Sustainable Communities? Nature Work and Mental Health

Hester Parr

Department of Geography University of Dundee

Sustainable Communities? Nature Work and Mental Health

Hester Parr, University of Dundee

Contents Page

Introduction and acknowledgements 2

Executive summary 3-5

Full Report Section 1:

Aims and objectives of research 6

Methods 7

Case study project profiles and visuals 9

Section 2

Literature and policy review 16

Section 3

Research Findings 24

Accessing garden projects 24

Gardening as a therapeutic activity 27

Gardening as a social activity 31

Gardening as a physical experience 35

Achieving social and community integration through urban nature work 37

Gardening as work and work training 42

Difficulties with garden work 46

Section 4

Conclusion 49

Visioning sustainable public mental health 53

Section 5

1

Reference list 55

Sustainable Communities?

Nature Work and Mental Health

Introduction

This report documents the findings from an Economic and Social Research Council (ESRC)

funded research project (RES-000-27-0043) on mental health, nature and social inclusion. It

draws on small-scale qualitative research conducted during 2004 with a range of organisations

in the UK, but predominantly in Scotland, that facilitate gardening work by people with

severe and enduring mental health problems. The executive summary highlights the main

findings from the project as well as highlights recommendations for policy and good practice.

Acknowledgements

This research was made possible by a grant awarded by the ESRC and I wish to thank them

for their support.

I would like to thank the participating projects for their time. In particular, I would like to

thank the staff and volunteers of each project for sharing their thoughts and giving their

generous assistance.

2

January 2005.

Executive Summary Study and methods

5 Garden projects across the UK were accessed in order to understand the role of

community garden work in assisting people with severe and enduring mental health

problems to achieve social inclusion and stability. 40 taped in-depth interviews with

garden workers were carried out: 20 volunteers (people with mental health problems)

and 20 paid support staff. 18 non-taped interviews were also carried out with

volunteers. Ethnographic observations over a period of 6 months were carried out in 2

garden projects (averaging at 2 days per week over the period).

Summary of Findings

Access to garden projects

• The gender and ethnic constitution of garden projects are dominated by white

British males

• Access to garden projects is dependent on adequate knowledge and awareness

amongst other mental health service providers

Gardening as a therapeutic activity

• Gardens, gardening and nature are generally experienced as therapeutic by

volunteers and staff

• The therapeutic effects include a variety of positive emotions and behaviours

• Volunteers experience the therapeutic effects of gardens in both active and passive

ways

Gardening as a social activity

• Gardening activities involve a range of social opportunities for isolated volunteers

• Garden work can involve senses of shifting social roles for volunteers

• Staff and client relationships can benefit from joint garden work

Gardening as a physical experience

• Garden work helps raise levels of physical activity amongst a sedentary group

• Different physicals skills and strengths may be developed

• Physical activity can help in the management of symptoms of ill health

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• Healthy eating levels may be increased

Achieving integration through urban nature work

• The location and layout of garden projects affects the opportunities for community

contact and integration

• Local communities integrate with garden projects in a range of practical ways

• Volunteers can feel increased senses of belonging as a result of garden work

Gardening as work and work training

• Most garden projects offer horticultural training and qualifications are highly

valued amongst volunteers

• There are perceived barriers to volunteers moving on from garden project work,

particularly into mainstream employment

• There are few ‘next step’ opportunities for trained volunteers

Difficulties with garden work

• Gardening work is physically and socially demanding for staff and volunteers

• UK garden projects are limited in their activity by weather and need to diverse

into other areas

• Resourcing, staffing and funding levels are a constant problem in terms of

adequate support, expertise and equipment.

Conclusions

• Garden work helps people with mental health problems achieve social inclusion

and stability

• Garden work seems to be most effective in terms of widening opportunities for

social inclusion and social networking when garden space is located in or near to

residential areas

• Contact with both nature and people facilitate stabilising effects

• People with mental health problems feel a range of primarily positive emotions

when engaged in garden work

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• Participating in garden work brings opportunities to rework stereotypical

constructions of ‘the mental patient’ through active citizenship in local

communities

Recommendations

• Gardening and mental health projects need to create better access routes for

women and ethnic minorities, especially in Scotland

• Horticultural therapy and social and therapeutic horticulture need a higher profile

with social and health care services at a national level

• National level good-practice guidelines need to be developed and co-ordinated

across all types of gardening projects

• Local authorities could develop innovative approaches to social inclusion and

social care by linking these to urban environmental regeneration

• Visioning the future opportunities for ‘next step’ employment for people with

mental health problems and other groups could be tied into a re-invigorated ‘green

social economy’

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Section 1

Aims and objectives of research

Academic context

This work is part of a larger funded research programme [ESRC RES-000-27-0043] about

mental health and social inclusion and concerns how people with mental health problems

experience social stability through participating in different kinds of spaces. The spaces under

investigation are categorised as natural, artistic and technological. What this means in practice

is that the research programme looks at examples of innovative community programmes and

projects that facilitate the participation of people with mental health problems in (i) gardening

activities, (ii) art and performance work and (iii) the use of the internet for social support. The

research programme is primarily academic in orientation and designed to facilitate the writing

of a book about mental health and social space by Dr Hester Parr of the University of Dundee.

However, the research conducted as part of this programme also has implications for users of

service, practitioners and policy makers. As such the results are being made available in easily

accessible formats in terms of printed reports, a web-site with further information and data

(http://www.dundee.ac.uk/geography/inclusion/) and a short video film (distributed by the

National Programme for Mental Health and Well-Being in Scotland)1.

Objectives

This study set out to investigate the relationship between community gardening

activities and people with severe and enduring mental health problems in terms of the

following overall questions and in the context of the voluntary sector projects that

organised this activity:

• How does working with nature help to achieve social inclusion and stability for

vulnerable groups?

• How are unstable identities positively changed through physical interactions with

land?

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• What do people with enduring mental health problems feel about garden work?

• Are there ways in which garden work might be best facilitated amongst this group?

• What are the key outcomes of garden work for this group?

• Are there any wider implications for public mental health?

This research was also directed primarily by academic questions about human selves

and identities in everyday social life and spaces, although the more user and policy

friendly findings are reported here.

Methods

A pilot study had taken place in March 2000 in the Ecoworks garden project in

Nottingham whereby staff and volunteers2 had been interviewed about the advantages

and disadvantages of garden work for people with severe and enduring mental health

problems (Parr, 2000). The findings from this project (Parr, 2000) were used as a basis

for designing and researching the current research programme on community

gardening for and by people with mental health problems. Ethical permission from

The Tayside Committee on Medical Research Ethics (and permission from the local

health authorities in which the participating garden projects were based) was attained

in January 2004 for the new research, itself facilitated by funding from the ESRC.

New research work took place between April 2004 and November 2004 involving 5

garden projects across the UK and sited in Glasgow, Edinburgh, Perth, Nottingham

and London (project profiles are below). In each project paid staff and volunteers were

interviewed about their role in the garden, their gardening experiences and feelings

about the work in which they participated. Semi-structured interview schedules were

used in each project that covered a variety of relevant key themes such as:

• History of garden project attendance

• Expectations of garden projects

1 The film will be finished in June 2005. Details from the author.

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2 In many voluntary sector projects, people with mental health problems are termed ‘users’ or ‘clients’. In many garden work projects for this group, however, other labels are used such as ‘volunteers’ or ‘workers’ or ‘staff’. For the projects accessed as part of this research, this was because it was felt that such terms avoided stigmatising those involved in garden work. This report will adopt the term ‘volunteer’ when referring to people with mental health problems, and ‘staff’ when referring to those workers who are paid to support gardeners with mental health problems. It is recognised that non-hierarchical ways of working means that some projects do not differentiate between gardeners in this way.

• Outcomes of garden work

• Reflections on therapeutic aspects of garden work

• Reflections on the social and practical skills gained as a result of garden work

• Experiences of work and training for work

• Managing and funding gardening and gardeners

• Future prospects and visions

Interviews were between 30 minutes and 1.5 hours long, were mostly taped and

carried out on-site in the garden projects. The taped interviews were then transcribed

and analysed for key themes using a basic coding framework through the NVIVO

software data management package. In all, 40 taped interviews were carried out with

staff and volunteers across the 5 garden projects. This included 20 taped interviews

with volunteers and 20 interviews with staff (with a wide range of roles and

connections to the projects concerned). A further 18 shorter non-taped interviews with

volunteers took place in the context of ethnographic (participant observation) work

over the course of the research period at several projects (but mostly focused on

Ecoworks, Nottingham and The Coach House Trust, Glasgow). Taped interviews with

volunteers included 18 with males and 2 with females and informal non-taped

interviews included 2 with females. In terms of staff, 10 females and 10 males

participated in interviews. All participants in this research project except one were

white British in terms of ethnic background.

Ethnographic research

Ethnographic research is otherwise known as participant observation, whereby the

researcher participates in the activities and social worlds under study and then records

observations and reflections in a research diary. This is then used to triangulate and

verify claims made by interviewees in verbal disclosures. The ethnographic work in

this project was concentrated in two sites over a period of 6 months. Recorded

observations are not re-presented as data in this report, but serve to contextualise some

of the more general comments on how garden projects operate and their

characteristics.

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Please note that all quotations from volunteers and staff in the report are anonymised

or attributed to pseudonyms.

Brief Garden Project Profiles

The ESRC research programme looked at 5 gardening projects for people with severe

and enduring mental health problems in 2004. 2 were sited in England and 3 were

sited in Scotland. Although there are considerable differences between each project in

terms of location, range of activities, client base, size and funding, for the purposes of

this report, common themes will be drawn out which apply to all. Academic and

conceptual implications of the research are reported in more depth elsewhere in Parr

(forthcoming, 2005).

Broad types/categories of garden space

• Allotments in residential areas

• Allotments on ‘wild’ common land/allotment site

• Removed garden spaces (walled gardens)

• Community gardens (predominantly used for project work, but with public access)

• Community gardening, landscaping and recycling projects

Ecoworks, Nottingham

Location: Inner city, St Anns, Nottingham

Type: Allotment (on ‘wild common land/allotment site’)

Annual Income: (2003-4) Approximately £55,000

Major Funders: County and City Social Services; NOF Healthy Living Centre; The

Community Fund; The Scarman Trust; Esme Fairbairn Foundation and other

charitable sources.

Service users: 6 (current) – 30 [varied numbers of volunteers and staffing over 10

year period]. Predominately white British client base, 90% male clients [previously

other ethnic minority groups have been involved].

Staff currently employed: 3 part time posts

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Remit: to provide gardening opportunities for disadvantaged people, including those

with mental health difficulties, and to promote integration between different people

and groups through garden work.

The Coach House Trust, Glasgow

Location: Residential area, West End, Glasgow (with multiple sites across North

West and South Glasgow)

Type: Community gardening and recycling project/community garden

Projected Annual Turnover 2004: £800,000

Main funders: Scottish Executive Strategic Waste Fund Not For Profit Sector;

Greater Glasgow Health Board; Social Work Department, Glasgow City council; New

Opportunities Fund; ERDF (European Regional Development Fund); other charitable

trusts.

Service users: 60 [98% male, 99% white British].

Volunteers: 19

Staff employees: 30

Remit: To counter social exclusion amongst a range of groups (those who are

unemployed and those with learning difficulties, drug and alcohol addiction and

mental health difficulties) through participation in a range of activities and training for

work opportunities.

The Walled Garden, Perth

Location: grounds of Murray Royal Hospital, Perth.

Type: Removed walled garden

Budget: (est/approx): £140, 000

Main Funders: Social Services; NHS Health Department.

Service users: 35 [80% male, 20% female, 100% White British]

Staff employees: 5

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Remit: To provide a supportive horticultural work environment for those with mental

health problems.

Redhall Gardens, Edinburgh

Location: residential/conservation area, South Edinburgh

Type: Removed walled garden

Budget: (est/approx) £138,000

Main funders: Social Work Department, City of Edinburgh and NHS Lothian.

Service users: 36 [60% male, 30% female, 5% ethnic minority representation]

Staff employees: 5 full time, 1 part-time

Remit: To provide a supportive horticultural work environment for those with mental

health problems.

St Mary’s Garden, Hackney, London.

Location: Inner city/residential/warehouse district, Hackney

Type: Community garden

Budget: (est/approx) £110,000

Main funders: Thrive; The Learning Trust, Hackney; Social Services (Learning

Disability Service and Community Mental Health Teams; Neighbourhood Renewal

Fund; New Deal for Communities, varied charitable trusts.

Service users: 30 (Male 62% Female 38%, 63% from black and ethnic minority

groups]

2 full time staff, 2 part time staff

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Remit: To provide therapeutic horticultural and work training opportunities for those

with mental health problems, learning disability, HIV and young offenders. To also

provide a community garden for the local community with a resident key holder

scheme.

Different gardening project spaces

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Section 2

Context for the study: A brief literature and policy review

Nature and health

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There is a multi-disciplinary and international literature base that has long evaluated

the varied connections between nature and health. Writing and research from

environmental psychology, nursing, ecopsychology, planning, wilderness therapy,

therapeutic horticulture, human ecology and human geography have all contributed to

a rich, if diverse, evidence base about perceived beneficial connections between a

range of nature-spaces and a range of aspects of human well-being (Kaplan et al,

1990; Kaplan, 1995; Maller et al, 2002; Morris, 2003; Sempik et al, 2003; Gesler,

1993; Gesler and Kearns, 2002). From early environmental psychology studies which

famously highlight the benefits of nearby nature for post-operative hospital patients

(Ulrich, 1983) to more recent work on the positive mental health implications of

woodland play for children (Bingley and Milligan, 2004), to the reported benefits of

gardening for refugees and survivors of torture (Lindon and Grut, 2002), health-nature

relationships are deemed important across many disciplines and international contexts

in terms of building human well-being and social and psychological capital. Although

it is impossible to do full justice to this literature base here, some common themes

emerge from research work that has looked at nature-health relations and these serve

to connect individual human health with local community and global community

health issues. There is hence a dominant message from this literature that nature can be

generically understood a resource for human health on several different scales and in

connection with a range of issues. The following list summarises just some of the ‘big

picture’ themes that traverse the nature-health literature in terms of perceived key

benefits:

Table 1: Nature use/relations and individual/community health benefits

• Restorative properties for general human mental and physical health and well-

being

• Therapeutic properties for a range of groups with different mental health and

physical health needs

• Building social capital and strong/er communities through collective uses of nature

• Environmental impacts and eco-sensitive awareness raising

• Global and local sustainability issues

• Food security and alleviating poverty

These benefits are potentially accessed through a range of different kinds of activities

and relations in different kinds of nature spaces:

Table 2: Diverse nature spaces

• Parks

• Urban nature spaces

• Forests and woodlands

• Farm and agricultural land

• Community gardens

• Allotments

• Private gardens

• Wilderness areas

• Seascapes and watery landscapes

• Institutional natures (in hospitals, workplaces, schools, prisons, clinics etc)

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The benefits of cultivating, living near, using, being and playing in nature in its

varied forms, but particularly in urban spaces of population concentration, is fuelling

research efforts to better understand the beneficial outcomes summarised above.

Recent EU initiatives, for example, are attempting to harness the research capacity that

exists to link nature spaces and human health (COST E39, 2004-2008). Current

funding strategies include facilitating collaborative engagements between different

academics and practitioners in order to collate the evidence base relating to health and

nature across Europe (see also ‘policy context’ below). There are also a wide range of

NGOs who contribute to our understanding of the practical capacities of nature spaces

in terms of the broad benefits to individual and community health.

Gardening, horticulture and health

One very specific aspect of the relationship between nature and health has formed the

basic context for this study. Gardening and horticulture3 has received considerable

attention in recent debates over the health-giving capacities of nature (Francis et al,

1994; Relf, 1992; Cooper Marcus et al, 1999; Simpson et al 1998, Sempik et al,

2003).

While the health implications of gardening and horticulture are thought to be

relevant for the general population as well as specific groups (such as the elderly,

children, people who are ill, offend, have dementia, learning difficulties or physical

disabilities), it is those with mental health issues who are privileged here. Indeed, the

known relationship between domesticated nature (gardens, landscaped park land, farm

land) and health can be argued to have specific roots in institutional health care for

people with mental health problems. Gardens and gardening were recognised as a

therapeutic medium for institutionalised populations since the late 1700s both in the

UK and the US where the benefits of field labour for asylum patients were noted by

contemporary psychiatrists of that period (Davis 1998; Paterson, 1997; Digby, 1985;

Philo, 2004, Parr 2005). In the 20th century, and building on asylum practices in the

19th century, occupational and rehabilitation practitioners of various persuasions have

extensively adopted what has been termed either ‘horticultural therapy’ or

‘therapeutic horticulture’ in relation to a range of vulnerable groups and settings

(Goodban and Goodban, 1990ab; Kaplan, 1995; Nehring and Hill, 1995; Seller et al,

1999; Simpson and Strauss, 1998). These terms respectively refer to the use of plants

and garden work to meet clinically defined goals (a treatment strategy), and more

generally, the well-being that may develop from gardening in both active or passive

ways:

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3 ‘Horticulture’ refers to the practice of cultivating plants, while ‘gardening’ can more generally refer to other activities such as weeding, landscaping, creating beds for plants, harvesting and so on.

‘Horticultural therapy is the use of plants by a trained professional as a

medium through which certain clinically defined goals may be met’

‘Therapeutic horticulture is the process by which individuals may

develop well-being using plants and horticulture. This is achieved by

active or passive involvement’ (Growth Point, 1999, p 4, cited in Sempik,

2003, p3)

In order to depict the current place of garden work in the UK’s community welfare

infrastructure, Sempik et al (2003) settle on the term ‘social and therapeutic

horticulture’. This term is used to indicate that horticultural activity with

disadvantaged groups is not often strictly clinically orientated, but rather is aimed at

providing opportunities to ‘improve the well-being of the individual in a more

generalised way’ (ibid, p4). The commonalities across different disciplines and

studies in terms of a convincing, but largely unacknowledged, evidence base for the

health-promoting dimensions to horticulture and gardening are summarised below and

can be seen to crystallise around the benefits of gardening in terms of individual and

collective health and social improvements:

Table 3: Some reported benefits of garden work amongst vulnerable groups

(after Sempik et al, 2003 and Morris 2003)

• Improved self-esteem and self confidence

• Development of work and social skills

• Development of independence

• Opportunities for emotional expression and reflection

• Enhanced spiritual and sensory awareness

• Useful employment

• Increased physical activity and exercise

• Consumption of healthy food in sociable ways

• Improved opportunities for social cohesion and behavioural improvements

• Accessing to opportunities for social inclusion

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Despite the positive messages from most research on horticulture and health, caution

must be also exerted in terms of thinking through how and under what circumstances

such benefits are achieved for particular participants. For example, many institutional

gardens may not provide the same opportunities for social cohesion and healthy eating

as a community based garden. Community gardening projects are also often

predominantly male spaces, as this research indicates, and there maybe multiple

access issues concerning different natural spaces (see below and Kurtz, 2001). Any

benefits must therefore also be understood alongside the local conditions and

circumstances through which garden work happens, as well as considering what

national guidelines might help to ensure the above outcomes for all (see concluding

comments).

One of the key points of interest for practitioners and policy makers is how

gardening and horticultural work facilitates social inclusion for vulnerable or

excluded groupings. In arguing how this work often involves key components of

‘social inclusion’, Sempik et al (2003) suggest that collective gardening, enacted

through community social welfare projects, enables gardeners with mental health and

other difficulties to participate in processes of

i) Consumption [buying/consuming the goods that other people

buy/consume]

ii) Production [engagement in socially valuable activity]

iii) Social interaction [the building of social networks and identity]

iv) Political engagement [self-determination and empowerment]

These elements are argued to be key dimensions of social inclusion (after Burchardt et

al, 2002 and cited in Sempik et al, 2003, p37) and processes from which people with

severe and enduring mental health problems (for example) may have been distanced

through institutionalisation. In this view, engagements with domesticated nature and

gardening are powerfully associated with current social policy goals, those being the

integration and normalisation of previously excluded people in everyday society.

Political and community contexts

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Mental health and mental health care have been recently linked with major

policy initiatives in the UK connected with ‘social inclusion’. Both the EU and the UK

can be seen to be pursuing a raft of policies connected to this concept. In current

political discourse the buzzword of ‘social inclusion’ is associated with access to

employment, good housing and health, education and participation in a wide variety of

social and economic arenas (Scottish Office, 1999; Scottish Executive, 2003a), while

conversely ‘social exclusion’ is associated with unemployment, poor housing, ill-

health, crime and lack of community participation (Social Exclusion Unit, 2001). In

terms of mental health it is clear that policy makers link ‘social inclusion’,

‘participation’ and the ‘improvement of clinical outcomes’ (Sainsbury Centre for

Mental Health (SCMH), 2002, p2; National Service Framework, 1999), and so

promote links between inclusion outcomes and mental well-being. For both ensuring

and maintaining mental well-being amongst the general population, then, and specific

improvements in terms of people who have experienced illness, opportunities for

community participation, education and inclusion are thought to be key dimensions to

success.

In the UK more generally there is a current political emphasis on active

participatory citizenship, facilitated by multifarious funded partnerships between the

state and communities (Fyfe and Milligan, 2003). This coincides with health care

policies that have sought to relocate the everyday lives of people with severe and

enduring mental health problems within community settings in order to end isolating

and stigmatising institutionalised care (Scottish Executive, 2003b). Simultaneously,

the drive to counter exclusionary processes and positions that many people in living in

poverty and disadvantaged communities find themselves located within has been

politically important (Social Exclusion Unit, 2001, 2004). The role of nature in this

broad political context is complicated, but has in various ways provided a platform

upon and through which politicians, communities, organisations and individuals have

claimed rights, sought participation, attained resources and articulated global and

‘traditional’ local community values in the search for an improved society. Combined,

the influences cited above are all driving factors as to why nature generally, and

horticulture for those with mental health problems specifically, is currently of interest

in UK communities and voluntary sector organisations.

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There are also now significant national forums for the promotion of inclusive

nature spaces (for example, Thrive, The Sensory Trust, The Federation of City Farms,

Greenspace and Greenspace (Scotland)) and which can be understood to be broadly

attempting to facilitate new links between citizenship, well-being and nature.

Community gardens are increasingly popular in UK cities and are open spaces

managed and operated by members of the local community for a variety of purposes

(Holland, 2004) including vegetable growing, recreation, training, education and

health promotion. Ideally community gardens exist to maintain or facilitate senses of

community in particular places and the aims of community participation and

empowerment is what (potentially) links the community garden idea with horticulture

for mental health. However, despite the growth in community gardens, and some

examples of integrated community work, most gardening work undertaken by people

with mental health problems occurs in special project spaces, which can hence

potentially limit the claimed advantages for social inclusion. Nonetheless, there is

some evidence of a greening of social policy and a greening of the voluntary and

community sector, a development surely framed by wider national and global politics

of environmentalism and sustainability. Such a national UK political context can be

argued to be conducive to the more widespread development and funding of

horticultural and community gardening work by people with mental health problems.

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In Scotland The National Programme to Improve the Mental Health and Well

Being of the Scottish Population (and Action Plan 2003-6) reportedly flows from the

Scottish Executive's commitments to social justice and health improvement.

Demonstrating an interest to exploring innovative means to build community well-

being (Scottish Executive, 2003c) as well as dismantling stigma about mental health

issues, the role of diverse nature spaces are arguably under-explored as a means

through which social inclusion and participation might be achieved. However, given

the stated commitments to ‘joined up’ thinking and action across mental health

promotion, prevention and treatment sectors (Henderson, 2004), there are possibilities

for the natural urban environment to be an imaginative focal point for action relating

to public mental health. In disadvantaged communities with poor social housing stock,

for example, the development of community garden work and accessible natural

spaces (by people with mental health problems amongst others) could assist in

building public mental health by facilitating safe participatory spaces of everyday

community life.

Table 4: Political contexts for new nature-health relations

• Community mental health care

• Political interest in improving public mental health

• European and UK focus on social exclusion

• Scottish focus on social inclusion and mental well-being

• Growth of environmental pressure groups

• Global, national and local environmental politics

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In summary, there are multiple global, national and local contexts for the current

development of community garden work and the adoption of urban natural spaces as

an innovative means of achieving and maintaining health amongst both general and

specific population groups.

Section 3

Research Findings

Accessing garden projects

There is no one route to participating in gardening and mental health projects and

volunteers were variously referred by CPNs, GPs, social workers and from in-patient

care. Informal access can also occur with self and social network referral being

commonly cited as pathways to gardening. Once referred applicants are usually

interviewed for their suitability for horticultural work and formal funding is applied

for. On the whole, most schemes sought clients or volunteers who were relatively

mentally stable and physically mobile, although some (varied) provision was made in

all schemes for wheelchair access. The diagnostic categories and labels applied to the

garden workers who contributed to this study are not recorded in detail, but ranged

from schizophrenia to bi-polar and to depressive and anxious conditions.

‘Well I actually heard about the Coach House when it was just beginning to start up. I had a friend that stayed near here that knew about it and she showed me it. But also my young sister helped arranged the funding for this when it was Belmont Gardens, before it became the Coach House’ Mel, Volunteer4 ‘My GP had mentioned it just in passing and so … I had no preconceived ideas’ Halley, Volunteer

Most volunteers report having few expectations at the point of project access,

beyond wanting to change isolated social positions, although some are at a point of

wanting to develop skills and participate in training after months or more usually

years of mental health care. However, many volunteers talked about the fear they felt

at entering a gardening project and the challenge of beginning work in an

environment of which they had little knowledge or expertise. What is valued at the

point of access is a supportive and clearly structured introduction to gardening tasks.

Working in peer teams where there are a range of abilities and levels of expertise is

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4 Please note that all quotations from volunteers and staff in the report are anonymised or attributed to pseudonyms.

also valued at initial access points. Women volunteers (few as they are) discuss the

challenge of entering male dominated work spaces and the importance of ensuring

women friendly spaces as well as the flexibility of working alone in gardens.

‘I was referred by my CPN who thought it would help, but when I came here I had never been near a garden in my life and I didn’t know anyone and I didn’t like it’ Kim, Volunteer ‘Basically I was looking for it as a permanent job, something I could do and develop in and utilise my skills and learn new ones’ Bill, Volunteer

Staff report how important it is to have good relationships with a range for

service providers in order to raise the profile of gardening and horticulture as viable

community activities for people with mental health problems. Some projects,

however, face major difficulties in maintaining consistent referral patterns for several

reasons:

• the perception of gardening as a ‘luxury’ service in already stretched

mainstream service budgets

• a lack of awareness amongst primary care providers (such as GPs) and the

difficulties of accessing them to raise awareness

• the unstable nature of funding sources in the voluntary sector resulting in

fluctuating staff numbers with knock on effects in terms of referrals.

In terms gender imbalance issues, garden project staff often locate the problem

at the point of referral with service providers outside the project perceiving gardening

and outdoor work as predominantly male activities and thus targeting those clients.

For long-established projects with a predominately male client base, few specific

strategies are employed to widen access to women. Only one project in the study had

specific women-friendly access routes and women-only garden spaces and activities.

‘When the project first started there was a lot of heavy work involved and so it tended to be men who came and now if you speak to women who come and see round the place, you can see that they are intimidated by the amount of men, particularly when there’s young men for example. It is difficult. The ethnic mix is the same – we only have 1 black person and 1 Asian person’

25

Staff

‘We mail shot all the GPs in the borough … it’s about 60 … and then followed up with phone calls with GPs or practice managers or whoever we could talk to … and we got a positive response … but not a single GP has referred anyone to us’ Staff

In terms of ethnic minority participation in garden projects there are different

factors that may contribute to gardening projects being predominantly white spaces,

including a general lack of integrative mental health service provision across different

ethnic groups (which may influence referral patterns) and differing culturally based

gardening practices and experiences of cultivation amongst particular ethnic groups.

In respect to the latter point, however, some sectors of ethnic minority groups place

particular cultural importance on cultivation (such as some older Black Caribbean

men) and so shared gardening and allotment work could act as an important resource

in addressing ethnic ghettos in mental health care. Similarly, refugees and asylum

seekers often arrive in the UK from land-based economies and may benefit from

mental health services that are focused on cultivation. Ecoworks in Nottingham is one

project from this study that had active involvement with a group of asylum seekers

before their deportation in 2003. St Mary’s in London is a project that attracts the

attention of multiple ethnic groups in the locality and who also use the space as a

community garden. Natural space arguably therefore holds the potential to act as a

bridge to hard-to-reach groups who may have complex mental health needs.

Key summary points

• Access to garden projects is dependent on knowledge and awareness amongst

other mental health service providers

• Volunteers are often fearful at point-of-entry to garden projects if they lack

horticultural experience

• The gender and ethnic constitution of garden projects is dominated by white

British males

• Women-friendly access routes to project garden spaces are few

• Gardening as a focus for culturally sensitive mental health service delivery for

ethnicity minority groups is under-explored

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Gardening as a therapeutic activity

Volunteers come to gardening projects with a range of experience of natural and

cultivational spaces, but with most having some exposure to these in association with

their mental health care. For some, this can mean an ambivalent relationship with

nature work, and something they associate with difficult times of their lives, or

services that did not suit them or gave them little choice. For others, who have little

experience, the work involved and the knowledge it requires can seem daunting.

Although there may be latent beliefs about health giving capacities of nature that may

underlie their initial decisions to access garden projects, few volunteers were

conscious of this affecting their access routes. It is common for volunteers to discuss

how they gradually came to experience nature and nature work (gardening and

horticulture) as therapeutic only after some time with the projects concerned.

Of the 38 volunteers interviewed as part of this study, 90% of them discussed

what might be summarised as broad ‘therapeutic effects’ of garden work. These

effects can be summarised as follows (using vocabulary by volunteers):

Terms used by volunteers to explain the therapeutic effects of garden work

• Therapeutic

• Calming

• Grounding

• Occupying

• Distracting

• Focusing

• Healing

A large majority of the volunteers discussed how general interactions with the natural

world and gardening activity in particular had helped them recover from mental health

problems, or at least helped to maintain their health status. Ethnographic observations

carried out as part of this study confirms that garden work sometimes helped to calm

erratic behaviour and provided a focus for negative energy and anger in difficult

times.

27

‘When you feel angry you just dig furiously, I associate gardening with getting anger out of the system more than anything else … it’s about getting rid of energy into the soil somehow. There is something about releasing anger into the soil’ Josh, Volunteer, ‘Between leaving the house and walking up here you feel different, you’re glad you came. As soon as you come up here it does have an effect on you … a positive effect … of leaving behind stuff … it helps to break the rhythm of stress’ Mandy, Volunteer

There are two dominant ways in which nature and garden work are deemed beneficial

for volunteers:

• as a passive sensory environmental experience that prompts positive reactions

and

• as a medium for action (physical, social, psychological) through which the

volunteer creatively works for their own health.

In other words, volunteers both held or developed beliefs about nature and gardens as

inherently healthy (automatically benefiting them) and as a medium for creative

healthy action (non-automatic health benefits).

Particularly important in terms of the therapeutic benefit of the garden projects

was horticulture itself, ie the cultivation of plants. This may be both because the

practice of plant growing is in itself experienced as therapeutically beneficial, and

also because plant growing features heavily in staff explanations of the benefits of

garden projects, and volunteers are influenced by these discourses. For example, plant

growing was discussed by many volunteers as:

• Involving care and concern beyond the self

• Helping to ground confused thinking

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• Involving positive emotions such as hope, pride and love

‘You have to focus on the plant, you have to go with that and it helps you, it just helps to ground you’ John, Volunteer ‘If you plant something it’s dependent on you, you have to slow your thoughts down to the speed of the plant and what’s happening to it. It fixes you … it’s quite a responsibility to care for the garden’ Kyle, Volunteer

Plants and plant growing are also often used as metaphors by both staff and volunteers

to discuss social and psychological difficulties. While this is a recognised feature of

horticultural therapy, many project staff do not claim to be practising such a formal

programmatic approach to garden work with mental health services users. Rather,

garden staff (often who are not trained mental health specialists) refer to the ‘natural’

healing capacity of gardens and garden work that they merely facilitate in a

generalised way.

‘… there’s lots of little magical spaces that people have here, where you just wander around and it just fills you up really and I suppose it’s allowing nature to heal you really ...’ Colin, Volunteer ‘The garden and gardening is healing really. It’s about the earth, it grounds you when you are totally disorientated by the world around you’ Peta, Volunteer

Staff in garden projects unsurprisingly held strong beliefs about the

inherent healing qualities of nature, as well as the social and educational

capacities of natural spaces for skills training (see below). Garden staff, therefore,

play an important role in terms of how gardens and gardening are experienced as

therapeutic by volunteers. Garden staff and garden projects differ in terms of their

emphasis on structured work programmes, the amount of therapeutic talk using

plant metaphors, their discussion of the natural healing power of nature and this

all influences the experience of gardening for volunteers.

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In general, where volunteers had relative freedom to develop areas of the

garden, or had responsibility for their own part of a plot for growing, they were

more likely to discuss at length the therapeutic effects of nature and gardening.

Where volunteers were more used to general landscaping and gardening in teams

or with close supervision, they were more likely to discuss at length the beneficial

social effects of gardening with others, rather than the therapeutic capacities of

nature per se.

‘I think that gardening is therapeutic for a lot of people… ill or not, disabled or not … it is basically using gardening whether it is self administered therapy or with the help of someone else to affect positive changes in lives’ Staff ‘We are organic and we are encouraging life to come in. That’s an interesting thought really, actually encouraging life into the site is the same as the life in the people as well … it’s about allowing people to express their energy, in the way that they want to’ Staff ‘I think particularly if you’re suffering like I’ve done with severe depressive episodes, it’s hard to think beyond surviving in the minute. You’re just wanting to get through the next minute almost or next few seconds. To actually look at a piece of ground and think, ‘that’s what it is like now, and then in 3 weeks time this will be like this, and then in 3 weeks time it will be like this, and then in 3 months time it will be like this’. You’ve actually started to create a future with the bit of earth that’s in front of you, and for yourself, which is something you don’t have’ Andrew, Volunteer

Finally, garden space itself is seen as importantly bound up with the

therapeutic experience of nature. Project gardens and allotments were primarily seen

by volunteers as variously:

• Safe spaces

• Creative spaces

• Tranquil spaces

• Spaces of retreat

• Social spaces

• Community spaces

The geography of garden spaces was also important with zoned gardens being the

most successful in creating accessible space suitable for use by people in different

psychological and physical states.

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‘I like the patterns on the worms, the patterns, they look like floaters in your eyes the worms. I like the noise of the bees buzzing outside, I like the sound of the wildlife outside, aye’. Callum, Volunteer

Key summary points

• Gardens, gardening and nature are generally experienced as therapeutic by

volunteers and staff

• The therapeutic effects include a variety of positive emotions and behaviours

• Volunteers experience the therapeutic effects of gardens in both active and passive

ways

• Plant cultivation is particularly important in discourses of healing

• Garden staff are also positive about the healing potential of gardens and garden

work and their beliefs and practices can influence volunteers

Gardening as a social activity

While most collective activities in community mental health services involve

opportunities for socialising (and garden work is no different here); there may be

particular aspects to the social activities that constitute this work that are worth

noting:

Social dimensions of community garden work

• Peer network opportunities

• Neighbourhood social contact opportunities

• Staff and client social contact

• Team working opportunities

• Food and social eating events

• Role shifting

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To pick up on just a few of the above list, the seasonal rhythms of garden work

means that work is differently paced throughout the year with a variety of tasks. This

not only tends to keep volunteers interested, as well as allowing for both able and less

able workers, it also lends itself to the creation of social opportunities based around

garden work. In summer times, and at times of harvest, when produce is plentiful,

most garden projects have social events both for workers and for wider

neighbourhood users (see below). The social significance of groups of people eating

produce grown by volunteers is particularly meaningful, and contributes to feelings of

pride and satisfaction, as well as providing a focus for conversation.

‘When I took manic depression and was classed as ill and hospitalised, I lost all my friends and even most of my family. They cut me off and I wasn’t included in anything anymore. So I’ve been having to try and start again at the Coach House. Not necessarily at the Coach House, but at that level. The Coach House now has basically replaced all the ones that I’ve lost’ Kevin, Volunteer

In terms of staff and client contact, garden work provides (some) opportunities

for collaborative engagement, rather than just top-down support and/or instruction

from the staff to the client. Volunteers also felt that their own service providers saw

them differently as a result of their garden work, as well as being able to (eventually)

provide semi-expert horticultural support to paid garden staff. In some projects the

atmosphere of collaborative equality established through garden work translates to a

‘work place’ atmosphere, whereby staff and volunteers often celebrate the end of a

working day or week with a visit to the local pub.

Some other aspects of garden work also allow volunteers opportunities to see

themselves in rather different social roles, moving from positions of dependence to

becoming more independent and embodying a status of ‘responsible worker’. Such a

move is discussed as being facilitated (for example) by the use of power tools like

saws and lawn-movers. Volunteers discuss the importance being trusted to use such

equipment, as for people with severe and enduring mental health problems, ‘trust’ is a

particularly meaningful relation.

‘The guy again with the fuchsias … is quite knowledgeable and he in the past has taken a great deal of the responsibility of the garden himself, he could partly run this place himself as could a few others’ Staff ‘Many of the decisions on what’s planted and how it’s planted is done jointly within the garden team’ Staff ‘I can feel that I can be trusted with a lawnmower’

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Jack, Volunteer

‘They (the CPNs) see me differently, they see me more settled ... getting on with my life and being motivated ..’ Tim, Volunteer

Team working is also a feature of many garden projects, especially where

there is not space to allow individual gardening plots. Team working was especially

helpful to new project members as it enabled peer instruction and support to take

place. Volunteers also felt that team work enabled friendships to be more easily

established. For volunteers who were established members of garden projects, the

peer support and instruction helped them to achieve senses of self-worth and job

satisfaction, as their roles shifted from ‘just’ ‘patient’ to ‘garden worker’.

‘If I’m feeling depressed, it’s nice to go out and work in the team along with the support staff … I feel that I’m in a safe environment, in amongst a safe crowd, there’s nobody sort of looking or talking or doing anything, and I’m working along with a lot of other people, volunteers and staff and whatever that are in the same boat’ Mick, Volunteer ‘I’m quicker and I’ve got experience, but you’ve got to allow for others, you’ve got to work together and some people are faster, some people are slower …. Sometimes I help them out, perhaps they’re having difficulty or whatever ... I just give them a hand to get it done …’ Tim, Volunteer

In addition, primary care workers (CPNs or support workers) beyond the garden

projects were sometimes invited in to work alongside volunteers in the gardens or

allotments. This was considered a beneficial practice as volunteers could demonstrate

activity, concentration and expertise to care workers who may have only regarded

them in the passive patient role previously.

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In some projects there are mixed working teams of people with mental health

problems and people from the local community (although this is not common), and

here there are opportunities for social integration that stretches beyond peer and staff

networks (see also below). In such schemes, it is important to stress the equality of all

volunteers, regardless of ability.

‘Ecoworks have a policy of calling everyone a volunteer and I might be on the management committee and helping with funding raising and someone else might need help with keeping his jumper on in the garden, but we’re both called volunteers and no one ever makes a distinction about ability or mental health status or anything’ Kit, Volunteer

Staff report that garden work can make differences to the social skills of

volunteers. Volunteers are commonly discussed in terms of their progression from

withdrawn and isolated social states to a point at which they are able to socially

engage with others. Staff often use the environment as a way to encourage

conversation with quieter members of gardening teams, arguing that the shared nature

of garden work and the ability to focus on natural surroundings reduces the pressure

on people who find socialising and maintaining relationships and conversations

difficult:

‘It’s very easy to look at something and say come and have a look at this in the pond, or come and have a look at this that’s flowering or whatever and that provides visual distractions that are useful. It makes it an easy setting to talk to people …’ Staff

As reported in the literature, there is some evidence from this study that people

involved in garden work subsequently gain experience of new social roles, partly tied

to increased political awareness of their roles as consumers of mental health services.

Some volunteers participate in garden management committees, team meetings and

planning processes associated with garden work. Others present talks on mental health

to interested parties or get involved with national conferences on horticultural or

mental health issues. While garden work does not seem to be particularly notable for

the raising of political awareness and participation amongst its volunteers, there is

evidence that this does occur.

Key summary points

• Gardening activities involve a range of social opportunities for isolated volunteers

• Garden work can involve senses of shifting social roles for volunteers

• Socialising and routine conversations can be linked to the natural environment

• Teamwork in garden can involve peer support

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• Staff and client relationships can benefit from joint garden work

Gardening as a physical experience

An important part of garden work is the benefit gained by increasing the physical

activity of people who lead very sedentary lifestyles. For many people with severe

and enduring mental health problems, medication use and lack of daily activities and

structure in their lives can mean that they are not usually physically active. This has

implications both for physical fitness and psychological health. Staff in garden

projects point out that the lifestyles of people who live in institutional care, or who are

predominantly bound into mental health care networks, often feature what are

conventionally understood as ‘unhealthy’ characteristics such as:

• High rates of smoking

• Low rates of physical activity

• Diets lacking in nutrients

Engaging in garden work can raise levels of physical activity to levels that suit the

abilities of the worker involved. Many volunteers in this study reported beneficial

effects of physical activity in terms of the impact on mental health and sleeping

patterns (possibly reducing medication use):

‘If it’s winter time and you’re digging … you’re going to dig like mad to keep warm’ Kim, Volunteer ‘Gardening is a very good piece of exercise and it’s like having relaxation …’ Mick, Volunteer ‘It’s physical and I enjoy it, at the end of the day to be quite frank I get a good nights sleep, because I’ve been moving and active’ Tim, Volunteer ‘You’re that tired you realise, oh I got that anger out you know. The frustration you take it out …’ Jock, Volunteer

Both staff and volunteers point out that garden work can mean not only increasing the

amounts and levels of physical activity, but also the development of different physical

strength and skills as they develop through particular tasks such as:

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• Manual dexterity with seedling and plants

• Handling complex garden equipment with care

• Building muscle strength with lifting and digging

• Visual focusing on seeds, plants and wildlife

For some volunteers, the physical benefits acquired from garden work are not only

tied into strength, relaxation and skills, but also connect to the acquiring of different

sensual and sensory experiences, which simply expand and improve their sense of

‘quality of life’. Particularly for those garden workers who work in allotment

environments, where they are exposed to prolonged experiences of wood-smoke,

fires, rain, cold and heat, physical experiences can be quite profound:

‘People for instance living in a residential home, it can tend to be a very stifled and claustrophobic environment. So people having the opportunity to come to somewhere like this, where it is open, and they can get out in the fresh air and get wet through if it’s raining, and get muddy, is actually quite an unusual thing. To have somewhere to sit by the fire and all this sort of stuff, I think is important.’ Ade, Volunteer ‘It’s about getting dirty, it’s about shoving your hands in the ground.’ Steve, Volunteer

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In times of ill-health the physical dimensions of garden work can take on more

meaning in terms of both the difficulties and the relief that this can bring. For those

who have experienced disabling levels of depression, for example, the challenge of

garden work can seem too physically demanding at points. For others, acute phases of

illness involve different physical experiences of garden work. For those with bi-polar

illness for example, frenetic and high-speed garden work can help to channel energy,

although this pace of work can be disruptive and alarming to others. Zoning garden

work can help to alleviate this problem.

‘You can suit a job to how you’re physically feeling. If I’m really tired and got no energy I can sit and sort seedlings’ Dave, Volunteer ‘I was once in the garden helping to mix some compost, and the big bin was oozing and they were doing it on a tarpaulin, but I was a bit hyper that I did it so hard and fast that I stretched the entire tarpaulin beneath it and around it. But the staff were fine about it, they were understanding. I got the work done fast though’ Mick, Volunteer

Garden project staff also argue that improved healthy eating is a key physical

outcome for participants who have mental health problems. For those newly resident

in community settings, or who live in institutional care, diets are often poor due either

to levels of cost or a lack of skills in terms of the preparation and consumption of

fresh fruit and vegetables. All of the garden projects in this study provide food for

their volunteers on a daily basis, and most used produce from the garden or allotment

(although not consistently throughout the year). This practice results in the double

benefit of raising consumption of nutritious (often organic) food and celebrating and

sharing the result of communal work efforts.

Key summary points

• People with mental health problems may have conventionally unhealthy lifestyles

• Garden work helps raise levels of physical activity

• Different physicals skills and strengths may be developed

• New sensory experiences may be acquired

• Physical activity can help in the management of symptoms of ill health

• Healthy eating levels may be increased

Achieving social and community integration through urban nature work

37

People with mental health problems who work in gardening and horticultural projects

report in general that their social networks are often strengthened as a result of their

participation. While there may be particular features of the social relations that are

created and maintained in garden projects (see above), there is a sense in which any

collective community activity amongst mental health service users will be likely to

strengthen peer networking to some extent. Beyond the formation of social

networking and development of social integration with other project users and project

staff, it is useful to discuss the wider potential for community integration.

In terms of wider social and community integration, the projects that took part

in this study had developed in different ways. For the projects based on allotment sites

or removed nature spaces, the potential for integration with community residents was

diminished, although relationships between individual and other plot-holders workers

were in evidence/had the possibility of being created5. For garden projects based in

densely populated locations, the integration between the project, its workers and the

local community is particularly important and forms the basis of commentary in this

section.

The garden projects under study comprised the following types of ‘garden

space’:

Broad types/categories of garden space

• Allotments in residential areas

• Allotments on ‘wild’ common land/allotment sites

• Removed garden spaces (walled gardens)

• Community gardens (predominantly used for project work, but with public access)

• Community gardening, landscaping and recycling projects

In general, the latter two ‘types’ provide most opportunity for face-to-face interactions

between volunteers and local community members. The allotments and removed

gardens provide less opportunity for daily contact with local community members

(based on reported and ethnographic observations) due to their less accessible

physical locations and site features (such as high border hedges or walls).

In terms of the community gardens and community landscaping projects,

being literally placed within well used residential and commercial spaces offered

multiple opportunities for volunteers to build senses of belonging and community in

place. The function of such spaces and schemes (ie. regenerating and creating usable

and visually pleasing green spaces) increase the sense in which volunteers are seen as

‘useful citizens’ providing local services, instead of ‘just’ receiving services. Both

staff and workers agree that (in particular) the transformation of wild or wasteful

38

5 These projects did hold well-attended social and open events for local communities.

urban nature into manicured and aesthetically pleasing public spaces is a powerful

symbol of the purpose and capacity of people with mental health problems. Such

symbolic transformations of space serve a dual purpose; as they involve the practical

re-skilling of a deskilled population: and help to convince local residents that people

with mental health problems contribute to the improvement of community life:

‘The people round about are great, they see what a great job the Coach House does and I think it helps empower everyone that’s here because the people around … don’t look at the negative side of people, they look at the positive side and they don’t look and say, ‘well because they’re disabled they can’t do that’ … there are some people in here, myself included, that are classed as being not able to live in society, and we’ve got our problems, but the level of knowledge and the things they [we] can do is incredible – you’ve seen yourself’ Terry, Volunteer ‘What we’re trying to do here is help people realise their full potential as opposed to everyone being at the lowest common denominator …. A lot of people from the local community are in and out the building all the time, or they’re in the shop, or they see people round the lanes and they can see what people are doing, and they just get involved. They [the volunteers] all speak to people, the people coming to do their recycling or coming to buy their herbs, so it’s all part of the community, it’s about breaking the fear factor ….’ Staff

While community landscaping, and community gardens provide value for the local

community, which helps the acceptance of mental health services (breaking down the

NIMBY factor), organic food production also benefits residents and provides points

of interest for nearby schools and so on. Such contact is important in terms of

breaking down barriers to integration due to stigma and negative attitudes towards

mental health issues. Community garden projects help local people understand that

people with enduring mental health problems can work, are able and can interact in

friendly, sociable ways on an everyday basis.

Urban gardening projects, then, can be argued to help to engineer change in

the social status of this group. More pragmatically, for the people involved, gardening

in community settings helps them in becoming more confident literally to be and to

socialise within these spaces. As a result, shifting expectations and relations are

traceable in the neighbourhood streets around which these kinds of activities are

based:

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‘It [the garden work] does change attitudes, it does, because you become more socialised, you get to meet people, talk to people, it becomes therapeutic as I say, you get to know people and it helps you a lot. It’s a familiar place with familiar faces and you get to know them you know …’ Gavin, Volunteer

Evidence of levels of integration between volunteers, projects and local communities

included the encouraged patronage local pubs ‘after work’, the support of the local

residents’ committees, sharing sheds and tools with neighbours, operating local

resident key holder schemes, selling garden produce, having significant local support

for ‘open days’ and gaining commissions for private landscaping and garden work.

Such examples suggest that fear and stigma are not the dominant ways in which

project workers are understood.

Examples of integrative social relations between garden projects and

communities

• Local resident committee support

• Routine community use of garden project space

• Routine conversations between community members and volunteers

• Sharing tools and garden sheds with neighbours

• Local key holder schemes

• Garden produce sales

• Collective use of local cafés and pubs by project workers

• Commissions for garden work

• Large numbers at open days

40

Ethnographic work over several months at one garden project confirms that

local residents do interact with garden workers on a daily basis, and that in some cases

casual friendships are formed between certain residents and workers that are

sedimented by routinised visits and conversational exchanges in the gardens.

However, there are limits to these inclusionary relations in that not many (if any)

volunteers appear to have built sustainable friendships that cross the community-

project divide that involve private home visits or phone calls (although this true of

most work-place settings). Despite this, some workers feel valued as a result of their

work in local community settings. These are very unusual words from someone with

severe and enduring mental health problems:

‘You’re not isolated in a wee box on your own, you’re part of the general community and well respected’ Mike, Volunteer

Volunteers seem to feel most pronounced senses of local integration when

they have worked on community gardens or private garden spaces through contract

work. Examples of social integration can occur on allotment sites, however, whereby

fellow plot holders share produce and advice about growing, visit project space and/or

offer visits to their plots. However, allotment spaces, like some community gardens

can risk isolation if their physical layout is not conducive to casual community

encounters, or if they are located away from busy allotment roadways or residential

areas. Such gardens and allotment sites offer other advantages in terms of protective

or restorative space for garden work while also still acting as important spaces of

social contact amongst volunteers6.

Gardens and allotments can occasionally be the focus of negative community

actions with acts of vandalism being recorded in some projects that formed this study.

There is little to suggest that these are the result of negative attitudes towards mental

health issues. Moreover, it is suggested that there may be beneficial implications for

wider public mental health, as discussed below.

Key summary points

• The location and layout of garden projects affects the opportunities for community

contact and integration

• Community garden work offers the potential to change attitudes to mental health

issues

• Local communities integrate with garden projects in a range of ways

• Volunteers can feel increased senses of belonging as a result of garden work

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6 It is important to note that these spaces are not ‘asocial’ when it comes to community contact, they simply do not have the same amount of casual, daily encounters with local residents as other garden spaces. This does not make them any less of a valuable resource.

Gardening as work and work training

4 of the 5 garden projects that contributed to this study claimed that their project was

in part orientated towards work and work training. For garden staff and project

managers training for mainstream work is often important in terms of funding and the

criteria under which this is acquired. Managers claim that health and social services

(often core funders for such projects) are understanding about the needs and skills of

the client base, but that they also require attempts to move volunteers on from projects

after a set period of time to further education, training or work. This depends,

however, on the client and the funding stream. Volunteers encountered in this study

had attended projects from between 1 month to 8 years, with the majority attending

for 3 years or more. There were no formal pathways to work in any of the projects in

the study and only a handful of examples of volunteers who had moved onto full time

mainstream work were cited by project staff.

In terms of formal training, all the garden projects had, at some point in their

history, offered horticultural training qualifications (such as SVQs, City and Guilds,

NVQs and John Muir Trust Awards). Approximately 30% of the interviewees in this

study had acquired some sort of qualification as a result of their participation in the

projects they attended7. For those that discussed the gaining of qualifications, this

resulted in feeling of achievement and pride, although not always directly in any

further education, training or work. In terms of ambitions, most volunteers aspired to

mainstream work, although not in always in gardening and horticulture. However,

they were also realistic in terms of their self-assessed low likelihood of success. Staff

were also pessimistic about the reality of moving volunteers into mainstream work

and pointed to the contradiction of external pressures to train volunteers for job

markets that are not likely to accommodate their needs. Green jobs relating to

gardening and horticulture are also in short-supply in the mainstream economy. For

some projects the solution to this problem is to create paid jobs for volunteers (and

there were examples of people who had moved on within particular organisations);

although the barriers to doing so are keenly felt by both staff and volunteers alike in

terms of:

42

7 Some volunteers could not remember or did not know.

• Losing benefits and access to supported accommodation

• Being exposed to workplace performance pressures

• Coping in a work environment where other people have mental health

problems

Turning to the garden work itself, some volunteers understood their gardening

activity as ‘real work’, and not as recreation, therapy, education or training. In some

projects expenses are paid to volunteers (a maximum of £20 per week) and these are

regarded as wages, reinforcing the notion of (some, but not all) garden projects as

primarily work spaces.

‘I see it as a real job for me … I see it as a lot of responsibility and I have to get out of my bed to come in you know and sometimes I struggle with that. I’m still on medication and that makes me tired in the morning …’ Peter, Volunteer ‘I think a lot of people will just stay here. I don’t think it’s like you come here and learn stuff and just move on, although I might look at that one day you know …not that I would know how or anything but … I don’t want to run before I can walk you know … I am fortunate to be here in the first place’ Rodney, Volunteer ‘I can’t earn anymore than £20 or my benefits would be affected … it’s something to look forward to.’ Tim, Volunteer

For some projects (such as The Coach House Trust), who attain money from other

sources than health and social services for environmental regeneration work, the

emphasis on work is justified by staff and volunteers by claiming that they are funded

to provide a local green community service. Many volunteers here discuss their work

in these terms.

‘I do feel like I am providing a service through the Coach House to help the local environment and how to protect the Glasgow’s district environment … they pay your wages, they give you £20 a week and that’s good money. I work here Tuesday, Wednesday and Fridays 1-4pm for that.’ Tony, Volunteer

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Conversely, to other volunteers, the garden work seems easy compared to what they

know or imagine of mainstream employment and it is conceived more as therapy or

even relaxing recreation. Some volunteers see gardening as an escape from the

pressures of mainstream work. In one project there was attempts to provide two

different but linked gardening experiences relating to these perceptions by zoning

some garden spaces for therapeutic and restorative work and some as highly

productive or highly landscaped training spaces. However, only having formal or

clearly defined progression routes from one to the other enables this strategy to work

effectively.

Garden staff across the 5 projects differed in their approach to gardening as

work and work training. While some garden programmes are well structured with

defined tasks and clear daily, weekly, monthly and seasonal planning, with rotated

working roles for particular individuals and teams, other projects are adhoc and

seemingly disorganised about working roles, training and schedules. For some staff,

this latter situation is a principled approach to working with people with mental health

problems, while for others it is a source of frustration as mainstream work ethics do

not seem to define garden project spaces:

‘If you’ve got a job you feel more part of society, you can hold your head up, you can speak to people easier, you discuss the Coach House. And the Coach House is quite well known now so whenever you do discuss it you always get into a pretty good conversation’ Kevin, Volunteer ‘My job is getting people job ready and I can’t get people job ready if lunch is supposed to stop at 12.45 and people aren’t getting to work until 1pm or 1.15pm … there’s sitting down for a couple of fags before they get going you know? In a real job would that happen – no! your boss would come in and order them to work …’ Staff ‘If somebody’s saying I don’t want to do this, I’m not about to say ‘well, you’re doing it’. That’s not right. I wouldn’t stand for that, so I don’t see why anyone else should, you know. But if they come along and do a bit then that’s great. It’s whatever level people are contributing, it’s valued.’ Staff

For all staff working with people who use strong medication, who may not be

physically strong and who lose concentration easily, training can be challenging and

there are numerous ways in which they seek to engage volunteers in gardening work

tasks:

44

• Providing clear instruction and explanation

• Repeating instructions and explanations

• Demonstrating the task

• Matching volunteers with appropriate tasks

• Creating understanding of task duration (start, process, end)

• Supporting and supervising the worker

• Being flexible with work speed and breaks

For projects that provide private garden contracting work, such levels of support may

be impossible to balance with the needs of the commissioning client, and one

difficulty is clearly maintaining this income stream and work experience base for

volunteers at the same time as providing a viable commercial service.

Project managers bemoan the lack of opportunities for green employment as a

‘next step’ for their volunteers. Staff suggest that proactive local state employment

policies might look to the social care sector for the provision of trained workers who

could then benefit regeneration initiatives, simultaneously addressing unemployment

levels amongst people with mental health problems, tackling stigma and improving

the environment.

Key summary points

• Gardening is understood as work and work training by most staff and some

volunteers

• Most garden projects offer horticultural training and qualifications are highly

valued amongst volunteers

• There are perceived barriers to volunteers moving on from garden project work,

particularly into mainstream employment

• Volunteers sometimes value garden work as a service to the local community and

think of their expenses as wages

• Garden projects differ widely in terms of their organisation of work and

philosophies about working amongst people with mental health problems

• Combining supportive work amongst people with severe mental health problems

with commercial contracting services is not easily achieved

45

• There are few ‘next step’ opportunities for trained volunteers

Difficulties with garden work

All garden projects face challenges of working with a client base who have complex

needs, use medication, have varying capacities for physical work and may not have

any experience of gardening and horticulture. For most projects similar difficulties

surrounding issues of endurance, strength, concentration and adaptation were

common in terms of training and working with volunteers. In the UK, and Scotland in

particular, the weather also determines the level of garden work which is possible, and

all projects found that offering alternative activities (such as classes, workshops, arts

work) were necessary to supplement the physical garden work in bad weather and in

winter time.

For some projects, the gardening work carried out in public spaces was

deemed extremely important in terms of the levels of local community acceptance.

Therefore there is sometimes a pressure between the need to maintain visually

pleasing and productive gardens for the local residents, and working with people who

easily damage beds and plants and are not always neat and tidy in their gardening

practice. In one garden project there were also problems with volunteers and staff

(allegedly) using project space for personal or illegitimate activities (like drinking and

drug-taking), which created controversy amongst other garden workers who felt local

community relations were at risk, as well as the mental health of other volunteers.

46

In terms of working relations, staff expressed frustration when instructions

were not followed, needed to be repeated many times, when particular volunteers

needed intensive support or when gardening work required to be re-done after

volunteers had left for the day. Ethnographic observations also recorded that some

volunteers were favoured as ‘good’ people to work with over others who were less

competent and compliant. There were occasionally conflicts amongst volunteers about

who got what task and where they were to be located in the garden. As volunteers

built up their own expertise, conflicts could arise with staff in terms of what was the

best plan for the garden, resulting in complicated social and power relations between

these garden workers, particularly when volunteers feel that garden work is

disorganised.

‘Some say I don’t want them in my garden because they trample my flowers and plants –so – teach them!, teach them!, that’s the whole point, so what if they’ve been here 7 years, no one has taken the time to tell them where to put their feet, it takes half a second …’ Staff ‘I’ve got more gardening education than [the staff]. I’ve got a diploma and they just want to do things their way. Apart from that, we need someone with quality and stamina and someone who can take the team, all of us, upstairs to talk about each garden and what needs done and then we’ve all got our own jobs to do or we all work with each other’ Rodney, Volunteer

General difficulties with garden work: volunteers perspectives

• Working in cold and wet weather

• Working when feeling ill

• Working in disorganised ways

• Feeling powerless over garden planning

• Lacking education about horticulture

• Unpleasant textures of nature

General difficulties with garden work: staff perspectives

• Working with demanding volunteers with complex needs

• Balancing the demands of garden work with support work

• Limited staffing and relevant expertise

• Limited equipment

• Limited funding

47

Other difficulties identified by project managers include the lack of or instability

of block or core funding from health and social services and other organisations. Most

projects exist on a complex amalgam of funding from a variety of sources, all of

which have competing demands in terms of demonstrable outcomes. In some other

cases, funding follows the client and when the client moves away, the project risks

being under-funded and hence acts as a disincentive to help volunteers achieve ‘next

steps’.

Key summary points

• Gardening work is physically and socially demanding for staff and volunteers

• UK garden projects are limited in their activity by weather and need to diverse

into other areas

• Disorganised garden work can be stressful for volunteers

• Volunteers with complex needs are demanding in terms of time in projects that

have few staff

• Local community expectation of garden spaces can be a pressure on garden staff

and volunteers

48

• Resourcing, staffing and funding levels are a constant problem in terms of

adequate support, expertise and equipment.

Section 4

Conclusion

The research findings of this study have demonstrated that garden and horticultural

projects for people with mental health problems are rich social spaces that are actively

engaging a hard-to-reach group on a number of different criteria. In terms of the broad

questions that defined this study:

• How does working with nature help to achieve social inclusion and stability

for vulnerable groups?

49

This research study demonstrates that gardening, in general, seems to offer

opportunities to engage in activities that help people with mental health problems in

terms of maintaining their health and their perceptions about recovering from

psychological difficulties. In terms of conventional understandings of social inclusion

(cf Sempik et al, 2003), garden work allows volunteers to further their capacity for

consumption (in terms of ‘wages’ which are distributed in some garden projects, and

their access to healthy food). Volunteers also engage in production (gardening is

understood as a socially valuable physical activity); social interaction (peer and

community social networks are strengthened) and to some small extent, political

engagement (experience of committee work, conferences and similar activities). In

terms of more generalised understandings of social inclusion and more particularly

how people feel included in the daily rhythms of places they frequent or live, garden

work is accompanied by feelings of worth, value and pride. These feelings are tied to

the sense that workers are making small, but important, differences to their local

environments. Such feelings are partly emergent from the positive community

responses to environmental and garden work, as well as from self, peer and staff

validation. For people with mental health problems to feel useful and that they are

making a difference to the world is a profound social act with positive psychological

benefits. Gardening projects may offer imaginative ways through which new versions

of social citizenship may be achieved and through which people with mental health

problems feel socially included in community settings. Caution must be noted,

however, that garden projects spaces are not accessible to all and more work must be

done to increase numbers of women and ethnic minority participants.

• How are unstable identities positively changed through physical interactions

with land?

Many volunteers clearly found the gardening and horticultural work therapeutic and in

ways which helped them gain perspectives on their own difficulties or some insights

into their needs for recovery. As reported in the literature (Morris, 2003), physical,

sensory, emotional and spiritual experiences seem to be enhanced by garden work, and

volunteers in this study validated this claim to some extent. For people who

experienced themselves and their identities as fragmented and fragile, garden work

provided opportunities for them to feel more ‘grounded’ and secure through both the

structure of work patterns and through focusing on their multi-dimensional

relationships with plant and wildlife. Apart from these complex relationships between

the self and nature, volunteers also gained opportunities to socialise with peers, staff

and local resident in different ways, which offered them access to (potentially)

supportive and sustainable relationships in ways beneficial to senses of self-identity.

• What do people with enduring mental health problems feel about garden

work?

Volunteers who participated in this study expressed a range of feelings about garden

work, both (primarily) positive and (less so) negative. To summarise, dominant

feelings of pride, hope, self-worth and self-esteem accompanied garden work,

alongside an amalgam of emotional states that might broadly be expressed as versions

of nature-love or ‘biophilla’. These feelings helped to distract people from focusing on

negative aspects of their own lives or health problems. At the same time, nature work

was experienced as emotionally challenging with feelings of frustration, anger and

sorrow accompanying some aspects of gardening.

50

It is important to note that the emotions that are bound up with nature work are

experienced partly with reference to complicated human-nature relations and partly

with reference to the managing and structuring of garden project work and its place in

the wider life of the individual volunteer. For example, ‘hope’ may be a feeling

experienced in relation to the sensations, psychological effects and metaphorical

readings prompted by seeing a seed grow into a plant, despite harsh weather

conditions. However, it may also be a feeling associated with a regular ability to get

out of bed and go to ‘work’, the new social networks acquired through project

attendance, or aspirations to move on to train and work in different natural

environments.

• Are there ways in which garden work might be best facilitated amongst this

group?

These following questions prompt more directive and summarised responses in terms

of conclusions:

• Garden work seems to be most effective in terms of widening opportunities for

social inclusion and social networking when garden space is located in or near to

residential areas

• Removed locations for nature work (walled gardens and allotments for example)

can provide important experiences of retreat and asylum, as well as increase peer

social contact and contact with communities of interest

• In general, well-structured garden work with clearly assigned working roles most

obviously benefits volunteers

• Combining practical work with education and joint-planning helps volunteers feel

ownership over garden space

• Combining individual and team working patterns offers a broad range of work and

social experiences

• Flexible working speeds, tasks and durations benefit volunteers

• Trusting volunteers with equipment like chain-saws and lawn-mowers is highly

valued and helps build their skills-base

• Combining individual plots with collective plots allows for different preferences to

be expressed and skills to be practised

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• Food production creates particular interest in gardeners, although consumption of

healthy foods may only be assured when projects provide the meals

• Making gardens accessible to the public through regular open days and events

increases the opportunities for social networking and community contact

• Peer buddy systems create friendly access points to garden projects for new

members and builds self-esteem amongst others

• Providing versions of counselling and support work is important in terms of

facilitating attendance in garden projects

• Creating pathways to work and training beyond garden projects would increase

their potential for helping people achieve their goals in terms of jobs and education

• What are the key outcomes of garden work for this group?

In general, volunteers are gaining:

• A positive focus and structure to daily and weekly life

• An opportunity to (re)learn skills and gain work experience/training

• Self esteem and self-worth and experimenting with different social and working

roles

• Access to safe spaces with opportunities for diverse emotional and sensory

experiences

• Developing physical strength and engaging in physical exercise

• Accessing opportunities for healthy eating

• Developing different social skills while interacting with peers, staff and the general

public

• Opportunities to rework stereotypical constructions of ‘the mental patient’ through

active citizenship in local communities

• Are there any wider implications for public mental health?

• Environmental regeneration benefits all in community settings in physical and

psychological terms

52

• The provision of natural spaces which are safe, visually stimulating and use-able in

urban settings are particularly valuable in terms of facilitating good public mental

health

• The work by people with mental health problems to provide such spaces

simultaneously helps to change public attitudes to mental health as garden workers

are seen to be active, useful and expert

• Combining environmental regeneration with education about mental health offers

the opportunity to both raise levels of public mental health and reduce stigma

Visioning sustainable public mental health

In this report gardening and horticultural projects for people with mental health

problems are shown to benefit this group on a range of different criteria. However,

even a small study such as this one highlights the fact that garden projects differ

dramatically in terms of their remit, locations, funding structures and working

practices, and yet all seem to offer something of quite profound merit to the people

who access them. At present, despite the over-lapping and complementary national

political frameworks which can be argued to constitute a healthy climate for the

development of environmentally friendly mental health care, there is no one

organisation or lobby which is pushing this agenda forward. In addition, despite claims

about joined-up thinking in the national and local state, there is little evidence that

those authorities responsible for shaping ‘the environment’ and ‘mental health care’

have a co-ordinated agenda for tackling individual and public mental health issues.

This is arguably a missed opportunity to develop an innovative approach to social care

and urban environmental regeneration.

53

While there are effective national organisations such as Thrive who provide

networking opportunities between gardening projects, and valuable education and

training for therapeutic horticulturalists, uptake is varied and many gardeners work in

projects without much or any mental health training. The status of ‘therapeutic

horticulture’ (which Thrive promotes) is arguably not as integrated into mental health

or medical services as it is in other countries such as the United States. While this is

not necessarily a disadvantage in terms of community mental health, there remains a

gap for a strong organisational voice to be pushing a national political agenda for a co-

ordinated ‘environmental mental health care’ at different scales. Developing national-

level good practice guidelines for garden and mental health projects, and linking this

into local core funding requirements and regulation might be one step along this road

(see Sempik et al, 2003).

In the future, a challenge remains for policy makers, civil servants, funders,

service providers and green pressure groups to establish a co-ordinated approach to

mental health care and public mental health issues. If sustainable community mental

health care in a consistently and core-funded voluntary sector works creatively

towards addressing the environmental needs of local communities (especially in

disadvantaged inner-and-outer city areas), then the implications for public mental

health and the possibilities for reducing stigma are exciting. In asking whether we

might hope for sustainable communities in the UK in connection with mental health

care issues, we could do worse than to look to gardening, horticulture and

environmental work for innovative routes forward. In this visioning of inclusive,

environmentally sustainable community work, the person with mental health problems

is an active citizen, working for their recovery of self as well as the community.

Creating opportunities for simultaneous and integrated training and garden work

amongst and with local residents would also further the inclusive potential of such

projects. Such a vision, however, has be underlain with a realistic understanding of the

difficulties of garden work for this group, and also the risk of exploitation (as in some

aspects of the history of asylum-based horticulture), as well as the risk of de-valuing

‘restorative’ nature work which primarily benefits the self or the volunteer community.

Rethinking sustainable communities and opportunities for an environmentally

progressive public mental health programme may also require innovative re-thinking

in terms of the benefits system and ‘therapeutic earnings’ for those people who engage

in such work (perhaps connected to ring-fenced local community taxation).

Finally, in visioning the opportunities for ‘next step’ employment for people

with mental health problems who feel able to take on further challenges, green job

opportunities could be provided to them and other local residents through a re-

invigorated ‘green social economy’. Here the local state might lead attempts to

regenerate neglected urban natural spaces across our cities, while simultaneously

building well-being and achieving senses of placed belonging amongst their

inhabitants.

54

Section 5

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58

To offer feedback or to seek further information, please contact:

Dr Hester Parr

Department of Geography,

University of Dundee,

Dundee

DD1 4HN

01382 344434

H.Parr@dundee.ac.uk