FGI Behavioral Health Design: Ligature-Resistant Requirements Explained (2018 and 2022 Editions)

2,000 foot-pounds. That is the impact load every exterior window in a psychiatric patient care area must be designed to resist, applied from the inside, in the FGI 2018 Hospital Guidelines §2.5-7.2.2.5(2)(a). Get the glazing wrong and the window becomes an elopement or self-harm route on opening day. This article covers glazing performance and seclusion room counts as the FGI Guidelines state them, and separates those requirements from design guidance.

Which FGI edition applies to your project?

The values below are quoted from the FGI 2018 Hospital Guidelines (as reproduced in FGI’s 2018 Hospital Formal Interpretations, updated 4/3/2024), the FGI 2022 Hospital interpretation on seclusion rooms (updated 8/12/2025), and the 2010 Guidelines text. The 2026 edition has since been released (fgicodes.org: “2026 Edition is Here!”, published as “FGI Codes for Planning and Design” and “FGI Handbooks for Planning and Design”). States adopt FGI editions separately (editions from 2014 to 2026 are in the adoption mix), so the section numbers and wording on your project may differ from this article. Ask the authority having jurisdiction (AHJ) which edition is adopted and read that text before you detail glazing or count seclusion rooms. Do not treat this article as the current requirement.

What are the key code numbers for behavioral health design?

FGI’s 2018 interpretation states that §2.5-7.2.2.5(2) applies only to exterior windows, and that wording added in the 2022 edition clarifies this; §2.5-7.2.2.5(1) (glazing material) applies to interior and exterior glazing, borrowed lights and glass mirrors in patient care areas. The 4-inch operable window opening is not in §2.5-7.2.2.5; it appears only as a “should” in a commenter’s remark in the ED secure holding room interpretation (see below).

What glazing requirements apply to psychiatric patient care areas?

Under §2.5-7.2.2.5(1) of the 2018 Hospital Guidelines, windows in patient care areas or areas used by patients, including the exterior pane of windows accessible from outdoor courtyards, are designed to limit the chance that patients break them and use the pieces to harm themselves or others. All glazing, interior and exterior, borrowed lights and glass mirrors are made with polycarbonate or laminate on the inside of the glazing, or with glazing that meets or exceeds Class 1.4 per ASTM F1233. Item (1)(b) states that use of tempered glass for borrowed lights is permitted. The text has no impact requirement for interior borrowed lights, and FGI’s interpretation notes that the Guidelines have no performance requirement for impact resistance of interior partitions. Whether your AHJ limits tempered borrowed lights, for example across a unit boundary, is a question for the AHJ.

Exterior windows in patient care areas or areas used by patients carry the performance requirement in §2.5-7.2.2.5(2): the entire window system and its anchorage, including frames, glazing, and hinges and locking devices for operable windows, is designed to resist impact loads of 2,000 foot-pounds applied from the inside and tested in accordance with AAMA 501.8. Social and dining spaces have a minimum net glazed area of 8 percent of the floor area (3).

How many seclusion rooms does a psychiatric unit need?

The FGI 2010 text (§2.1-2.4.3.1) provides at least one seclusion room for each 24 beds or fewer and for each major fraction thereof on each psychiatric unit, and says that if a facility has more than one psychiatric nursing unit the number is a function of the total number of psychiatric beds in the facility. In its 2022 Hospital interpretation FGI confirms the count: 144 beds need 6 rooms (144 / 24 = 6), 152 beds also need 6 (152 / 24 = 6.33; a major fraction is one half or more), and 156 beds need 7 (the additional 12 beds are a major fraction). FGI also confirms that organizing the required rooms into a seclusion suite shared by several units meets the intent, and encourages a behavioral and mental health risk assessment to confirm that co-locating them supports patient and staff safety. Contributors to the interpretation stress adequate support spaces for the suite and caution against long transport to a distant suite.

Source: FGI 2022 Hospital Formal Interpretations (as of 8/12/2025), reference 2.1-2.4.3. Whether the “each unit” minimum applies to a grouped suite depends on the edition and the AHJ; a contributor to the interpretation reads it as at least one room for each unit.

What makes an ED secure holding room compliant?

An ED secure holding room is defined in §2.2-3.1.4.3 of the 2018 Hospital Guidelines. FGI’s 2018 interpretation records that the Guidelines are silent on using it for another purpose, and that a room meeting the requirements for both uses is logically compliant. The ligature measures below are commenters’ expectations in that interpretation (stated as “should”), not text of the Guidelines:

• a solid ceiling or ceiling with glued or clipped-in-place tiles
• impact-resistant lighting
• ligature-resistant HVAC grilles
• tamper-resistant electrical outlets protected by GFCI and a remote master switch
• ligature-resistant door hardware, with the door swinging outward or double-acting to foil barricade attempts
• shatter-resistant glazing, including mirrors and picture frames
• any operable window limited to an opening of 4 inches

One commenting architect described dual-use rooms with medical gases and outlets behind a secure overhead door, and noted that this required coordination and waivers with the local AHJ.

How do ligature risk zones shape space-by-space design?

FGI’s June 2022 white paper “Design of Behavioral Health Crisis Units” (guidance beyond the minimum requirements of the 2022 Guidelines, not a code) asks the functional program to describe a risk assessment that assigns each patient a high, medium or low risk patient care area, and the ligature-resistant features for each. It labels spaces with typical risk levels:

The white paper words these as “typically” or “often” designed as high or medium risk. The project’s own risk assessment and the AHJ decide the designation. The white paper also lists weaponization, cutting, durability, hiding, elopement and wedging as safety considerations.

What staff safety features does the FGI white paper recommend?

The white paper (guidance, not code) suggests: two means of retreat for staff at the intake room, fixed and portable duress alarms, a consultation room with barricade-resistant hardware, a vision panel, a duress alarm and options for staff retreat, surveillance camera monitors shielded from patient view, an “area of refuge” behind a strategically placed locked door where staff may retreat during a serious threat, and use of the buddy system. For the minimum requirements, read the Behavioral Health Crisis Unit sections of the adopted edition (§2.2-3.2 in the 2022 Hospital Guidelines and §2.8-3.5.7 in the 2022 Outpatient Guidelines, per the white paper).

Which mistakes should you check for in behavioral health drawings?

1. Applying the 2,000 ft-lb window rule to interior borrowed lights. FGI’s interpretation says §2.5-7.2.2.5(2) applies only to exterior windows.
2. Missing the AAMA 501.8 test. ASTM F1233 Class 1.4 addresses glazing material; exterior windows also need the AAMA 501.8 test (§2.5-7.2.2.5(2)(b)). The two are separate items.
3. Undercounting seclusion rooms. At 156 beds the count is 7, not 6, because 156 / 24 = 6.5 and one half is a major fraction (FGI 2022 interpretation).
4. Presenting the white paper or interpretation comments as binding code. Binding text is in the adopted edition; the white paper and the commenters’ remarks are guidance.
5. Specifying a soiled workroom when a soiled holding room is acceptable. FGI’s 2018 interpretation allows a soiled holding room instead of a soiled workroom on a psychiatric unit (§2.5-2.2.8.12 via §2.1-2.8.12), and says it can be applied to earlier editions. Where patients may need bedpans, commenters say a workroom with a clinical sink is needed.