How Milieu Design Impacts Patient Autonomy in Behavioral Health

ObjectiveThe purpose of this study was to investigate how environmental affordances in the behavioral health inpatient milieu affect a patient's sense of autonomy.BackgroundPatients who feel empowered are more likely to participate in their care, which can, in turn, improve the quality of care (Ippolito et al. 2020). However, the lack of patient empowerment can have negative consequences in behavioral health facilities such as intensified physical violence, aggression, and loneliness in the milieu (Bellman et al., 2022; Dell et al., 2019; Hickmann et al. 2022). Research has also demonstrated that patient empowerment is closely linked to patient autonomy (Gagné, 2003; Hodgins et al., 2006). However, there is little insight as to how milieu spaces can foster patient autonomy.MethodsThis study utilizes a triangulated methodology to conduct a post occupancy evaluation through an on-site environmental assessment and behavioral observations within key milieu spaces.ResultsThe results demonstrated that access to scenic views, tactile features, patient's ability to move freely throughout the unit, and access to immediate provider care were significant indicators that differentiated patient autonomy between facilities. The behavioral observations showed that negative behaviors occurred around the edges of the milieu as well as when external stressors were involved. The autonomy score findings encapsulated by the designer evaluation were also closely associated with the frequency of positive behaviors observed by staff.ConclusionOutcomes include responsive design recommendations for design implementation.