While simply spending time in green space has demonstrable health benefits for patients, healthcare sites can also design gardens to support their patients in additional ways. Horticultural therapy is becoming more widely used within mental health services, including CAMHS. There are huge benefits to working collaboratively, socialising, having a sense pf purpose and responsibility and learning new skills, which is come cases can lead to horticultural certifications and building connections with the wider community – which can ease the discharge process and reduce anxiety and isolation.

Combined with spending time outdoors, in a green space, and away from the typically sterile hospital environment, using a therapeutic garden can speed up recovery times and ensure that treatment is far more pleasant and inviting, for both patients and staff.

NHS Forest sites with therapeutic gardens

One flagship initiative is the Grow your Own project at Guild Lodge, a medium secure mental health hospital in Preston. Launched in 2013, the space has a polytunnel, raised beds, chicken coop, aquaponic growing systems and covered training area, where offers service users can learn horticultural skills. Much of the produce is sold on the hospital kitchens. Some service users are employed through the scheme on fixed-term contracts, and have gone on to gain horticultural qualifications, making it much easier to be involved in the community post-discharge.

In a built up South London borough, the Lambeth GP Food Co-op has taken advantages of slivers of green spaces out the back of GP surgeries, a hospital and a local restaurant to offer horticultural therapy to service users with depression and anxiety, arthritis and diabetes, among other conditions. GPs can recommend and prescribe volunteer gardening sessions to their patients, who benefit from the gentle exercise and the option to socialise in a structured way. A purpose-built garden at the Pulross Centre supports in-patients recovering from strokes and other brain injuries.

A volunteer gardens at King's Hospital's Jennie Lee Garden, part of Lambeth GP Food Co-op
A volunteer gardens at King’s Hospital’s Jennie Lee Garden, part of Lambeth GP Food Co-op. Photo: Vicki Brown / Centre for Sustainable Healthcare 2021. Attribution 4.0 International (CC BY 4.0).
North Cotswolds Hospital rehab and physiotherapy. All rights reserved.
North Cotswolds Hospital rehab and physiotherapy. All rights reserved.

At North Cotswolds Hospital, staff gave input into a physiotherapy garden on the site, which now features raised benches, steps and sloping paths with handrails, and a variety of surfaces including grass, gravel and brick. These spaces are used by Occupational Therapists to assist their patients with their rehabilitation, while boosting their independence and self-confidence. Location is key: the site’s gym leads directly onto the therapeutic space, ensuring patients can access it as needed, either independently or in groups. Thoughtful planting offers colourful displays in warmer months, while the landscaping keeps it interesting in winter. The spaces are fully wheelchair accessible.

“I have really enjoyed the opportunity to undertake some of my physiotherapy sessions outdoors, not only is the lovely scenery a welcome distraction from the hard work, but the cooling breeze is most welcome!” – Patient, North Cotswold Hospital

How to create a therapeutic garden

These types of spaces must be designed in close collaboration with clinical staff, who will understand the needs of service users and the potential for therapeutic sessions to be delivered outdoors. Even a small space can be turned into a therapeutic garden if designed well – consider accessibility in terms of paths and handrails, as well as the use of raised beds so that service users can participate in growing, or simply smell or touch flowers and leaves that appeal to the senses.

Some sites will need to ensure a certain level of privacy, as well as security, particularly in mental health units. In this case, greenery can be a good way to screen high walls to make the space feel less intimidating, for example. If a space is fully enclosed, you will need to consider the availability of water – is there a tap, or a place to run a hose? Can you install rainwater butts if infection risk is low?

As well as considering space, sunlight and water access, planting plans will also need to adapt to the available staff resource. Who will be maintaining these gardens? Are ground teams able to manage the space? Are there dedicated gardeners or community volunteer groups? Do you want to grow produce that needs cooking, or which service users can eat and enjoy fresh on site? Bethlem Royal Hospital has an OT kitchen where service users can learn to prepare the food they have harvested; pre-pandemic, a weekly market invited community members to buy surplus ingredients, which gave service users experience of packaging, pricing and selling the items. If this is not an option, it may be best to stick fruit and salad crops.

Bethlem Royal Hospital's Occupational Therapy Garden
Bethlem Royal Hospital’s Occupational Therapy Garden. Photo: Maudsley Charity. All rights reserved
Mosaic at Highbury Community Garden
Mosaic at Highbury Community Garden. Photo: Miriam Dobson / Centre for Sustainable Healthcare 2021. Attribution 4.0 International (CC BY 4.0).

Consider the use of tools: easy grip, flexible and long-handled adaptive tools will make the experience much more accessible and enjoyable for people with limited mobility and other physical health issues. In many cases, you will need to ensure that all tools can be accounted for and stored securely. Raised beds are commonly installed, and you can also create raised beds that are designed for wheelchair users.

Gardens designed for physiotherapy will be quite different. Physical features will need to match the movement needs of patients, while also providing visual interest. Benches may need to be slightly raised, and placed to allow for frequent rest stops if needed. If space allows, a pergola can be installed along a walkway and planted with climbers to provide shade, as well as privacy.

For all gardens, use may be highly seasonal, so think about how these spaces can be used in winter. Polytunnels and greenhouses can extend growing seasons and created sheltered spots for cleaning and organising pots and tools on colder or wetter days, as well as providing spaces for learning and socialising. Work with garden designers to ensure a range of flowering and fruiting seasons, as well as incorporating evergreen shrubs or trees which will keep the space looking cheerful even in the winter months. Some therapeutic gardens extend their reach with Men’s Sheds, where male service users can meet for tea, chat and share gardening or DIY skills in an informal environment, such as Broadgreen Hospital’s potting shed, run by Macmillan Cancer Support.

This is also where garden artwork can come in handy – some sites, such as Bethlem Royal and Highbury Community Garden, use these spaces for art workshops with service users, where the fruits and blooms will serve as inspiration for murals, sculptures and mosaics.

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Banner photo: Bethlem Royal Occupational Therapy Garden. Copyright: Lisa Harewood/Maudsley Charity 2019