Therapeutic, sensory and healing gardens

Julia Moore

LANDSCAPE ARCHITECT, BESPOKE LANDSCAPE ARCHITECTS

 

Many of us know the expression, ‘green is good’, but how many of us recognise that a landscape can also be good for our health? Growing evidence demonstrates that landscapes are a proven aid to health and wellbeing. It achieves this, not just by providing outdoor places designed to keep us physically fit and healthy; landscape can also help us address the more hidden areas of good health management. For example, for children well managed landscapes can aid learning and help them develop social, cognitive and emotional behaviour. Within the adult population they can help alleviate symptoms of Alzheimer’s, dementia, stress and even depression. (1) Having good quality landscape around people and the places they work is certainly ‘good for us’ and is an invaluable investment. 

I recently visited the USA where I had the opportunity to see many new and innovative landscape designs. Speaking with landscape and healthcare professionals it was quite evident that many are championing investment into the concept of ‘landscape of health’. As part of this movement, therapy gardens are being built with increasing frequency in healthcare settings. (2) Therapy gardens are green spaces that have been specifically designed to meet the physical, psychological and social needs of the people using the garden, as well as their caregivers, family members, friends and employees. These healing environments are not just limited to hospitals, they can be found in a variety of settings including nursing homes, retirement communities and hospices.  

As early as 1993 the American Horticultural Therapy Association (AHTA) were developing best practice and evidence based design principles around the design of these therapeutic gardens. The American Society of Landscape Architects (ASLA) now has an independent group of people dedicated to increasing the awareness and importance of therapeutic gardens. (3)

During my trip I visited Portland, Oregon where I was fortunate to meet with Teresia Hazen, M.Ed., HTR, QMPH. Teresia is a leading professional in Therapeutic Garden Design and management and is the coordinator of the Therapeutic Gardens and Horticultural Therapy for Legacy Health System. She oversees several therapeutic gardens throughout Oregon and Washington states and was kind enough to give me a guided tour of several of the gardens at Emmanuel Medical Centre, including ‘The Children’s Garden & Childrens Terrace’ and the ‘Randall Burns Garden.’  

The Emanuel children’s garden was designed in 1996 through a phased construction approach, the final stages opening in 1999.  Over 19 disciplines were involved in the development stages of this garden. These ranged from Speech Therapists to School Teachers, Spiritual Care staff and Landscape Architects, all of whom had very specific goals and needs for the garden setting. The goal for the design team was to create a therapeutic and restorative garden with the main focus on paediatric patients, their families and the healthcare professionals that are involved with the treatment of these patients. 

Conditions within the gardens were supportive to ensure it was a safe, secure and comfortable environment. The gardens offered a universal design to accommodate the needs of outpatients, ambulatory children and their families to siblings that need to ‘run off steam’. At times the garden was also required to provide for adult patient rehabilitation therapy and programmed activities. In a few instances the gardens are set aside as the location for patients to peacefully pass away in a natural and peaceful setting – away from the sterile hospital rooms.

 

Key design interventions ensured children and their families were provided with a place to play and explore in a home-like setting.  Year round rehabilitation is undertaken in the garden, therefore the built structure of the garden had to be modified to improve accessibility including stairs, ramps and inclines, providing opportunities for cognitive and physical activities. Wheelchair users also had to be incorporated as well as seating being provided to support those with decreased balance as well as places for other users to sit. There were areas for walking and break out zones for solitude and gathering. The plant media used in the garden ensured four seasons of sensory stimulation. 

The latest edition to legacy gardens is the Children’s Terrace, located on the second floor. This garden provides wonderful views of the children’s garden below. Following similar design process to the children’s garden below this garden provides diversions and solitude to patients, staff and other hospital visitors. 

This stage of the Legacy Emmanuel project was supported with a $560,000(USD) grant from the TKF Foundation (4), a philanthropy dedicated to the creation of spaces that provide opportunities to connect with nature. Discussions with Teresia and the benefactor highlighted the important commitment to clinical research these projects require. Often a large percentage of the funding received for these therapy gardens is allocated for research and data collection. In one particular instance three PhD students were involved in data collection at one such garden. Data collected regarding the use of the garden along with subsequent interviews with patients and family was aimed at gathering evidence to prove the health benefits of these spaces and to ultimately elevate the recognition of these gardens in the healthcare industry as exemplar models as well as being able to influence standards in ongoing practice. 

Teresia hoped this research would be able to influence those at the highest level in the American Health System where there is still an underlying need for many to understand that nature heals. The research aims to demonstrate the fact that these gardens are a cost effective (initial investment plus ongoing maintenance) mechanism when it comes to measuring the dollar value of health.    

So the question needs to be asked,where does this leave us in New Zealand?  The implementation and use of ‘Green’ space is largely ignored in New Zealand mainstream, public health and practice. Therapy gardens are few and far between in our hospitals and those that are available often lack the scientific design rigour executed in those gardens incorporated into American healing environments. 

Due to the rising costs of healthcare and the increasing challenges that physical and mental health services are facing alongside the global phenomenon of an ageing population there is undoubtedly an opportunity to review how we in New Zealand view the use of green space in the healing process. Landscape architects can play a role individually and collectively by utilising salutogenic design principles. Designing spaces that focuses on health and wellbeing as well as providing good quality, safe and functional spaces not only have a positive effect on human health, they also carry significant economic and ecological benefits.


FOOTNOTES

(1) Chalfont, G.E., and S. Rodiek. 2005. Building Edge: An Ecological Approach to Research and Design of Environments for People with Dementia. Alzheimer’s Care Today 6, 4: 341.

(2) Hazen, T (2013). Therapeutic Garden Characteristics. A quarterly publication of the American Horticultural Therapy Association 21,2: 3.

(3) Nature Sacred (2015) Nature Sacred Retrieved from http://naturesacred.org/

(4) Annapolis, Md.