Don’t overlook ceiling tile choices

Some clinicians don’t believe that there should ever be acoustical ceiling tile (ACT) in an inpatient psychiatric environment. They argue against our standing reach argument by reminding us that a 6-foot tall man standing on the shoulders of a 6-foot tall man can reach over 12 feet. Even an architect can follow that math!

The problem with that argument is that design can’t solve everything. We have to make choices and remember that in many areas, patients are supervised.

So today, let’s study the nuance of ceiling selection. There are generally two types of ceilings:

1. Ceiling tile systems, of which the most common is the simple 2x2 ceiling tile that is probably above your head right now (if you are in an office); and

2. Hard ceilings, of which the most common is gypsum board, the same stuff that most walls are made of. There are many variations of both, but for this conversation, let’s just focus on those two common options.

ACT has many advantages. Because the tiles are removable, it is easy to get to the ducts, dampers, valves and junction boxes above the ceiling. This is important both to cost of construction and to cost of maintenance. ACT also has an acoustically dampening quality. How much depends on which tile you select, but a ceiling that absorbs sound can play an important part in creating a therapeutic environment. I could write another whole post on the importance of good acoustic strategies in behavioral healthcare, but for now, please just accept that this is important.

ACT also has its drawbacks. This is mostly from a security standpoint.

Because the tiles are removable, a person, if they can reach it, could hide things above the ceiling. They could also break off a piece of the grid to use as a weapon against themselves, other patients, or staff. There is also the possibility of what I term “frustration mischief,” which is the tendency of frustrated patients to try to break things as a means of “punishing” the staff.

Conversely, a hard ceiling seems to be the answer to all of ACT’s drawbacks. You can’t hide things above it. You can’t break off pieces of it and it is difficult to damage it. There can also be an aesthetic value to a hard ceiling. You can choose any paint color you want, vary heights and slope or other options to add variety to a space.

Unfortunately, a hard ceiling is, acoustically, exactly what is sounds like: hard. Combined with a hard floor and a rectilinear room, you can have an acoustically uncomfortable space. You also have problems with access to above ceiling infrastructure which can have a cost impact, both short term and long term.

Take my word for it

If you are willing to take my word for it that you don’t want to put patients in an acoustically uncomfortable space, then we have two options: Use hard ceilings with other acoustical treatment, or use ACT at a sufficient height that patients can’t reach it. Of course the answer is going to vary by space.

We recommend hard ceilings in rooms with a low expected population or in which patients are likely to be unsupervised such as interview rooms, patient rooms, time out rooms, etc. We also generally recommend ACT in spaces where groups will gather and which offer reasonable supervision such as group rooms, treatment rooms, classrooms, dining areas, etc.

The final recommendation, to circle back, is to be careful about the height of your ACT ceiling. We use 10 feet as a rule--the height of a basketball goal. As a reference point it offers a simple clarity. The average adult male cannot touch the rim of a basketball goal while standing; can touch it at the peak of a good jump; and can’t really get any higher than that.

Based on that, we concluded that you can’t hide things above a ceiling if you can barely touch it at the peak of your jump and you can’t do much damage either. We still recommend that all ceiling devices be tamper proof and that staff be extra vigilant if you have an unusually tall patient in their care.

Perfect? No, but this is a very good set of choices and it reminds us that while design is valuable in a psychiatric environment, it must work hand in hand with important operational decisions. If two men manage to stand on each other’s shoulders while hiding things above the ceiling in a supervised group room, I think we have an operational issue that needs to be addressed.