We are pleased to have received such commendations of our review on psychiatric ward design. ^{Reference Papoulias, Csipke, Rose, McKellar and Wykes1} We believe, as the other commentators do, that this is a long-neglected area that needs more research to inform future investment – including the UK government’s recently promised increase in in-patient wards for younger people.

The physical environment of healthcare facilities does affect the patient experience and their satisfaction and is recognised as an integral part of care delivery. ² The study mentioned in Dr Jenkins’ letter strengthens the evidence base for the contribution of ward privacy to violence reduction. ^{Reference Jenkins, Dye and Foy3} As that letter also indicates, measures have largely remained focused on clinical outcomes and any research can only hint at the key design components that drive these changes. Our review emphasised the need for patient-focused outcomes and their involvement in ward design. We have developed some novel methodology that can highlight positive and negative issues in current design from the patient perspective and have also developed measures to monitor the effects of changes in ward design. We hope that tools enabling robust, patient-centred evaluation of in-patient facilities might contribute to the recognition of the complex contribution of the material environment – in its physical and psychosocial dimensions – to patient outcomes.