Informing the redesign of psychiatric seclusion rooms: a mixed-methods pre-evaluation with individuals with lived experience

BACKGROUND: In acute psychiatric inpatient settings, where perception is altered and emotional vulnerability is heightened, many facilities use coercive seclusion rooms for safety. This practice has been increasingly criticized for its psychological impact. While architectural guidelines emphasize human-centered and biophilic design to support well-being, empirical evidence on how design features in this specific setting affect patients remains limited. METHODS: This mixed-methods study examined how individuals with lived experience of coercive isolation in seclusion rooms (N = 30) perceived different wall designs. The participants viewed ten digitally rendered images of a to-be-redesigned seclusion room, including furniture, varying in wall design (six nature-themed images, three wall colors: blue, green, beige; and a white empty control room) and rated each on restfulness, stress, liking, and overwhelm. This was followed by qualitative interviews on needs and design preferences. RESULTS: Nature-themed wallpapers, especially an image of grass-covered dunes by the sea, and blue and green wall colors were rated as more restorative and less stressful than both the empty white control room and a beige-painted comparison room, or a more complex, ‘rough’ wilderness nature image. Qualitative findings emphasized calm, homelike, nature-themed, and controllable environments, orientation, more transparent and empathetic communication, and respectful care. CONCLUSIONS: Individuals with lived experience respond more favorably to blue and green color schemes and non-complex, calm nature imagery, compared to more neutral or sterile low-stimulation designs, challenging long-standing assumptions that sensory deprivation best supports de-escalation in seclusion. The study further illustrates the feasibility and ethical value of participatory pre-evaluative research to inform design. TRIAL REGISTRATION: The study and main analyses were pre-registered 2024/08/22 at aspredicted.org (#187275) https://aspredicted.org/9ht9-ckwn.pdf . CLINICAL TRIAL NUMBER: Not applicable.