Biophilic spaces for mental health and wellbeing

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Central to this transformation is the integration of biophilic design (design that connects people with nature) principles that prioritise mental health and psychological wellness alongside clinical excellence. Stress in healthcare settings stems not only from experiences of suffering, illness or pain, but also from lack of privacy, exposure to unfamiliar or anxiety-inducing sounds, inadequate lighting and unpleasant odours. Such stressors can exacerbate anxiety and concern for health, leading to broader physiological effects. Fortunately, exposure to nature is proven to reduce stress.

Healthcare environments have long been sterile, institutional spaces that inadvertently contribute to stress and anxiety for both patients and staff. Research consistently demonstrates that exposure to natural elements can significantly reduce cortisol levels, lower blood pressure and accelerate healing processes.

For healthcare workers facing unprecedented burnout rates, and patients experiencing the vulnerability of illness, biophilic design offers evidence-based solutions that address mental health at the environmental level.

The NHS’s journey toward Net Zero by 2040 creates a unique opportunity to align sustainability goals with wellbeing outcomes. Biophilic spaces inherently support environmental objectives while delivering measurable improvements in psychological health, creating a powerful synergy between planetary and human wellness.

Evidence-based biophilic interventions

Modern healthcare architecture must move beyond token gestures of ‘adding some plants’ to embrace comprehensive biophilic strategies supported by robust research.

Experience from specialised facilities like UCLH’s Proton Beam Therapy Centre has demonstrated that even the most technologically advanced healthcare environments benefit significantly from biophilic integration, where patients facing intensive treatments show measurably reduced anxiety levels when surrounded by natural elements.

Key interventions include:

Natural light optimisation: Circadian-responsive lighting systems that mirror natural daylight patterns have been shown to improve sleep quality for patients and reduce seasonal affective symptoms among staff working long shifts. Strategic window placement and light wells can transform clinical spaces from anxiety-inducing environments into calming, healing spaces.
Living green systems: Proper natural planting and views or access to external gardens provide more than aesthetic appeal in their winning combination of daylight and nature. Studies indicate that patients with views of nature require shorter hospital stays and less pain medication. For staff, access to green spaces during breaks significantly reduces stress hormones and improves job satisfaction.

Experience from specialist healthcare facilities has shown the transformative power of dedicated green spaces — winter gardens that provide year-round access to nature, and expansive landscaped courtyards that offer respite for both patients and staff, demonstrating how generous outdoor green spaces can become the heart of a healing environment.

Natural material integration: The tactile experience of wood, stone, plants and light creates psychological connections to the natural world. In high-stress clinical environments, particularly those involving complex procedures, these materials can be incorporated into reception areas and staff spaces to create environments that feel less institutional and more human-centred.

Real-world application in specialist treatment facilities has shown that patients report feeling more relaxed and confident when surrounded by natural textures, even in highly technical medical settings. However, these must be restricted in operating rooms and sterile environments, intensive care units and certain patient areas to mitigate risks of allergens, microbes or pathogens and due to the high level of control and hygiene required for critically ill patients.

Biomorphic design elements: Architectural forms that echo natural patterns — flowing curves, fractal geometries, organic shapes — trigger positive psychological responses. These design elements can be subtly integrated into everything from ceiling patterns to furniture design.

Supporting staff mental health through environment

Healthcare workers face unique stressors that environmental design can help mitigate. Biophilic spaces specifically designed for staff wellbeing include:

Restorative break areas: Dedicated spaces with natural views, comfortable seating among living plants and access to fresh air provide essential psychological restoration during demanding shifts. These areas should be positioned to offer privacy and tranquillity away from clinical pressures.
Stress-reduction zones: Quiet spaces with natural lighting and comfortable furnishings give staff places to decompress.
Connection to outdoors: Staff dining areas and meeting rooms should prioritise outdoor views and, where possible, direct access to landscaped areas. Even brief connections with nature during the workday can significantly impact mental resilience.

Patient-centred biophilic design

For patients, biophilic environments can transform the healthcare experience from enduring treatment to actively participating in healing:

Healing gardens: Therapeutic outdoor spaces designed for different mobility levels provide patients with opportunities for gentle exercise, social interaction and psychological restoration. These spaces should accommodate wheelchairs, include seating for varying abilities and offer both sunny and shaded areas.
Room design for recovery: Patient rooms incorporating natural views, especially of living plants, create environments that support faster healing. Families benefit from these calming spaces during emotionally challenging times.
Wayfinding through nature: Using natural elements and biomorphic patterns as navigation aids reduces the anxiety associated with navigating complex healthcare facilities. This approach is particularly beneficial for patients with cognitive challenges or high stress levels.

As we design for 2070, not just 2025, biophilic healthcare spaces must be adaptable and integrated with emerging technologies to be future-proofed:

Smart building integration: Biophilic elements should work alongside intelligent building systems, with sensors monitoring air quality and automated systems adjusting natural lighting based on circadian rhythms.
Technology-nature balance: Future healthcare will integrate AI diagnostics and robotic surgery within biophilic environments that work with infection control material and regulations. The challenge is creating spaces where high-tech medical care feels human and connected to nature rather than cold and intimidating.

Measuring success: Mental health outcomes

The effectiveness of biophilic healthcare design must be measured through comprehensive mental health metrics:

Patient satisfaction scores and anxiety levels.
Staff turnover rates and job satisfaction surveys.
Recovery time data and medication usage.
Sleep quality assessments for both patients and staff.
Cortisol level monitoring in high-stress clinical areas.

Implementation challenges and solutions

Creating truly biophilic healthcare environments requires addressing practical concerns and lessons learned from complex healthcare projects across multiple trust partnerships:

Infection control: Modern horticultural techniques allow for plant systems that meet strict healthcare hygiene standards. Experience from specialist treatment centres has shown that air-purifying plants can actually improve indoor air quality when properly maintained, even in environments requiring the highest levels of clinical precision.
Integration with complex systems: Advanced medical facilities, particularly those involving specialised equipment and multi-trust collaborations, present unique challenges for biophilic integration. However, these projects have demonstrated that natural elements can be successfully incorporated without compromising technical requirements or clinical workflows.
Maintenance requirements: Biophilic elements require ongoing care, but automated watering systems and hardy plant selections can minimise maintenance while maximising benefits.
Cost considerations: While initial investment may be higher, biophilic design delivers measurable returns through reduced staff turnover, shorter patient stays and improved satisfaction scores.

The path forward

As the New Hospital Programme moves forward, architect selection must prioritise firms capable of integrating biophilic design principles with clinical excellence. This means choosing architects who understand both the science of nature’s impact on human psychology and the practical realities of healthcare delivery.

Our experience as Design Lead Architects for the UCLH and SWBH NHS Trusts collaborating with Scott Tallon Walker Architects, HKS Inc. and Sonnemann Toon has shown that the principles are already working successfully in the UK, but we are glad not to be alone here. Several outstanding hospitals around the world provide inspiring examples, including: the Khoo Teck Puat Hospital in Singapore by KTPH with its superlative planting on balconies, courtyards and bridges; the Norwegian Outdoor Care Retreat (Friluftssykehuset) by Snøhetta featuring secluded wooden shelters near Oslo University Hospital and Sørlandet Hospital; and finally, the Acute Psychiatry Ward at Östra Hospital in Gothenburg, Sweden designed by White Arkitekter, featuring a corridor-free design and healing environments, which have been studied for their positive impact on patient wellbeing and reduced aggression.

The opportunity before us is unprecedented. We can create healthcare environments that don’t just treat illness but actively promote mental health and wellbeing for everyone who enters them. These spaces can demonstrate that high-tech medical care and connection to nature aren’t opposing forces but complementary elements of truly healing environments.

The decisions made today about biophilic integration will influence patient experiences, staff mental health and healing outcomes for the next half-century. We must ensure these 40 new hospitals represent not just the future of medical technology, but the future of human-centred, mentally supportive healthcare environments.

The question isn’t whether we can afford to prioritise biophilic design in healthcare — it’s whether we can afford not to. In an era of rising mental health challenges and healthcare worker burnout, nature-connected design offers evidence-based solutions that support both clinical outcomes and human flourishing.

Laura Carrara-Cagni

Laura Carrara-Cagni RIBA, is director of Cagni Williams Associates, a practice specialising in sustainable healthcare design, and co-founder of Cagni Williams Energy, a consultancy delivering Net Zero strategies for healthcare estates. With over 30 years’ experience, she has led numerous projects across the civic, cultural, educational, and residential sectors, integrating energy-efficient strategies to achieve Net Zero Carbon (NZC) goals.

She is committed to advancing sustainability in the built environment, notably through innovative solutions in healthcare, such as the Midland Metropolitan University Hospital and La Spezia Hospital in Italy. A passionate advocate for reducing carbon emissions in architecture, she serves as co-chair of the Urban Land Institute Europe – Life Science and Healthcare Product Council. She also takes up speaking engagements, writes, and serves as a juror for architectural and art awards.