Hospital design for inpatient psychiatry: A realistic umbrella review

The evaluation of the effects of architecture and design in psychiatric hospitals primarily focuses on final outcomes, such as disease progression, and is made from the perspective of evidence-based medicine. Meanwhile, the evidence-informed, realist approach addresses how the intervention works. Understanding the underlying action mechanisms of the intervention is needed to facilitate its scaling-up and adaptation in new environments. This umbrella review reports in which ways architecture and design have an effect on patients' and staff experience in inpatient psychiatric hospital. The search was constructed around three key concepts (psychiatric hospital, design, and staff and patient outcomes) and was conducted across three reference databases (Embase, Medline, and PsychINFO). Academic and gray literature was analyzed. Information on design and architectural features in psychiatric hospitals, their effects on patients and staff experience, and the acting mechanisms enabling these effects were extracted. From 951 original references, 14 full texts were included in the analysis. Design and architectural features (e.g., aesthetic appeal of places, home-like environment) in psychiatric hospitals address patients' stress, boost social interaction, foster patients' autonomy and feelings of control, ensure respect for patient's privacy and dignity, and prevent under-and overstimulation. Using theory-driven evaluation may facilitate future hospital renovation and the evaluation of its effect.