Review: The impact of art, design and environment in mental healthcare: a systematic review of the literature

Aims: There has been a burgeoning interest in arts and the environment in healthcare. While research has been undertaken on the clinical impact of disciplines, relatively little research has studied the impact of broader arts for health interventions. This paper reports findings from a systematic review of the arts for health literature, encompassing research on the impact of visual art, design and the environment on the well-being of patients and staff in mental healthcare settings. Methods: A systematic review of over 600 papers published between 1985 and 2005 on the impact of arts, design and environments in mental healthcare was undertaken. The review includes a discussion of contextual and policy literature, as well as 19 reports of quantitative and qualitative studies that met our inclusion criteria. Results: The largest number of studies focused on the aspects of art, design and environment that were relevant to mental healthcare. These studies suggest that this can affect health, including physiological, psychological, clinical and behavioural effects. Exposure to stressful visual and aural environments may reduce levels of stress and enhance recovery. Architectural design consideration is important in mental health settings, especially for patients with conditions such as dementia that can make wayfinding difficult. Exposure to art in healthcare environments has been found to reduce anxiety and depression. Environment features have also been found to affect staff, and improvements in visual and acoustic conditions may reduce risks of errors in some care settings. Qualitative studies provide insights into factors affecting the impact of arts, including issues of power and control, perceptions and influence of key stakeholders, and user participation. A key issue to emerge from this study is that arts interventions do not necessarily address the lack of control exercised by patients in healthcare environments. Conclusions: While there is extensive literature on the impact of design, environment and the arts on health, there is still a need for further research that addresses methodological challenges of evaluating complex interventions. Our review found evidence that environmental enhancements can have a positive impact on health and well-being of staff and patients in mental healthcare. Arts, when considered within this framework of evidence-based design, can also contribute to well-being, offering reassurance and creating identity in healthcare settings. Further research is needed in this area, as well as research that explores the contribution of other models of art that do not fit within the framework of `evidence-based design'. Finally, responses to the arts are contingent on a number of complex social and political factors; further understanding of these is needed in order to inform future research and evaluation of the arts in healthcare.