahead, what gives you hope about the future of your work?

McVey: I’m encouraged by the growing connection between academic research and behavioral health outcomes, and by the shift toward community based facilities that reduce stigma. These environments are increasingly seen as assets rather than liabilities.

Rome: What gives me hope is the growing collective commitment to mental health, especially in pediatrics and early intervention. Across the industry, clinicians, designers, researchers, operators, and manufacturers are working together with a shared sense of purpose. For a field that has historically been underserved, seeing this level of compassion, innovation, and advocacy surrounding the future of care feels deeply meaningful and long overdue.

What can architects working in other practice areas learn from mental and behavioral health designers?

McVey: Clarity is essential. Behavioral health environments require nuanced zones and scales including public, semipublic, private, and individual spaces. That thinking easily translates to education, workplace, and civic design, among other areas. Flexibility and choice are also key. People need different types of spaces for different moments, and that principle applies everywhere.

Rome: Behavioral health design teaches us that architecture is deeply emotional work. Every space shapes how people feel, regulate, connect, and belong. Above all, this work has taught me the profound importance of listening carefully to the people whose lives will unfold within these environments because the most healing spaces are created when people feel seen, heard, and deeply considered.

Kathleen M. O’Donnell is a freelance writer, editor, and communications strategist based in Washington, D.C. She is committed to telling stories that provide useful insights to architects and designers and highlight the impact of their work.