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New Research Validates "Five Levels of Safety" Approach



An evidence based research paper by Sara Bayramzadeh, PhD, that was published in the Health Environments Research & Design Journal in June of 2016 explored the 5 levels of risk concept that has been included in the Design Guide for the Built Environment of Behavioral Health Facilities since it was first published in 2003.  This research done for this study validates this principal as being a sound basis for assigning risk in behavioral health settings.


(Health Environments Research & Design Journal 2017, Vol. 10(2) 66-80 copyright The Author(s) 2016. Reprints and permission: https://us.sagepub.com/en-us/nam/journals-permissions)


The level of concern for the safety of patients and staff due to the design of the built environment is not the same in all parts of a behavioral health unit or facility. The level of precautions necessary depends on the amount of supervision the patient will have while using that part of the facility.

The level of concern falls roughly into five categories (with 5 being the highest level of concern):

  • LEVEL 1 | Staff and Service Areas – where patients are not allowed. Compliance with all applicable codes and regulations.

  • LEVEL 2 | Corridors, Counseling and Interview Rooms – where patients are highly supervised and not left alone for periods of time.

  • LEVEL 3 | Lounges and Activity Rooms – where patients may spend time with minimal supervision

  • LEVEL 4 | Patient Rooms and Patient Toilets – where patients spend a great deal of time alone with minimal or no supervision.

  • LEVEL 5a | Admissions (especially emergency admissions which often take place after hours) – where staff interact with newly admitted patients that present potential unknown risks and/or where patients may be in a highly agitated condition.

  • LEVEL 5b | Seclusion Rooms – where patients may be located under extreme conditions.


Each of these levels of concern requires increasing attention to the built environment to reduce the potential of the patients being afforded a means of doing harm to themselves or others. These levels are cumulative, and all steps taken for lower levels are also required for a higher level. For example: all steps recommended for Levels 1, 2 and 3 are also recommended for Level 4.

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