The Future of Behavioral Healthcare: Rethinking Milieu


Every setting cues us how to behave. Is it loud and active? Quiet and intimate? Cozy or spare?

The design of behavioral health settings matters. Exacerbated by the COVID-19 pandemic, the number of children and teens dealing with mental and behavioral health issues continues to rise as modern life bombards us with stressors. Adolescents and children are struggling with unprecedented levels of depression, anxiety, mood disorders, post-traumatic stress, and other mental and behavioral health conditions that sometimes require more than medication or therapy appointments. When an inpatient or day hospital program is needed to help cope with a mental illness or life crisis, the space should also be therapeutic.

Adolescents and children are struggling with unprecedented levels of depression, anxiety, & mood disorders, ...

It’s time to take a closer look at the collection of therapeutic settings known as milieu. In a behavioral health hospital or long-term residential care facility, these settings foster social interactions and activity, and it’s where inpatients (stays of up to two weeks) and residents (stays of 2-3 days) spend most of their day. Milieu is used for group therapy sessions, guided activities, dining, and free choice time. While most facilities provide milieu ranging from highly controlled unit spaces to education or recreation areas common to the building, creating enriching spaces that offer social choices and reduce aggressive behavior are key to successful milieu design. Done right, these spaces can restore a sense of normalcy during a vulnerable time, de-stigmatize an institutional experience, and be restorative.

Dr. Joseph Luria, MD, Vice President of Mental Health Operations at Cincinnati Children’s Hospital Medical Center, and I recently presented research, observations, and results on how varied milieu space positively impacts patient care through increased family involvement, increased therapeutic programming, fewer restraints/seclusions, shorter patient stays, and less employee turnover.

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Angela Mazzi FAIA, FACHA, EDAC is a Principal at GBBN. Harnessing studies on human psychology, research on our biological need for nature, a focus on clinical workspaces, and experience with Lean strategies, Angela creates exceptional environments that empower patients and practitioners. She regularly presents and publishes her research in industry and peer reviewed journals and is sought out by Healthcare Design Magazine, the New York Times, and other publications to share her healthcare expertise with their readers.