At the heart of America’s rural Midwest, a quiet revolution is reshaping the future of behavioral healthcare. While big-city systems work to deinstitutionalize care environments, the need in remote and rural communities is growing louder by the day – challenged with balancing workforce shortages, geography, privacy concerns, and increasing demand for specialized behavioral health services. Progress is visible in large cities, but it’s the breakthroughs in the Midwest’s unexpected places that are putting rural health systems on the map.
Rural Systems Bridging Behavioral Healthcare
A national leader in behavioral health and trauma-informed design, JLG Architects helps communities bridge the distance and drive equitable access to human-centered care. To ensure patients can stay close to home, we follow a framework of behavioral health design principles, including safety & security, therapeutic environments, normalization, flexibility & adaptability, and community & social connection. Demonstrating these principles are several rural Midwest communities reshaping the very foundation of behavioral healthcare.
A 360 Expansion Solution: Altru 860
In Grand Forks, ND, Altru is building a behavioral health solution that ensures fewer patients are sent to larger neighboring health systems. This summer, the 17,000-square-foot expansion of Altru 860 broke ground, now renamed the Altru Behavioral Health Center. This facility—soon housing 15,000 square feet of inpatient space and 2,000 square feet of outpatient services—is part of a larger investment that addresses a critical regional need for mental health services. The facility will use trauma-informed design to destigmatize mental illness, optimize access, and personalize the patient experience, with sensory-sensitive features, enhanced privacy, and access to natural light. Once completed in 2026, the number of inpatient beds will double, fostering a comprehensive approach and full spectrum of resources to treat mental and behavioral health.
Investing in Stronger People: North Dakota State Hospital
In Jamestown, ND, our team recently broke ground on the new North Dakota State Hospital; a 316,246-square-foot facility that unites all behavioral health services under one roof. The Hospital had been operating from multiple buildings totaling 650,000 square feet, including a main 1980s facility and several late 1800s buildings.
The new facility will support over 300 staff and 140 beds in a modern, trauma-informed environment, with inpatient, community-based, and specialized therapeutic spaces, including forensic, geriatric, and sex offender treatment programs.
Building educational partnerships, the hospital will designate spaces for regional higher education institutions, such as the University of North Dakota’s School of Medicine. Altogether, the hospital invests in stronger infrastructure and people, integrating with the broader mental health care continuum while transitioning from institutional to compassionate, community-based care.
Empowering Independence: Anne Carlsen Center
Also in Jamestown, Anne Carlsen Center is a North Dakota-based non-profit serving those with cerebral palsy; orthopedic, vision, and hearing disabilities; autism; pervasive and behavior disorders; and other medical acuities. Within a new 110,000-square-foot facility, JLG’s Healthcare Studio helped the Center reimagine its role as development and educational leaders, ensuring all individuals, regardless of ability, have the opportunity to live a life of independence.
Here, architects, students, families, and providers worked together to design a unique live-learn community and campus supporting its Jamestown location and satellite facilities. The family-friendly campus is designed for cutting-edge innovation, advanced assistive technologies, indoor/outdoor play with passive supervision, private resident rooms, flexible classrooms, and state-of-the-art therapies. All decisions—including accessible wayfinding and visual definition of living, learning, and therapy zones—were carefully weighed to balance safety, inclusivity, functionality, empathy, and autonomy. Within a uniquely controlled community serving over 400 individuals daily, the Center nurtures independence for life within its walls and beyond.
Stigma-Free Care: Sanford Moorhead Behavioral Health Clinic
At Sanford Health in Moorhead, MN, their rural-based system equitably prioritizes mental health for complete physical health. To enhance services and access to specialized patient needs, JLG completed a 9,000-square-foot fit-up in the existing shell space on the second floor of the Moorhead clinic, which was completed in 2022.
The team set the tone for holistic healing with a dignified waiting area, decorative glass dividers, biophilic graphics, two group therapy rooms, a day-lit corridor, and 32 sensory-sensitive provider offices with tunable lighting and transitional artwork. Through a calming palette, multi-level privacy, sensory-sensitive design, and simplified wayfinding, Sanford Health provides stigma-free, compassionate care.
Healing Trauma, Healing Spaces: Children’s Home Society
The Children’s Home Society of South Dakota (CHSSD) empowers children aged 4-14 by addressing emotional and behavioral concerns within a safe space to overcome trauma. To guide families toward strength and safety, CHSSD worked with JLG over three months to create a Master Plan and Facility Assessment that identified program and space goals, safety/security needs, building deficiencies, and opportunities. User feedback further contributed with a plan for healing, stability, and routine.
CHSSD has since purchased a 100,000-square-foot facility located on a 27-acre site in Rapid City, allowing renovation of campus, with only minimal additions. Our recommendations identified interior renovation, mechanical/electrical, site improvements, and new amenities to support a day school, kitchen/dining facilities, business offices, a Psychiatric Residential Treatment wing, and a clinic.
More than Buildings
For JLG’s Healthcare Studio, these projects are more than buildings — they are catalysts for health equity, stigma reduction, access, innovation, and community pride. By blending national expertise with a deep understanding of local identity, architects can help systems and organizations set the pace for human-centric behavioral health, ensuring every patient’s story is met with compassion and dignity.
