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Introduction: The architectural design of hospitals has proved to have an impact not only on patient safety but also on their recovery. However, most of the studies on this topic focused on the design of general medical wards and only a small number of studies have looked at the design of psychiatric units. Objectives: To review the available evidence and examine any consistent themes in architectural design that are related to better patient outcomes. Methods: A comprehensive and systematic search was undertaken in Medline database and grey literature sources. Our study protocol was registered with PROSPERO after a scoping search was performed. Screening process involved 4 researchers divided in two teams. Discrepancies were resolved through involvement of a fifth external researcher. Quality assessment and data extraction were conducted by 2 teams of researchers. Results: We found a total number of 1165 articles from database searches and 150 from grey literature. Eighty-six studies were included in the full text analysis which included 59 from databases and 27 from grey literature. Conclusions: In our systematic review we have found limited number of RCTs and quasi-experimental studies on the topic. We identified several consistent themes across these studies that point to an impact of the architectural design on the outcomes of patients with mental ill health. Based on our findings, we recommend that more experimental research should be undertaken to strengthen the evidence that will inform evidence-based guidelines. [ABSTRACT FROM AUTHOR]