The User Experience of the Locked Unit

It has been three weeks since my interview with the non-profit hospital. The process from the recruiter screen to the actual first in-person meeting took a while, and I have not heard back since. In this field, silence is common. It took a month to get my current position, so I am treating the wait as standard operating procedure rather than a rejection.

While I wait, I am still on the floor at the acute hospital. Something in my perspective is shifting.

I used to think my taste was limited to software products. I cared about how a button feels or how a user flows through an app. Recently, I have started thinking obsessively about physical architecture.

The hospital where I work was built over 30 years ago. It is a large facility with nine distinct units. I understand that it cannot easily be modernized, but the age of the building reveals the philosophy of its time. The design prioritizes containment over care. It is a hardened facility. Everything is sealed. The primary design constraint is preventing liability. The goal is stopping patients from eloping (AWOL) and removing ligature risks where a patient could harm themselves.

These are necessary safety features. But safety is not the same as therapy.

I suspect the architecture itself acts like a nosocomial infection. Just as a patient can catch a germ in a medical unit, a psychiatric patient can contract new stress simply from the building's design.

The most glaring flaw is acoustic. In an acute unit, crises happen around the clock. Currently, when a patient has an episode, the entire unit participates in it. It does not matter if it is noon or midnight. I watch patients trying to read, rest, or just exist while someone down the hall is throwing their body weight against a door, screaming, or banging the walls.

If I were a patient here, finding peace would be impossible. If I cannot find quiet, I cannot regulate my emotions. It creates a feedback loop. The environment causes chronic stress, which causes more outbursts, which causes more noise.

This connects to a deeper design failure: the lack of a middle ground. A patient currently has two choices: the overstimulating, public dayroom or a cramped bedroom shared with strangers. There is no semi-private alcove where a patient can decompress without being in full isolation.

This architectural gap forces our hand. Because there is no soft timeout room, we often have to use the hard seclusion room for de-escalation. Even if we leave it unlocked and place a staff member outside on ligature watch, the optics are wrong. We are trying to help a patient find calm, but the only space available is a sterile, concrete box designed for containment.

Worse, when space is this limited, chemical restraints become a default solution. I have observed that we often rely on emergency medication simply because we lack the physical space to let a patient walk off their agitation safely. If the architecture offered more movement and privacy, I believe we could reduce the number of injections we administer.

Then there is the light. We are a locked facility, which means fresh air is rare. Patients only see the sun during scheduled activities. The color palette of the unit is drab. I give the facility credit for the individual reading lights above the beds. It is a small touch of autonomy. However, the overall lack of natural light disrupts circadian rhythms.

We are asking people to heal their minds in a space that deprives them of the biological basics. They need quiet, regulation, and sunlight.

I want to push the conversation beyond risk mitigation. We have solved the problem of how to keep patients inside the building. The next design challenge is how to make the inside of the building a place where recovery is actually possible.