Date of Award


Document Type


Degree Name

Master of Science (MS)

Legacy Department

Architecture and Health

Committee Member

Dina Battisto, Primary Advisor

Committee Member

David Allison, Committee Member

Committee Member

Elizabeth Baldwin, Committee Member


Casualty statistics resulting from 10+ years of combat action/deployments in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) have yielded multiple casualties. These casualty types include the visibly and invisibly wounded, where the visible (physical) wounds include but are not limited to gunshot/shrapnel, blunt trauma and blasts from Improvised Explosive Devices (IED). The invisibly wounded include but are not limited to Combat Stress, Anxiety, Post-Traumatic Stress Disorder (PTSD) and Traumatic Brian Injury (TBI). Unfortunately and although operations in Iraq and Afghanistan have decreased, invisible wounds continue to persist yielding an increase in soldier behavioral health complications which at an all-time high with statistics reflecting minimal patient healing progress. To make matters worse, war-fighters affected by these “invisible wounds” experience difficulties in family relationships and societal reintegration where statistics show that 1 US Combat Veteran commits suicide every 65 minutes (Reuters, 2013). Additionally, historical studies have focused on curative solutions with little information existing on Behavioral Health Facilities that foster this care environment. With the continued suicide rate and the complexities of Behavioral Health still misunderstood, a collective effort of solutions (treatment, medicine, programs and facilities) are required to effectively address issues of Solder Behavioral Health and improve patient outcomes for the future. Optimally designed Behavioral Health Facilities are of significant importance to provide an adequate environment for Behavioral Health treatment. However, literature reviews reveal little if any data regarding Evidence Based Design solutions to enhance their care potential, in particular create a safe and therapeutic healing environment within the military. Acknowledging that suicides often occur as a result of low self-esteem and the presence of man-made hazards, creation of a safe and therapeutic environment will not only resolve the most significant concerns with Behavioral Health (staff/patient safety and eliminate patient suicide) but also present an atmosphere of pride and dignity. Both factors coupled together in an optimally designed environment will enable those soldiers who suffer from Behavioral Health complications to receive care within the Military Health System (MHS) that can address these “wounds” and treat them respectably. To adequately research and expand upon the issues of safety and therapeutics within Behavioral Health Facilities, a qualitative research approach (Creswell 2014) will be employed utilizing a case study research strategy (Stake 1995; 2005) that utilizes multiple methods inclusive of qualitative and quantitative data. The objective of the study is to investigate how environmental factors of Military In-Patient Behavioral Health Units promote or deter two significant outcomes, safety and therapeutics, within three areas: private patient spaces (bedrooms); communal spaces (such as activity rooms, day rooms, etc.) and therapy areas (such as group therapy rooms). Although there are additional spaces that exist within the In-Patient Behavioral Health Facility (e.g. – Soiled Linen storage, Supply, Staff Conference Room, etc.), private, communal and therapy spaces are the only collective areas that combine staff and patient operations on a daily basis. This research study will explore the impacts the built environment has on safety and therapeutics within In-Patient Behavioral Health Military Healthcare units, comparing two high-volume patient facilities in different settings. Exploring facilities in different settings will provide an understanding of how the built environment factors (BEF - space layout, hardware & fixtures and finishes & furnishings) are linked to safety and therapeutic outcomes through four facility related dimensions: Visual Appeal, Physical Comfort, Mental Comfort and the Absence of Hazards. Multiple data collection methods will be used including: review of archived documents (floor plans, MHS Space Planning Criteria, etc.); interviews with clinical staff and technical end users; interviews with subject matter experts involved with treatment program management & implementation and onsite observations. Research findings will reveal how the aforementioned BEF will either positively or negatively influence the creation of a safe space for patients and staff as well as coexist with therapeutics to provide an optimal patient care environment. Data analysis and conclusions from this study will be provided to the MHS to potentially enhance space planning criteria and templates to enhance In-Patient Behavioral Health facility design for the present as well as into the future.



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