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Therapeutic Horticulture

by Tim Spurgeon(more info)

listed in herbal medicine, originally published in issue 71 - December 2001

It is surprising how many people tell me that they find gardening therapeutic. I usually ask them what they mean by that and they often have difficulty explaining it. They mostly mean that doing gardening makes them feel good. It can be used as a place to forget about the worries of daily life, to lose oneself, a retreat or sanctuary.

It is this element of peace and tranquillity that has often been linked to gardens and has been used for many, many years in helping people to recover from illness or as part of a rehabilitation process.

The escape from the rat race into our gardens can easily be linked to the sentiments of Esquirol, the nineteenth-century French psychiatrist who had gardens incorporated into the design of his asylums so that "The calm that the psychiatric patient now enjoys, far from the tumult and noise and the mental rest conferred by removal from their business and domestic problems, is very favourable to their recovery."[1]

Gardening for exercise and health
Gardening for exercise and health

This desire to provide healing through involvement with nature progressed through many stages throughout the eighteenth, nineteenth and twentieth centuries. Before the development of the asylums, treatment was mostly carried out in people's own community - a practice to which we have returned with the implementation of 'Community Care' since the 1980s and 1990s.

However, when the large institutions were being closed down, there was largely no planning to transfer horticultural therapy facilities into the community.[2]

These changes have paralleled medical advances over a similar period. The development of medication to alleviate symptoms as well as the refinement in identifying conditions and then providing more relevant treatments for those conditions have gone on apace. Along with the medical approach, the development of and/or the increase in the use of alternative and complementary treatments have further widened the range of options for people to use.

Of course, some of these treatments are not so new - ever since humans came into contact with plants, they have used them for their benefit; for food, shelter and medicine.

The use of gardens and gardening throughout the ages has survived the changes in approaches and treatments. It is even more widely used today than it has ever been. Its applications vary from formal treatments in forensic psychiatry to horticultural therapy 'prescriptions' provided by general practitioners;[3] from the benefits and use of indoor plants in public buildings to the use of 'green gyms'. They include the use of structured programmes involving practical activities, leading to measurable outcomes, as well as the more informal and passive interaction of simply being in and enjoying the garden.

Rarely are these applications full time and ideally they should relate to the gardening activity people can do at home. The home garden is possibly the biggest resource in terms of green spaces available for the masses in the UK. Nearly 84% of households have access to a garden and, in terms of land area, private gardens make up around 3% of England and Wales - approximately 1 million acres or the size of the county of Somerset, where I live.[4] The same report stated that just over two-thirds of the adult population (67%) claim to garden on a regular basis.

The Health Benefits

The health benefits of gardening have been well chronicled over many years - even at Government level. The Health Education Authority identified gardening as a main method through which older people can get the half-an-hour activity a day that promoted health, strength and mobility.[5] It increases heart rate and the feeling of well-being, and looking out of your hospital window onto vegetation can increase your rate of recovery from surgery.[6]

The 1998 DETR report on the future of allotments in the UK recommended that local authorities recognize and exploit the therapeutic value of allotments for people affected by mental or physical ill health. As well as the psychological benefits of taking part in a rewarding hobby, gardening can help socially-excluded people integrate back into the community, help people rebuild their strength and mobility after an accident or illness and make healthier eating a realistic option for people on low incomes.[7,8]

More than 6 million people in the UK live with sensory or physical impairment, mental ill health or learning difficulties, either from birth or through accident, illness or old age. Gardening is the main hobby of over one-third of the 1.7 million visually-impaired people in the UK, 66% of whom are over the age of 75.[9] Re-learning gardening skills following sight loss can restore confidence in carrying out other aspects of daily living.[10]

The most commonly quoted reason that older people move into residential care is their inability to cope with their garden.[11] However, when people do move, even into sheltered housing schemes, gardening activity reduced from 80% to 15%. Growing vegetables had been given up altogether.[12]

Using your home garden for health benefits is a real option. It is easier and cheaper than going to the gym, aerobics class, swimming pool or any other more formal activity. You can work at your own pace and achieve something as you go along. If in doubt about what you should be doing in the garden - especially after an operation or illness - make sure you get advice from your doctor, nurse, physiotherapist, etc.

However, all this becomes more of a problem if the garden is in a condition that makes it difficult to look after.

There are a number of ways of making sure that you succeed in the garden. They can be divided into three broad headings:

1. The design of the garden of the garden, including what you grow in it;
2. The tools that you use to do gardening;
3. Planning what you do and how to do it.

All these aspects need to be considered to make the most of the garden as an enjoyable health resource rather than a chore and a frustration.

Design

  • Make sure that all paving materials are laid evenly;
  • Make your paths wide enough for you to use with a stick or walking frame, etc.;
  • If a ramp is needed, make sure that it has a gradient of no more than 1 in 15;
  • Make sure that there is good, even access between the house, greenhouse, shed and the most commonly used areas of the garden;
  • Keep paths clean, free of fallen leaves, moss and other debris; this will keep them in a safe condition to use;
  • Cut back plants that are growing over the paths to avoid tripping on them;
  • Avoid plants that are difficult to grow;
  • Choose plants that grow well in the conditions that you have. For example, there is no point in trying to grow alpines in very wet, clay soil;
  • Select plant material that does not require regular or ongoing maintenance;
  • Use ground cover plants to spread over bare ground to cut down on weeding;
  • Reduce the width of borders so that you do not have to stand on them;
  • Over the years, remove the plants that are difficult to maintain;
  • Raising the ground level of the bed might help with access to the soil level;
  • Mulches of bark, plastic, or gravel, etc., will suppress weed growth and conserve moisture in the soil.

Tools

To help you select tools:

  • Try tools before buying - consider the tool weight, grip and balance;
  • Find the lightest tools with the widest handles - they are easier to grip;
  • Increase the handle width by padding out;
  • Choose 'ratchet' type pruners - several easier squeezes cut through the branch;
  • Check what material the tool is made of - stainless steel tools offer less resistance in the soil, and are easier to clean, but are not so sharp. Plastic, carbon fibre or aluminium are the lightest;
  • Look for tools with interchangeable heads - buy a length of handle that suits you to use with a selection of tool heads. The heads can double as hand tools;
  • Good posture makes gardening easier - whatever job is being undertaken keep the back as straight as possible and select tools that allow the correct posture to be maintained;
  • Vary gardening jobs undertaken, so that different body and hand movements are required;
  • Two-wheeled barrows with 'pram' or 'walking stick' handles are generally the easiest to use and can be steered with just one hand.

Planning Before You Start

Plan your gardening not only by seasons but before each gardening session. Take ten minutes in the warm, preferably drinking a cup of tea, and work out carefully what you aim to achieve (be realistic), what tools you require, how much time and strength you will need to tidy up (best to do it as you go along) and what clothes to wear. Warm yourself up with some gentle flexing exercises before getting going to avoid strains and back problems.

Gather all the tools and take them to where you need them. Avoid unnecessary journeys and fruitless hunts in the tool shed, which interrupt the actual gardening and use up your energy to no effect. Attack jobs logically and don't create extra work; for instance, put weeds straight into a bucket and not onto the path where they will have to be brushed up later.

Don't fight yourself. If illness or ageing mean you really cannot manage cutting your hedge by hand, be honest with yourself and either hire or buy a power tool that may solve the problem, liaise with a willing neighbour or, as a very last resort, opt to replace your hedge with fencing.

Once you have achieved what you set out to do, don't move onto something else without having planned it as carefully.

If you implement those above points that are relevant to you, your garden really will become an area for positive health. In the words of Gay Search in her recent book, Healing Gardens, "...unlike other forms of exercise which are an end in themselves and so can become boring very quickly, gardening has a tangible end product - a beautiful garden and delicious home-grown produce - as well as health benefits".[13]

There is one extra aspect to ensuring that you get the most from your garden and it is perhaps the most important aspect for any gardener. It is having somewhere comfortable to sit and do nothing more than admire what you have achieved and enjoy the garden - preferably with a drink in you hand!

Further Information

For further information please contact Thrive at The Geoffrey Udall Centre, Beech Hill, Reading RG7 2AT; tel: 0118 988 5688; or e-mail Tim Spurgeon at: tims@thrive.org.uk
Find out more about the work of Thrive by visiting its website at http://www.thrive.org.uk and about easier gardening at http://www.carryongardening.org.uk, which has been used as an information resource for this article.

References

1. Esquirol De la Folie. Quoted in Shorter. Op cit. Paris. 1816.
2. Ryan A and Spurgeon T. Community Based Horticultural Therapy for Mentally Ill People. Growth Point. 32(HT132). 1987.
3. Blackthorn.
4. Mintel. Gardening review. Leisure Intelligence. MINTEL. London. 1997.
5. Health Education Authority. Guidelines: Promoting Physical Activity with Older People. HEA. London. 1997.
6. Ulrich RS. View from a window may influence recovery from surgery. Science. 224: 420. 1984.
7. House of Commons. The Future of Allotments, Volume 1. Report and Proceedings of the Committee. HC560-1. Environment, Transport and Regional Affairs Committee, House of Commons, London. 1998.
8. Crouch D, Sempik J and Wiltshire R. Growing in the Community: Good Practice Guide for the Management of Allotments. LGA Publications. London. 2001.
9. Bruce I, McKennell A and Walker E. Blind and Partially Sighted Adults in Britain: the RNIB Survey. Volume 1. HMSO. London. 1991.
10. Spurgeon TP. Carry on gardening: supporting visually impaired gardeners. in Stoneham J and Kendle A eds. Plants and Human Well-being. Sensory Trust and Horticulture for All. 1996.
11. Ryan A. Networks for Elderly People. Growth Point. No. 50. Summer 1992.
12. Stoneham J and Jones R. Residential landscapes: their contribution to the quality of older people's lives. in Wells SE ed. Horticultural Therapy and the Older Adult Population. The Haworth Press. London. pp17-26. 1997.
13. Search G. The Healing Garden: Gardening for the Mind, Body and Soul. BBC Worldwide Ltd. London. 2001.

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About Tim Spurgeon

Tim Spurgeon is Advisory Services Manager with Thrive, the national (UK) charity promoting the use of horticulture and gardening for training and employment, therapy and health. Trained as a horticulturist and teacher of adults with learning difficulties, he has worked for 28 years in various therapeutic horticulture settings. He is now responsible for Thrive's services to individual older and disabled gardeners, research in therapeutic horticulture and links with international work.

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