Gardening as a mental health intervention: A review

ArticleinMental Health Review Journal 18(4) · September 2013with 17,103 Reads 
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
Cite this publication
Abstract
Purpose - The number of gardening-based mental health interventions is increasing, yet when the literature was last reviewed in 2003, limited evidence of their effectiveness was identified. The aim of this review was to evaluate the current evidence-base for gardening-based mental health interventions and projects through examining their reported benefits and the quality of research in this field. Design/methodology/approach - Studies evaluating the benefits of gardening-based interventions for adults experiencing mental health difficulties were identified through an electronic database search. Information on the content and theoretical foundations of the interventions, the identified benefits of the interventions and the study methodology was extracted and synthesised. Findings - Ten papers published since 2003 met the inclusion criteria. All reported positive effects of gardening as a mental health intervention for service users, including reduced symptoms of depression and anxiety. Participants described a range of benefits across emotional, social, vocational, physical and spiritual domains. Overall the research was of a considerably higher quality than that reviewed in 2003, providing more convincing evidence in support of gardening-based interventions. However, none of the studies employed a randomised controlled trial design. Research limitations/implications - There is a need for further high-quality research in this field. It is important that adequate outcome measures are in place to evaluate existing gardening-based mental health interventions / projects effectively. Originality/value - This paper provides an up-to-date critique of the evidence for gardening-based mental health interventions, highlighting their potential clinical value.

Do you want to read the rest of this article?

Request Full-text Paper PDF
Advertisement
  • ... school gardens) in that community gardening is communal and collective in nature and cuts across ages, genders and cultures. Participation in community gardening has been linked to economic and ecological benefits [9], and evidence indicates that such amenities improve health [10][11][12], wellbeing [13,14], social [15,16], and sustainability [3,[17][18][19] outcomes at an individual and planetary scale. This is because community gardens and other forms of gardening provide affordable and convenient fresh food, horticulture therapy and learning environments that improve academic performance, social interaction, and respite [13,[20][21][22][23][24][25][26][27][28]. ...
    ... Participation in community gardening has been linked to economic and ecological benefits [9], and evidence indicates that such amenities improve health [10][11][12], wellbeing [13,14], social [15,16], and sustainability [3,[17][18][19] outcomes at an individual and planetary scale. This is because community gardens and other forms of gardening provide affordable and convenient fresh food, horticulture therapy and learning environments that improve academic performance, social interaction, and respite [13,[20][21][22][23][24][25][26][27][28]. Wells et al. [29] and Soga et al. [30] conclude that community gardens can address health inequalities. ...
    ... Upon closer examination gardening can take many forms and is a popular leisure activity with therapeutic benefits [13,28,50,51]. Research suggests the existence of gender differences (likely reflective of gender conditioning) in gardening behaviour. ...
    Article
    Full-text available
    Abstract Background Increased global urbanisation has led to public health challenges. Community gardens are identified as a mechanism for addressing socio-ecological determinants of health. This study aims to explore motives for joining community gardens, and the extent to which participation can be facilitated given barriers and enablers to community gardening. Such a study fills a gap in the public health literature, particularly in the Australian context. Methods This paper presents findings from semi-structured interviews with 23 participants from 6 community gardens across Melbourne. Applying phenomenological, epistemological and reflexive methodologies and thematic analysis of the data, this study provides a snapshot of drivers of community garden participation. Results Results were categorised into six enabling themes to participation. These themes revolved around (i) family history, childhood and passion for gardening; (ii) productive gardening, sustainability and growing fresh produce in nature; (iii) building social and community connections; (iv) community and civic action; (v) stress relief; and (vi) building identity, pride and purpose. Time costs incurred, garden governance and vandalism of garden spaces were among the barriers to community garden participation. Conclusion Although an interest in the act of gardening itself may be universally present among community gardeners to varying degrees, the findings of this study suggest that motivations for participation are diverse and span a range of ancestral, social, environmental, and political domains. This study contributes exploratory insights on community garden motivations and sustained involvement across multiple urban sites in Melbourne (Australia). This study recommends extending this work by undertaking future quantitative research that can move from local case studies to a national guidelines on how to engage more people in urban agriculture activities like community gardening.
  • ... Notably, in the literature concerning alternative and complementary treatments is a discussion about the value of nature-based practices. Indeed, despite the fact that most research concerning effective treatment of PTSD focuses on evidenced-based treatments, there is a growing body of research that suggests for some, being in nature and activity therein is of benefit (Annerstedt & Währborg, 2011;Caddick & Smith, 2014;Cipriani et al., 2017;Clatworthy, Hinds & Camic, 2013;Frumkin et al., 2017). There is also a body of research that suggests that interacting with nature is beneficial for veterans specifically (Atkinson, 2009;Caddick & Smith, 2014;Dustin, Bricker, Arave, Wall & West, 2011;Duvall & Kaplan, 2014;Mowatt & Bennett, 2011;Poulsen, Stigsdotter & Refshage, 2015;Wise, 2015). ...
    ... Though this modality is extremely versatile and has a wide variety of potential applications, studies of its efficacy are limited and research concerning therapeutic horticulture's efficacy with respect to US veterans is lacking. Part of the challenge of assessing therapeutic horticulture -while also clearly one of the great advantages of the modality -lies in the fact that it can be offered in so many ways and under so many different circumstances, rendering its "success" particularly difficult to rigorously measure (Cipriani et al., 2017;Clatworthy et al., 2013;Kamioka et al., 2014). An additional challenge in terms of assessing therapeutic horticulture's efficacy with respect to veterans lies in the fact that the VA does not currently consider the modality a best practice and/or a practice that facilities would benefit from employing, though more than a few VA facilities currently facilitate some type of gardening program. ...
    ... In addition to Sempik, Aldridge and Becker's analysis, a fairly small group of other researchers have considered the modality but have offered some valuable observations. Chief among these is the finding that even if not rigorously evaluated, people who have participated in therapeutic horticulture report improvement in their symptoms ("symptoms" in this instance is used very broadly to include a range of both physical and mental health conditions) (Cipriani et al., 2017;Clatworthy et al., 2013;Detweiler et al., 2015;Sempik et al., 2003;Sempik, Rickhuss & Beeston, 2014). Cipriani et al. and Clatworthy et al.'s analyses detailed these improvements, noting meaningful findings including: decreases in depression and anxiety; positive advances with respect to selfesteem, social behavior, and personal relationships; improvements with respect to affect/agitation; progress with respect to mental well-being with specific improvements regarding paranoia, suspicion, depression, and anxiety; advancements in behavior/engagement, and cognitive functioning; decreases in stress and increases in ability to cope with life challenges; and enhancements in sleep (Cipriani et al., 2017;Clatworthy et al., 2013). ...
    Article
    The Department of Veterans Affairs (VA) faces a plethora of challenges as it daily encounters and treats veterans. With a great prevalence of co-occurring diagnoses, veterans’ needs today are significant and arguably more complex than ever before (Clark, Bair, Buckenmaier, Gironda & Walker, 2007; Phillips et al., 2016). The following two papers seek to build a justification for reconsidering how post-traumatic stress disorder (PTSD) is treated given the illness’ prevalence and the efficacy of current treatments. The first paper reviews the literature and includes: a chronology of the PTSD diagnosis; an examination of current treatments offered by the VA and consideration of their effectiveness; a discussion of current and alternative treatments offered for PTSD; and an exploration of therapeutic horticulture as a healing modality for veterans coping with PTSD. After reviewing the historical and theoretical foundation for this research, the second paper details a mixed method study designed to better understand the depth and breadth of therapeutic horticulture programs that have been operationalized at VA facilities. Using survey and interviews of VA personnel, the author elicited information about VA therapeutic horticulture programs and was able to deduce themes related to the genesis of programs, details of programs’ operationalization and facilitation, and the impact on veterans. The author concludes the study with recommendations for those VA facilities considering implementing a therapeutic horticulture program along with an appeal that the VA begins to more earnestly consider the increasing body of evidence concerning the efficacy of therapeutic horticulture.
  • ... Whilst indoor exercise options such as the on-site gym and keep fit sessions were available to staff, the opportunity to exercise outdoors was an attractive opportunity. There is empirical support from systematic reviews for greater returns in respect of physical and mental wellbeing from exercising outdoors (Coon et al, 2011;Clatworthy et al, 2013;Berto, 2014 Whilst the short duration of exercising on the GM project (twice a month for up to an hour) is arguably insufficient to derive optimal benefits in mental and physical wellbeing, nonetheless Barton & Pretty (2010) ...
    ... Findings also suggest that outdoor exercise has better adherence rates than indoor options (for example walking in man-made facilities such as shopping precincts, or working out in a gym), and that outdoor exercisers related more to emotions and feelings such as enjoyment, being less tense, less depressed, having more energy and being revitalised compared to people working out in an indoor setting (Coon et al, 2011); further, they were also more likely to be repeat exercisers than their indoor counterparts (Bird, 2004;Plante et al, 2007). In recent years, a plethora of GE options including gardening, horticulture and conservation work has been noted by numerous researchers as having a positive impact on mental and physical health (Pretty et al, 2005;Clatworthy et al, 2013;Page, 2008;Fieldhouse, 2003;Natural England, 2016). Park et al (2014) and Christie et al (2015) have demonstrated how gardening can even be a useful mode to attain moderate to higher intensity levels of exercise, commensurate with UK Government guidelines for adults, essentially a 'workout'. ...
    ... Research participants related to numerous enhancements to personal fitness, health and wellbeing, as well as positive impacts regarding their sense of personal agency and increased social capital. Undertaking gardening activities therefore appears to bestow wide-ranging benefits, including mental wellbeing (Clatworthy et al, 2013), particularly when conducted as part of a group, whereby the social interactions fostered both motivate further engagement and help people develop new networks of value to themselves, thereby building social capital (Putnam, 1995). ...
    Preprint
    Full-text available
    Workplace health is becoming a major consideration for employers, not simply due to ongoing legislative requirements from a health and safety perspective, but because of the business-related costs resulting from ill health at work-with lost productivity, absenteeism, presenteeism, low morale, damage to reputation and reductions in turnover all detrimental factors for businesses. This study utilised an ethnographic methodology to investigate the health and wellbeing benefits to staff (n=7, mean age 53.3; F=5; M=2) engaging with a specific 'green exercise' 1 project 'Green Minds' at a university campus in the UK. Specifically, the research sought to 'unearth' the underpinning mechanisms behind reported benefits to health and wellbeing reported by participants, a significant gap in the research within the domain of green exercise more generally (Gladwell et al, 2013; Pretty et al, 2017; Rogersen et el, 2020; Clatworthy et al, 2013; Glackon & Beale, 2018). The two researchers thus adopted an ethnographic approach by fully immersing themselves with the group and the gardening activities over six months prior to collecting data as part of a significant time-phased familiarisation process, and can thus be categorised as 'active participants' with an 'insider perspective'. The study sought to explore the engagement of participants in the specific context (corporate setting) and its cultural impact as part of a broader corporate health strategy. Each participant was engaged in the gardening activities for 30-45 minutes during the interview phase. In addition, researchers kept reflective fieldwork notes and took photographs as part of the ethnographic nature of inquiry, with repeat interviews conducted at a later date with each participant. The research revealed five main themes. 1) Nature based activity was seen as a useful and necessary escape from work-related stressors; 2) social connectedness was enhanced as a result of participation in the project; 3) beneficial impacts upon individual physical and mental health and wellbeing were revealed, related to 4) enhancements to personal agency; 1 Green exercise, as defined by Pretty et al (2005) as: any physical activity conducted in the presence of nature', for example: gardening, conservation work, running, cycling, walking, horse-riding. 2 and 5) access issues were acknowledged. The transparent benefits of participation in this form of nature-based activity suggest employers should consider creating green exercise related physical activity group-based opportunities for employees that not only benefit the employee, but also contribute to corporate goals in terms of higher productivity, better morale in the workforce, lower rates of absenteeism, less presenteeism and a happier, healthier corporate environment. Significant cost savings may be made as a result, although this paper did not attempt to quantify such wide-ranging impacts; instead, it focused on understanding the participant experience in workplace interventions.
  • ... The therapeutic value of the natural environment -for physical and mental health -has been documented from ancient times through to the modern day (AHTA 2012;Söderback, Söderström, & Schälander, 2004;Clatworthy et al, 2013). Pioneers of the occupational therapy profession recommended the use of activities such as gardening to promote wellbeing during the 1950's (Genter, Roberts, Richardson & Sheaff, 2015). ...
    ... Meanwhile, a growing number of studies have suggested how mental ill-health is specifically improved through accessing greenspace (Beyer et al, 2014;Nutsford, 2013). Other researchers have similarly highlighted the restorative effect of natural environments (Mackay and Neill, 2010;Ulrich, Simons, Losito, Fiorito, Miles & Zelson, 1991;Clatworthy et al, 2013) with reference to specific theoretical constructs such as 'attention restoration theory' (Kaplan and Kaplan, 1989), although there is not always consensus on the precise mechanisms for these effects (Bowler et al, 2010), or even whether all green environments elicit the same beneficial impact upon mental health. ...
    ... There is already convincing research suggesting the restorative influence of natural environments in promoting recovery from pre-existing mental ill-health, as well as potentially preventing future susceptibility (Bowler et al, 2010;Clatworthy et al, 2013;Groenewegen et al, 2006). This benign influence is associated with feelings of inner calm, an escape from daily worries and routine work, and the effortless attention derived from the 'soft fascination' of engaging in nature-based activity, such as tending to plants (Kaplan, 1995 Similarly, Jane referred to the opportunities to be involved with either tending to a variety of planted areas, or the more 'wild, woodland bit'; and also the delight that volunteers gained from the fauna that occasionally frequented the grounds, including creatures such as voles, slowworms, muntjac deer and rare butterflies. ...
    Article
    Full-text available
    An increasingly robust evidence base supports the therapeutic value of nature on mental health and wellbeing. The rise in reported mental ill-health across the world has major implications for the effective use of healthcare budgets, as well as economic consequences. Health practitioners may need to consider going beyond traditional mental health service provision and look to more widespread engagement with community-based interventions. This is especially important given that the structured nature of service provision may present significant challenges for some people with mental ill-health (MIND, 2016). Thus, this study explored the experiences of volunteers with mental health problems attending an unorthodox center in a woodland setting within the North West of England, which seeks to promote health and wellbeing through green exercise. An ethnographic approach, involving the use of fieldwork diaries and photographs, explored the center’s informal and unique physical and socio-cultural environment. Formally researching as outsiders on participants was deemed incongruent with the empowering ethos of the center. Following a six-week relationship building period, in which the researchers immersed themselves in the practical activities, individual fieldwork interviews were conducted with each of the volunteers (n=11). Transcribed data revealed three key themes underpinning the self-reported positive impacts on personal mental health and wellbeing. The importance of the physical and social environment was paramount, whereby volunteers recognized the restorative effects of the natural environment, but also stressed the flexible, informal and ‘no nonsense’ ethos of the center, combined with the social support, as major factors in delivering positive health outcomes. The clear sense of purpose and meaning underpinning activity choice/participation, and the feeling of togetherness this fostered, were also major influences. Using existing skills and developing new ones demonstrated the power of occupational engagement in enhancing enjoyment, achievement and overall contribution. Recognition of the influence of the context and structure of services on people’s ability to engage in therapeutic activities is therefore crucial in order to enable people to access support in their mental health recovery. Key words: mental ill-health; natural environment; mental wellbeing; green exercise, occupation; volunteers.
  • ... "Green exercise" (i.e., exercising in green spaces) provides mental and physical health benefits, which go beyond the activity alone (Barton, Bragg, Wood, & Pretty, 2016). Horticultural therapy has been used to improve mental health and reduce stress in people with dementia, people recovering from serious health disorders, and youth at risk (Annerstedt & Wahrborg, 2011;Brown & Jameton, 2000;Clatworthy, Hinds, & Camic, 2013;De Bruin et al., 2010;Gonzalez, Hartig, Patil, Martinsen, & Kirkevold, 2010). Among older adults, physiological parameters such as blood pressure and heart rate decrease, while psychological parameters such as power of concentration and mood improve after a period of time spent resting in a garden (Dahlkvist et al., 2016;Ottoson & Grahn, 2006; J. W. Tang & Brown, 2006). ...
    ... Less is known about how aging affects individuals' ability to interact with nature as living circumstances evolve (Tse, 2010). Such interactions are likely to become progressively more health-dependent, as susceptibility to health risks increases and mobility declines (Clatworthy et al., 2013), creating a negative feedback loop whereby aging is associated with reduced access to nature, leading to lower quality of life. ...
    Article
    Nature interaction is seen as a potentially inexpensive intervention to address many health issues. Aging is associated with declining health and mobility. Older people are known to benefit from nature contact; however, less is known about how aging limits access to nature. We investigated older adults occupying family, downsized, and rest homes to determine factors driving changes in nature engagement, and the quality of available nature. Less time was spent in natural places as people aged, depending on the extent of nature connectedness, frailty status, home type, and whether they lived alone or not. Most reported reduced nature engagement and expressed feelings of sadness, frustration, and anger. Gardens assumed an important role in enabling nature contact to continue, in that time spent in gardens was unrelated to age or frailty. Garden variability meant the quality of the nature experience was likely lower for those living in downsized and rest homes.
  • ... Research elsewhere shows promising results regarding the influence of urban gardens on several issues related with health, quality of life, education and environmental sustainability. [14][15][16][17][18][19][20] Promising results in Portugal would contribute to the reinforcement of the role these structures play in public health decisions and to their expansion along the urban territory. ...
    ... Several studies have detected improved outcomes in physical activity, food and nutrition intake, mental and physical health, social skills, pain and smoking habits. [16][17][18][19][20]27 In a world with so many physically and mentally debilitating chronic diseases, the active inclusion of organic gardens into urban planning could become part of the solution. The implications for public health are promising and profound. ...
    Article
    Full-text available
    Objective: To describe the environmental practices of participants in an urban organic community garden at the beginning of their gardening experience and after a period of six months, and to discover their opinion about how this activity influenced the consumption of vegetables, fruits and organic food. Method: Interviews using structured questionnaires were conducted twice with 115 city dwellers: when they started in the vegetable garden and about 6 months later. The questionnaire included questions related to environmental practices. The second evaluation also included questions related to the consumption of organic food, vegetables and fruit. Results: This research showed significant behavioural transformation, including positive outcomes in environmental practices such as recycling and trying to persuade friends or family to recycle, compost leftovers or choose to walk/bike to save petrol. In the opinion of the participants, activities in the organic community garden helped to increase consumption of fruits, vegetables and organic food. Conclusion: The study results reinforce the hypothesis that an organic community vegetable garden can induce significant, positive behavioural changes among its users. In particular this research suggests horticulture is associated with positive improvements in personal environmental behaviours, awareness of the environment's high social priority and increased consumption of organic food, fruit and vegetables.
  • ... Their days on ordinary sick-leave decreased compared to reference groups receiving support from Occupational Health Services [14] and a reference group receiving care as usual [15]. The outcomes in terms of decreased symptoms of depression and anxiety and increased perceived health and social competence was supported by a literature review [16]. ...
    ... Although there seemed to be support for NBR, knowledge was lacking regarding which specific components were successful [16]. Some clues might be given; nature-based activities have been perceived as inspiring, enjoyable and undemanding, and the environments in their beauty seemed to contribute to recovery [17,18]. ...
    Article
    Background: Support has been found for using garden therapy as form of intervention for clients with common mental disorders, but no consensus has been found for what contributes to perceived meaningfulness of garden therapy. Aims: To investigate whether participants perceived garden therapy as meaningful, and if so, what contributed to the meaningfulness. Material and methods: Narrative individual interviews were conducted twice with six participants who participated in garden therapy and once with two participants. Data was analysed using narrative methodology. Results: Perceived meanings in garden therapy were associated to the participants’ individual needs and prerequisites: to land, just be, relax, go back to basics, understand, verbalise, enhance energy, and socialise. The group leaders had an important role to create safety and trust, and to adapt the activities and use of the environment. The activities, the garden environment and social group contributed to perceived meaning in garden therapy. Conclusions: Garden therapy offered the participants possibilities to meet their different needs and thereby perceived meaning. To achieve this, the group leaders need to adapt the gardening individually to each participant. Significance: Various components were perceived as meaningful. The group leaders therefore have to adapt the garden therapy to each participant’s needs.
  • ... Moreover, Alipour et al. (2020) determined the relevance between the QOL and horticultural therapy due to aging, and reported that horticultural therapy is a noninvasive method that is useful in promoting the quality of elderly life. Other studies are also reporting that horticultural therapy reduces psychological pain by relieving depression that is one of the major mental and behavioral disorders, as well as anxiety, stress and negative emotions (Clatworthy et al., 2013;Gonzalez et al., 2011;Kamioka et al., 2014;Soga et al., 2017). ...
    ... Gonzalez et al. (2011) also proved that the horticultural therapy program alleviates depression, anxiety, stress and negative emotions of adults diagnosed with depression and improves positive emotions, thereby reducing psychological pain. Moreover, according to literature reviews on horticultural therapy performed on subjects with mental and behavior disorders or problematic symptoms, horticultural therapy had positive effects on depression, which is one of the major symptoms of mental and behavior disorders(Clatworthy et al., 2013;Kamioka et al., 2014;Soga et al., 2017).Unlike the results of previous studies in which horticultural therapy is found effective in alleviating depressive symptoms, this study did not show a significant level of positive change as a result of the statistical testing. This may be firstly due to the fact that the number of subjects ...
  • ... The evidence included reduced symptoms of depression and anxiety, and a range of self-reported benefits across emotional, social, physical, occupational and spiritual aspects of the lives of mental health service-users. [14] Studies focused on mental health outcomes give further insight into the multiple effects of nature-based interventions that go beyond the benefits of contact with nature or physical exercise. Indeed, an additional potential positive effect of nature-based interventions is that they tend to be designed as social activities, and therefore have the potential to mitigate social isolation and enable engagement with a person's community. ...
    ... A strong theme from the current study was that the intervention bolstered self-confidence and self-esteem, aligning with other research. [14] Given that poor self-esteem can be an indicator for the development of mental health disorders, [16] it seemed particularly pertinent that participants with mental health issues in the current study should benefit from improved selfesteem. Additionally, one of the challenge with common mental health disorder (anxiety and depression) is that they can co-occur with other factors such as social isolation because people are reluctant to leave their homes which, in turn, can lead to a lack of physical exercise from not going out. ...
    Article
    Aims To assess the biopsychosocial effects of participation in a unique, combined arts- and nature-based museum intervention, involving engagement with horticulture, artmaking and museum collections, on adult mental health service users. Methods Adult mental health service users (total n = 46 across two phases) with an average age of 53 were referred through social prescribing by community partners (mental health nurse and via a day centre for disadvantaged and vulnerable adults) to a 10-week ‘creative green prescription’ programme held in Whitworth Park and the Whitworth Art Gallery. The study used an exploratory sequential mixed methods design comprising two phases – Phase 1 (September to December 2016): qualitative research investigating the views of participants ( n = 26) through semi-structured interviews and diaries and Phase 2 (February to April 2018): quantitative research informed by Phase 1 analysing psychological wellbeing data from participants ( n = 20) who completed the UCL Museum Wellbeing Measure pre–post programme. Results Inductive thematic analysis of Phase 1 interview data revealed increased feelings of wellbeing brought about by improved self-esteem, decreased social isolation and the formation of communities of practice. Statistical analysis of pre–post quantitative measures in Phase 2 found a highly significant increase in psychological wellbeing. Conclusion Creative green prescription programmes, using a combination of arts- and nature-based activities, present distinct synergistic benefits that have the potential to make a significant impact on the psychosocial wellbeing of adult mental health service users. Museums with parks and gardens should consider integrating programmes of outdoor and indoor collections-inspired creative activities permitting combined engagement with nature, art and wellbeing.
  • ... Horticulture has been long used as a therapeutic activity for people with mental illnesses, such as schizophrenia and depression [3,4]. People's interactions with plants, through goal-orientated horticultural activities in the form of active gardening, as well as the passive appreciation of nature, could be therapeutic to people with mental disorders in many ways [5,6]. ...
    ... Several systematic reviews highlighted the limited number of quality research on HT for people with mental illness [3,24]. The structure of HT for people is diverse, and there were too many possible therapy objectives and outcome variables in HT. ...
    Article
    Full-text available
    Background: Horticultural therapy (HT) has long been used in the rehabilitation of people with mental illness, but many HT programs are not standardized, and there have been few evaluation studies. Aims: This study evaluated the process and outcomes of a standardized horticultural program using a mixed methodology, i.e., systematic integration ("mixing") of quantitative and qualitative data within a study. Methods: Participants who have mental illnesses were assigned to a treatment (HT) and a comparison group (n = 41 for each group). The process and outcomes of the program, including stress and anxiety, engagement and participation, affect changes, mental well-being, and social exchange, were obtained using self-completed questionnaires, observational ratings of participants during the group, as well as through a focus group. Results: The study results supported the proposal HT is effective in increasing mental well-being, engagement, and the sense of meaningfulness and accomplishment of participants. Many participants reported a reduction in stress and anxiety in the focus group, but positive changes in affect were not fully observed during the group process or captured by quantitative measures. The participants also did not report increases in the social exchange over the HT sessions. Conclusion: The evidence supports that HT is effective in increasing mental well-being, engagement in meaningful activities, but did not result in significant affect changes during therapy, or increase social exchanges among people with mental illness.
  • ... Natural environments have been shown to reduce stress [2,3], increase the ability to focus attention [4,5], increase curiosity, motivation and commitment to learning situations [6]; and increase opportunities for physical and emotional activity through playful activities in nature [7][8][9]. Systematic reviews provide a basis of knowledge for the statement that introducing animals and nature into treatment and pedagogy has demonstrable effects [10][11][12][13][14]. For the clinical group of children with autism, several studies have reported an increase in social initiatives, a decrease in typical autistic behaviors, a reduction in stress, and a lower level of anxiety during therapy sessions when the children were accompanied by a dog or a guinea pig [15][16][17][18][19]. Improvements are also reported in behavior, social interaction, and communication after treatment with equine assisted therapy [20,21]. ...
    Article
    Full-text available
    Animals are increasingly included in treatment for children with autism, and research has shown positive effects, such as increased social initiatives, decreased typical autistic behaviors, and decreased stress. However, there are still knowledge gaps, for example, on underlying mechanisms and effects from longer treatment duration. The purpose of this study is to contribute to these gaps and ask questions about the ways in which animals and nature can improve conditions for psychological development through support from therapists. The method is based on grounded theory. Data comes from a treatment model (duration 1½ years, a total of nine children), from environmental psychology and developmental psychology, both typical and atypical as in autism. The results consist of three key categories; reduce stress and instill calm, arouse curiosity and interest, and attract attention spontaneously. These three key categories are related to an underlying core variable, vitality forms, which was described by Daniel Stern and, according to him, is important in forming overall experiences. The starting point is the brain’s way of encoding many internal and external events based on movement perception. Here it is argued that the vitality forms from nature and animals are particularly favorable for effecting development-promoting interactions with a therapist.
  • ... The positive impact of contacting nature with activity in the green area on the physical and mental health of all age groups, especially the elderly, is something that has been proven by a large number of recent studies Ulrich, 1984;Sherman et al, 2005;Stigsdotter, & Grahn, 2002;Pouya & Demirel,2015;Ulrich et al, 1991;Marcus & Barnes, 1999, Rappe, & Kivelä, 2005. One of the most important and effective activities in this field is horticulture (Rae, 2014;Shaw, 2015;Clatworthy et al, 2013). For decades, horticulture has been used as a treatment for people with disabilities and needs, including adults with physical and mental disabilities, children with disabilities, the elderly and prisoners. ...
    Article
    Full-text available
    Horticulture is the cultivation of fruits, flowers, and vegetables. This is used as a therapeutic approach. Horticultural activities may be a new strategy for the elderly to promote mental, social and cognitive functioning. Over the past few decades, horticulture has been used as a suitable treatment for elderly in long-term care centers while gardening is still not used as a treatment for the elderly in Turkey. The aim of the study was to review the benefits or the positive effects of horticultural therapy on elderly in nursing homes. The study also provides some helpful design solutions to promote the creation of such spaces in nursing homes especially in Turkey. Horticulture requests of elderly individuals in nursing homes need to be met in a way allowing easy access of individuals in nursing homes. The importance of the horticulture in this organization must be understood and adopted.
  • ... It also contributes to reducing stress, anger, fatigue, depression, and anxiety (25). Consequently, the commitment to gardening is increasingly recognized not only as a profitable health intervention (26), but also as a therapy for people with psychological health problems, the so-called "horticultural therapy" (27). ...
    Article
    Full-text available
    Background and aim of the work: The ongoing pandemic of COVID-19 is a strong reminder that the lockdown period has changed the way that people and communities live, work, and interact, and it's necessary to make resilient the built environment, both outdoor and mainly the indoor spaces: housing, workplaces, public buildings, and entertainment facilities. How can we re-design the concept of Well-being and Public Health in relation to the living places of the future? Methods: According to the previous statements and scenario, this paper aims to integrate the building hygiene and well-being, focusing the possible responses, both existing and for the new buildings, taking home a strong message from this "period" of physical distancing. Results: The Well-being and Public Health recommendations for a healthy, safe, and sustainable housing are framed into the following key points: 1. Visible and accessible green elements and spaces; 2. Flexibility, adaptability, sharing, and crowding of living spaces, and compliant functions located into the buildings; 3. Re-appropriation of the basic principles and archetypes of sustainable architecture, thermal comfort and Indoor Air Quality (IAQ); 4. Water consumption and Wastewater Management; 5. Urban Solid Waste Management; 6. Housing automation and electromagnetic fields; 7. Indoor building and finishing materials. Conclusions: The Well-being and Public Health recommendations for a healthy, safe and sustainable housing may provide a useful basis for Designers, Policy Makers (fostering tax incentives for building renewal), Public Health experts and Local Health Agencies, in promoting actions and policies aimed to transform living places in healthier and Salutogenic spaces.
  • ... Other reviews (one systematic and the other a simple literature review) with a broader nature-based remit (Annerstedt & Währborg, 2011;Bragg & Atkins, 2016), and also with a narrow but overlapping focus on conservation or horticulture therapy and gardening, exist (Clatworthy, Hinds, & Camic, 2013;Kamioka et al., 2014;Lovell, Husk, Cooper, Stahl-Timmins, & Garside, 2015). One of the broader reviews, involving 38 papers, included nature-assisted interventions, wilderness and horticulture therapies, but not care farms, and focused on a wide range of vulnerable groups (Annerstedt & Währborg, 2011), but mostly related to disaffected youth, and those with mental health problems or dementia. ...
    Article
    Full-text available
    Care farming (also called social farming) is the therapeutic use of agricultural and farming practices. Service users and communities supported through care farming include people with learning disabilities, mental and physical health problems, substance misuse, adult offenders, disaffected youth, socially isolated older people and the long term unemployed. Care farming is growing in popularity, especially around Europe. This review aimed to understand the impact of care farming on quality of life, depression and anxiety, on a range of service user groups. It also aimed to explore and explain the way in which care farming might work for different groups. By reviewing interview studies we found that people valued, among other things, being in contact with each other, and feeling a sense of achievement, fulfilment and belonging. Some groups seemed to appreciate different things indicating that different groups may benefit in different ways but, it is unclear if this is due to a difference in the types of activities or the way in which people take different things from the same activity. We found no evidence that care farms improved people's quality of life and some evidence that they might improve depression and anxiety. Larger studies involving single service user groups and fully validated outcome measures are needed to prove more conclusive evidence about the benefits of care farming.
  • ... Our model (Fig. 1) illustrates how access to nearby nature and outdoor resources are critical for health and well-being. These attributes can include presence or absence of parks [99], gardens [100], or farmers markets [48], and also involve how people feel when experiencing these places, and what impact living near them can have on mental and physical health and well-being. The ways in which people perceive their environment may involve the bonds people have with these places, also known as place attachment or a broader sense of beauty, e.g., aesthetics. ...
    Article
    Purpose of Review Recent reports of a “loneliness epidemic” in the USA are growing along with a robust evidence base that suggests that loneliness and social isolation can compromise physical and psychological health. Screening for social isolation among at-risk populations and referring them to nature-based community services, resources, and activities through a social prescribing (SP) program may provide a way to connect vulnerable populations with the broader community and increase their sense of connectedness and belonging. In this review, we explore opportunities for social prescribing to be used as a tool to address connectedness through nature-based interventions. Recent Findings Social prescribing can include a variety of activities linked with voluntary and community sector organizations (e.g., walking and park prescriptions, community gardening, farmers’ market vouchers). These activities can promote nature contact, strengthen social structures, and improve longer term mental and physical health by activating intrapersonal, interpersonal, and environmental processes. The prescriptions are appropriate for reaching a range of high-risk populations including moms who are minors who are minors, recent immigrants, older adults, economically and linguistically isolated populations, and unlikely users of nature and outdoor spaces. Summary More research is needed to understand the impact of SPs on high-risk populations and the supports needed to allow them to feel at ease in the outdoors. Additionally, opportunities exist to develop technologically and socially innovative strategies to track patient participation in social prescriptions, monitor impact over time, and integrate prescribing into standard health care practice.
  • ... Overall, these and other health-promoting interventions based on both biotic and abiotic elements of nature have been indicated with the term "green care" (Sempik et al., 2010). In this context, gardening and horticulture are considered costeffective health interventions (Clatworthy et al., 2013) and an occupational therapy (i.e. the so-called horticultural therapy) for people with psychological diseases (Gonzalez and Kirkevold, 2014). The horticultural therapy represents a widely accepted technique for favouring social adaptation and for the development of healing and stress-reducing programs involving clinical and healthy populations (Söderback et al., 2004;Largo-Wight, 2011). ...
    Article
    Contact with nature and care of gardens are assumed to have important therapeutic functions. This work is an open pilot study exploring the potentiality of caring local biodiversity in a healing garden as a tool to promote multi-purpose ecosystem services and social benefits. A group of “Biodiversity Custodians”, composed by young people with autism spectrum disorder, was constituted to realize a healing garden in Morrano di Orvieto (TR, Umbria, Italy) with the aim to carry out an integrated approach for conservation of crop landraces. This approach provided opportunities for nature contact and synergistic inter-personal exchanges in a more biodiverse environment and socio-cultural context, leading to a significant improvement of the rehabilitative objectives effectiveness in the participants, especially regarding their social skills and interpersonal relationships. In addition, a series of agronomical, plant physiological and biochemical/nutritional functional traits were determined and proposed as cost-effective and reliable tools to set-up screening and evaluation tests of landraces germplasm. Hence, the care of “life diversity” at plant, human and socio-cultural level in the healing garden was the basis for the promotion of ecosystem services and health care roles, pursuing two main crucial goals: i) the improvement of health, subjective well-being and interpersonal relationships in highly vulnerable people of local community and ii) the conservation and valorisation of local biodiversity by the care of crop landraces, the acquisition of relevant historical and functional data useful for local farmers, breeders and researchers and by transfer of this heritage to future generations. Therefore, this pilot study demonstrated as proper management of healing gardens may represent a concrete way to promote health care intervention and both agro-biodiversity and cultural diversity, leading to a widespread improvement of the environmental protection and human wellbeing.
  • ... For example, the field of horticulture therapy explores gardening to reach therapeutic goals. One theory 38 to explain the effect nature stimuli have on us is Ulrich's psycho-physiological stress reduction theory . He suggests that we are predisposed to find non-threatening nature stimuli to be relaxing. ...
    Thesis
    Full-text available
    This research explored using games to communicate butterfly conservation knowledge. The inquiry was explored using the Practice as Research methodology. Informed by literature research a game prototype was created to generate significant insights. Results suggest that games are a suitable means to communicate conservation knowledge to a broader audience. Games reach people from a variety of backgrounds. They reach both people uninterested and invested in conservation. To communicate conservation knowledge through play requires merging Instructional and Game design. This paper shows games as a suitable way to teach names of common butterfly species and their ecological needs.
  • ... Activities outside work, such as physical exercise, provide an excellent opportunity to restore an individual's fitness, and to help control individual health risk factors [18]. Activities such as leisure sports, physical exercise, and gardening may diminish the symptoms of depression and anxiety, while improving sleep quality and other psychological factors [18,19]. The health events caused by chronic or acute illness affect work production and workers' attitudes [6]. ...
    Article
    Full-text available
    Objectives: Presenteeism is currently recognized as a significant global health issue that can potentially cause productivity losses. Hence, many studies have analyzed the relationships between workplace factors and presenteeism. However, few studies have considered non-occupational factors. This study examined the associations between presenteeism and activities outside work, including volunteering, self-development, leisure/sports, and gardening and house repair activities, in Korean wage workers. Methods: This study analyzed the fourth Korean Working Conditions Survey, in which a total of 19 294 wage workers participated. To identify relationships between presenteeism and activities outside work, multivariate logistic regression analysis was used after adjusting for general and occupational characteristics. Results: Self-development and leisure/sports activities significantly increased the odds ratio (OR) of presenteeism (OR, 1.166; 95% confidence interval [CI], 1.061 to 1.282 and OR, 1.276; 95% CI, 1.181 to 1.379, respectively). Conclusions: Certain activities outside work, such as self-development or leisure/sports, were related to presenteeism among Korean wage workers. Although many previous studies have emphasized the positive effects of those activities on health, this study documented negative effects of these activities outside work on health.
  • ... Not assessed in this study. [83,[105][106][107][108][109][110][111][112][113][114] 14. Residential retreats. ...
    Article
    Full-text available
    Engagement with nature is an important part of many people’s lives, and the health and wellbeing benefits of nature–based activities are becoming increasingly recognised across disciplines from city planning to medicine. Despite this, urbanisation, challenges of modern life and environmental degradation are leading to a reduction in both the quantity and the quality of nature experiences. Nature–based health interventions (NBIs) can facilitate behavioural change through a somewhat structured promotion of nature–based experiences and, in doing so, promote improved physical, mental and social health and wellbeing. We conducted a Delphi expert elicitation process with 19 experts from seven countries (all named authors on this paper) to identify the different forms that such interventions take, the potential health outcomes and the target beneficiaries. In total, 27 NBIs were identified, aiming to prevent illness, promote wellbeing and treat specific physical, mental or social health and wellbeing conditions. These interventions were broadly categorized into those that change the environment in which people live, work, learn, recreate or heal (for example, the provision of gardens in hospitals or parks in cities) and those that change behaviour (for example, engaging people through organized programmes or other activities). We also noted the range of factors (such as socioeconomic variation) that will inevitably influence the extent to which these interventions succeed. We conclude with a call for research to identify the drivers influencing the effectiveness of NBIs in enhancing health and wellbeing.
  • ... The positive impact of contacting nature with activity in the green area on the physical and mental health of all age groups, especially the elderly, is something that has been proven by a large number of recent studies Ulrich, 1984;Sherman et al, 2005;Stigsdotter, & Grahn, 2002;Pouya & Demirel,2015;Ulrich et al, 1991;Marcus & Barnes, 1999, Rappe, & Kivelä, 2005. One of the most important and effective activities in this field is horticulture (Rae, 2014;Shaw, 2015;Clatworthy et al, 2013). For decades, horticulture has been used as a treatment for people with disabilities and needs, including adults with physical and mental disabilities, children with disabilities, the elderly and prisoners. ...
  • ... Council for Therapy and Rehabilitation through Horticulture has been established in 1973 at the National Arboretum and USDA National Agricultural Library and this again was renamed as American Horticultural Therapy Association in 1988. Previous studies have shown that there is escalating understanding about the use of gardening activities in hospital outdoor setting for the patients benefit (Clatworthy et al., 2013;Genter et al., 2015). Numerous reports have confirmed that green environment increases psychological well-being, reduces stress, anxiety and depression (Gonzalez et al., 2010;Wood et al., 2016). ...
    Article
    Full-text available
    Therapeutic garden is gaining popularity as non-pharmacological approach in modem health-care system. It is a type of healing garden mainly used as physical therapy or horticultural therapy programmes which may include both horticultural and non-horticultural activities. These activities are very helpful in treatment of patients, stress reduction of staff and patients, increase in outcome of hospitals, increase in work efficiency and reducing cost of treatment. Therapeutic gardens are mainly designed for patients suffering from mental illnesses like autism, dementia, Alzheimer’s disease, etc. In this article, an effort has been made to present an empirical literature on the use of therapeutic gardens in healthcare setting.
  • ... Other reviews have searched for impact of nature interventions, especially within the mental health field regarding patients with a psychiatric diagnosis [7][8][9]. Mental health issues are increasing and it is suggested that in 2020, 15% of the health care global burden is related to mental health [4]. ...
    Article
    Full-text available
    Background The effect of nature-based interventions on self-reported mental well-being in patients with physical disease is gaining increasing attention. However, there is a lack of randomized controlled trials investigating this area. Due to the massive costs in health care systems, there is a need for new strategies to address these issues and an urgent need for attention to this field. Nature-based interventions are low cost, easy to implement, and should get attention within the health care field. Therefore, the objective was to find the impact of nature interventions on mental well-being in humans with a physical disease. Methods In four major databases (PubMed, Cinahl, PsycINFO, and Cochrane Library), a systematic review of quantitative studies of nature’s impact on self-reported mental health in patients with physical disease was performed. A total of 1909 articles were retrieved but only five met the inclusion criteria and were summarized. Results All five studies were quantitative, with a control group and a nature-based intervention. A source of heterogeneity was identified: the patients in one of the five studies were psychosomatic. In the four studies with somatic patients, significant benefit of nature on self-reported mental health outcomes was found; the only study that failed to show a significant benefit was the one with psychosomatic patients. Conclusion A significant effect of nature on mental well-being of patients with somatic disease was found. The result in patients with psychosomatic disease is inconclusive, and more studies in this category are needed. Further research on the effect of nature on mental health is merited, with special attention to standardizing intervention type and dose as well as outcome measures within each medical discipline.
  • ... Other reviews (one systematic and the other a simple literature review) with a broader nature-based remit (Annerstedt & Währborg, 2011;Bragg & Atkins, 2016), and also with a narrow but overlapping focus on conservation or horticulture therapy and gardening, exist (Clatworthy, Hinds, & Camic, 2013;Kamioka et al., 2014;Lovell, Husk, Cooper, Stahl-Timmins, & Garside, 2015). One of the broader reviews, involving 38 papers, included nature-assisted interventions, wilderness and horticulture therapies, but not care farms, and focused on a wide range of vulnerable groups (Annerstedt & Währborg, 2011), but mostly related to disaffected youth, and those with mental health problems or dementia. ...
    Conference Paper
    Full-text available
    Care farming (also called social farming) is the therapeutic use of agricultural and farming practices. Service users and communities supported through care farming include people with learning disabilities, mental and physical health problems, substance misuse, adult offenders, disaffected youth, socially isolated older people and the long term unemployed. Care farming is growing in popularity, especially around Europe. This review aimed to understand the impact of care farming on quality of life, depression and anxiety, on a range of service user groups. It also aimed to explore and explain the way in which care farming might work for different groups. By reviewing interview studies we found that people valued, among other things, being in contact with each other, and feeling a sense of achievement, fulfilment and belonging. Some groups seemed to appreciate different things indicating that different groups may benefit in different ways but, it is unclear if this is due to a difference in the types of activities or the way in which people take different things from the same activity. We found no evidence that care farms improved people's quality of life and some evidence that they might improve depression and anxiety. Larger studies involving single service user groups and fully validated outcome measures are needed to prove more conclusive evidence about the benefits of care farming.
  • ... Another alive of the elderly at retirement homes should balance with the social and physical environment to support their daily life and health (Dahlan et al., 2010). Much scientific evidence indicates that natural environments or garden can promote human health (Clatworthy, Hinds, & Camic, 2013). Visiting the garden is can improve the elderly mood and quality of life. ...
  • ... Programmes focussing on healthy eating and physical activity have shown a reduction in metabolic syndrome criteria and decreased systolic blood pressure (Forsberg, Bj€ orkman, Sandman, & Sandlund, 2008), and greater weight reduction and improved fitness compared with a control group (Bartels et al., 2015;Naslund et al., 2017). Furthermore, support has been found for complementary interventions such as creative activities (Caddy, Crawford, & Page, 2012;Leckey, 2011), music therapy (Bidabadi & Mehryar, 2015;Guti errez & Camarena, 2015) and nature-assisted activities (Clatworthy, Hinds, & Camic, 2013;W€ ahrborg, Petersson, & Grahn, 2014), resulting in reduced symptoms, increased life quality and health and/or promoted social networks. ...
    The study aimed to explore participants’ perceptions and experiences of the Culture and Health programme in Sweden for clients with long-term mental health disorders. A qualitative approach with interviews was applied. Grounded Theory guided the analysis and selection of informants. A total of 15 informants were interviewed. A core category ‘A turning point in dealing with everyday life beyond the mental illness’ with three categories: inner life, social life and occupational life emerged. A theory indicating the importance of asking clients about their expectations, was formulated. Further studies are warranted, including studies of effects.
  • ... The capacity for community gardening to promote social inclusion, interaction and connectedness has been identified (Ohmer et al., 2009;Turner, 2011;Firth et al., 2011;Clatworthy et al., 2013;Nordh et al., 2016;Soga et al., 2017;Kingsley et al., 2019a). However, to what extent this occurs is contested. ...
    Article
    Within the context of increased urbanisation, the value of access to and participation in green spaces (such as community gardening) is progressively understood as fundamental to the social, cultural, environmental and health needs of urban populations. This article is an exploration of six urban community gardens in Melbourne (Australia) towards understanding the social capital stocks and other related factors like mutual support, social networks and community connections associated with these settings. This is the first Australian study to review social capital across community garden settings. Twenty-three participants were involved in this qualitative study, which utilised semi-structured interviews. The results indicate that community gardens are perceived as a place for social interaction and support, which enable connections and mutual benefits that enhance a sense of community. Members identified factors reducing social capital stocks like exclusion, lack of support and vandalism. Although this study identified social capital benefits of community gardening, it was difficult to differentiate between bridging, bonding and linking social capital. Therefore, although some recommendations could be garnered from this study to enhance socially-desirable outcomes, more compelling research is required to make informed policy change around enhancing social capital and community gardening.
  • ... This finding is consistent with the notion that GE behaviours can facilitate wellbeing improvements in adults [1][2][3][4][5][6][7][8]16]. In terms of impacts of regular doses of participation, the current findings are also consistent with those concerning frequent participation in horticultural activity [37,38], perhaps unsurprisingly, as sometimes horticulture is considered as a 'GE' activity; although it is often considered distinct and therefore researched in its own right. Horticultural activities share key features with the projects included within the current study: social interaction, physical activity and interaction with nature. ...
    Article
    Full-text available
    This study investigated the efficacy of medium-term Green Exercise (GE; being physically active within a natural environment) interventions for improving wellbeing, by pooling data collected at the start and end of participants’ engagement with a range of GE interventions. Hypotheses were that (i) interventions would show good efficacy for improving wellbeing in the overall sample; (ii) compared to participants reporting ‘average to high’ wellbeing at the start of their project, participants with ‘low’ starting wellbeing would report greater improvements post-intervention; and (iii) improvements would significantly differ between age groups. The pooled dataset was categorized in line with UK norms (n = 318) and analyzed using a standardized meta-analysis approach. Effect size was large: g = 0.812 (95% CI [0.599, 1.025]), and differences in wellbeing changes associated with project duration, age or sex were not statistically significant. Compared to those reporting ‘average-high’ starting wellbeing, participants reporting ‘low’ starting wellbeing exhibited greater improvements (BCa 95% CI [−31.8, −26.5]), with 60.8% moving into the ‘average-high’ wellbeing category. GE can play an important role in facilitating wellbeing and can provide alternative pathways for health and social care practice. Public health commissioners should consider integrating such interventions for patients experiencing low wellbeing or associated comorbidities.
  • ... Gardening has been a popular pastime globally throughout time and is one of the most commonly accessible ways of experiencing nature [1]. The evidence base for the health and well-being benefits of gardening is rapidly growing with studies showing that community gardening is associated with improvements in symptoms of mental health conditions such as depression and stress [2,3], and in encouraging healthy lifestyle behaviors such as increased fruit and vegetable intake which reduces the risk of cardiovascular disease [4][5][6]. Additionally, gardening has been shown to be beneficial to specific populations, such as older adults in terms of overall health, quality of life, improved cognitive ability, and social benefits [7]. ...
    Article
    Full-text available
    Gardening has long been a popular pastime. There is a growing evidence base for the health and well-being benefits of gardening. Community gardening brings a social aspect to gardening, thereby increasing the potential benefits to include addressing social inclusion and poor community health through sharing of values, support of others, and building networks. This systematic review protocol aims to determine the characteristics of community gardening that could lead to beneficial outcomes such as connection with the community and development of new skills. Thirteen academic databases will be searched for studies looking at the benefits of community gardening, with a focus on vulnerable populations. Data will be extracted from all studies meeting the inclusion criteria and summarized to provide an overview of the current literature. This systematic review aims to provide a comprehensive investigation into community gardening, its benefits, and how they are achieved for the target population. By gathering and synthesizing this information, the review should allow policy makers and practitioners to work more effectively to address health and social inequities, by highlighting areas of need and enabling optimization of future interventions.
  • ... Beyond improving access to more nutritious food, urban agriculture can also improve the physical health of growers through the exertion involved in cultivation and harvesting, and mental health can be maintained through an improved connection to nature and increased community cohesion (Wakefield et al. 2007;Clatworthy et al. 2013;Hawkins et al. 2013). For example, it has been found in the Netherlands that allotment holders are healthier than their neighbours without allotments, although this was only significant for those over the age of 62 (van den Berg et al. 2010).There is also evidence of more diffuse benefits of urban farming beyond those that grow and consume the food, since the simple presence of greenspace in cities is also positively associated with human health (Groenewegen et al. 2012). ...
    Article
    Full-text available
    Food production depends upon the adequate provision of underpinning ecosystem services, such as pollination. Paradoxically, conventional farming practices are undermining these services and resulting in degraded soils, polluted waters, greenhouse gas emissions and massive loss of biodiversity including declines in pollinators. In essence, farming is undermining the ecosystem services it relies upon. Finding alternative more sustainable ways to meet growing food demands which simultaneously support biodiversity is one of the biggest challenges facing humanity. Here, we review the potential of urban and peri-urban agriculture to contribute to sustainable food production, using the 17 sustainable development goals set by the United Nations General Assembly as a framework. We present new data from a case study of urban gardens and allotments in the city of Brighton and Hove, UK. Such urban and peri-urban landholdings tend to be small and labour-intensive, characterised by a high diversity of crops including perennials and annuals. Our data demonstrate that this type of agricultural system can be highly productive and that it has environmental and social advantages over industrial agriculture in that crops are usually produced using few synthetic inputs and are destined for local consumption. Overall, we conclude that food grown on small-scale areas in and near cities is making a significant contribution to feeding the world and that this type of agriculture is likely to be relatively favourable for some ecosystem services, such as supporting healthy soils. However, major knowledge gaps remain, for example with regard to productivity, economic and employment impacts, pesticide use and the implications for biodiversity.
  • ... The psycho-physiological stress reduction theory is focused on the effect of nature on overall physiological and emotional health (Clatworthy, Hinds, & Camic, 2013). This theory can be associated with the earlier biophilia hypothesis which posits that an innate attraction to other living organisms is a basic human quality and that the continued expression of this tendency is essential for psychological and spiritual well-being (Wilson, 1984). ...
  • ... Previous research suggests that spending time in natural environments and using nature therapy in rehabilitation programmes can increase quality of life, reduce symptoms of heart disease [17,18], relieve symptoms of stress [18][19][20][21][22], reduce symptoms of anxiety and depression [23], and increase the ability to return to work after sick leave [24]. Most of these studies have been conducted in more urban green areas and gardens. ...
    Article
    Full-text available
    Many men have poor mental health and need help to recover. However, designing a rehabilitation intervention that appeals to men is challenging. This study protocol aims to describe the ‘Wildman Programme’, which will be a nature-based rehabilitation programme for men on long-term sick leave due to health problems such as stress, anxiety, depression, post-cancer and chronic cancer, chronic obstructive pulmonary disease (COPD), cardiovascular disease, or diabetes type II. The programme will be a nature-based rehabilitation initiative combining nature experiences, attention training, body awareness training, and supporting community spirit. The aim of the study will be to examine whether the ‘Wildman Programme’ can help to increase quality of life and reduce stress among men with health problems compared to treatment as usual. The study will be a matched control study where an intervention group (number of respondents, N = 52) participating in a 12-week nature-based intervention will be compared to a control group (N = 52) receiving treatment as usual. Outcomes are measured at baseline (T1), post-treatment (T2), and at follow up 6 months post-intervention (T3). The results of this study will be important to state whether the method in the ‘Wildman Programme’ can be implemented as a rehabilitation offer in the Danish Healthcare System to help men with different health problems.
  • ... It is now widely accepted that spending time in natural or semi-natural environments (e.g., forests, grasslands, gardens and parks) can result in significant positive mental and physical health benefits [1][2][3]. For example, the Japanese practice of Shinrin-yoku or 'forest bathing' has been shown to enhance innate immunity via lymphocyte cell activity and can reduce diastolic and systolic blood pressure [4,5]; gardening can provide relief from acute stress and improve symptoms of depression [6,7]; and simply spending time in nature can enhance psychological restoration (the ability to recover from stress) and can facilitate healthy child development [8][9][10]. Through the biophilia hypothesis, Wilson (1984) argues that humans hold an innate affinity to seek connections with nature. ...
    Article
    Full-text available
    Prescribing nature-based health interventions (green prescribing)-such as therapeutic horticulture or conservation activities-is an emerging transdisciplinary strategy focussed on reducing noncommunicable diseases. However, little is known about the practice of, and socioecological constraints/opportunities associated with, green prescribing in the UK. Furthermore, the distribution of green prescribing has yet to be comprehensively mapped. In this study, we conducted a socioecological exploration of green prescribing. We deployed online questionnaires to collect data from general practitioners (GPs) and nature-based organisations (NBOs) around the UK and conducted spatial analyses. Our results indicate that GPs and NBOs perceive and express some common and distinct constraints to green prescribing. This highlights the need to promote cross-disciplinary communication pathways. Greenspace presence and abundance within close proximity (100 and 250 m) to GP surgeries (but not greenness-as a proxy for vegetation cover) and NBO presence within 5 km were associated with higher levels of green prescribing provision. Lower levels of deprivation were associated with higher frequency of NBOs. This suggests that the availability of greenspaces and NBOs could be important for green prescribing provision, but there could be greater opportunities in less deprived areas. Important foci for future research should be to establish transdisciplinary collaborative pathways, efficient infrastructure management and a common vocabulary in green prescribing-with the overall aim of reducing inequalities and enhancing planetary health.
  • ... Previous reviews have focused on the health impacts of "nature-assisted" [20] gardening [21] and horticultural therapies [22], and green exercise [23][24][25]. While all of these therapies involve the connection between nature and human health, they each do so in different ways. ...
    Article
    Full-text available
    Nature prescription programs have emerged to address the high burden of chronic disease and increasingly sedentary and screen-based lifestyles. This study examines the base of evidence regarding such programs. We conducted a narrative review of published literature using four electronic databases. We included case studies, research design articles, and empirical studies that discussed any type of outdoor exposure or activities initiated by a health-care provider from an outpatient clinic. We examined articles for information on target populations, health outcomes, and structural and procedural elements. We also summarized evidence of the effectiveness of nature prescription programs, and discussed needs and challenges for both practice and research. Eleven studies, including eight empirical studies, have evaluated nature prescription programs with either structured or unstructured formats, referring patients either to nearby parks or to formal outdoor activity programs. Empirical studies evaluate a wide variety of health behaviors and outcomes among the most at-risk children and families. Research is too sparse to draw patterns in health outcome responses. Studies largely tested program structures to increase adherence, or patient follow-through, however findings were mixed. Three published studies explore providers' perspectives. More research is necessary to understand how to measure and increase patient adherence, short and long-term health outcomes for patients and their families, and determinants of provider participation and participation impacts on providers' own health.
  • ... Community gardens usually refer to plots of land collectively gardened by a group of people living in an urban area in diverse settings such as schools, neighborhoods, nursing homes or hospitals [6,7]. Beyond evidence drawn from community gardening within institutions such as schools or health care settings [8][9][10][11], several studies have investigated the potential health effects of community gardening on urban residents. Increased intake of fruits and vegetables, increased physical activity and better social and mental health ndings have been reported in several qualitative studies [12,13]. ...
    Preprint
    Full-text available
    Background: Despite the increasing number of studies on gardening and health, evidence of health benefits of community gardening is limited by cross-sectional design. The “JArDinS” quasi-experimental study aimed to assess the impact of community garden participation on the adoption of more sustainable lifestyles in French adults. Methods: Individuals starting gardening in community gardens in Montpellier (France) in 2018 (N=66) were compared to pairwise matched individuals with no experience in community gardening (N=66). Monthly household food supplies, physical activity measured by accelerometers and questionnaires on physical, mental and social well-being, sensitivity to food waste, and connection with nature were used to explore sustainability of lifestyles in social/health, environmental and economic dimensions. Data were collected at baseline (t0) and 12 months later (t1). Linear mixed models were used to determine the independent effect of community gardening on investigated lifestyles components. In-depth interviews were conducted at t1 with 15 gardeners to better understand changes that may have occurred in gardeners’ lives during the first year of gardening. Results: At t0, gardeners had lower education level, lower BMI and reported lower percentage of meals consumed outside of the home in total household meals compared to non-gardeners (p<0.05). At t1, the mean weight of fruit and vegetables harvested from the garden was 19.5g/d/p. Participating in the community garden had no significant impact on any of the social/health, environmental and economic lifestyle components investigated. Qualitative interviews suggested the existence of pre-established health and environmental consciousness in some gardeners and revealed several barriers to the participation such as lack of time, lack of gardening knowledge, difficulty of gardening, health problems and conflicts with other gardeners. Conclusions: Using a longitudinal design allowing causality assessment, no impact was observed of the first year of community gardening on lifestyle sustainability. The pre-established sensitivity to sustainability and the various barriers encountered by new gardeners might explain the absence of community gardening impact. Further rigorous longitudinal studies are needed to determine whether or not community gardening is a relevant public health tool. Trial registration: The study was registered at clinicaltrials.gov as NCT03694782. Date of registration: 3rd October 2018, retrospectively registered.
  • ... Ultimately, the goal must be for society at large to tackle the shocking stigma and discrimination that people with complex needs experience daily, and to develop more inclusive, holistic practices as a way of life. However, as an immediate pragmatic step, at an individual level, therapeutic approaches have been shown to provide: psychological enhancement, coping strategies to withstand challenges, and development of self-esteem to encourage participation in society and to pursue the right to be employed (Bragg et al., 2013;Clatworthy et al., 2013). Besides therapeutic help, it is essential that people with complex needs have educational qualifications, to enter the labour market with a greater likelihood of being employed (Dixon, 2006). ...
    Article
    Full-text available
    Youth unemployment rates in the United Kingdom are almost triple that of adults (11.3% and vs. 4%, respectively), particularly impacting the employability of young people with complex needs, of whom 61.8% are unemployed. Interventions facilitating transition into work can operate at individual, community and government levels. The main objectives of this review were to explore current practices, identify factors affecting and strategies used to improve employability, and classify strategies at multi-levels. Findings suggest that collaborative strategies covering training, work practices, therapeutic support and creating appropriate work environments, with active involvement of young people, are key in supporting young people with complex needs into employment. Classification of factors indicated four categories: skills-based approaches, job/work experience accessing approaches, therapeutic interventions, and supportive working environments.
  • Article
    This article focuses on an innovative approach to treating people bereaved by the suicide of a loved one. Nature is powerful and restorative, and some research already supports the therapeutic use of nature to address grief. We outline a therapeutic gardening approach to use with survivors of suicide loss and present a case study. This approach can be used by counselors who work individually with people bereaved by suicide as a way of assisting and supporting them through their grief. Though we suggest that nature can be used as part of the therapeutic process, careful consideration should be made to ensure privacy and confidentiality. Implementing this approach requires planning and intentionality.
  • Article
    Background: There is increasing awareness of the potential health benefits derived from gardening activities. Gardening practices are gaining momentum in Native American (NA) communities, yet no efforts have applied a community-based participatory research approach within a social-ecological model to understand opportunities and barriers for group gardening on an American Indian reservation. Objectives: The primary objective of this study was to identify influences across social-ecological levels that promote or hinder the implementation of community gardens and use of locally grown foods on the reservation; a secondary objective was to assess the feasibility of implementing a group gardening program for NA adults and potential of collecting health outcome measures. Method: Community members and academicians collaborated to develop and implement this study. The study (1) conducted interviews with key stakeholders to identify influences across social-ecological levels that promote or hinder the implementation of community gardens and using locally produced food and (2) assessed the physical and psychological well-being of NA adults participating in a group gardening feasibility study. Results: Major factors influencing using locally grown food and community gardens that emerged from nine interviews included knowledge/experience, self-efficacy, Elders, traditional ways, community values, generational gaps, and local tribal policies. Twenty NA adults with prediabetes or diabetes participated in the feasibility study. The Profile of Mood States Inventory showed consistently positive change in score for participants in the group gardening program versus the comparison group. Conclusions: This study identified key influences for growing locally grown food, and approaches for implementing group gardening programs for NA adults.
  • Article
    Full-text available
    Objective To systematically identify and describe studies that have evaluated the impact of gardens and gardening on health and well-being. A secondary objective was to use this evidence to build evidence-based logic models to guide health strategy decision making about gardens and gardening as a non-medical, social prescription. Design Scoping review of the impact of gardens and gardening on health and well-being. Gardens include private spaces and those open to the public or part of hospitals, care homes, hospices or third sector organisations. Data sources A range of biomedical and health management journals was searched including Medline, CINAHL, Psychinfo, Web of Knowledge, ASSIA, Cochrane, Joanna Briggs, Greenfile, Environment Complete and a number of indicative websites were searched to locate context-specific data and grey literature. We searched from 1990 to November 2019. Eligibility criteria We included research studies (including systematic reviews) that assessed the effect, value or impact of any garden that met the gardening definition. Data extraction and synthesis Three reviewers jointly screened 50 records by titles and abstracts to ensure calibration. Each record title was screened independently by 2 out of 3 members of the project team and each abstract was screened by 1 member of a team of 3. Random checks on abstract and full-text screening were conducted by a fourth member of the team and any discrepancies were resolved through double-checking and discussion. Results From the 8896 papers located, a total of 77 * studies was included. Over 35 validated health, well-being and functional biometric outcome measures were reported. Interventions ranged from viewing gardens, taking part in gardening or undertaking therapeutic activities. The findings demonstrated links between gardens and improved mental well-being, increased physical activity and a reduction in social isolation enabling the development of 2 logic models. Conclusions Gardens and gardening can improve the health and well-being for people with a range of health and social needs. The benefits of gardens and gardening could be used as a ‘social prescription’ globally, for people with long-term conditions (LTCs). Our logic models provide an evidence-based illustration that can guide health strategy decision making about the referral of people with LTCs to socially prescribed, non-medical interventions involving gardens and gardening.
  • Chapter
    This chapter argues that there is a natural alignment between family therapy and ecology given that humans and nature are not separate and distinct entities but instead are interrelated. Operating from this premise, this chapter outlines and discusses methods and interventions to utilize in therapy that incorporate nature. Some examples include how to utilize outdoor experiences, using nature metaphors or using nature objects therapeutically, nature restoration experiences, wilderness immersion, and animal assisted therapies. A case example is provided to illustrate the ideas that have been presented.
  • Thesis
    Full-text available
    Esta pesquisa visa contribuir para a implantação de serviços de agricultura urbana (AU) em instituições de longa permanência para idosos (ILPI), de modo que a atividade se adeque às necessidades e desejos dos idosos institucionalizados. As ILPIs são instituições integrantes do campo da hospitalidade, e devido à elevada taxa de longevidade e ao aprimoramento nas condições de saúde dos indivíduos longevos, a inserção do cultivo de alimentos como atividade terapêutica e ocupacional deve atender aos preceitos estabelecidos pelos conceitos de hospitalidade como filosofia organizacional e envelhecimento ativo. O objetivo geral deste estudo é a proposição de um modelo de aplicação prática da AU como serviço de hospitalidade em ILPIs, de modo a estabelecer um fator de diferenciação. Esta pesquisa se caracteriza como estudo de múltiplos casos, de abordagem qualitativa, natureza aplicada e de cunho exploratório e descritivo. Para a seleção dos casos de estudo foram predeterminados quatro critérios, que resultaram na escolha de três instituições. A coleta de dados ocorreu por meio de pesquisa documental, entrevistas, grupo focais e observação, junto a duas unidades de pesquisa: idosos e ILPIs. A análise dos dados foi realizada por meio de triangulação de dados e análise de conteúdo por categorização. Como resultado verificou-se que os idosos institucionalizados demonstram elevado interesse pela prática de cultivo de alimentos e constituem uma demanda para a atividade. Todavia, as ILPIs raramente ofertam atividades de cultivo para seus hóspedes. Também foram levantadas as informações necessárias para o desenvolvimento apropriado do modelo, de forma a atender as exigências regulamentares e promover benefícios tanto aos idosos como às próprias instituições. O modelo proposto não aspira estabelecer maneiras como as ILPIs irão desenvolver as atividades de AU, mas determinar os elementos imprescindíveis para que o serviço de AU seja adequado e configure um diferencial para a instituição. Salienta-se que o modelo pode ser adotado por diversas modalidades de ILPIs.
  • Article
    Full-text available
    The aim of this study was to learn views from healthcare practitioners and the general public for housing communal amenities that could best support senior well-being for ageing in place. The literature review identified 30 popular communal amenities and was tested via a questionnaire survey conducted in Taiwan. Participants (N = 759) evaluated the importance level of the proposed amenities with five-point Likert scale. Data were analysed with Friedman Ranking Test and Kruskal–Wallis test. Results showed that both respondent groups placed outdoor open space, trail and garden with seat as top three important amenities, where outdoor and multifunction were the spatial and functional qualities. While the general public believed physical category amenities were more important, healthcare practitioners put emphasis on social and spiritual categories. Within the general public group, respondents aged 65 years and older had different views than younger respondents on dog run area, BBQ areas and video game room. Swimming pool and religious space were viewed as an important amenity by respondents from different regions. It was concluded that in Taiwan, views may differ with upbringing and cultural backgrounds, residing regions and age. The initial findings can assist policymakers, real estate developers and designers for decision-making in future housing projects.
  • Article
    Full-text available
    Nature-based interventions have been proposed to promote physical and mental health and give stress reduction. Little attention has been given to the potential of zoos for human health and wellbeing. A disadvantaged group in Sweden regarding access to nature are individuals with disabilities who consequently do not have the same access to these health benefits as other groups. To increase awareness and knowledge regarding spending time in nature and with animals, courses directed at caretakers for persons with disabilities and their users were held at Nordens Ark, a zoo in Sweden. To explore if the courses had led to increased nature activities, and if participating in the courses had affected caretakers’ and their users’ health and wellbeing, questionnaires and interviews for evaluating the courses were used. The results showed improved quality in nature visits because of course participation as well as positive effects for the wellbeing, sustainability for the caregivers and users in their working lives, and relationships were positively affected. The conclusion from this study is that nature and animal-based education should be more frequent to provide opportunities for a disadvantaged group to have the positive effects of nature of which most other groups have obvious access to.
  • Article
    Full-text available
    Numerous toxicants contaminate soil and negatively affect the environments that children explore. Accurately measuring these toxicants and characterizing the level of soil contamination may be difficult and must include measurements of both the environmental concentrations and the exposure responses of human populations. This article reviews the current methods and technologies available for quantifying soil contamination. Several intervention strategies exist for limiting human exposure to contaminated soils and the strengths and weaknesses of these methods are discussed. Lastly, current policies on soil contamination and the importance of protecting vulnerable populations by developing means to improve health conditions for children are reviewed.
  • Article
    Full-text available
    In recent years, children’s use of mobile phones has grown rapidly, which might lead to an increase in mental stress and negatively affect their health. Despite increasing evidence that horticultural activity can provide significant health benefits, few scientific evidence-based studies are currently available regarding these benefits to children’s health and wellbeing in schools. Therefore, this study aims to determine the potential benefits of horticultural activity for children from both psychological and physiological perspectives. Twenty-six elementary school students (mean age, 8.12 ± 0.21 years) were asked to perform a plant-related task and a mobile game task for 5 min. During both tasks, physiological sensors were used to measure the participants’ heart rate variability, skin conductance, and skin temperature. Additionally, the participants’ emotional responses were assessed using semantic differential and State–Trait Anxiety Inventory tests immediately after each task. Results revealed that, compared with the mobile game task, participants’ health statuses were positively correlated with the horticultural task, including a considerable decrease in skin conductance and sympathetic nervous activity, together with a marginal increase in parasympathetic nervous activity. Such responses suggested that horticultural activity increased relaxation and decreased feelings of stress. Furthermore, the horticultural activity was associated with a substantial increment in comfort, naturalness, relaxation, and cheerfulness feelings, as well as a significant reduction in depression and a reduction in total anxiety levels. Given these positive benefits, horticultural activity may provide a great contribution to children’s healthy life at school, prompt psychological relaxation and minimize mental stress relative to smartphone games.
  • Article
    Social Prescribing (SP) is the referral of patients to non-clinical services for practical, physical or psychosocial support. Recent guidelines from the National Health Service England mean that SP will become commonplace for people with complex healthcare needs. Autistic adults make up 1% of the population and commonly have co-existing physical and mental health conditions, therefore they are likely to be referred to SP services. As yet, no studies have examined the efficacy of SP for autistic adults. In this letter, we review the existing literature examining the efficacy of SP in the general population. We further examine the factors that should be considered when offering SP to autistic adults in order to optimise outcomes.
  • Chapter
    In the Foreword to Gerard Robinson and Elizabeth English Smith's Education for Liberation volume on educational initiatives in prison, Newt Gingrich and Van Jones note that educational programs “do something powerful: they give hope and dignity to the incarcerated.” The authors wholeheartedly agree and while they recognize the importance of higher education programs that confer degrees and therefore credentials out in the free world, they find that education can be broadly understood in prison in ways that greatly enhance the hope and dignity of the incarcerated. In this chapter, they explore the creation of a Japanese-style healing garden at the Oregon State Penitentiary (OSP), a maximum security, 2,000-person male prison in Salem, Oregon. This prisoner-led initiative was a resounding success, despite all the odds against it, because it was animated by a philosophy of transformative justice that both prison administration and prisoners could believe in, and it embraced the need for meaningful and inclusive community partnerships.
  • Article
    Full-text available
    We are living in an age of concern for mental health and wellbeing. The objective of the research presented in this paper is to investigate the perceived health, social value and happiness benefits of urban agriculture (UA) by focusing on home and community food gardens in South Australia. The results reported in this paper are from “Edible Gardens”, a citizen science project designed to investigate the social value, productivity and resource efficiency of UA in South Australia. Methods include an online survey and in-field garden data collection. Key findings include: dominant home gardener motivations were the produce, enjoyment, and health, while dominant community gardener motivations were enjoyment, connection to others and the produce. Exploratory factor analysis revealed four key factors: Tranquillity and Timeout, Develop and Learn Skills, the Produce, and Social Connection. The key difference between home and community gardeners was an overall social connection. Although home gardeners did not appear to actively value or desire inter-household social connection, this does not mean they do not value or participate in other avenues of social connection, such as via social learning sources or by sharing food with others. The combined results from this research regarding health and wellbeing, social connection and happiness support the premise that engagement in home or community food gardening may provide a preventative or supportive role for gardener health and wellbeing, regardless of whether it is a conscious motivation for participation.
  • The Healing Fields: Working with Psychotherapy and Nature to Rebuild Shattered Lives
    • S Linden
    • J Grut
    Linden, S. and Grut, J. (2002), The Healing Fields: Working with Psychotherapy and Nature to Rebuild Shattered Lives, Frances Lincoln Limited, London.
  • Nature-based therapeutic interventions
    • U K Stigsdotter
    • A M Palsdottir
    • A Burls
    • A Chermaz
    • F Ferrini
    • P Grahn
    Stigsdotter, U.K., Palsdottir, A.M., Burls, A., Chermaz, A., Ferrini, F. and Grahn, P. (2011), " Nature-based therapeutic interventions ", in Nilsson, K. and Sangster, M. (Eds), Forests, Trees and Human Health, Springer Verlag, New York, pp. 309-42.
  • Nature as clinical psychological intervention: evidence, applications and implications
    • A Adhemar
    Adhemar, A. (2008), " Nature as clinical psychological intervention: evidence, applications and implications ", Msc thesis, University of Arhus, Arhus.
  • Supportive nature and stress: wellbeing in connection to our inner and outer landscape
    • A Adevi
    Adevi, A. (2012), " Supportive nature and stress: wellbeing in connection to our inner and outer landscape ", Doctoral thesis, Swedish University of Agricultural Sciences, Alnarp.
    • R Hine
    • J Peacock
    • J Pretty
    Hine, R., Peacock, J. and Pretty, J. (2008), " Working the land ", Mental Health Today, June, pp. 23-6.
  • Article
    There is evidence that some kinds of environmental exposures, including contact with plants, contact with animals, views of landscapes, and wilderness experiences, may have positive health effects. Indeed, this link is the basis for such clinical practices as horticultural therapy. However, the available evidence falls short of what is routinely required of a new medication or surgical procedure. Physicians, health policy experts, and regulators require rigorous evidence of the efficacy and safety of clinical practices. This presentation will introduce the paradigm of clinical epidemiology, the field of medical research that evaluates clinical practices. It will review methods such as the randomized clinical trial, and concepts such as the safety and efficacy of clinical practices. Finally, it will propose a marriage of clinical epidemiology and horticulture, identifying key research needs and opportunities at the intersection of horticulture and human health, and suggesting ways that sound science can help evaluate and advance horticultural therapies.
  • Article
    Full-text available
    Objective To investigate the effect of applying horticulture activity on stress, work performance and quality of life in persons with psychiatric illness. Methods This study was a single-blinded randomized controlled trial. Using convenience sampling, 24 participants with psychiatric illness were recruited to participate in a horticultural programme and were randomly assigned to experimental and control groups. Two participants dropped out from experimental groups after assignment. Ten participants in the experimental group attended 10 horticultural sessions within 2 weeks, while 12 participants in the control group continued to receive conventional sheltered workshop training. Participants were assessed before and after programme using Chinese version of the Depression Anxiety Stress Scale (DASS21) and the Personal Wellbeing Index (PWI-C), and the Work Behavior Assessment. Results There was a significant difference in change scores of the DASS21 (p = .01) between experimental and control group. There were no significant differences in change scores of the PWI-C between the two groups. Conclusion Horticultural therapy is effective in decreasing the levels of anxiety, depression and stress among participants in this pilot study, but the impact of the programme on work behavior and quality of life will need further exploration.
  • Article
    In this paper the powerful relations between mental health and nature are explored with reference to past asylum horticultural practices and to contemporary community gardening schemes for people with mental-health problems in the United Kingdom. Through the use of archival evidence, alongside contemporary voices of experience, understandings of the therapeutic and social dimensions to nature work are outlined and deconstructed. It is argued that particular discourses concerning the powers of nature (work) in managing madness and mental-health problems are largely consistent across time and space (from the asylum to the community). However, in the contemporary era it is particular types of nature work that arguably contribute most directly to state agendas for social inclusion, and therefore to securing the place of people with mental-health problems in mainstream society. By briefly profiling the voices of staff and 'volunteers' from two urban garden schemes in England and Scotland, different experiences of garden work as 'restorative' and as 'interventionist' will be discussed. I conclude by evaluating how embodying and enacting gardening work act as a sustainable vehicle for new versions of social citizenship for people traditionally marginalised in mainstream society.
  • Article
    Full-text available
    Aims and method: Mental Health Recovery Star is a multifaceted 10-item outcomes measure and key-working tool that has been widely adopted by service providers in the UK. We aimed to explore its factorial validity, internal consistency and responsiveness. Recovery Star readings were conducted twice with 203 working-age adults with moderate to severe mental health problems attending a range of mental health services, and a third time with 113 of these individuals. Results: Mental Health Recovery Star had high internal consistency and appeared to measure an underlying recovery-oriented construct. Results supported a valid two-factor structure which explained 48% of variance in Recovery Star ratings data. Two Recovery Star items ('relationships' and 'addictive behaviour') did not load onto either factor. There was good statistically significant item responsiveness, and no obvious item redundancy. Data for a small number of variables were not normally distributed and the implications of this are discussed. Clinical implications: Recovery Star has been received enthusiastically by both mental health service providers and service users. This study provides further evidence for its adoption in recovery-focused mental health services and indicates that items relating to addictive behaviour, responsibilities and work could be further developed in future.
  • Article
    Research on executive functioning and on self-regulation have each identified a critical resource that is central to that domain and is susceptible to depletion. In addition, studies have shown that self-regulation tasks and executive-functioning tasks interact with each other, suggesting that they may share resources. Other research has focused specifically on restoring what we propose is the shared resource between self-regulation and executive functioning. Utilizing a theory-based natural environment intervention, these studies have found improvements in executive-functioning performance and self-regulation effectiveness, suggesting that the natural environment intervention restores this shared resource. © The Author(s) 2010.
  • Article
    Ecotherapy is an umbrella term for a gathering of techniques and practices that lead to circles of mutual healing between the human mind and the natural world from which it evolved. It includes horticultural therapy, wilderness excursion work, time stress management, and certain kinds of animal-assisted therapy. This article provides an overview of research into ecotherapy's treatment efficacy and argues for a psychology of place designed to reconnect people psychologically with the world a place at a time.
  • Article
    In most cases, therapy is addressed as an indoor, verbal, and cognitive activ- ity, with the relationship between therapist and client at its center (McLeod, 2003). This article presents an alternative approach to therapy, conducted in creative ways in nature, addressing the environment not merely as a setting but as a partner in the process. The article includes examples of work that took place with different clients, in varied settings. It aims at presenting basic con- cepts from this young framework that will inspire other practitioners to "open the doors" and explore these ideas with their clients in nature.
  • Article
    Full-text available
    Introduction: Physical exercise has been proven to benefit the general population in terms of mental health and wellbeing. However, there is little research investigating the impact of exercise on mental health and quality of life for people who experience a severe and enduring mental illness. Method: This review aims to describe the effect of physical exercise intervention on the mental health and quality of life of people with severe mental illness. Quantitative and qualitative articles published between 1998-2009 were sourced using electronic databases. Articles were included if the study intervention involved exercise and the outcome measure included mental health or quality of life. Sixteen articles were analysed for common themes and appraised critically. Findings: The findings show that exercise can contribute to improvements in symptoms, including mood, alertness, concentration, sleep patterns and psychotic symptoms. Exercise can also contribute to improved quality of life through social interaction, meaningful use of time, purposeful activity and empowerment. Implications: Future research is warranted to describe the way exercise can meet the unique needs of this population. Studies with a focus on psychological outcome measures would provide greater evidence for its use in therapy.
  • Article
    Introduction: The use of horticulture in mental health settings is widespread. Moreover, its effectiveness is supported by a body of qualitative evidence. Aims: The investigators in this research study sought to determine those aspects of their horticultural projects that conferred the greatest therapeutic benefit to their clients. They used outcome measures to rate the responses of participants, paying particular attention to the participants' expressed motivation. Method: Qualitative and quantitative methods were used to evaluate six horticultural projects. Ten participants were interviewed, using an adapted version of the Work Environment Impact Scale (WEIS) to rate factors that supported their motivation. Fifty participants were assessed, using the Volitional Questionnaire (VQ) to observe and rate the extent of their motivation. Findings: The therapeutic value of horticulture arose from a complex interplay of personal factors, including gender-based preferences, individual interests and social needs. Conclusion: The benefits of engaging in horticultural activity are not automatic. The external environment provides challenges, which can be graded by the facilitators to maximise the therapeutic benefit.
  • Article
    Full-text available
    Purpose: The occupation of gardening has historically generated a wealth of literature. Although espousing its positive impact on wellbeing, evidence is typically anecdotal in nature, with only one major synthesis of reliable evidence to date. This study sought to explore people's experiences and personal meanings of gardening within the literature, from 2003-2010, in order to present a concise body of evidence and to inform occupational therapy practice. Procedures: A meta-ethnography was used in gathering high quality qualitative studies, synthesising through a process of translations, rather than aggregation, in order to preserve meanings from within a range of culturally specific contexts. Four papers, out of 214 initially identified, met the inclusion criteria employed. Findings: This study has identified processes within the occupation of gardening in a natural environment, which offer satisfying and meaningful methods of recovery for people who are marginalised within society. This has been shown on an individual and a community health level. Conclusion: This study has highlighted fundamental links between gardening and wellbeing, and how occupational therapists can broaden practice and have an impact upon health at a community level.
  • Article
    Full-text available
    A sense of belonging is a key element in enabling social inclusion through meaningful occupations. This is evident in occupational science and social and therapeutic horticulture (STH) literature. How these theories interact in practice was explored at Thrive's STH project in Battersea in London. A workshop conducted with Thrive Battersea's therapists examined how gardening may facilitate health and wellbeing through belonging. The authors reflect on themes of belonging from the workshop. The implications for occupational therapy from this apparently rich synergy of occupational science, STH and social inclusion are considered.
  • Article
    The needs of people with serious mental health problems are frequently not met by services and service users' difficulties are further compounded by social isolation and exclusion. Clients attending a community mental health team horticultural allotment group described the importance that they attached to social contact in the group. This study aimed to develop an understanding of how this experience came about so that it could be harnessed more effectively. A qualitative approach was used to explore the subjective experience of meaning that had underpinned regular attendance by nine group members. Qualitative interviews and a focus group generated data, which were examined in the light of concepts drawn from the literature on therapeutic horticulture, social networking and meaning in occupation. The participants described the restorativeness of the allotment setting, a resurgent destigmatised identity and attachment to a highly valued social network. The study concludes that there are particular qualities of the plant-person relationship that promote people's interaction with their environment and hence their health, functional level and subjective wellbeing. The embeddedness of allotments within communities means that they have great potential as media for occupational therapy and as mechanisms for social inclusion.
  • Article
    Full-text available
    Argues that evolutionary heritage underlies humans' consistent preference for stimuli from the natural environment and that research on affective and aesthetic responses is needed to understand human interaction with the environment. It is noted that the rapidly expanding empirical record concerning aesthetic and affective responses to natural environments is in need of a well-developed theoretical foundation. An integrated conceptual framework to address this theoretical lack, drawing on recent theory and research on emotion, is proposed. This framework explains how affects arise in the natural environment; postulates their functions; and links them to cognition, activity in physiological systems, and behavior. The present author, in developing the framework, questions the view that feelings result from cognitive processes, asserting that feelings (not thoughts) are the initial response in environmental encounters. The observer's initial feeling reaction shapes subsequent cognitive events. The relative sequence of feeling and thinking in environmental encounters represents a fundamental issue in understanding human interaction with the environment. (98 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    Full-text available
    An engaged lifestyle is seen as an important component of successful ageing. Many older adults with high participation in social and leisure activities report positive wellbeing, a fact that fuelled the original activity theory and that continues to influence researchers, theorists and practitioners. This study's purpose is to review the conceptualisation and measurement of activity among older adults and the associations reported in the gerontological literature between specific dimensions of activity and wellbeing. We searched published studies that focused on social and leisure activity and wellbeing, and found 42 studies in 44 articles published between 1995 and 2009. They reported from one to 13 activity domains, the majority reporting two or three, such as informal, formal and solitary, or productive versus leisure. Domains associated with subjective wellbeing, health or survival included social, leisure, productive, physical, intellectual, service and solitary activities. Informal social activity has accumulated the most evidence of an influence on wellbeing. Individual descriptors such as gender or physical functioning sometimes moderate these associations, while contextual variables such as choice, meaning or perceived quality play intervening roles. Differences in definitions and measurement make it difficult to draw inferences about this body of evidence on the associations between activity and wellbeing. Activity theory serves as shorthand for these associations, but gerontology must better integrate developmental and psychological constructs into a refined, comprehensive activity theory.
  • Chapter
    Between-group outcome research is a scientific approach to evaluating the effectiveness of psychotherapy and the mechanisms of change associated with those treatments for psychological disorders. This area of research is replete with important methodological issues that need to be considered in order for investigators to draw the strongest, most specific cause-and-effect conclusions about the active components of treatments, human behavior, and the effectiveness of therapeutic interventions. In this chapter, we present the various methodological considerations associated with these experiments. The chapter begins with a description of the different experimental designs from which investigators may choose in designing a therapy outcome study. These designs include the no-treatment and common factors comparison designs, as well as the dismantling, additive, catalytic, and parametric designs. We also present the methodological, client/participant, and therapist concerns that must be taken into account in the design stage of a treatment outcome investigation. Following this, we discuss the measurement of change, starting with the considerations surrounding dependent variables and ending with methods of analyzing data and assessing clinically significant change. Finally, after a presentation on small-N experimental designs, we discuss the importance of scientific research in naturalistic settings. Keywords: design; methodology; naturalistic; outcome; psychotherapy; therapy
  • Article
    ABSTRACT– A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
  • Chapter
    Full-text available
    The need to document the efficacy of nature-based therapeutic modalities is of concern to all who support and encourage this field of endeavour. While a relatively large body of information is available very few of the articles are published in clinical and medical journals that provide the underlying basis for academic, programmatic and policy decisions, and little of it is based on the high level of rigorous research needed to gain respect as a contributing part of health-care science. In addition, the difficulties in forming a coherent profession go beyond the lack of adequate and appropriate research to the core problem of uniform terminology in the field and coherent theoretical framework to guide the research and implementation of treatment. With that conclusion in mind, the majority of this paper will look at models (either as text or diagrams) that have been put forth, as a starting point for establishing effective theories of human-nature interaction in a therapeutic or treatment setting to guide future research in horticultural therapy (HT), animal-assisted therapy (AAT) and Agriculture in Healthcare programs. Based on the experiences discussed relevant to HT, recommendations for future action are given.
  • Chapter
    Full-text available
    The point of departure of this chapter is to view nature-based settings as an important asset for improvement and promotion of health. During the last decades the concepts of healthy nature-based settings and accompanying treatment programs have been referred to by many names, making the subject difficult to interpret. Here the development of the theoretical framework and the research area are described. The second part of the chapter focuses on the structure of a therapy program and the health design of the nature-based setting. From the theories and experiences, including both research as well as best practice presented, the chapter ends with recommendations for future aims of research projects within this area.
  • Article
    Full-text available
    Different conceptual perspectives converge to predict that if individuals are stressed, an encounter with most unthreatening natural environments will have a stress reducing or restorative influence, whereas many urban environments will hamper recuperation. Hypotheses regarding emotional, attentional and physiological aspects of stress reducing influences of nature are derived from a psycho-evolutionary theory. To investigate these hypotheses, 120 subjects first viewed a stressful movie, and then were exposed to color/sound videotapes of one of six different natural and urban settings. Data concerning stress recovery during the environmental presentations were obtained from self-ratings of affective states and a battery of physiological measures: heart period, muscle tension, skin conductance and pulse transit time, a non-invasive measure that correlates with systolic blood pressure. Findings from the physiological and verbal measures converged to indicate that recovery was faster and more complete when subjects were exposed to natural rather than urban environments. The pattern of physiological findings raised the possibility that responses to nature had a salient parasympathetic nervous system component; however, there was no evidence of pronounced parasympathetic involvement in responses to the urban settings. There were directional differences in cardiac responses to the natural vs urban settings, suggesting that attention/intake was higher during the natural exposures. However, both the stressor film and the nature settings elicited high levels of involuntary or automatic attention, which contradicts the notion that restorative influences of nature stem from involuntary attention or fascination. Findings were consistent with the predictions of the psycho-evolutionary theory that restorative influences of nature involve a shift towards a more positively-toned emotional state, positive changes in physiological activity levels, and that these changes are accompanied by sustained attention/intake. Content differences in terms of natural vs human-made properties appeared decisive in accounting for the differences in recuperation and perceptual intake.
  • Article
    Directed attention plays an important role in human information processing; its fatigue, in turn, has far-reaching consequences. Attention Restoration Theory provides an analysis of the kinds of experiences that lead to recovery from such fatigue. Natural environments turn out to be particularly rich in the characteristics necessary for restorative experiences. An integrative framework is proposed that places both directed attention and stress in the larger context of human-environment relationships.
  • Article
    Full-text available
    This study aimed to assess changes in psychological distress and social participation in adults diagnosed with clinical depression during and after participating in a therapeutic horticulture programme, and to investigate if the changes covaried with levels of group cohesiveness during the intervention. An intervention with a single-group design was repeated with different samples in successive years (pooled n = 46). In each year, five groups of 3-7 participants went through the intervention. Data were collected before, twice during, and immediately after a 12-week therapeutic horticulture programme, as well as at 3-months' follow up. Mental health assessments included the Beck Depression Inventory, the State Subscale of Spielberger State-Trait Anxiety Inventory, the Positive Affect Scale from the Positive and Negative Affect Scale, the Perceived Stress Scale, and the Therapeutic Factors Inventory-Cohesiveness Scale. The analysis of the pooled data confirmed significant beneficial change in all mental health variables during the intervention. Change from baseline in depression severity persisted at 3-months' follow up. Increased social activity after the intervention was reported for 38% of the participants. The groups quickly established strong cohesiveness, and this continued to increase during the intervention. The average level of group cohesiveness correlated positively, but not significantly, with change in all mental health outcome variables.
  • Article
    Nature's potentially positive effect on human health may serve as an important public health intervention. While several scientific studies have been performed on the subject, no systematic review of existing evidence has until date been established. This article is a systematic evaluation of available scientific evidence for nature-assisted therapy (NAT). With the design of a systematic review relevant data sources were scrutinised to retrieve studies meeting predefined inclusion criteria. The methodological quality of studies and abstracted data were assessed for intervention studies on NAT for a defined disease. The final inclusion of a study was decided by the authors together. The included studies were heterogeneous for participant characteristics, intervention type, and methodological quality. Three meta-analyses, six studies of high evidence grade (four reporting significant improvement), and 29 studies of low to moderate evidence grade (26 reporting health improvements) were included. For the studies with high evidence grade, the results were generally positive, though somewhat ambiguous. Among the studies of moderate to low evidence grade, health improvements were reported in 26 cases out of 29. This review gives at hand that a rather small but reliable evidence base supports the effectiveness and appropriateness of NAT as a relevant resource for public health. Significant improvements were found for varied outcomes in diverse diagnoses, spanning from obesity to schizophrenia. Recommendations for specific areas of future research of the subject are provided.
  • Article
    Full-text available
    Two studies with single-group design (Study 1 N = 18, Study 2 N = 28) addressed whether horticultural activities ameliorate depression severity and existential issues. Measures were obtained before and after a 12-week therapeutic horticulture program and at 3-month follow-up. In both studies, depression severity declined significantly during the intervention and remained low at the follow-up. In both studies the existential outcomes did not change significantly; however, the change that did occur during the intervention correlated (rho > .43) with change in depression severity. Participants' open-ended accounts described the therapeutic horticulture experience as meaningful and influential for their view of life.
  • Article
    Full-text available
    This paper is a report of a study conducted to assess change in depression severity, perceived attentional capacity and rumination (brooding) in individuals with clinical depression during a therapeutic horticulture programme and to investigate if the changes were mediated by experiences of being away and fascination. Individuals with clinical depression suffer from distortion of attention and rumination. Interventions can help to disrupt maladaptive rumination and promote restoration of depleted attentional capacity. A single-group study was conducted with a convenience sample of 28 people with clinical depression in 2009. Data were collected before, twice during, and immediately after a 12-week therapeutic horticulture programme, and at 3-month follow-up. Assessment instruments were the Beck Depression Inventory, Attentional Function Index, Brooding Scale, and Being Away and Fascination subscales from the Perceived Restorativeness Scale. Mean Beck Depression Inventory scores declined by 4.5 points during the intervention (F = 5.49, P = 0.002). The decline was clinically relevant for 50% of participants. Attentional Function Index scores increased (F = 4.14, P = 0.009), while Brooding scores decreased (F = 4.51, P = 0.015). The changes in Beck Depression Inventory and Attentional Function Index scores were mediated by increases in Being Away and Fascination, and decline in Beck Depression Inventory scores was also mediated by decline in Brooding. Participants maintained their improvements in Beck Depression Inventory scores at 3-month follow-up. Being away and fascination appear to work as active components in a therapeutic horticulture intervention for clinical depression.
  • Article
    Including exercise for the prevention and treatment of mental disorders is a promising area of research for exercise scientists since data indicate that many of these disorders are not treated at all, and there is a significant delay in treatment. This review provides an appraisal of the recent use of exercise to prevent and treat specific mental disorders and provides a recommended framework for future progress of this research. More research is needed to overcome methodological issues to demonstrate the efficacy and effectiveness of exercise and to integrate mental and physical healthcare for widespread dissemination.
  • Article
    Clinically depressed persons suffer from impaired mood and distortion of cognition. This study assessed changes in depression severity and perceived attentional capacity of clinically depressed adults (N=18) during a 12-week therapeutic horticulture program. The Beck Depression Inventory (BDI) and Attentional Function Index (AFI) were administered at baseline, twice during (4 and 8 weeks), and immediately after the intervention (12 weeks), and at a 3-month follow-up. Experiences of being away and fascination related to the intervention were measured at 4, 8, and 12 weeks. The mean BDI score declined 9.7 points from pretest (27.3) to posttest (p < .001) and were clinically relevant (deltaBDI > or =6) for 72% of the cases. The mean AFI score increased 10.2 points from pretest (68.8) to posttest (p = .06). The greatest change in BDI and AFI scores occurred in the initial weeks of the intervention. The reduction in BDI scores remained significant and clinically relevant at the 3-month follow-up (N=16). The decline in depression severity during the intervention correlated strongly with the degree to which the participants found that it captured their attention. Therapeutic horticulture may decrease depression severity and improve perceived attentional capacity by engaging effortless attention and interrupting rumination.
  • Article
    A summary of the main findings of a review of the literature on social and therapeutic horticulture – the use of horticulture and gardening to promote health, well-being and social inclusion among vulnerable people.
  • Article
    This evidence paper summarises the findings of the third and final phase of the Growing Together study of the use of social and therapeutic horticulture (STH) as a form of health and social care provision for vulnerable adults. The first phase of the research, a review of the literature, has already been published (Sempik et al, 2003) and summarised in Evidence Issue 6. The second phase, findings from a survey of STH projects showing the level of activity and participation in the UK were summarised in Evidence Issue 8. Full details of these findings have recently been published (Sempik et al, 2005). In order to study the effects of participation in STH, 24 garden ‘projects’ were examined in depth. Interviews were recorded with 137 clients, 88 project staff and carers, and 11 health professionals. The findings show that STH is an effective form of social care which promotes social inclusion and well-being for people with a wide range of social, mental and physical problems, including those with mental ill health, learning difficulties, challenging behaviour, physical disabilities and others.
  • Article
    Full-text available
    The present literature review conceptualises landscape as a health resource that promotes physical, mental, and social well-being. Different health-promoting landscape characteristics are discussed. This article is based on a scoping study which represents a special kind of qualitative literature review. Over 120 studies have been reviewed in a five-step-procedure, resulting in a heuristic device. A set of meaningful pathways that link landscape and health have been identified. Landscapes have the potential to promote mental well-being through attention restoration, stress reduction, and the evocation of positive emotions; physical well-being through the promotion of physical activity in daily life as well as leisure time and through walkable environments; and social well-being through social integration, social engagement and participation, and through social support and security. This scoping study allows us to systematically describe the potential of landscape as a resource for physical, mental and social well-being. A heuristic framework is presented that can be applied in future studies, facilitating systematic and focused research approaches and informing practical public health interventions.
  • Article
    Full-text available
    El presente art�culo se centra en la modelizaci�n econ�mica y el an�lisis emp�rico de estructuras sostenibles del consumo privado, tratando de extender los modelos econ�micos convencionales de consumo. El punto de partida para el an�lisis de consumo sontenible de energ�a para el transporte es el concepto de funciones de producci�n de los hogares. El punto principal del an�lisis son los servicios de consumo derivados de una combinaci�n de stocks (sistema de transportes) y flujos (principalmente, energ�a). Los patrones de consumo sostenible pueden alcanzarse mediante una sustituci�n de flujos por stocks (por ejemplo, mejoras en la eficiencia energ�tica del sistema de transportes). Los dos factores esenciales en el contexto del consumo sostenible son, por un lado, los cambios en la demanda de los servicios de consumo deseados y, por otro, la estructura de la combinaci�n entre flujos y stocks necesarios para la provisi�n de dichos servicios. The paper focuses on economic modelling and empirical analysis of sustainable structures in private consumption and strives to extend conventional economic consumption models. Starting point for the model analysis of sustainable consumption of energy for transport purposes was the household production function concept. The focal point of the analysis is consumer services derived from a combination of stocks (transport systems) and flows (mainly energy). Sustainable consumption patterns can arise, when within service demand production substitution of flows by stocks (e.g. improvements in energy efficiency of transport systems) takes place. Two essential factors are crucial in the context of sustainable consumption: the demand shifts concerning the consumer services desired, and the composition of the stock-flow mix necessary for the service provision.
  • While institution-bound programs in horticulture therapy were appropriate for the era in which long-term hospitalization was the primary mode of psychiatric treatment, the supported employment paradigm updates this mode of treatment for the current era of community psychiatry.
  • Article
    This paper describes a conceptual model of recovery from mental illness developed to aid the state of Wisconsin in moving toward its goal of developing a "recovery-oriented" mental health system. In the model, recovery refers to both internal conditions experienced by persons who describe themselves as being in recovery--hope, healing, empowerment, and connection--and external conditions that facilitate recovery--implementation of the principle of human rights, a positive culture of healing, and recovery-oriented services. The aim of the model is to link the abstract concepts that define recovery with specific strategies that systems, agencies, and individuals can use to facilitate it.
  • Article
    The results we have recorded represent no new discoveries. The beneficial effects of suitable occupation in mental illness have been known since the time of Pinel. It is our contention, however, that the staffing and administrative problems of mental hospitals may lead to this form of therapy being available only to the "good" patients and to a neglect of the principle(3) that work per se is not the main thing. We have endeavored to show that, provided it is adapted to the patient's particular needs, occupational therapy can improve the condition of even the most "hopeless" cases. Of the 14 patients who participated in our pilot project, only one has failed to show a striking degree of improvement. The other 13 are still mentally ill, but in relinquishing their positions of isolation, they have become better adapted to the hospital environment. This improvement of interpersonal relationships has been accompanied by reduction of socially illtolerated habits, to such a degree that in 2 cases the relatives w...
  • Article
    The current debate about social inclusion in the field of mental health reveals a tension between the political and economic objectives of social policy. The former utilises the language of citizen empowerment and rights, whilst the latter is concerned with reducing welfare dependency through labour market activation. A central question here is whether a suitable programme of therapeutic work, training and support will produce better outcomes than those predicted by either a clinical diagnostic assessment or indeed open employment in the labour market. This article evaluates a research project with mental health users designed to develop pathways towards inclusion. The principal means for achieving this was a programme of 'green' land-based activities, training and social support. The researchers employed a mixed method approach, utilising a quasi-experimental design with a hypothetical control and standardised testing. This was followed by interviews with users, staff and focus group discussion. The evaluation produced some unexpected findings; for example, it was found that no strong correlation existed between diagnosis and performance. Many users performed better than had been predicted by their diagnostic assessment. However, the reasons for this remained unclear until the qualitative interviews enabled users to give accounts of the problems they faced, explain what inclusion meant for them, and outline how the project had brought gains in confidence, motivation and self belief. The data gathered during the research derived from different epistemological positions. This can be seen as representing two ways of 'slicing the reality cake' rather than producing one complete view of mental health users reality. One construction related to how 'the system' diagnosed, processed, and 'objectively' managed them. The other was about how users' responded to their situation, utilised the opportunities available, and made 'subjective' sense of their experience.