11 November, 2008
Page, M. (2008) Gardening as a therapeutic intervention in mental health. Nursing Times; 104: 45, 28–30 This article describes why one low-secure unit chose to initiate a horticultural therapy project and organize it as a ‘workers’ cooperative’. The therapeutic benefits of gardening are explored, particularly focusing on the social benefits. The article also discusses the issue of hope, which is an intrinsic requirement in gardening. AUTHOR
Mathew Page, MSc, DipHE Nursing Studies, Dip Integrated Approaches to Serious Mental Illness, RN, is business development and governance manager, 2gether NHS Foundation Trust, Gloucester. Background
A number of problems may be considered endemic in many secure mental health facilities, which are often associated with long-term institutionalization. The problem of poor physical health in this group (Meiklejohn et al, 2003) is compounded by negative symptomology of serious mental illness and use of high-dose antipsychotics. For clinicians working in these environments, the issues that need to be considered for patients include lack of motivation, poor work skills, obesity, cardiac problems, poor diet and lack of regular exercise. Gardening as therapy
While the initial inspiration for this project arose from my personal reflection that gardening is a beneficial experience, an evidence base underpins what is generally described as horticultural therapy. Enthusiastic gardeners argue that producing one’s own food is a great tonic in a number of ways but specifically this project was interested in the benefits of increased exercise, increased knowledge and skills, and improved diet. Not long after this project began, Mind (2007) published a report that used research data and case studies to demonstrate that Eco therapy is a simple, cost-effective means of improving well-being. Alongside horticultural activities, a variety of options such as open air walks were also found to be helpful. Mind (2007) made several recommendations challenging service providers to consider Eco therapy as a viable treatment. Burls (2007) described some of the benefits of Eco therapy as being associated with the relationship between a healthy environment and the person; the fact that the practice of Eco therapy itself enhances the environment is a secondary benefit. Horticultural therapy is well established in the UK across a variety of health and social care specialists. The charity Thrive, a small, national organization that promotes horticultural therapy, runs two garden projects – one in Berkshire and the other in London. It also supports over 900 garden projects around the UK. Johnson (1999) considered how horticultural therapy is used in a variety of settings from the published evidence. He noted that its efficacy in elderly care is most well proven but also drew attention to the dearth of research available to establish its benefit to people in a custodial setting. While this project is not in this type of setting, many residents do come from the prison or secure mental health system and as such there are certain common characteristics. Johnson (1999) reflected on the importance of the physical environment and how people approach other living things. Interestingly, Fieldhouse (2003) also found the plant-person relationship to be immensely important. He considered the importance of the evolutionary relationship between people and plants and advanced the view that people have a ‘fascination’ with plants. Fieldhouse found a gardening group has two key benefits: the first involves cognitive benefits of enhanced mood, reduced arousal and improved concentration; the second is the social nature of the group – the need to cooperate with each other to achieve the end goal. Fieldhouse (2003) concluded that this type of intervention is beneficial because it focuses on skills and aspirations rather than symptoms and deficits. Burls...