Balancing daylight and safety for patients in specialty health care facilities

Nearly half, 48%, of the specialty hospital projects under construction over the next three years will be behavioral health centers or psychiatric hospitals, according to the American Society for Health Care Engineering (ASHE) and Health Facilities Management 2024 Hospital Construction Survey. In these facilities, safety and healing are of utmost importance, and natural light and outdoor access play a significant role in promoting mental health and healing.

Whether it is new construction, a renovation or an adaptive reuse project, window selection is an important consideration. Depending on the level of supervision provided, as well as furnishings and equipment in the patient spaces, window products’ evaluation may include resistance to or restriction of:

• Escape attempts or passage of contraband
• Attack to window components, using blunt or sharp objects
• Tampering with, or disabling, locking devices
• Laceration or self-harm by cutting
• Ingestion of components or materials
• Abrasion, prying or cutting
• Weaponization of parts
• Ligature

Unlike conventional windows, behavioral windows must be designed to withstand high impacts from the interior. If a patient runs into the window, or strikes or throws an object against it, energy must be transferred sequentially through hardware, window frames, anchorage and substrates.

AAMA 501.8 is the Standard Test Method for Determination of Resistance to Human Impact of Window Systems Intended for Use in Behavioral Care Applications. Updated in 2023, it involves using a weighted impact device to apply as much as 2,000 foot-pounds of energy to the face of the window. After testing, the window system must meet specific post-impact safety, security and enclosure conditions.

Due to the uniqueness of behavioral care projects, window selection in areas accessible to patients can be more challenging. Window product evaluation often starts early in the design process. Typically, the design team will evaluate a sample window with the owner and staff. They will best understand the risks and needs of the patient population being served for patient safety to remain the primary consideration.

Safety features

Infills

To resist human impacts, the interior glazing may require polycarbonate, tempered laminated glass or glass-clad polycarbonate infills. These infills may have different size limitations due to availability and the results of impact testing. In general, larger and more flexible glazing represents the worst case for infill areas. Smaller or more rigid glazing places higher loads on hardware and anchors. Therefore, both minimum and maximum sizes need to be addressed in testing.

Structural and architectural detailing

The structural and architectural detailing of behavioral windows is also critical. Substrates may require reinforcement to transfer impact loads to the building structure. For installation, steel strap anchorages will maximize energy absorption. Through-frame anchors may be optional as substrates allow or specially designed impact receptors may be available. In installation, tamper-resistant sealants may be required in in-patient areas exposed to the interior. These security sealants are flexible, abrasion-resistant and highly tenacious.

Hardware and interior glazing

Other window safety features will include concealed hinges, tamper and ligature-resistant hardware components, and tamper-resistant interior glazing materials. Integral between-glass blinds offer privacy control with concealed raise/lower cords and optional occupant-controlled tilt.