Unique challenges and solutions in behavioral health facility construction

This blog post was authored by Lindsay Corotis, Vice President - Account Manager, Skanska USA Building.

The demand for behavioral health services is at an all-time high, with one in five Americans experiencing mental illness. This growing need has spurred significant investment in specialized facilities designed to provide comprehensive care. However, building these critical environments presents unique challenges that go beyond standard construction practices. Below are some key considerations for successfully developing behavioral health facilities, from understanding occupant needs to vital constructability and security requirements.

Understand For Whom You are Building

A well-designed and constructed behavioral health facility can significantly contribute to positive patient outcomes, from ensuring comfort to promoting recovery and rehabilitation. By carefully considering the unique needs of this vulnerable population, builders can create environments that support healing, foster independence, and ultimately improve lives.

Slated for completion in January 2026, Skanska is currently in the final stages of the Cordilleras Mental Health Center Replacement project in Redwood City, California. Owned by San Mateo County and originally housing clients in a building constructed as a tuberculosis hospital in 1952, the replacement 77,000-sf campus consists of four single-story mental health recovery centers, each accommodating 16 occupants, as well as a three-story co-housing building for 57 residents.

The buildings are arrayed around a central open space, offering sheltered outdoor seating, community gardens, and recreation courts. A key consideration throughout the project has been the specific needs of the occupants, both during the construction phase and once the new center is complete.

Active construction is occurring next door to the existing facility, prompting mitigation measures related to safety, communication, and noise. These begin with an onboarding and training process for all project personnel. For example, all tools must be properly stored when not in active use to prevent any chance of self-harm among on-site residents. We have also emphasized the importance of language used by our employees and subcontractors. People living at the facility are our clients, and that is how they should be referred to in any interactions. To address potential discomfort, sound monitors were installed to track construction noise levels and clients were equipped with noise cancelling headphones.

While particular concerns will vary depending on the client, building site and other factors, taking the time to educate the project team for whom they are building and why different behaviors might be required can go a long way in terms of a positive experience and successful outcome for all.

Consider Constructability Alongside Security Requirements

There are important nuances to building a behavioral health facility that make the construction process different from your typical hospital or medical office building project. Various security and anti-ligature requirements come into play, not only dictating products and finishes that can be used but potentially affecting building access and final commissioning and balancing. Early collaboration between parties can greatly impact success, with delivery methods like design-build allowing the contractor to have influence over design elements and provide feedback on constraints they may present during the commissioning and operation of the building due to specific anti-ligature components.

Consider ceiling tiles, for example. This common material cannot be used in high-risk areas of a behavioral health facility. If access panels are not coordinated and installed during construction, your team can encounter major issues when it comes time to balance the building and access any above ceiling components.

Our team ran into a challenge on the Cordilleras project in regard to furniture and electrical outlet access. In these types of facilities, furniture must either be very heavy or is often fixed in place with caulk to walls, which creates the potential for hiding electrical outlets. While we successfully resolved this issue, it would be prudent for teams to model furniture during BIM coordination, even if provided by the owner.

While easy to overlook, these nuances have the ability to create costly rework and delay schedules if not properly planned. Therefore, close collaboration from the earliest stage possible can help ensure the team accounts for all possible scenarios.

Lessons Learned

The clients at Cordilleras have now moved into the new buildings and our team is currently finishing site work. Unlike most projects, here we had the opportunity to construct four identical buildings, allowing our team to adapt, implement lessons learned, and gain production efficiencies with each build. These are lessons we will carry with us to future projects.

Successfully delivering behavioral health facilities requires a deep understanding of the unique needs of occupants, stringent security requirements, and a collaborative approach to constructability. By prioritizing these elements, builders can create healing environments and meet the growing demand for specialized mental health services.

About the Author
Lindsay Corotis is Vice President - Account Manager for Skanska USA Building in California, leading its Healthcare Market. She can be reached at [email protected].