Two countries, one challenge: What the US and UK can learn from each other about mental health design

Two countries, one challenge: What the US and UK can learn from each other about mental health design

Made for Living | In conversation with Stephen Parker, Architect

From trauma-informed design and lived experience to funding and community crisis care, architect Stephen Parker explores how the US and UK can learn from each other to create safer, more therapeutic mental health environments.

We say therapeutic design, you say trauma-informed

For decades, mental health environments have been shaped by the need to manage risk. Secure doors, durable fixtures, and controlled spaces all play an essential role in protecting people during vulnerable times.

But physical safety is only part of the picture.

Stephen is a US architect whose work spans specialized mental healthcare facilities, from community recovery centers to inpatient settings.

He is an Associate of the UK’s Design in Mental Health Network and a practitioner with the Trauma Informed Design Society, giving him a unique and valuable perspective on how the two countries approach safety, therapy, and the built environment.

From managing risk to understanding trauma

In the US, behavioral healthcare design has historically focused on institutional safety and risk management. The growing influence of trauma-informed care is changing that perspective.

Stephen highlights the role of the Substance Abuse and Mental Health Services Administration (SAMHSA), whose Four Rs framework encourages services to realize the impact of trauma, recognize its signs, respond appropriately, and resist retraumatization.

For designers, this means considering not only what a building must prevent, but how people experience it.

Does a space offer privacy and choice? Do safety measures provide reassurance or reinforce restriction?

Where lived experience and therapeutic design enter the process

One interesting difference between the US and UK is how lived experience influences decisions.

In the US, peer support is a recognized principle of trauma-informed care, although this tends to be incorporated into care delivery rather than engagement with facilities teams and the wider design industry.

In the UK, people with lived experience are increasingly involved directly in designing facilities, products, and processes, working alongside NHS trusts, clinicians, and architects.

Both approaches recognize the importance of listening. The opportunity lies in bringing these perspectives together.

A patient room door, for example, must meet safety requirements and allow emergency access. But someone who has experienced inpatient care might ask something different: does it give me privacy and feel like my own space?

While the UK may be further along in incorporating lived experience at various levels of decision-making, perhaps UK healthcare organizations could consider integrating people with lived experience into frontline care roles.

Good design considers both. Safety should protect people without taking away their dignity.

Different funding systems, shared pressures

Even when everyone agrees on what better care environments should look like, funding can stand in the way.

In the UK, NHS capital investment operates within established public funding structures. Budgets are limited and projects compete for priority, but approved projects can benefit from greater funding certainty.

In the US, Stephen describes a much more varied system, with projects drawing on federal, state, county, and private funding, alongside different reimbursement arrangements.

This can make planning unpredictable, but may also allow some facilities to move more quickly when funding becomes available.

Despite these differences, both countries face a familiar challenge: demonstrating why investment in safer, more therapeutic environments matters.

The value of getting design right

The true cost of a healthcare environment goes beyond its initial construction or renovation.

Doors that are difficult to operate during emergencies, fixtures that repeatedly fail, and environments that feel unnecessarily restrictive can all place additional pressure on staff and patients.

Reliability, maintenance, staff confidence, and patient dignity all contribute to the long-term value of a building.

The changing front door of mental healthcare

One of the most significant developments Stephen discusses is taking place beyond traditional inpatient units, an area where the US has arguably made earlier progress and continues to move quickly.

Across the US, dedicated behavioral health crisis facilities are changing how people access emergency mental healthcare.

Historically, someone experiencing a psychiatric crisis might arrive at a general emergency department, an environment not always suited to their psychological needs.

New models are offering alternatives.

Among them is EmPATH, or Emergency Psychiatry Assessment, Treatment, and Healing, associated with psychiatrist Dr. Scott Zeller.

These dedicated services provide assessment and stabilization in environments designed specifically for people experiencing mental health crises.

The aim is to provide appropriate care earlier, helping individuals access inpatient treatment, community support, or discharge according to their needs.

A different environment for a different moment

Designing for crisis care requires a different balance of safety, observation, privacy, and dignity.

A busy emergency department may be appropriate for physical emergencies, but noise, unfamiliar surroundings, and long waits can intensify psychological distress.

Trauma-informed design offers an opportunity to create calmer, more supportive spaces that respond to people’s needs during a crisis.

When services grow faster than design guidance

Stephen highlights the rapid growth of smaller crisis facilities across the US, often supported by new funding opportunities.

However, specialized design guidance for these settings is still developing.

This creates a challenge for smaller communities that may lack access to experienced behavioral healthcare designers.

Lessons already learned in inpatient settings should not need to be learned again in crisis facilities.

How can the UK learn as it reinvigorates community mental healthcare?

With UK Prime Minister Andy Burnham’s August 2026 announcement of £343 million in funding for 100 community mental health centers and 59 mental health emergency departments across England, the UK is entering an important new chapter in mental healthcare.

The ambition is clear: bring care closer to communities, intervene earlier, and reduce pressure on traditional emergency departments.

But as investment accelerates, how do we ensure these new spaces are designed around the people who will use them?

In our recent article on Mental Health Emergency Departments, we explored how dedicated crisis environments could transform emergency mental healthcare. And in our conversation with Charlotte Burrows, The Future of Community Mental Healthcare, we discussed the importance of creating services shaped by the needs of local communities.

Stephen’s experience in the US offers timely lessons. From established EmPATH models to the challenges of designing smaller crisis facilities, there is much to learn from what has worked and what hasn’t.

As the UK invests in these new services, we have an opportunity to draw on those experiences from the outset, creating environments that support safety, dignity, and recovery rather than simply expanding capacity.

Learning from each other’s hard lessons

Perhaps the most valuable lesson from Stephen’s perspective is that progress depends on sharing what hasn’t worked, as well as what has.

The US offers experience in specialist crisis care, trauma-informed design frameworks, and flexible community services.

The UK offers valuable examples of embedding lived experience into decisions about mental healthcare environments.

Neither system has all the answers.

But sharing practical lessons, from building layouts and clinical workflows to funding and product design, can help others avoid repeating mistakes.

And those lessons matter.

A poorly positioned room, an awkward access route, or a door that’s difficult to operate under pressure can affect the everyday experiences of patients and staff.

Learning from those details can make a meaningful difference.

If you have ideas to share or would like to be featured in a future Made for Living article, get in touch.

Together, we design for good.