I have a particular interest in how the physical environment shapes emotional regulation, sensory experience, and feelings of safety. As an autistic person, I also value sensory design and service accessibility, and I’m passionate about creating therapeutic spaces that genuinely support recovery.

Design is a core component of patient safety

My interest comes from experiencing first-hand how profoundly the built environment can affect emotional state, distress levels, and the ability to feel safe and engage in treatment. Poorly designed wards can feel chaotic, overwhelming, and sometimes frightening. My experience of patient involvement in co‑production projects, from artwork to furniture selection, helped me realise that design isn’t superficial; it’s a core component of patient safety and experience.

As an autistic person, sensory design is very important to me, and I’ve experienced how unmet sensory needs can escalate distress.

These experiences have made me want to advocate for safer and more therapeutic environments. Seeing the transformative impact of thoughtful design for mental health —such as improved acoustics, better lighting, and more predictable, calming spaces— has shown me how design can actively support or hinder safety.

How the environment can impact patient safety

• Environments that feel like containment: institutional or outdated spaces can make people feel unsafe, watched, or confined. People should have access to outdoor spaces and fresh air, but not every mental health ward provides immediate access (eg. many wards require leave from hospital to be agreed by a care team, as there are not gardens designed into the ward environment).
• Sensory overload: harsh lighting, echoing voices in corridors, and unpredictable multi‑use spaces can heighten distress, especially for autistic people and those with experiences of trauma. There were times I had no control over sensory input as a patient, and this felt extremely destabilising and made me unsafe. I disengaged with and resisted treatment, and I self-harmed. The National Autistic Society reports that the average length of stay for autistic people in mental health hospital is 4.6 years, which is a considerably long time.[1] The Assuring Transformation dataset can help ICBs to look at where inequalities are for autistic people without LD in comparison to the general population.[2] I am curious about how much building design contributes to this inequity (rather than the clinical care provided).
• Lack of temperature control: wards that become extremely hot or cold can make rooms unsafe both physically and emotionally. Hot rooms feel stuffy and uninviting to use, both for staff and patients. High temperatures can make me feel more irritable and less rational. Many psychiatric medications also impact body temperature regulation. As temperatures are rising globally, improving ventilation and prioritising resources for this is becoming more essential.
• Poor acoustic design: noise and echoing make communication difficult, increasing misunderstandings and conflict.
• Lack of safe respite spaces: without somewhere quiet to withdraw, people may seek unsafe alternatives. I hid on my windowsill often as a patient, escaping observations and noise – but being unseen for two hours was a risk, and I wasn’t always keeping myself safe.
• Old buildings and shared facilities: shared bathrooms and dormitory bedrooms, and a lack of purpose-use ward spaces can create conflict, distress, and act as a barrier to treatment being therapeutic. Designing ensuite bedrooms, creating dedicated rooms for therapy, group activities, and quiet/sensory rooms can make a difference to how safe a ward feels.

When design supports safety

An example of a positive design change I experienced was the installation of a sound‑absorbing panel at an inpatient mental health service. It made a noticeable difference- reducing echoing and softening the overall noise level, which helped communication feel calmer and more respectful.

This kind of acoustic improvement reduces the intensity and unpredictability of sounds on a ward. Also, seeing our photographs on the wall made me, as a patient, feel safe, heard, and included.

Connecting with others through art and design ultimately lifted me out of a state of intense suicidality and depression. That lens has led me to be very passionate about design being directly connected to patient safety.

Challenges and barriers

Key challenges and barriers to designing healthcare environments in ways that support patient safety:

• Budget constraints: sensory‑friendly or trauma‑informed design is often seen as optional rather than essential.
• Legacy buildings: older wards may be structurally unsuitable for modern design standards.
• Competing priorities: safety is often interpreted narrowly (eg ligature reduction, or a reduction in a particular category of reported incidents) rather than holistically, which can overshadow sensory and emotional safety.
• Lack of awareness: designers and decision‑makers may not fully understand sensory needs or lived experience perspectives.
• Operational pressures: busy wards can deprioritise environmental improvements or require more focus and time than ward staffing allows.
• Limited co‑production: without meaningful involvement from service users, important design needs can be overlooked.

These barriers mean that environments sometimes prioritise containment over comfort, despite evidence that therapeutic design improves safety.

Considerations for safer design

• Co‑production from the start: involve service users, carers, and staff in every stage of design—not just as a consultation step.
• Sensory‑informed design: consider lighting, acoustics, temperature, predictability, and access to quiet spaces.
• Flexibility and choice: offer different types of spaces for different needs—calming rooms, social areas, private space, and low‑stimulus zones.
• Accessibility as standard: such as acoustic design for autistic people, people with hearing impairments, and sensory processing differences.
• Trauma‑informed principles: prioritise dignity, autonomy, and emotional safety.
• Feedback loops: continue involving patients after the building opens to refine and improve the environment.

Final reflections

Feeling safe is not the same as being objectively safe, and both matter equally in mental health settings. Design should never be an afterthought: it is a therapeutic intervention in its own right.

When we create environments that respect sensory needs, reduce distress, and promote autonomy, we support recovery and reduce risk.

Co‑production with patients isn’t just good practice, it’s essential for designing spaces that truly work for the people who use them.

References

1. National Autistic Society. Number of autistic people in mental health hospitals: latest data. June 2025. Accessed online 13/15/26.

2. NHS England. The Assuring Transformation dataset (Table 3, column F&G: average length of stay for autistic patients without a learning disability). March 2026. Accessed online 13/05/26. 

1. Develop honest and open relationships.
2. Agree a long-term vision for adult mental health services. 
3. Partnership outcomes framework.
4. Develop a governance and quality assurance framework.
5. Early intervention and prevention.
6. Care and support assessment framework.
7. Workforce plan.
8. Multi-disciplinary training programme. 
9. Develop integrated commissioning capacity.
10. Rapid response and shared escalation processes.
11. Access guidance.
12. Hospital discharge.

• Restrictive Practice - CAMHS Low Secure
• Restrictive Practice - CAMHS Medium Secure
• Restrictive Practice - CAMHS PICU
• Restrictive Practice - CAMHS T4
• Restrictive Practice - D/deaf (Adults)
• Restrictive Practice - D/deaf CAMHS
• Restrictive Practice - Eating Disorders (Adults)
• Restrictive Practice - High Secure (Adults)
• Restrictive Practice - Low Secure (Adults)
• Restrictive Practice - Medium Secure (Adults)
• Restrictive Practice - Obsessive Compulsive Disorder and Body Dysmorphic Disorder Service
• Restrictive Practice - Perinatal
• Restrictive Practice - Tier 4 Personality Disorder

As with the adoption of any new technology into clinical workflows, it is important for practitioners to learn how to manage the cultural shift required to take advantage of a vision-based patient monitoring and management system. The engineering framework described in this article will help them to understand how the tasks involved in patient care (assess, observe, intervene, and improve) can be optimised through the adoption of a vision-based system, which offers nonintrusive physical and physiological monitoring of quantified patient state.

Potential further developments in the vision-based system include metrics of sleep quality, agitation, and more detailed analysis of patterns of behavior. Development of non–contact-sensing of patient temperature at a distance and with affordable technology would also be valuable.

The report highlights the following key findings about children and young people's mental health:

• One in six children aged 6 to 16 were identified as having a probable mental health problem in July 2021, a huge increase from one in nine in 2017.
• Boys aged 6 to 10 are more likely to have a probable mental disorder than girls, but in 17 to 19-year-olds this pattern reverses, with rates higher in young women than young men.
• By the age of eight, 7 in 10 children report at least one adverse childhood experience (ACE).Three in four adolescents exposed to ACEs develop mental health problems by the age of 18, including major depression, conduct disorder, alcohol dependence, self harm, suicide attempts, and posttraumatic stress disorders (PTSD).
• In 2018, the suicide rate in women aged under 25 years had significantly increased since 2012 to its highest ever recorded level of 3.3 per 100,000.
• Nearly half of 17–19-year-olds with a diagnosable mental health disorder have selfharmed or attempted suicide at some point, rising to 53% for young women.
• In 2018-19, 24% of 17-year-olds reported having self-harmed in the previous year, and seven percent reported having self-harmed with suicidal intent at some point in their lives. 16% reported high levels of psychological distress.
• There was a 47% increase in the number of new emergency referrals to crisis care teams in under-18-year-olds between December 2019 and April 2021.
• Consistent findings showing people in marginalised groups are at greater risk of mental health problems, including people from Black, Asian and other minority ethnic backgrounds, lesbian, gay, bisexual and transgender people, disabled people and people who have had contact with the criminal justice system, among others.

Recommendations

• A commitment from the next Prime Minister to fund an immediate £1bn children and young people’s mental health wellbeing recovery programme to improve the quality and effectiveness of mental health care and support, with guaranteed appointment and treatment times as part of a wider post pandemic commitment to children and young people.
• New local frameworks for children and young people’s wellbeing (aged 0-25) between health, children’s services, schools, youth offending teams and the police to provide an integrated approach with common performance targets and pooled financial contributions from all partners.
• Guaranteed mental health assessments for children and young people at points of vulnerability. This would mean an automatic assessment and guaranteed mental health package for children entering care and automatic assessments for children and young people at risk of exclusion from school, who go missing, at the point of arrest, or are involved in violence or crime. It would include a guarantee of assessment by education psychologists for any child at risk of exclusion.
• A national implementation programme to embed a whole school and college approach to mental health and wellbeing across all education settings in the country. This should include a commitment from Government to provide a funding package for Mental Health Support Teams beyond 2023/24 to ensure that all schools have access to this vital additional support by 2030.
• An ambitious programme of drop in mental health hubs delivered in the community. These new community drop-in centres will provide vital drop in access and work with local community groups to provide outreach support, funded by the new recovery programme.
• A national ‘Programmes on Prescription’ scheme in every area. Building on emerging local approaches, the roll out of a major funded programme of social prescribing for mental health wellbeing that enables GPs and health professionals to pay for sports and arts sessions, music, drama, activities, youth clubs, outings, and volunteering programmes to improve young people’s confidence, self-esteem, and skills and make friends.
• A major recruitment programme with ambitious targets to build the children and young people workforce required to meet this expansion of services. It is vitally important to ensure that this workforce is diverse and culturally competent.
• Wellbeing and mental health training and support for all professionals working with children and young people. Identifying and understanding the mental health needs of children is vital if they are to be offered the help they need.
• Make co-production and community work a cornerstone of mental health care to ensure long-term trusted relationships for young people and to give them a constant point of contact.
• Improved wellbeing on digital platforms. We know that many children feel more comfortable and sometimes prefer help online, which should also be extended and supported as an important strand of a local strategy.
• Better information and support for parents to support children and young people’s positive mental health and wellbeing.
• Improving the mental health and well-being of young people at risk of harm and being involved in the criminal justice system. This should be measured as a core aspect of NHS equality targets with leadership, resources, and delivery plans.

• By 2022, there needs to be a multidisciplinary mental health workforce plan, alongside the refresh of the mental health strategy, that provides the staffing needed to provide care at the point of need.
• A guarantee mental health receives its share of Covid health funding, and that there is a longer-term assessment of what funding is needed to meet the mental health needs of all Scots.
• A national transitions strategy for our most vulnerable young people, ensuring they can transition into adulthood with the right care and support.
• A public health-led approach to addressing drug and alcohol addictions, including access to care and treatment for those with a dual diagnosis.
• By 2026, use 1% of what we spend on health to support the mental health of our young people through Child & Adolescent Mental Health Services (CAMHS).