Article Summary
In mental and behavioural health settings, furniture is not background detail. It is a lever for safety, de-escalation and flow. Pineapple, a leader in creating design-led, robust furniture for challenging environments, exemplifies how non-institutional aesthetic can improve patient experience, reduce staff burden and support more efficient operations. This approach aligns with insights from Dr. Scott Zeller MD, Vice President for Psychiatry at Vituity, Inc. and Assistant Clinical Professor of Psychiatry, at the University of California-Riverside School of Medicine, who has shown that environments designed for comfort and autonomy, dramatically reduce aggression, restraints and unnecessary hospitalisation.
Mental health demand continues to rise, creating urgent challenges for healthcare environments. Roughly 1 in 4 adults in England experiences a mental health issue each year. Many in crisis end up in general hospitals ill-equipped to calm or treat them. In England alone, A&E visits for mental health emergencies reached 216,182 last year . Too often, these patients wait prolonged periods in bright, chaotic A&E corridors – an experience described as “close to torture” by one senior NHS nurse . At least 5,260 people in acute mental distress waited over 12 hours in A&E for a bed in 2024, a five-fold increase since 2019  . Such scenarios are distressing for patients and frustrating for staff, highlighting a critical need to rethink the design of mental health spaces.
This feature draws on insights from Michelle Blackie, Head of Strategic Marketing at Pineapple, whose work focuses on creating safe yet non-institutional environments, alongside perspectives from Dr Scott Zeller, a leading authority in emergency psychiatry and pioneer of the EmPATH (Emergency Psychiatric Assessment, Treatment and Healing) unit model. Both highlight how design can support a more humane and operationally effective approach to mental healthcare.
Beyond Safety: The Philosophy of Reduced-Ligature Design
Reduced-ligature design aims to reduce opportunities for self-harm, but historically it has been associated with cold, institutional environments. Blackie challenges this assumption, arguing that safety and dignity should not be mutually exclusive. “Safety can go hand in hand with empathy,” she notes.
“Patients deserve to not only be safe, but feel safe too, so it is important that behavioural and mental health facilities reflect calm, comfort and a sense of familiarity – not just compliance. When designed thoughtfully, these spaces can contribute to people feeling seen, not managed.”
This reframing is critical. When a space feels punitive or custodial, agitation tends to rise. Conversely, environments that feel familiar and domestic reduce anxiety and support more constructive engagement. Recessed fixtures, rounded edges, continuous hinges and the avoidance of stash points can all be integrated without sacrificing warmth or comfort.
The Cost of Poor Design
Institutional cues such as harsh lighting, hard acoustics and bolted furniture can heighten stress and agitation. In mental health settings, that often translates into more behavioural incidents, longer observation hours and greater strain on staff. Bright, noisy wards can overwhelm someone in psychosis or severe anxiety, provoking aggression or trauma responses. “Imagine going through possibly the worst time of your life, in an environment that makes you feel that you are being punished for being ill, instead of being supported at your most vulnerable”, says Blackie.
Poor design can escalate behaviours that then require restrictive practices or security interventions. Each incident draws multiple staff away from other tasks, disrupts flow, and heightens risk. In a system already struggling with workforce shortages, these avoidable pressures have material impact.
Furniture as a Clinical Intervention
Furniture is often seen as a practical requirement, but in mental health settings it functions as a clinical tool. Durable, reduced-ligature, non-weaponised products such as weighted chairs or rotationally moulded pieces without joins, reduce risks and allow staff to focus on therapeutic engagement rather than constant monitoring.
A well-designed environment supports autonomy: patients can move freely, sit comfortably, adjust lighting, or access their own blankets and refreshments. This mirrors findings from Dr Zeller’s work in the United States, where enabling patients to meet their own needs – something as simple as getting a drink without asking – dramatically reduces agitation and aggression.
EmPATH Units: A Case Study in Environmental Transformation
The EmPATHÂ (Emergency Psychiatric Assessment, Treatment and Healing) model offers a powerful case study of environment-driven outcomes. These units provide a calm, open, non-institutional space adjacent to an emergency department, designed specifically for people in acute mental health crisis. Dr Zeller explains:
“We found that mitigating a lot of agitation and aggression simply had to do with giving people space and making them comfortable – having them able to meet their needs independently.”
The design includes areas for pacing, sensory spaces, and self-service snack stations. It is ligature-safe yet welcoming. And the results are striking:
- 75% of patients   are discharged within 24 hours, avoiding unnecessary inpatient admission.
- Physical restraints fall from 15-20% of cases in Emergency Rooms to one or two in every thousand.
- Staff report calmer environments, fewer incidents, and better ability to deliver therapeutic care.
Operationally, the model reduces bed blocking, frees emergency capacity, and improves patient flow. One US hospital reported $34 million in savings to government payors over 2.5 years by reducing unnecessary admissions; another saved $861,000 in its first year by ending emergency department boarding and eliminating sitter and security costs. While the NHS is a different system, the underlying principle is universal: the environment shapes clinical behaviour, patient trajectory, and operational efficiency.
Staff-Centric Design
Any discussion of mental health environments must include staff. High-acuity settings are emotionally demanding, and poorly designed spaces exacerbate fatigue and stress. Creating dedicated respite rooms, ergonomic work areas and safe but comfortable staff furniture is not a luxury; it is essential for safety, retention and high-quality care.
Design can also soften the dynamic between staff and patients. When spaces feel less custodial, interactions become more human, and therapeutic relationships strengthen – an effect repeatedly observed in both Pineapple’s projects and EmPATH units internationally.
10 Principles for Safer, Therapeutic Mental Health Spaces
Use furnishings that are ligature-resistant, unbreakable and non-weaponisable (e.g. continuous frames, weighted designs), but choose options that look and feel like domestic furniture rather than security equipment.
Favour homely, human-centred décor over clinical or custodial aesthetics. Avoid harsh lighting and barren walls, instead incorporate warm colours, artwork and soft furnishings, while meeting hygiene needs to “normalise” the space and help restore patient dignity.
Design Floorplans so staff can discreetly observe patients at risk. This enables supervision without intrusiveness, supporting both safety and a sense of personal space.
Where possible, allow patients to control aspects of their environment such as dimming their lights, adjusting room temperature, or choosing between a quiet lounge versus a social area. Even small choices greatly enhance one’s sense of autonomy and reduce the feeling of being “punished” or powerless.
Maximise access to natural light in daytime to improve mood and regulate sleep cycles, and provide adjustable, softer lighting in the evenings. Gentle, glare-free lighting reduces confusion and has a calming physiological effect (important for conditions like psychosis or dementia).
Noise is a known trigger for stress and aggression. Use acoustic wall panels, high-performance ceilings, and smart zoning of loud areas. Smaller dining or activity rooms (instead of cavernous halls) prevent overwhelming noise levels, enabling calmer interactions.
If feasible, include access to outdoor courtyards or indoor gardens. Even design elements like water features, nature murals, or sensory rooms with soothing visuals can provide therapeutic distraction and help de-escalate anxiety.
Provide private retreat spaces such as quiet rooms or single bedrooms where patients can have personal downtime without constant observation, as this supports dignity and recovery. Equally, create comfortable communal areas for curated social activities, since positive interaction is part of healing, the layout should allow easy flow between private and shared zones
Include dedicated staff respite rooms and ergonomic work areas. Choose furniture for nurses’ stations or staff lounges that is also robust and safe, but comfortable. A well-rested, less stressed staff is better able to provide high-quality care. Moreover, designing areas where staff and patients can interact more informally can humanise their relationship
Adapt the environment to the specific patient population and care model. For instance, a long-term learning disability residence should feel truly like home and may require fewer reduced-ligature measures, whereas an acute psychiatric admissions unit needs higher security features. Avoid blanket solutions, consult end-users and modify design standards for each context to ensure they are appropriate (overly cautious measures can sometimes backfire or hinder daily life).
The Economics of Design: Efficiency Through Environment
In the NHS, delays, incidents and length of stay all have estate implications. Well-designed, reduced-ligature environments reduce behavioural incidents, decrease observation hours, and support smoother transitions through care pathways. These improvements directly affect operational efficiency, staff utilisation and capacity. As Dr Zeller said:
“Every time someone with a behavioural health emergency sits in a regular A&E bed, that’s a bed that could turn over multiple times. Instead, they wait for hours, sometimes days, and often get sent to inpatient facilities they don’t need. EmPATH changes that equation.”
In systems where estate pressure is acute, the environment becomes a strategic asset: a lever for flow, not simply a backdrop to care.
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Breaking the Mold: From Products to Partnership
One recurring theme is the need for early, multidisciplinary collaboration. Estates teams, clinicians, designers and suppliers must work together from the outset rather than layering safety features onto layouts designed for a different purpose.
Blackie notes that involving mental health design partners early on in the process provides valuable opportunities to embed common-sense changes – wayfinding cues, zoned lighting, storage strategies – address patient overwhelm, improve safety and reduce staff workload. Early collaboration ensures environments are not only safe but operationally coherent
Environments That Heal
The message for healthcare leaders is clear: the physical environment of mental health care is not incidental. It directly shapes behaviour, experience, and operational performance. Calmer, more intuitive spaces reduce incidents. Domestic, dignified design accelerates recovery. Staff-supportive environments reduce burnout. And thoughtful reduced-ligature solutions improve safety without compromising humanity.
As demand grows, the healthcare estate must evolve from passive infrastructure to active clinical asset. Designed well, it becomes a force multiplier, supporting better outcomes, smoother flow and safer, more compassionate care. Because in mental health, as Dr Zeller’s work shows, the environment does not just house care. It is care.
