Rachael-Designing for the Mind: Mental & Behavioral Health Innovation in AEC

In this episode of the AEC Women on Top podcast, we sit down with Rachael Rome, the Global Director of Mental and Behavioral Health and Studio Practice Leader for the Dallas Health Practice at HKS, Inc. Rachael shares her professional journey leading transformative design strategies across the full spectrum of high-acuity healthcare environments. With a collaborative, research-driven approach, she discusses how she translates complex client needs into performance-driven architectural solutions that blend profound empathetic design thinking with rigorous operational insights.

The conversation dives deep into the high-stakes, technically complex portfolio Rachael manages across the behavioral health continuum. Listeners will gain an inside look at the architectural planning required for specialized spaces, including pediatric outpatient clinics, neurodiverse sensory labs, interventional psychiatry platforms, inpatient units for medically complex patients, forensic psychiatry settings, and memory care environments. Rachael explains her involvement from early concept through construction and occupancy, illustrating how women are driving execution, continuity, and vision at every stage of major capital projects.

Furthermore, Rachael details how she leverages advanced operational methodologies—such as simulation modeling, behavioral mapping, and long-range campus master planning for multi-phased developments—to establish technical authority and challenge traditional spatial designs. This episode serves as an inspiring blueprint for women in technical industries looking to merge human-centric advocacy with executive strategy, demonstrating how to lead complex corporate spaces and reshape the future of healthcare infrastructure.

Transcript

SPEAKER_01 0:02

Great. I'm so excited to have you. Okay, so I sent you the questions. Did you get them? Yes, ma'am. Okay, great. I'm gonna start with giving you a little flavor of my intro. Sure. Then we'll do a brief pause and I'll say, I'm so excited to have you. I'd love to learn more about you. Tell me what you do, and that'll be the point where you answer question number one. Okay. Gotcha. Okay. Okay, great. So I say something along the lines of this is AEC Women on Talk, the podcast meant to inspire women. That's much longer than that, but um today we have Rachel Romy. Yes. Rachel Romy as our guest. And Rachel, I'm so excited to have you on. Thank you so much for taking time out of your very busy day to join me in a conversation.

SPEAKER_00 1:13

Thank you. I'm excited to be here.

SPEAKER_01 1:15

Can you give us an idea what you do and start with like your name and title, and then try to explain to us what that means?

SPEAKER_00 1:26

Okay, I would love to. So I'm Rachel Romy. I am the Global Director of Mental and Behavioral Health Design at HKS, where I lead teams across the country to design environments that support people during some of their most vulnerable moments of their lives. Our work really spans the full continuum of care from pediatric behavioral health and crisis stabilization to the more forensic and SMI conditions. We also do geriatric work. We do environments that support substance use recovery and academic medical centers. But really at its core, my work is about people. I spend my days bridging clinicians and patients, families, contractors, operators, researchers, design teams, and so many other folks to create environments that are safer, more compassionate, and more human-centered. I care deeply, deeply about extending mental health support beyond just patients. I think our industry has a massive responsibility and a stewardship to care for the well-being of people designing, building, and operating these environments every day as well. And honestly, I think the role that I value most is being a mom. My family is a huge grounding point in my life. So they remind me constantly why this work is important and matters in the first place.

SPEAKER_01 3:04

I love that you brought up that you're a mom because as you were talking about the meaningful work that you do, I thought, and you care for people at home.

SPEAKER_00 3:15

That's like the most important people.

SPEAKER_01 3:18

Yes, but your whole life is devoted to caring for people, which is such a feminine trait that I think in the world goes unseen in a lot of ways. And I love that you have found a way to make this your life calling. So can you explain a little bit about how you got to where you are and what that trajectory looked like for your career?

SPEAKER_00 3:49

Yeah, I will try my best. It has definitely not been linear or a straight line in any way. I started my career at RTKL right out of college, which is actually where this friendship and I guess podcast connection began. Shout out to our RTKL colleagues of past. Back then, I was super, super fascinated by the intersection of architecture, research, human behavior, and healthcare operations. I found myself asking a ton of questions about why environments affect people the way they do, why we were doing things the way that we were, asking just like a lot of questions of the industry that I was not satisfied with the answers to. So while practicing architecture, I started pursuing graduate studies in counseling and psychology because I wanted to understand the human side of care. Over time, I would say behavioral health became the place where all of those interests really converged for me. I saw the convergence of design, neuroscience, trauma, operations, safety, dignity, and systems thinking kind of all coming together in a really exciting way. So I have been incredibly, incredibly fortunate to work alongside really amazing mentors, clinicians, contractors, owners, and researchers who have expanded and continue to expand the way that I think about healthcare design. What started as a huge curiosity and interest slowly became a massive calling. So today I lead the global behavioral health practice and I work on projects across the country and across the globe, but I still carry a lot of the lessons I learned really early in my career about curiosity, humility, and listening first. I love that.

SPEAKER_01 5:56

Let me say that again.

SPEAKER_00 6:01

We are experiencing the allergy season.

SPEAKER_01 6:04

Oh my gosh, so much. I was like, I better not be getting sick. And then I was like, no, nerd, you've been in the garden. I love that you were so curious about care and the human side of care that you sought further higher education to teach yourself, basically, about this.

SPEAKER_00 6:32

Looking back, it was totally wild because we, I mean, you and I were staying up so late working on proposals and researching, and then to take night classes on top of that. Like looking back, it seems like it was maybe not a very well-informed decision. And I think at the time I was kind of questioning it, but I'm so grateful that I took the risk and just explored a curiosity because it's landed in a really exciting and unique place.

SPEAKER_01 7:05

Absolutely. I think some of our craziest ideas are exactly what lead us to a place of fulfillment where we are creating impact. Absolutely. Think about what would have happened if you didn't follow through on that crazy idea. And you were like, this doesn't really make sense, and I don't know what I would do with this.

SPEAKER_00 7:32

Yeah. I think I would probably be working on waterproofing details. I would still be on the exterior design side of life. I don't know. It it's hard to tell where would like life would have taken us, but here we are today.

SPEAKER_01 7:50

I love that journey for you. And I love that you just took a risk and thought fuck it. Let's see what happens. Um everyday thought that crosses my eyes. Yeah. Yeah. So talk to me a little bit about how did you come to acquire that flavor for life to just try something new and different and see what happens. Not everyone feels comfortable making those types of leaps. So talk to me a little bit about how you feel comfortable doing those crazy things.

SPEAKER_00 8:37

I think my mom would answer this in a way along the lines of I have never accepted something as the way things should have done until I firmly believe in it. I think that I've grown up kind of challenging norms and asking a lot of questions and pressing on spaces that I think could have some room for improvement. I think I started to explore things on the simulation side of what was being done in hospitals, and then asking a lot of questions about the clinical operations and saying, okay, we're looking at, you know, heads and beds and throughput, and we're looking at like how fast can we move this patient from intake to discharge, and not asking about the quality of the experience and how do you measure the quality of the experience? Like, there's takeaways on patient satisfaction, staff satisfaction, there's you know, there's metrics that we can pull from those or start to find trends from. But I was really fascinated by the unkind of spoken qualities within the environment and how that was affecting recidivism and how that was affecting, you know, their actual, you know, clinical performance or the the other things in the environment that were not nurse steps or access to natural light. I was like, what else can we talk about? There has to be something else that we're not considering, and how else can we improve this condition? And thankfully, I think we worked in a place that supported those questions and found resources that could start to answer them. But I think I just wanted to follow it through to the very end. And it just led me in a deeper and deeper appreciation for human diversity and diversity of thought. Um, and then that kind of translated into deep, deep, deep dive into behavioral analysis and behavior.

SPEAKER_01 10:58

You know that I feel very strongly about what an awesome way to contribute to the world, being involved in like healthcare and behavioral health in any aspect. But I just find this journey, your journey in particular, so wonderful. Anyone who knows you knows you're like the walking sunshine. And how easy would it be to just be like, I'm amazing as I am, and I'm just going to give to the world what I feel like giving. And instead, you've just given your your all by following your curiosity and your desire to help others. And I think that's so beautiful. Thank you, Lauren. Okay. So my next question is what problem do you solve? I feel like you've talked about that in various ways, but I want to give you the opportunity to address anything you may have left out.

SPEAKER_00 12:04

Yeah. I think one of the biggest problems that I solve, and I will say we solve because I have an incredible team that supports this work. It is absolutely not just a one-lady show. But I think the biggest problem that we solve is that historically, mental health environments have often been completely underfunded. They've been misunderstood or designed without fully considering the lived experience of patients, families, and staff. I think the disenfranchised get so many disservices in this world. I think they're incredibly neglected. The access issue alone keeps me up at night regularly. But I think behavioral health is incredibly complex because the environment itself becomes a huge part of the treatment. The lighting, the acoustics, visibility, privacy, sensory stimulation, staff safety, dignity, workflow. I mean, the list could go on and on, but they all matter so deeply within that space. So my team works very, very hard to create spaces that support healing while also helping organizations operate more sustainably. We help clients to think about safety without creating environments that feel like punitive. We help reduce staff burnout and improve recruitment and retention. We help contractors and consultants understand the why behind behavioral health requirements a lot. Mostly so projects can be delivered more collaboratively and thoughtfully. We don't ever want to just say, you know, because we said so. We want them to understand here's how we are handling this condition and here is why, so that they can make the greater kind of leap to other conditions and say, hey, you know, we've noticed that maybe this is a space that we should handle with more care and we can have those conversations collaboratively at a larger scale. I also spend a lot, a lot of my time advocating for systems level change around codes, standards, and access to care and how we think about mental health in the built environment overall. So a lot of time kind of knowing all of the different codes across the country and across the globe, and then kind of looking at the care models that fall within those jurisdictions and kind of helping to bring some understanding to the operators and to the folks that are writing the codes. Wow, that's a lot.

SPEAKER_01 15:08

I can imagine. I can imagine. Okay, so I think I spoke to you about this before, but just to kind of reframe the upcoming question. The kind of premise behind this podcast and why I wanted to start it is to give women an idea. And it could be younger women, but it could also be just women in general, right? Just to give them an idea of career trajectories and that they're not always linear. And maybe, you know, because of the economy or because of just life changes or whatever it is, when people find themselves in this place of like, oh my God, what am I gonna do next? That there are ways to figure it out, right? So my next question. My next question is how could the system better support women?

SPEAKER_00 16:21

I love this question, and I'm going to be careful not to speak about my answer for the next two hours. I think one of the biggest opportunities is recognizing that leadership and caregiving are not competing identities. So many women are quietly carrying an extraordinary level of responsibility at work and at home simultaneously. And the systems around us are often still built as though someone else is managing the rest of our life behind the scenes. I think growing into this position, like early in my career, I did not have very good boundaries on what my time looked like outside of work. And so I think I saw people getting into positions of leadership or excelling and being celebrated because they were compromising what that looked like. And I think that being female in the industry really had this kind of compounding feeling, like doing my job, like really doing an incredible job at my job was not enough. There needed to be something more. So I think since having my son, I've always been very, very honest about my boundaries around family. My children will always come first. I use the word push intentionally because protecting that priority has not always been very like warmly received or automatically respected. Um, but there is still like a lingering expectation in many industries, especially leadership-driven industries, that availability equals commitment. And I do not believe that sacrificing presence at home is the price women should have to pay for professional credibility. In behavioral health design, we talk constantly about the importance of stability, emotional support, attachment, and community. But I don't think those values are always understood or reflected within our own organizations. I know that if I were consistently unavailable to my family, it would directly impact my kids, their emotional well-being, and their behavior. And that is not a trade-off that I am personally willing to make. I think women are often encouraged to overextend themselves toward causes and initiatives and expectations that might not fully align with their values or with their strengths. And over time, I've learned that when you really continually pour energy into things that don't genuinely resonate with you, your work loses authenticity. So I think the most impactful leadership comes from clear alignment and not necessarily just performance-based work. I think, you know, there is this dichotomy of what we are kind of required to walk as women, where it's like you have to be strong but soft, not too strong, and you have to be professional but also warm and encouraging. And I think that there's a lot of expectations that can look like they're in conflict. But I think the best leaders I have worked with understand that supporting people as whole human beings creates stronger teams, healthier organizations, and ultimately better work. I believe deeply in supporting family and community, work and work families, like the same. I think being authentic in all places is key.

SPEAKER_01 20:40

That was such a wonderful description of our current status. Thank you. I feel that in so many ways. And in fact, that's what pushed me to start my own consulting is so that I could be present with my family and with the causes and with whatever it is that I spend my time doing that aligns with me versus because a company told me I need to go and do a thing, right? So love that. Thank you. I have one last question. Let's do it. What would you tell your younger self?

SPEAKER_00 21:32

I would tell her that she does not have to prove her worth by carrying everything alone or say yes to every expect expectation placed in front of her. I just mentioned this, but I think early in my career I thought strength meant overperforming, over delivering, being Endlessly available and pushing through exhaustion without complaint. I spent a ton of energy trying to meet expectations that were not always aligned with who I was or what I truly valued. And over time I've realized that boundaries are not selfish. They're necessary. Not every opportunity deserves your energy. Not every cause is yours to carry. And when you commit yourself to things that do not genuinely align with your beliefs, your strengths, or your priorities, people can feel the difference. I think the work, again, just becomes less authentic. I would also tell her on repeat that empathy and softness and emotional intelligence, those things are not weakness. Those qualities have become some of my greatest strengths as a leader, as a designer, as a mom, as a teammate, hopefully as a wife. I've pushed really hard throughout my career against the idea that professional success should come at the expense of being present for a lot of causes. And that resistance has not always been comfortable, but I would still make that same choice again and again and again. Some of the most meaningful moments in my life have not been titles or recognition. I would say like most of them have not. They have been like mentoring the young designers or helping teammates feel seen and supported when they are introverted and don't like spotlight. So finding ways to celebrate them individually when nobody else is looking, or watching a behavioral health facility open that will serve families or the unhoused for decades, or hearing my boys run to the door after I come home after work. Like those are the things that lift me up. So at the end of the day, I think success means very little if you lose your health, your relationships, your sense of self or your family in the process. So I think I would tell myself, like, you know, double down on the boundaries, protect your energy, and continue to love your people.

SPEAKER_01 24:35

Wonderful, wonderful advice. Love that. Double down on your boundaries.

SPEAKER_00 24:47

I feel like you and I could have had a conversation with both of our younger selves.

SPEAKER_01 24:55

I don't think I can publish what I would say to my younger self.

SPEAKER_00 25:00

We'll talk about it the next time you're in town.

SPEAKER_01 25:03

Yes. Speaking of, okay, I'm gonna end this recording because we are done with this, but I do want to keep chatting with you. So I'm gonna do a quick outro. Thank you, Rachel, so let me start again. Thank you, Rachel, so much for joining us today. I am just continually enamored with you. I appreciate your time and your energy.

SPEAKER_00 25:32

The feeling is absolutely mutual. I adore you. So thank you so much for having me.