Green shoots of recovery.

Lambeth Lambeth Community Care Centre

After years of neglect, calls to seriously integrate nature into healthcare facilities for therapeutic benefit are finally being taken seriously. Rebecca Allmark reports HD Aug 2003.

After years of neglect, calls to seriously integrate nature into healthcare facilities for therapeutic benefit are finally being taken seriously. Rebecca Allmark reports.

It is fair to say that you don't need a medical expert to tell you that looking out onto a beautiful well-tended garden will have a more positive effect on an individual's well-being than staring out at a car park. It has in fact required experts from all over the world to affirm this, and ask why landscaping has been such a neglected area of hospital design why such a fundamental aspect of people's well being has been so easily dismissed as a 'cost' rather than a benefit.

The therapeutic effect of the natural environment has become a hot topic. Academics such as Roger Ulrich and Clare Cooper Marcus have devoted studies to measuring and recording how green spaces make people feel, how they can speed recovery and how this in turn may even save money. Years of scientific research to try and quantify the rarefied notion that nature is 'healing' all to try and encourage hospitals that are currently concrete jungles that natural spaces are something they simply cannot afford not to have.

It is a cause that is gaining momentum and the many lectures, research projects and papers on the subject seem to be bearing fruit as the idea of healing gardens becomes less 'alternative.' Trusts are taking on board what the green-fingered lobbyists have to say and are looking to turn around their previously neglected courtyards and create peaceful havens.

Designer and chairman of Art and Architecture Graham Cooper says that the effective integration of nature into hospitals could mean that patients are returned back to their homes earlier. "Gardens reduce stress and anxiety and can provide emotional comfort," he says. "We should be trying to get people to re-engage with the rhythms of nature to reduce stress, which in turn aids the immune system, making patients better equipped to cope with their recovery." For Cooper the critical factor is engaging with nature to nourish the senses connecting the personal space with the landscape.

This emphasis on connecting with nature is also advocated by Dr Christine Milligan, lecturer and researcher at the Institute of Health Research at Lancaster University. Dr Milligan has found that working in the garden can have a positive effect on well-being, although she says in hospitals this activity would require support. "Gardening requires planning, which keeps the mind active and people can see the results of their labour," she says. "For older people especially, going out and working in the garden can provide a social network and they feel useful passing on their knowledge to other people."

Case Study

Newham Healthcare NHS Trust has invested a great deal of time and effort in the careful planning of how best to turn an unused barren courtyard into an area where patients can sit, escape, and engage with nature. When grants were made available from the King's Fund's 'Enhancing the Healing Environment' project, Newham put a brief together of how it wanted to transform their courtyard into a healing garden on a rather limited budget of £35,000. The Frederick Gibberd Partnership stepped up to the challenge and designed a low-maintenance garden divided into four sensory parts; sight, sound, scent and touch.

Sylvie Gabbey was the landscape architect for the project. She has well-developed ideas of what constitutes a healing garden. "Everyone has different requirements and the design should allow everyone to have their special place," she says. "The planting must be varied and there should be different types of seating so people can be alone or together. Ideally the path should be curvy and long to maximise the walk and give the element of discovery. Every time you go you should see something new. Green is the colour of relaxation, and going outside and having something to look at and getting fresh air breaks the stress and anxiety that simply being in a hospital can create."

Early on in the project Gabbey met patients to get their input into the project. "We went to the hospital and presented colourful images of how the garden might look to a dozen stroke patients and they gave us their responses. From this we were able to build up a picture of what was important to them," she says.

Although the courtyard is not particularly large, Gabbey has maximised this idea of discovery and interest by breaking the area into sensory zones. The first section of the garden provides a pathway surrounded by a variety of architectural plants, all with distinctive form and texture. This "tactile" section is designed to be simple but also to initiate movement across the garden.

The "colour" section of the garden, designed to stimulate sight, offers a choice of seating surrounded by a spectrum of multicoloured planting. A large variety of perennial plants create a changing landscape and a selection of shrubs adds interest throughout the year. A curved path surrounded by fragrant flowers and aromatic foliage planting forms the "intimate" space. The raised bed slopes maximise the view of the plant space enabling wheelchair users to get full benefit. Curved seats are attached to the raised planter and allow users to have close contact to the planting. The colour and intimate sections also provide space for temporary art exhibits and a small venue for entertainment.

The "contemplative" area, which exploits sonic benefits, contains a wall mounted water feature, constructed with a stainless steel sheet to reflect light, that adds a soothing sound to the area (see pic, p18). A single seat has been placed here for users to look at the water feature while being secluded.

Incorporating the arts into the garden was an essential aspect for the trust and is something that Gabbey sees as a key element to any healing space, to relieve the stress of being in hospital. "Art adds so much to a garden," she says. "It gives people something to look at the garden's first purpose. She adds: "Even if it isn't exactly to their taste it does give them something to talk about."

The trust's site development coordinator Adrian Clement is in no doubt of the benefits that the garden will bring to patients: "Newham is an incredibly busy hospital and the main benefit of the garden is being able to get away from the hustle of the ward to go to a place where there is quiet, privacy and personal space something there is often not much of in the hospital itself."

As Newham now looks to develop the other courtyards on the site, Clement is determined that those who hold the purse-strings should take note of the real benefits that investments in landscaping can bring. "We have to convince the people who approve spending that this is something we cannot afford not to do," he says. "We must learn how to persuade them that investing in landscaping has long-term financial benefits. Projects need not be expensive it is about using otherwise dead spaces creatively."

Having packed up their trowels at Newham, the Frederick Gibberd Partnership is currently on site at Charing Cross Hospital, London, providing creative solutions for the new £14m three-storey mental health unit. For this project the landscaping will be arranged over three levels to facilitate access to gardens for patients. As in Newham this will provide much needed greenery in a densely urban area.

The impact that nature can have on people's quality of life and medical outcomes is becoming more widely recognised and Graham Cooper for one is keen to see that the level of expectation is raised with designs focused on patients' needs. To this end he has launched The Nature of Healing Arts, a touring exhibition that features several case studies from recent key hospital projects across the UK. The exhibition features eight panels different settings where patients would come into contact with nature. They explore approaches to applying natural resources to stimulate all the senses.

Cooper's idea is to explore ways of integrating nature into communal areas and within reach of the patient's personal space, providing them with something more than a view from a window.

Projects such as these suggest that we may be turning a corner in providing therapeutic green spaces for patients. Globally, more than a little investment has been ploughed into this research topic and it seems that at last the various strands are being brought together to support the growing acceptance of the benefits within the NHS. Projects such as Newham show that a real impact can be made on a limited budget what is really needed is a serious attitude towards improving quality of life for patients. There is still a long way to go before therapeutic gardens are the norm but at last they are becoming recognised as valid tools for healing.

Note Nature of Healing Design

"The Nature of Healing Art" is a touring exhibition which commences at the Dorset County Hospital on 27 June. The exhibition, which features projects from the UK and Japan, focuses on engaging the users of health facilities with the natural environments. It explores ways and means of applying natural resources to encourage sensory stimulation and emotional comfort, and forms part of a joint UK/Japanese initiative, The Nature of Health Design, which presents the cultural contrast between western and oriental approaches. The exhibition features "positive interventions, which are animated by the elements to stimulate the hospital user," says organiser Graham Cooper. "Each exhibition panel shows potential space along the patient pathway, where art, architecture and garden design works to connect patients to the surrounding landscape." The exhibition will appear in a range of venues, including public locations within participating hospitals and established architecture centres. A series of educational events are to be held at the locations, including the Grounds for Health symposium at the Royal Devon & Exeter Hospital on 4 October. Confirmed hospital venues are: Dorset County Hospital (June -Sept 2003), Chelsea & Westminster Hospital Japan Festival September 2003, Royal Devon & Exeter Hospital October 2003.

Other venues include: The Architecture Centre Bristol and The Lighthouse Glasgow

 

Homepage    Health Design.