The psychiatric ward as a therapeutic space: systematic review.

BACKGROUND Hospital care is still an integral part of mental healthcare services. But the impact of ward design on treatment outcomes is unclear. AIMS To review the effects of ward design on patient outcomes and patient and staff well-being. METHOD A systematic review of literature was carried out on Medline, Embase and PsycINFO. Papers on psychogeriatric and child and adolescent wards were excluded as these necessitate specific safety features. RESULTS Twenty-three papers were identified. No strong causal links between design and clinical outcomes were found. Private spaces and a homely environment may contribute to patient well-being. Different stakeholders may experience ward design in conflicting ways; design has a symbolic and social dimension for patients. CONCLUSIONS Data on the impact of design on treatment outcomes are inconclusive. Rigorous randomised controlled trials, qualitative studies and novel methods are called for. Different stakeholders' responses to the ward as a symbolic environment merit further investigation.