Positive Approaches Journal, Volume 14, Issue 2
Naggy | 20-29
Volume 14 ► Issue 2 ► September 2025
Creating Nurturing Environments to Support Mental Health
Erin M. Naggy OTD, OTR/L
Abstract
Individuals with neurodiversity receive and interpret sensory information differently than their peers who do not experience neurodiversity. These differences add challenges to effectively coping with a sensory rich environment. Careful planning for supportive environmental design can bolster their ability to cope with challenges of daily life. This article highlights evidence-based techniques to create supportive environments utilizing the Ecology of Human Performance Theory from occupational therapy.
Theoretical Underpinnings
Evidence-based interventions presented in this article align with the occupational therapy frame of reference, the Ecology of Human Performance.1 This theory discusses the interplay between a person and their environment. It further explains how the relationship between person and environment affects the ability to complete tasks essential to one’s life. The concept of ecology reflects the need for efficient processing of information received from the environment and reacted to by the person’s sensory systems. A person’s skills and behavior grow from the interaction between the person and their context – whether physical, social, or environmental. The context in which a person exists endlessly changes due to its dynamic nature and interactions with the environment.
Occupational Therapy
Occupational therapy, an established branch of healthcare, grew exponentially in 1920 when soldiers returned from World War I with various mental and physical health needs. 2 Occupational therapy practitioners (OTP) recognize the interrelated nature of the client’s mental health and engagement in essential activities, seeking to improve both.3 OTPs adapt the physical and social environment as well as the demands of the activity to support the client’s successful engagement3. OTPs may recommend strategies and resources for the client to minimize physical and psychological challenges that affect occupational engagement.Sensory Integration
The term “sensory integration,” developed by A. Jean Ayres, reflects a homeostasis in receiving, interpreting, and responding to stimuli – both internal and external. Treatment procedures aim to provide specific stimuli of appropriate quality and type. These sensations elicit organizational effects on the subcortical processing mechanism of the central nervous system. Sensory integration techniques provide controlled sensory input, organization and interpretation of stimuli, and generate adaptive responses.4 Sensory strategies support coping skills by finding other ways to react to impulses and allow time to choose more acceptable behaviors and reactions. Having easy access to tools that calm sensory systems remains paramount to the process.5 A comfortable stimulus assists in organizing central nervous system processing functions which attenuate, and allows for interpretation of, stimuli in the environment. If there exists an increase in unmet stimulus needs during non-treatment periods, sensory integration can provide a gradual reduction of anxiety and often decreases self-injurious behavior.4
Sensory Rooms
Representing the strongest evidence for modification of the mental-health environment, sensory rooms provide a change to the physical environment. These calming rooms give allotted space for safety plan implementation, adapting current groups, and engagement in sensory experiences.5, 6, 7 A sensory room typically features calm, cool colors such as shades of green or blue. Different features may include a nature mural, decreased light and sound, and comfortable seating options. These rooms provide a “safe space” where patients self-regulate and take the onus for their choices. Sensory items such as weighted objects, fidget toys, and supplies for journaling kept in an accessible cabinet allow for patients to select items which support their mood. Reported patient and staff experiences show that sensory rooms support emotional regulation, promote self-management, and positively impact the overall patient admission experience and ward environment.7
Sensory room users report positive overall effects of spending time in the room – especially noting emotional regulation.8 Patients expressed that the person-centered nature of the sensory room reinforced the concept of being a “person,” the importance of the care environment, choice and responsibility, risk awareness and management, as well as different forms of knowing.9
The sensory room acts as a “safe space” away from the bustle of a noisy and busy atmosphere. Sensory room users described that sensory strategies helped them to lessen their dependance on another person by increasing their responsibility and self-control.5 Availability of sensory items allows the user to make choices for themselves – an important skill for community integration and empowerment.8
Music
Relaxing music improves overall behavior of mental health patients, especially with self-selected music. Familiarity with music selections supports optimal relaxation when utilized as a coping skill. Of further benefit, music has been found to improve the quality of sleep in mental health settings.9 Listening to music causes the sympathetic nervous system to decrease norepinephrine, lowering depression and anxiety. When used in conjunction with sensory rooms, findings indicate an improvement in patients’ mood. Music may be accessed through personal devices like an MP3 player, CD player, radio, cell phone (or other personal device), television channels, or via internet access.
Other Facility Adaptations
Handrails
Use of handrails can increase the safety of a patient’s environment but can also pose additional hazards as possible ligature (tying an item around the neck) risks—as patients may use these items for self-harm or attempts at strangulation. To mitigate this risk, many facilities utilize handrails without space behind them so that patients cannot tie anything onto them. These are helpful along corridors, as well as in shower and toileting spaces for safety from falls and assisting in balance.
Hats
Patients who bang their heads or are a fall risk, often benefit from the use of a protective head covering. Some models are large and unattractive and may cause a feeling of stigma when worn, although they would provide safety for the wearer. There are also regulations and requirements for when these are, and are not, acceptable. An online search will provide resources for padded hats—beanie-type, fishing-style, and even baseball cap hats that offer protection while appearing as a typical hat, which can be easily removed when needed.
Vests
Sensory stimulation for calming includes various weighted and compression garments. Both kinds of clothing, such as vests, scarves, or lap pads, provide sensory proprioceptive input. Proprioception provides information about the body’s position and movements through receptors in joints without needing to use vision. The role of proprioception in daily activities, exercise, and sports has been extensively investigated for the lasting calming effect of joint pressure and movement.10 Weighted vests use heaviness to stimulate proprioceptors in the major joints of the body, but weight must be added after the patient attenuates to the stimulation. Compression garments provide a “hug” to the body and present another clothing option for those who are hypersensitive to touch.
Fidgets
>Different toys for physical manipulation and sensory stimulation provide a distraction for those with sensory processing difficulties. Consulting with an occupational therapy practitioner allows for individualization and identification of effective sensory items. Common fidgets include squeeze balls, textured balls, flexible or spongy items, “pop-its,” stress cubes, or any small manipulative. Caution should be used when choosing items for individuals who eat non-food items or those who may use pieces to self-harm.
Case Examples
Client one, a 33-year-old female with autism and post-traumatic stress disorder, experiences hypersensitivity to sound, covering her ears and crying when loud shouting or crying appears in her environment. Her occupational therapist evaluates her using a standardized assessment and creates a sensory plan for her. The client is educated about using the sensory room as a calming space when noises are overwhelming. For times when she cannot access the sensory room, she carries an MP3 player in her pocket and plays music to calm herself before feeling overwhelmed. When she attends large events or knows she will be around loud noises, she wears noise-canceling headphones to prevent noise-induced anxiety. Over time, she learns how to prepare herself to avoid her sound triggers, giving her a sense of empowerment and control.
Client two is a 41-year-old male diagnosed with bipolar I disorder with autistic features. He jumps off curbs, crashes into his peers in the hallway, and has had several falls recently. He displays low muscle tone—being very flexible with loose joints and muscles—which makes safely navigating his environment challenging. His occupational therapist recommends wearing a weighted vest to give more sensory input. This client follows scheduled times for him to walk over different surfaces for a variety of different sensations while accompanied by staff for safety. He joins exercise groups to strengthen his muscles and learn his body’s position in space to avoid running into others. Over time he falls less frequently, and staff notes a decrease in impulsive behaviors—supporting his safety.
Conclusion
The creation of a supportive environment assists those with mental health needs to prevent overstimulation, provides safe places to self-regulate, and supports safety for patients and staff. Studies continue to identify sensory strategies and practices to support people with altered sensory systems in organizing, interpreting, and responding to stimuli in more effective ways. Creating a nourishing sensory environment, gives patients the best chance to learn autonomy and coping skills for success in facilities and in the community.
References
1. Dunn W, Brown C, McGuigan A. The ecology of human performance: A framework for considering the effect of context. The American Journal of Occupational Therapy.1994; 48(7): 595–607. doi.10.5014/ajot.48.7.595.
2. Dunlop W. A brief history of occupational therapy. The Canadian Journal of Occupational Therapy. 1933; 1(1): 6-10. doi.10.1177/000841743300100.
3. American Occupational Therapy Association. Occupational therapy services in the promotion of psychological & social aspects of mental health. The American Journal of Occupational Therapy. 2010; 64(6_Supplement): S78–S91. doi.10.5014/ajot.2010.64s78.
4. Bright T, Bittick K, Fleeman B. Reduction of self-injurious behavior using sensory integrative techniques. The American Journal of Occupational Therapy. 1981; 35(3): 167-172. doi.10.5014/ajot.35.3.167.
5. Matson R, Kriakous S, Stinson M. The experiences of women with a diagnosis of borderline personality disorder (BPD) using sensory modulation approaches in an inpatient mental health rehabilitation setting. Occupational Therapy in Mental Health, 2021; 37(4): 311-331. doi.10.1080/0164212X.2021.1933674.
6. Chalmers A, Harrison S, Mollison K, Molloy N, Gray K. Establishing sensory-based approaches in mental health inpatient care: A multidisciplinary approach. Australasian Psychiatry. 2012; 20: 35-39. doi.10.1177/1039856211430146.
7. Haig S, Hallet N. Use of sensory rooms in adult psychiatric inpatient settings: A systematic review and narrative synthesis. International Journal of Mental Health Nursing. 2022; 32(1): 54-75. doi.10.1111/inm.13065.
8. Lindberg M, Samuelsson M, Persius K., Björkdahl A. The experiences of patients in using sensory rooms in psychiatric inpatient care. International Journal of Mental Health Nursing. 2019; 28(4): 930-939. doi.10.1111/inm.12593.
9. Bensimon M, Shaul S, Div S, Sandler L, Teitelbaum A. Patient-centered approach in closed psychiatric wards: The curative power of relaxing music chosen by patients. Israel Journal of Psychiatry and Related Sciences. 2018; 55(2): 52-58.
10. Han J, Waddington G, Adams R, Anson J, Liu Y. Assessing proprioception: A critical review of methods. Journal of Sport and Health Science. 2016; 5(1):80-90. doi:10.1016/j.jshs.2014.10.004.
Biographies
Erin M. Naggy is an occupational therapist with over 25 years of experience working with families. She graduated from Gannon University in 2000 with a Bachelor of Science degree and received her Occupational Therapy Doctorate from Chatham University in 2017. She has worked in academia for several occupational therapy assistant and doctor of occupational therapy universities. She has presented for Children’s Interagency Conference, Forensic Rights and Treatment Conference, the American Occupational Therapy Association, Pennsylvania Occupational Therapy Association, Early Childhood Education Summit, and Assistive Technology Industry Association Conference. She currently works as an occupational therapist at Torrance State Hospital treating in their civil and forensic programs. She can usually be found reading, cooking, or transporting her children all across western PA as an unofficial mom taxi. She enjoys connecting with fellow colleagues and can be reached using the contact information below.
Contact Information
Erin M. Naggy
OTD, OTR/L
Email: enaggy@pa.gov
Connect with Erin on LinkedIn