It’s so lovely to see people come alive again.

Peter O’Hare Head of Occupational Therapy at Bethlem Royal Hospital

Any allotment owner or gardener can testify to the restorative powers of pottering about on the plot; weeding flower beds, watching with excitement as new seedlings thrive, and harvesting something you have grown with your own hands.

It’s no surprise then that a kitchen garden has always been an important feature at Bethlem Royal, a psychiatric hospital in southeast London. Bethlem’s history dates back almost 800 years, and as these types of institutions were once very segregated from the outside world, the ability to grow food on site was a necessity, as well as an economic choice, as patients were enlisted to tend to the gardens. There was also early recognition of the therapeutic benefits – as well as recreational purpose – of green spaces.

Particularly since the pandemic, there’s no doubt about it, the garden really came into its own. It was a place where people felt safe, to be able to be doing stuff – but still, there was a way of connecting with others as well as with nature, so it was really effective. When you hit on something that feels right, I think you just know it.

– Peter O’Hare

Gardening and occupational therapy

On Bethlem’s current site in Beckenham, where it has been based since the 1930s, the original large walled kitchen garden “once had extensive greenhouses, backsheds, a mushroom forcing house and vines.” It gradually served less of a nutritional function and was increasingly used by the Occupational Therapy Department for therapeutic horticulture, and to provide ingredients to the Occupational Therapy kitchen.

The new OT Garden was created in 2007, with a wide range of patients in mind. Bethlem provides services to people across the full spectrum of mental health needs and learning disabilities, and spending time in the garden helps them in many ways. Service users are referred to the gardening sessions here, and risk assessed to ensure they are safe to use tools, able to participate in group settings and not a risk to themselves or others.

Bethlem OT Walled Garden's mosaic
Bethlem OT Walled Garden’s mosaic. Photo: Vicki Brown / Centre for Sustainable Healthcare 2021. Attribution 4.0 International (CC BY 4.0)

Patients with severe anxiety or obsessive compulsive disorder can appreciate the mindfulness inherent in sowing and weeding, using all their senses to be immersed in nature, while those with eating disorders can experience a different way of engaging with food. The scent of flowers, and witnessing the changing seasons, can recall memories for people with dementia or Alzheimer’s. The plot also features a sensory garden, where groups are invited each week to experience the textures, smells and transformation of the plants.

Growing and harvesting produce can instil a sense of pride and self-worth, giving the service users – some of whom spend years at Bethlem – a sense of purpose. They can also gain valuable horticultural and planning skills, and some have participated in the national John Muir environmental award scheme, which encourages connection with nature.

“This is not just about engaging in horticulture. It is an opportunity to challenge a person’s own illness or belief systems or thoughts or abilities. Their confidence is so reduced, not just because of illness, but also stigma. So many things can eat away at confidence, so by coming here, using a tool, digging a hole properly, it makes them feel capable.”

– Sara Miller, former horticultural instructor at Bethlem Royal Hospital

Feeding the patients, and the community

Tucked away behind a wall, the OT Garden is surprisingly large. As well as vegetable and herb beds, there are polytunnels and greenhouses, and the walls are covered with vines and trained fruit trees. In summer, lavender blooms fill the garden with scent and the hum of bumblebees.

The plot is managed by two part-time garden instructors, each working four days a week and funded via the Maudsley Charity. As well as tending to the vegetable plots and nearby orchard, they run gardening activities for service users as part of recovery plans designed by their occupational therapists.

“We’ve had a lot of people coming through the gardening groups who never really had a chance to have done much of that before, and they suddenly are really interested, really want to get an allotment of their own. Or we get people with an anxiety disorder, and some people with anxiety aren’t even able to go into a garden. So it’s amazing to see a transformation with those who are able to overcome those fears, and by the time they leave to be able to be – not anxiety free, exactly – but able to go into gardens and enjoy them and benefit from them.”

– Peter O’Hare

Some of the produce they harvest is used in the OT kitchen. Ensuring that service users can prepare nutritious meals is an essential part of recovery programmes for many patients here, prior to discharge. Staff and neighbouring residents can also purchase fruit and veg, as well as jars of delicious preserves prepared in the OT Kitchen. The cooks have come up everything from grape and rosemary preserve to spicy squash and apple chutney, and ‘jumbleberry jam’ featuring the site’s variety of berries. They also use a dehydrator to prepare herbs and infusions for sale, as well as dried fruit.

Prior to the Covid-19 pandemic, staff and other community members visited the site for the weekly shopping session, during which patients could practise weighing and packaging the items. Currently, food boxes are ordered remotely and packed up for collection.

While there is no doubt that the garden is incredibly productive, the gardeners have ensured that there is still space for nature. There are untamed borders, bursting with wildflowers in spring and summer, and attracting pollinators vital to the whole plot. In one corner a small pond provides a particularly wild patch, in which biodiversity thrives. An insect house hangs on the wall behind.

Service users in the polytunnel at Bethlem OT Walled Garden
Service users in the polytunnel at Bethlem OT Walled Garden. Photo: Maudsley Charity. All rights reserved.

Blossoming creativity

The OT Garden’s walls are adorned with seasonal sketches inspired by the space, illustrating the flowers, greenhouse and pots of plants. The art department works closely with the OT team, and as well as the day-to-day art therapy, they also invite visiting artists to work with service users on large exhibition pieces for the on-site Bethlem Gallery.

Woad, Weld and Madder: from plot to palette’ saw patients growing and harvesting plants to produce natural dyes and pigments. These were used to colour fabrics and create watercolour paints, with patients able to follow the whole process from sowing the plants to creating artworks with the pigments. As part of the Chelsea Fringe, an initiative from the Chelsea Flower Show, service users made hundreds of pompoms as part of an art installation that involved globe-shaped flowers such as alliums.

Working with the earth gives me a sense of perspective, which helps when I feel overwhelmed. The garden is a friendly space where the pressures of life disappear.

Service user at Bethlem Royal Hospital

Related articles

Further reading: Maudsley Charity’s Bethlem case study

Banner image: Bethlem Royal Hospital’s Occupational Therapy Garden. Copyright Maudsley Charity. All rights reserved

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