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    Sustainable Communities: Nature Work and Mental Health Sustainable Communities: Nature Work and Mental Health Document Transcript

    • 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 PageIntroduction and acknowledgements 2Executive summary 3-5 Full ReportSection 1:Aims and objectives of research 6Methods 7Case study project profiles and visuals 9Section 2Literature and policy review 16Section 3Research Findings 24Accessing garden projects 24Gardening as a therapeutic activity 27Gardening as a social activity 31Gardening as a physical experience 35Achieving social and community integration through urban nature work 37Gardening as work and work training 42Difficulties with garden work 46Section 4Conclusion 49Visioning sustainable public mental health 53Section 5Reference list 55 1
    • Sustainable Communities? Nature Work and Mental HealthIntroductionThis 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. Itdraws on small-scale qualitative research conducted during 2004 with a range of organisationsin the UK, but predominantly in Scotland, that facilitate gardening work by people withsevere and enduring mental health problems. The executive summary highlights the mainfindings from the project as well as highlights recommendations for policy and good practice.AcknowledgementsThis research was made possible by a grant awarded by the ESRC and I wish to thank themfor their support.I would like to thank the participating projects for their time. In particular, I would like tothank the staff and volunteers of each project for sharing their thoughts and giving theirgenerous assistance.January 2005. 2
    • Executive SummaryStudy and methods5 Garden projects across the UK were accessed in order to understand the role ofcommunity garden work in assisting people with severe and enduring mental healthproblems to achieve social inclusion and stability. 40 taped in-depth interviews withgarden workers were carried out: 20 volunteers (people with mental health problems)and 20 paid support staff. 18 non-taped interviews were also carried out withvolunteers. Ethnographic observations over a period of 6 months were carried out in 2garden projects (averaging at 2 days per week over the period). Summary of FindingsAccess 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 providersGardening 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 waysGardening 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 workGardening 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• Healthy eating levels may be increased 3
    • 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 workGardening 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 volunteersDifficulties 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• Participating in garden work brings opportunities to rework stereotypical constructions of ‘the mental patient’ through active citizenship in local communities 4
    • 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’ 5
    • Section 1 Aims and objectives of researchAcademic contextThis work is part of a larger funded research programme [ESRC RES-000-27-0043] aboutmental health and social inclusion and concerns how people with mental health problemsexperience social stability through participating in different kinds of spaces. The spaces underinvestigation are categorised as natural, artistic and technological. What this means in practiceis that the research programme looks at examples of innovative community programmes andprojects that facilitate the participation of people with mental health problems in (i) gardeningactivities, (ii) art and performance work and (iii) the use of the internet for social support. Theresearch programme is primarily academic in orientation and designed to facilitate the writingof 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 ofservice, practitioners and policy makers. As such the results are being made available in easilyaccessible 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 theNational Programme for Mental Health and Well-Being in Scotland)1.ObjectivesThis study set out to investigate the relationship between community gardeningactivities and people with severe and enduring mental health problems in terms of thefollowing overall questions and in the context of the voluntary sector projects thatorganised 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?• What do people with enduring mental health problems feel about garden work? 6
    • • 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 selvesand identities in everyday social life and spaces, although the more user and policyfriendly findings are reported here.MethodsA pilot study had taken place in March 2000 in the Ecoworks garden project inNottingham whereby staff and volunteers2 had been interviewed about the advantagesand disadvantages of garden work for people with severe and enduring mental healthproblems (Parr, 2000). The findings from this project (Parr, 2000) were used as a basisfor designing and researching the current research programme on communitygardening for and by people with mental health problems. Ethical permission fromThe Tayside Committee on Medical Research Ethics (and permission from the localhealth authorities in which the participating garden projects were based) was attainedin 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 5garden projects across the UK and sited in Glasgow, Edinburgh, Perth, Nottinghamand London (project profiles are below). In each project paid staff and volunteers wereinterviewed about their role in the garden, their gardening experiences and feelingsabout the work in which they participated. Semi-structured interview schedules wereused in each project that covered a variety of relevant key themes such as: • History of garden project attendance • Expectations of garden projects1 The film will be finished in June 2005. Details from the author.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 wasbecause it was felt that such terms avoided stigmatising those involved in garden work. Thisreport 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 mentalhealth problems. It is recognised that non-hierarchical ways of working means that someprojects do not differentiate between gardeners in this way. 7
    • • 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 visionsInterviews were between 30 minutes and 1.5 hours long, were mostly taped andcarried out on-site in the garden projects. The taped interviews were then transcribedand analysed for key themes using a basic coding framework through the NVIVOsoftware data management package. In all, 40 taped interviews were carried out withstaff and volunteers across the 5 garden projects. This included 20 taped interviewswith volunteers and 20 interviews with staff (with a wide range of roles andconnections to the projects concerned). A further 18 shorter non-taped interviews withvolunteers took place in the context of ethnographic (participant observation) workover the course of the research period at several projects (but mostly focused onEcoworks, Nottingham and The Coach House Trust, Glasgow). Taped interviews withvolunteers included 18 with males and 2 with females and informal non-tapedinterviews included 2 with females. In terms of staff, 10 females and 10 malesparticipated in interviews. All participants in this research project except one werewhite British in terms of ethnic background.Ethnographic researchEthnographic research is otherwise known as participant observation, whereby theresearcher participates in the activities and social worlds under study and then recordsobservations and reflections in a research diary. This is then used to triangulate andverify claims made by interviewees in verbal disclosures. The ethnographic work inthis project was concentrated in two sites over a period of 6 months. Recordedobservations are not re-presented as data in this report, but serve to contextualise someof the more general comments on how garden projects operate and theircharacteristics.Please note that all quotations from volunteers and staff in the report are anonymisedor attributed to pseudonyms. 8
    • Brief Garden Project ProfilesThe ESRC research programme looked at 5 gardening projects for people with severeand enduring mental health problems in 2004. 2 were sited in England and 3 weresited in Scotland. Although there are considerable differences between each project interms of location, range of activities, client base, size and funding, for the purposes ofthis report, common themes will be drawn out which apply to all. Academic andconceptual 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, NottinghamLocation: Inner city, St Anns, NottinghamType: Allotment (on ‘wild common land/allotment site’)Annual Income: (2003-4) Approximately £55,000Major Funders: County and City Social Services; NOF Healthy Living Centre; TheCommunity Fund; The Scarman Trust; Esme Fairbairn Foundation and othercharitable sources.Service users: 6 (current) – 30 [varied numbers of volunteers and staffing over 10year period]. Predominately white British client base, 90% male clients [previouslyother ethnic minority groups have been involved].Staff currently employed: 3 part time postsRemit: to provide gardening opportunities for disadvantaged people, including thosewith mental health difficulties, and to promote integration between different peopleand groups through garden work. 9
    • The Coach House Trust, GlasgowLocation: Residential area, West End, Glasgow (with multiple sites across NorthWest and South Glasgow)Type: Community gardening and recycling project/community gardenProjected Annual Turnover 2004: £800,000Main funders: Scottish Executive Strategic Waste Fund Not For Profit Sector;Greater Glasgow Health Board; Social Work Department, Glasgow City council; NewOpportunities Fund; ERDF (European Regional Development Fund); other charitabletrusts.Service users: 60 [98% male, 99% white British].Volunteers: 19Staff employees: 30Remit: To counter social exclusion amongst a range of groups (those who areunemployed and those with learning difficulties, drug and alcohol addiction andmental health difficulties) through participation in a range of activities and training forwork opportunities. The Walled Garden, PerthLocation: grounds of Murray Royal Hospital, Perth.Type: Removed walled gardenBudget: (est/approx): £140, 000Main Funders: Social Services; NHS Health Department.Service users: 35 [80% male, 20% female, 100% White British]Staff employees: 5Remit: To provide a supportive horticultural work environment for those with mentalhealth problems. 10
    • Redhall Gardens, EdinburghLocation: residential/conservation area, South EdinburghType: Removed walled gardenBudget: (est/approx) £138,000Main 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-timeRemit: To provide a supportive horticultural work environment for those with mentalhealth problems. St Mary’s Garden, Hackney, London.Location: Inner city/residential/warehouse district, HackneyType: Community gardenBudget: (est/approx) £110,000Main funders: Thrive; The Learning Trust, Hackney; Social Services (LearningDisability Service and Community Mental Health Teams; Neighbourhood RenewalFund; New Deal for Communities, varied charitable trusts.Service users: 30 (Male 62% Female 38%, 63% from black and ethnic minoritygroups]2 full time staff, 2 part time staffRemit: To provide therapeutic horticultural and work training opportunities for thosewith mental health problems, learning disability, HIV and young offenders. To alsoprovide a community garden for the local community with a resident key holderscheme. 11
    • Different gardening project spaces 12
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    • Section 2 Context for the study: A brief literature and policy reviewNature and healthThere is a multi-disciplinary and international literature base that has long evaluatedthe varied connections between nature and health. Writing and research fromenvironmental psychology, nursing, ecopsychology, planning, wilderness therapy,therapeutic horticulture, human ecology and human geography have all contributed toa rich, if diverse, evidence base about perceived beneficial connections between arange 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 whichfamously highlight the benefits of nearby nature for post-operative hospital patients(Ulrich, 1983) to more recent work on the positive mental health implications ofwoodland play for children (Bingley and Milligan, 2004), to the reported benefits ofgardening for refugees and survivors of torture (Lindon and Grut, 2002), health-naturerelationships are deemed important across many disciplines and international contextsin terms of building human well-being and social and psychological capital. Althoughit is impossible to do full justice to this literature base here, some common themesemerge from research work that has looked at nature-health relations and these serveto connect individual human health with local community and global communityhealth issues. There is hence a dominant message from this literature that nature can begenerically understood a resource for human health on several different scales and inconnection with a range of issues. The following list summarises just some of the ‘bigpicture’ themes that traverse the nature-health literature in terms of perceived keybenefits: 16
    • 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 povertyThese benefits are potentially accessed through a range of different kinds of activitiesand 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) The benefits of cultivating, living near, using, being and playing in nature in itsvaried forms, but particularly in urban spaces of population concentration, is fuellingresearch efforts to better understand the beneficial outcomes summarised above.Recent EU initiatives, for example, are attempting to harness the research capacity thatexists to link nature spaces and human health (COST E39, 2004-2008). Currentfunding strategies include facilitating collaborative engagements between different 17
    • academics and practitioners in order to collate the evidence base relating to health andnature across Europe (see also ‘policy context’ below). There are also a wide range ofNGOs who contribute to our understanding of the practical capacities of nature spacesin terms of the broad benefits to individual and community health.Gardening, horticulture and healthOne very specific aspect of the relationship between nature and health has formed thebasic context for this study. Gardening and horticulture3 has received considerableattention 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 berelevant for the general population as well as specific groups (such as the elderly,children, people who are ill, offend, have dementia, learning difficulties or physicaldisabilities), it is those with mental health issues who are privileged here. Indeed, theknown relationship between domesticated nature (gardens, landscaped park land, farmland) and health can be argued to have specific roots in institutional health care forpeople with mental health problems. Gardens and gardening were recognised as atherapeutic medium for institutionalised populations since the late 1700s both in theUK and the US where the benefits of field labour for asylum patients were noted bycontemporary psychiatrists of that period (Davis 1998; Paterson, 1997; Digby, 1985;Philo, 2004, Parr 2005). In the 20th century, and building on asylum practices in the19th century, occupational and rehabilitation practitioners of various persuasions haveextensively 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 plantsand garden work to meet clinically defined goals (a treatment strategy), and moregenerally, the well-being that may develop from gardening in both active or passiveways:3 ‘Horticulture’ refers to the practice of cultivating plants, while ‘gardening’ can moregenerally refer to other activities such as weeding, landscaping, creating beds for plants,harvesting and so on. 18
    • ‘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 welfareinfrastructure, Sempik et al (2003) settle on the term ‘social and therapeutichorticulture’. This term is used to indicate that horticultural activity withdisadvantaged groups is not often strictly clinically orientated, but rather is aimed atproviding opportunities to ‘improve the well-being of the individual in a moregeneralised way’ (ibid, p4). The commonalities across different disciplines andstudies in terms of a convincing, but largely unacknowledged, evidence base for thehealth-promoting dimensions to horticulture and gardening are summarised below andcan be seen to crystallise around the benefits of gardening in terms of individual andcollective 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 19
    • Despite the positive messages from most research on horticulture and health, cautionmust be also exerted in terms of thinking through how and under what circumstancessuch benefits are achieved for particular participants. For example, many institutionalgardens may not provide the same opportunities for social cohesion and healthy eatingas a community based garden. Community gardening projects are also oftenpredominantly male spaces, as this research indicates, and there maybe multipleaccess issues concerning different natural spaces (see below and Kurtz, 2001). Anybenefits must therefore also be understood alongside the local conditions andcircumstances through which garden work happens, as well as considering whatnational guidelines might help to ensure the above outcomes for all (see concludingcomments). One of the key points of interest for practitioners and policy makers is howgardening and horticultural work facilitates social inclusion for vulnerable orexcluded groupings. In arguing how this work often involves key components of‘social inclusion’, Sempik et al (2003) suggest that collective gardening, enactedthrough community social welfare projects, enables gardeners with mental health andother 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 etal, 2002 and cited in Sempik et al, 2003, p37) and processes from which people withsevere and enduring mental health problems (for example) may have been distancedthrough institutionalisation. In this view, engagements with domesticated nature andgardening are powerfully associated with current social policy goals, those being theintegration and normalisation of previously excluded people in everyday society.Political and community contexts Mental health and mental health care have been recently linked with majorpolicy initiatives in the UK connected with ‘social inclusion’. Both the EU and the UK 20
    • can be seen to be pursuing a raft of policies connected to this concept. In currentpolitical discourse the buzzword of ‘social inclusion’ is associated with access toemployment, good housing and health, education and participation in a wide variety ofsocial and economic arenas (Scottish Office, 1999; Scottish Executive, 2003a), whileconversely ‘social exclusion’ is associated with unemployment, poor housing, ill-health, crime and lack of community participation (Social Exclusion Unit, 2001). Interms of mental health it is clear that policy makers link ‘social inclusion’,‘participation’ and the ‘improvement of clinical outcomes’ (Sainsbury Centre forMental Health (SCMH), 2002, p2; National Service Framework, 1999), and sopromote links between inclusion outcomes and mental well-being. For both ensuringand maintaining mental well-being amongst the general population, then, and specificimprovements in terms of people who have experienced illness, opportunities forcommunity participation, education and inclusion are thought to be key dimensions tosuccess. In the UK more generally there is a current political emphasis on activeparticipatory citizenship, facilitated by multifarious funded partnerships between thestate and communities (Fyfe and Milligan, 2003). This coincides with health carepolicies that have sought to relocate the everyday lives of people with severe andenduring mental health problems within community settings in order to end isolatingand stigmatising institutionalised care (Scottish Executive, 2003b). Simultaneously,the drive to counter exclusionary processes and positions that many people in living inpoverty and disadvantaged communities find themselves located within has beenpolitically important (Social Exclusion Unit, 2001, 2004). The role of nature in thisbroad political context is complicated, but has in various ways provided a platformupon and through which politicians, communities, organisations and individuals haveclaimed 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, andhorticulture for those with mental health problems specifically, is currently of interestin UK communities and voluntary sector organisations. There are also now significant national forums for the promotion of inclusivenature spaces (for example, Thrive, The Sensory Trust, The Federation of City Farms,Greenspace and Greenspace (Scotland)) and which can be understood to be broadlyattempting to facilitate new links between citizenship, well-being and nature. 21
    • Community gardens are increasingly popular in UK cities and are open spacesmanaged and operated by members of the local community for a variety of purposes(Holland, 2004) including vegetable growing, recreation, training, education andhealth promotion. Ideally community gardens exist to maintain or facilitate senses ofcommunity in particular places and the aims of community participation andempowerment is what (potentially) links the community garden idea with horticulturefor mental health. However, despite the growth in community gardens, and someexamples of integrated community work, most gardening work undertaken by peoplewith mental health problems occurs in special project spaces, which can hencepotentially limit the claimed advantages for social inclusion. Nonetheless, there issome evidence of a greening of social policy and a greening of the voluntary andcommunity sector, a development surely framed by wider national and global politicsof environmentalism and sustainability. Such a national UK political context can beargued to be conducive to the more widespread development and funding ofhorticultural and community gardening work by people with mental health problems. In Scotland The National Programme to Improve the Mental Health and WellBeing of the Scottish Population (and Action Plan 2003-6) reportedly flows from theScottish Executives 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 healthissues, the role of diverse nature spaces are arguably under-explored as a meansthrough which social inclusion and participation might be achieved. However, giventhe stated commitments to ‘joined up’ thinking and action across mental healthpromotion, prevention and treatment sectors (Henderson, 2004), there are possibilitiesfor the natural urban environment to be an imaginative focal point for action relatingto public mental health. In disadvantaged communities with poor social housing stock,for example, the development of community garden work and accessible naturalspaces (by people with mental health problems amongst others) could assist inbuilding public mental health by facilitating safe participatory spaces of everydaycommunity life. 22
    • 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 In summary, there are multiple global, national and local contexts for the currentdevelopment of community garden work and the adoption of urban natural spaces asan innovative means of achieving and maintaining health amongst both general andspecific population groups. 23
    • Section 3 Research FindingsAccessing garden projectsThere is no one route to participating in gardening and mental health projects andvolunteers were variously referred by CPNs, GPs, social workers and from in-patientcare. Informal access can also occur with self and social network referral beingcommonly cited as pathways to gardening. Once referred applicants are usuallyinterviewed for their suitability for horticultural work and formal funding is appliedfor. On the whole, most schemes sought clients or volunteers who were relativelymentally stable and physically mobile, although some (varied) provision was made inall schemes for wheelchair access. The diagnostic categories and labels applied to thegarden workers who contributed to this study are not recorded in detail, but rangedfrom schizophrenia to bi-polar and to depressive and anxious conditions.‘Well I actually heard about the Coach House when it was just beginning to startup. I had a friend that stayed near here that knew about it and she showed me it. Butalso my young sister helped arranged the funding for this when it was BelmontGardens, 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 ofwanting to develop skills and participate in training after months or more usuallyyears of mental health care. However, many volunteers talked about the fear they feltat entering a gardening project and the challenge of beginning work in anenvironment of which they had little knowledge or expertise. What is valued at thepoint 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 is4 Please note that all quotations from volunteers and staff in the report are anonymised orattributed to pseudonyms. 24
    • also valued at initial access points. Women volunteers (few as they are) discuss thechallenge of entering male dominated work spaces and the importance of ensuringwomen 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 hadnever 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 developin and utilise my skills and learn new ones’Bill, Volunteer Staff report how important it is to have good relationships with a range forservice providers in order to raise the profile of gardening and horticulture as viablecommunity activities for people with mental health problems. Some projects,however, face major difficulties in maintaining consistent referral patterns for severalreasons: • 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 problemat the point of referral with service providers outside the project perceiving gardeningand outdoor work as predominantly male activities and thus targeting those clients.For long-established projects with a predominately male client base, few specificstrategies are employed to widen access to women. Only one project in the study hadspecific 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 tendedto be men who came and now if you speak to women who come and see round theplace, you can see that they are intimidated by the amount of men, particularly whenthere’s young men for example. It is difficult. The ethnic mix is the same – we onlyhave 1 black person and 1 Asian person’Staff 25
    • ‘We mail shot all the GPs in the borough … it’s about 60 … and then followed upwith phone calls with GPs or practice managers or whoever we could talk to … andwe 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 differentfactors that may contribute to gardening projects being predominantly white spaces,including a general lack of integrative mental health service provision across differentethnic groups (which may influence referral patterns) and differing culturally basedgardening practices and experiences of cultivation amongst particular ethnic groups.In respect to the latter point, however, some sectors of ethnic minority groups placeparticular cultural importance on cultivation (such as some older Black Caribbeanmen) and so shared gardening and allotment work could act as an important resourcein addressing ethnic ghettos in mental health care. Similarly, refugees and asylumseekers often arrive in the UK from land-based economies and may benefit frommental health services that are focused on cultivation. Ecoworks in Nottingham is oneproject from this study that had active involvement with a group of asylum seekersbefore their deportation in 2003. St Mary’s in London is a project that attracts theattention of multiple ethnic groups in the locality and who also use the space as acommunity garden. Natural space arguably therefore holds the potential to act as abridge 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 26
    • Gardening as a therapeutic activityVolunteers come to gardening projects with a range of experience of natural andcultivational spaces, but with most having some exposure to these in association withtheir mental health care. For some, this can mean an ambivalent relationship withnature work, and something they associate with difficult times of their lives, orservices that did not suit them or gave them little choice. For others, who have littleexperience, the work involved and the knowledge it requires can seem daunting.Although there may be latent beliefs about health giving capacities of nature that mayunderlie their initial decisions to access garden projects, few volunteers wereconscious of this affecting their access routes. It is common for volunteers to discusshow they gradually came to experience nature and nature work (gardening andhorticulture) as therapeutic only after some time with the projects concerned. Of the 38 volunteers interviewed as part of this study, 90% of them discussedwhat might be summarised as broad ‘therapeutic effects’ of garden work. Theseeffects 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• HealingA large majority of the volunteers discussed how general interactions with the naturalworld and gardening activity in particular had helped them recover from mental healthproblems, or at least helped to maintain their health status. Ethnographic observationscarried out as part of this study confirms that garden work sometimes helped to calmerratic behaviour and provided a focus for negative energy and anger in difficulttimes. 27
    • ‘When you feel angry you just dig furiously, I associate gardening with getting angerout of the system more than anything else … it’s about getting rid of energy into thesoil 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 youcame. 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, VolunteerThere are two dominant ways in which nature and garden work are deemed beneficialfor 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 asinherently healthy (automatically benefiting them) and as a medium for creativehealthy action (non-automatic health benefits). Particularly important in terms of the therapeutic benefit of the garden projectswas horticulture itself, ie the cultivation of plants. This may be both because thepractice of plant growing is in itself experienced as therapeutically beneficial, andalso because plant growing features heavily in staff explanations of the benefits ofgarden projects, and volunteers are influenced by these discourses. For example, plantgrowing was discussed by many volunteers as:• Involving care and concern beyond the self• Helping to ground confused thinking• Involving positive emotions such as hope, pride and love 28
    • ‘You have to focus on the plant, you have to go with that and it helps you, it just helpsto ground you’John, Volunteer‘If you plant something it’s dependent on you, you have to slow your thoughts down tothe speed of the plant and what’s happening to it. It fixes you … it’s quite aresponsibility to care for the garden’Kyle, VolunteerPlants and plant growing are also often used as metaphors by both staff and volunteersto discuss social and psychological difficulties. While this is a recognised feature ofhorticultural therapy, many project staff do not claim to be practising such a formalprogrammatic 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 ageneralised way.‘… there’s lots of little magical spaces that people have here, where you justwander around and it just fills you up really and I suppose it’s allowing nature toheal you really ...’Colin, Volunteer‘The garden and gardening is healing really. It’s about the earth, it grounds youwhen you are totally disorientated by the world around you’Peta, Volunteer Staff in garden projects unsurprisingly held strong beliefs about theinherent healing qualities of nature, as well as the social and educationalcapacities of natural spaces for skills training (see below). Garden staff, therefore,play an important role in terms of how gardens and gardening are experienced astherapeutic by volunteers. Garden staff and garden projects differ in terms of theiremphasis on structured work programmes, the amount of therapeutic talk usingplant metaphors, their discussion of the natural healing power of nature and thisall influences the experience of gardening for volunteers. In general, where volunteers had relative freedom to develop areas of thegarden, or had responsibility for their own part of a plot for growing, they weremore likely to discuss at length the therapeutic effects of nature and gardening.Where volunteers were more used to general landscaping and gardening in teams 29
    • or with close supervision, they were more likely to discuss at length the beneficialsocial effects of gardening with others, rather than the therapeutic capacities ofnature 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 helpof someone else to affect positive changes in lives’Staff‘We are organic and we are encouraging life to come in. That’s an interestingthought really, actually encouraging life into the site is the same as the life in thepeople as well … it’s about allowing people to express their energy, in the way thatthey 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 throughthe next minute almost or next few seconds. To actually look at a piece of ground andthink, ‘that’s what it is like now, and then in 3 weeks time this will be like this, andthen 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 thetherapeutic experience of nature. Project gardens and allotments were primarily seenby volunteers as variously:• Safe spaces• Creative spaces• Tranquil spaces• Spaces of retreat• Social spaces• Community spacesThe geography of garden spaces was also important with zoned gardens being themost successful in creating accessible space suitable for use by people in differentpsychological and physical states. 30
    • ‘I like the patterns on the worms, the patterns, they look like floaters in your eyes theworms. I like the noise of the bees buzzing outside, I like the sound of the wildlifeoutside, 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 volunteersGardening as a social activityWhile most collective activities in community mental health services involveopportunities for socialising (and garden work is no different here); there may beparticular aspects to the social activities that constitute this work that are worthnoting: 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 To pick up on just a few of the above list, the seasonal rhythms of garden workmeans that work is differently paced throughout the year with a variety of tasks. Thisnot only tends to keep volunteers interested, as well as allowing for both able and lessable workers, it also lends itself to the creation of social opportunities based aroundgarden work. In summer times, and at times of harvest, when produce is plentiful, 31
    • most garden projects have social events both for workers and for widerneighbourhood users (see below). The social significance of groups of people eatingproduce grown by volunteers is particularly meaningful, and contributes to feelings ofpride 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 myfriends and even most of my family. They cut me off and I wasn’t included in anythinganymore. So I’ve been having to try and start again at the Coach House. Notnecessarily at the Coach House, but at that level. The Coach House now has basicallyreplaced all the ones that I’ve lost’Kevin, Volunteer In terms of staff and client contact, garden work provides (some) opportunitiesfor collaborative engagement, rather than just top-down support and/or instructionfrom the staff to the client. Volunteers also felt that their own service providers sawthem 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 theatmosphere of collaborative equality established through garden work translates to a‘work place’ atmosphere, whereby staff and volunteers often celebrate the end of aworking day or week with a visit to the local pub. Some other aspects of garden work also allow volunteers opportunities to seethemselves in rather different social roles, moving from positions of dependence tobecoming more independent and embodying a status of ‘responsible worker’. Such amove is discussed as being facilitated (for example) by the use of power tools likesaws and lawn-movers. Volunteers discuss the importance being trusted to use suchequipment, as for people with severe and enduring mental health problems, ‘trust’ is aparticularly meaningful relation.‘The guy again with the fuchsias … is quite knowledgeable and he in the past hastaken a great deal of the responsibility of the garden himself, he could partly run thisplace himself as could a few others’Staff‘Many of the decisions on what’s planted and how it’s planted is done jointly withinthe garden team’Staff‘I can feel that I can be trusted with a lawnmower’Jack, Volunteer 32
    • ‘They (the CPNs) see me differently, they see me more settled ... getting on with mylife and being motivated ..’Tim, Volunteer Team working is also a feature of many garden projects, especially wherethere is not space to allow individual gardening plots. Team working was especiallyhelpful to new project members as it enabled peer instruction and support to takeplace. Volunteers also felt that team work enabled friendships to be more easilyestablished. For volunteers who were established members of garden projects, thepeer support and instruction helped them to achieve senses of self-worth and jobsatisfaction, 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 thesupport staff … I feel that I’m in a safe environment, in amongst a safe crowd, there’snobody sort of looking or talking or doing anything, and I’m working along with a lotof 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 towork together and some people are faster, some people are slower …. Sometimes Ihelp them out, perhaps they’re having difficulty or whatever ... I just give them a handto get it done …’Tim, VolunteerIn addition, primary care workers (CPNs or support workers) beyond the gardenprojects were sometimes invited in to work alongside volunteers in the gardens orallotments. This was considered a beneficial practice as volunteers could demonstrateactivity, concentration and expertise to care workers who may have only regardedthem in the passive patient role previously. In some projects there are mixed working teams of people with mental healthproblems and people from the local community (although this is not common), andhere there are opportunities for social integration that stretches beyond peer and staffnetworks (see also below). In such schemes, it is important to stress the equality of allvolunteers, regardless of ability. 33
    • ‘Ecoworks have a policy of calling everyone a volunteer and I might be on themanagement committee and helping with funding raising and someone else mightneed help with keeping his jumper on in the garden, but we’re both called volunteersand 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 ofvolunteers. Volunteers are commonly discussed in terms of their progression fromwithdrawn and isolated social states to a point at which they are able to sociallyengage with others. Staff often use the environment as a way to encourageconversation with quieter members of gardening teams, arguing that the shared natureof garden work and the ability to focus on natural surroundings reduces the pressureon people who find socialising and maintaining relationships and conversationsdifficult:‘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 visualdistractions 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 peopleinvolved in garden work subsequently gain experience of new social roles, partly tiedto increased political awareness of their roles as consumers of mental health services.Some volunteers participate in garden management committees, team meetings andplanning processes associated with garden work. Others present talks on mental healthto interested parties or get involved with national conferences on horticultural ormental health issues. While garden work does not seem to be particularly notable forthe raising of political awareness and participation amongst its volunteers, there isevidence 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• Staff and client relationships can benefit from joint garden work 34
    • Gardening as a physical experienceAn important part of garden work is the benefit gained by increasing the physicalactivity of people who lead very sedentary lifestyles. For many people with severeand enduring mental health problems, medication use and lack of daily activities andstructure in their lives can mean that they are not usually physically active. This hasimplications both for physical fitness and psychological health. Staff in gardenprojects point out that the lifestyles of people who live in institutional care, or who arepredominantly bound into mental health care networks, often feature what areconventionally understood as ‘unhealthy’ characteristics such as:• High rates of smoking• Low rates of physical activity• Diets lacking in nutrientsEngaging in garden work can raise levels of physical activity to levels that suit theabilities of the worker involved. Many volunteers in this study reported beneficialeffects of physical activity in terms of the impact on mental health and sleepingpatterns (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 nightssleep, 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 youtake it out …’Jock, VolunteerBoth staff and volunteers point out that garden work can mean not only increasing theamounts and levels of physical activity, but also the development of different physicalstrength and skills as they develop through particular tasks such as: 35
    • • 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 wildlifeFor some volunteers, the physical benefits acquired from garden work are not onlytied into strength, relaxation and skills, but also connect to the acquiring of differentsensual and sensory experiences, which simply expand and improve their sense of‘quality of life’. Particularly for those garden workers who work in allotmentenvironments, 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 andclaustrophobic environment. So people having the opportunity to come to somewherelike this, where it is open, and they can get out in the fresh air and get wet through ifit’s raining, and get muddy, is actually quite an unusual thing. To have somewhere tosit 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 In times of ill-health the physical dimensions of garden work can take on moremeaning in terms of both the difficulties and the relief that this can bring. For thosewho have experienced disabling levels of depression, for example, the challenge ofgarden work can seem too physically demanding at points. For others, acute phases ofillness involve different physical experiences of garden work. For those with bi-polarillness 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 gardenwork can help to alleviate this problem. 36
    • ‘You can suit a job to how you’re physically feeling. If I’m really tired and got noenergy I can sit and sort seedlings’Dave, Volunteer‘I was once in the garden helping to mix some compost, and the big bin was oozingand they were doing it on a tarpaulin, but I was a bit hyper that I did it so hard andfast that I stretched the entire tarpaulin beneath it and around it. But the staff werefine 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 physicaloutcome for participants who have mental health problems. For those newly residentin community settings, or who live in institutional care, diets are often poor due eitherto levels of cost or a lack of skills in terms of the preparation and consumption offresh fruit and vegetables. All of the garden projects in this study provide food fortheir 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 doublebenefit of raising consumption of nutritious (often organic) food and celebrating andsharing 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 increasedAchieving social and community integration through urban nature workPeople with mental health problems who work in gardening and horticultural projectsreport in general that their social networks are often strengthened as a result of theirparticipation. While there may be particular features of the social relations that arecreated and maintained in garden projects (see above), there is a sense in which anycollective community activity amongst mental health service users will be likely tostrengthen peer networking to some extent. Beyond the formation of social 37
    • networking and development of social integration with other project users and projectstaff, it is useful to discuss the wider potential for community integration. In terms of wider social and community integration, the projects that took partin this study had developed in different ways. For the projects based on allotment sitesor removed nature spaces, the potential for integration with community residents wasdiminished, although relationships between individual and other plot-holders workerswere in evidence/had the possibility of being created5. For garden projects based indensely populated locations, the integration between the project, its workers and thelocal community is particularly important and forms the basis of commentary in thissection. The garden projects under study comprised the following types of ‘gardenspace’: 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 projectsIn general, the latter two ‘types’ provide most opportunity for face-to-face interactionsbetween volunteers and local community members. The allotments and removedgardens provide less opportunity for daily contact with local community members(based on reported and ethnographic observations) due to their less accessiblephysical 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 offeredmultiple opportunities for volunteers to build senses of belonging and community inplace. The function of such spaces and schemes (ie. regenerating and creating usableand visually pleasing green spaces) increase the sense in which volunteers are seen as‘useful citizens’ providing local services, instead of ‘just’ receiving services. Bothstaff and workers agree that (in particular) the transformation of wild or wasteful5 These projects did hold well-attended social and open events for local communities. 38
    • urban nature into manicured and aesthetically pleasing public spaces is a powerfulsymbol of the purpose and capacity of people with mental health problems. Suchsymbolic transformations of space serve a dual purpose; as they involve the practicalre-skilling of a deskilled population: and help to convince local residents that peoplewith 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 doesand I think it helps empower everyone that’s here because the people around … don’tlook at the negative side of people, they look at the positive side and they don’t lookand say, ‘well because they’re disabled they can’t do that’ … there are some peoplein here, myself included, that are classed as being not able to live in society, andwe’ve got our problems, but the level of knowledge and the things they [we] can do isincredible – you’ve seen yourself’Terry, Volunteer‘What we’re trying to do here is help people realise their full potential as opposed toeveryone being at the lowest common denominator …. A lot of people from the localcommunity are in and out the building all the time, or they’re in the shop, or they seepeople round the lanes and they can see what people are doing, and they just getinvolved. They [the volunteers] all speak to people, the people coming to do theirrecycling or coming to buy their herbs, so it’s all part of the community, it’s aboutbreaking the fear factor ….’StaffWhile community landscaping, and community gardens provide value for the localcommunity, which helps the acceptance of mental health services (breaking down theNIMBY factor), organic food production also benefits residents and provides pointsof interest for nearby schools and so on. Such contact is important in terms ofbreaking down barriers to integration due to stigma and negative attitudes towardsmental health issues. Community garden projects help local people understand thatpeople with enduring mental health problems can work, are able and can interact infriendly, sociable ways on an everyday basis. Urban gardening projects, then, can be argued to help to engineer change inthe social status of this group. More pragmatically, for the people involved, gardeningin community settings helps them in becoming more confident literally to be and tosocialise within these spaces. As a result, shifting expectations and relations aretraceable in the neighbourhood streets around which these kinds of activities arebased: 39
    • ‘It [the garden work] does change attitudes, it does, because you become moresocialised, you get to meet people, talk to people, it becomes therapeutic as I say, youget to know people and it helps you a lot. It’s a familiar place with familiar faces andyou get to know them you know …’Gavin, VolunteerEvidence of levels of integration between volunteers, projects and local communitiesincluded the encouraged patronage local pubs ‘after work’, the support of the localresidents’ committees, sharing sheds and tools with neighbours, operating localresident key holder schemes, selling garden produce, having significant local supportfor ‘open days’ and gaining commissions for private landscaping and garden work.Such examples suggest that fear and stigma are not the dominant ways in whichproject 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 Ethnographic work over several months at one garden project confirms thatlocal residents do interact with garden workers on a daily basis, and that in some casescasual friendships are formed between certain residents and workers that aresedimented 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 ofmost work-place settings). Despite this, some workers feel valued as a result of their 40
    • work in local community settings. These are very unusual words from someone withsevere and enduring mental health problems:‘You’re not isolated in a wee box on your own, you’re part of the general communityand well respected’Mike, Volunteer Volunteers seem to feel most pronounced senses of local integration whenthey have worked on community gardens or private garden spaces through contractwork. Examples of social integration can occur on allotment sites, however, wherebyfellow plot holders share produce and advice about growing, visit project space and/oroffer visits to their plots. However, allotment spaces, like some community gardenscan risk isolation if their physical layout is not conducive to casual communityencounters, or if they are located away from busy allotment roadways or residentialareas. Such gardens and allotment sites offer other advantages in terms of protectiveor restorative space for garden work while also still acting as important spaces ofsocial contact amongst volunteers6. Gardens and allotments can occasionally be the focus of negative communityactions 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 mentalhealth issues. Moreover, it is suggested that there may be beneficial implications forwider 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 work6 It is important to note that these spaces are not ‘asocial’ when it comes to communitycontact, they simply do not have the same amount of casual, daily encounters with localresidents as other garden spaces. This does not make them any less of a valuable resource. 41
    • Gardening as work and work training4 of the 5 garden projects that contributed to this study claimed that their project wasin part orientated towards work and work training. For garden staff and projectmanagers training for mainstream work is often important in terms of funding and thecriteria 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 ofthe client base, but that they also require attempts to move volunteers on from projectsafter 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 studyhad attended projects from between 1 month to 8 years, with the majority attendingfor 3 years or more. There were no formal pathways to work in any of the projects inthe study and only a handful of examples of volunteers who had moved onto full timemainstream work were cited by project staff. In terms of formal training, all the garden projects had, at some point in theirhistory, offered horticultural training qualifications (such as SVQs, City and Guilds,NVQs and John Muir Trust Awards). Approximately 30% of the interviewees in thisstudy had acquired some sort of qualification as a result of their participation in theprojects they attended7. For those that discussed the gaining of qualifications, thisresulted in feeling of achievement and pride, although not always directly in anyfurther education, training or work. In terms of ambitions, most volunteers aspired tomainstream work, although not in always in gardening and horticulture. However,they were also realistic in terms of their self-assessed low likelihood of success. Staffwere also pessimistic about the reality of moving volunteers into mainstream workand pointed to the contradiction of external pressures to train volunteers for jobmarkets that are not likely to accommodate their needs. Green jobs relating togardening and horticulture are also in short-supply in the mainstream economy. Forsome projects the solution to this problem is to create paid jobs for volunteers (andthere 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 interms of:7 Some volunteers could not remember or did not know. 42
    • • 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 gardeningactivity as ‘real work’, and not as recreation, therapy, education or training. In someprojects expenses are paid to volunteers (a maximum of £20 per week) and these areregarded as wages, reinforcing the notion of (some, but not all) garden projects asprimarily 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 ofmy bed to come in you know and sometimes I struggle with that. I’m still onmedication 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 andlearn stuff and just move on, although I might look at that one day you know …notthat I would know how or anything but … I don’t want to run before I can walk youknow … 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 tolook forward to.’Tim, VolunteerFor some projects (such as The Coach House Trust), who attain money from othersources than health and social services for environmental regeneration work, theemphasis on work is justified by staff and volunteers by claiming that they are fundedto provide a local green community service. Many volunteers here discuss their workin these terms.‘I do feel like I am providing a service through the Coach House to help the localenvironment and how to protect the Glasgow’s district environment … they pay yourwages, they give you £20 a week and that’s good money. I work here Tuesday,Wednesday and Fridays 1-4pm for that.’Tony, VolunteerConversely, to other volunteers, the garden work seems easy compared to what theyknow or imagine of mainstream employment and it is conceived more as therapy or 43
    • even relaxing recreation. Some volunteers see gardening as an escape from thepressures of mainstream work. In one project there was attempts to provide twodifferent but linked gardening experiences relating to these perceptions by zoningsome garden spaces for therapeutic and restorative work and some as highlyproductive or highly landscaped training spaces. However, only having formal orclearly defined progression routes from one to the other enables this strategy to workeffectively. Garden staff across the 5 projects differed in their approach to gardening aswork and work training. While some garden programmes are well structured withdefined tasks and clear daily, weekly, monthly and seasonal planning, with rotatedworking roles for particular individuals and teams, other projects are adhoc andseemingly disorganised about working roles, training and schedules. For some staff,this latter situation is a principled approach to working with people with mental healthproblems, while for others it is a source of frustration as mainstream work ethics donot 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 canspeak to people easier, you discuss the Coach House. And the Coach House is quitewell known now so whenever you do discuss it you always get into a pretty goodconversation’Kevin, Volunteer‘My job is getting people job ready and I can’t get people job ready if lunch issupposed 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 jobwould 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 doingit’. 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 levelpeople are contributing, it’s valued.’Staff For all staff working with people who use strong medication, who may not bephysically strong and who lose concentration easily, training can be challenging andthere are numerous ways in which they seek to engage volunteers in gardening worktasks: 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 breaksFor projects that provide private garden contracting work, such levels of support maybe impossible to balance with the needs of the commissioning client, and onedifficulty is clearly maintaining this income stream and work experience base forvolunteers 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 employmentpolicies might look to the social care sector for the provision of trained workers whocould then benefit regeneration initiatives, simultaneously addressing unemploymentlevels amongst people with mental health problems, tackling stigma and improvingthe 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• There are few ‘next step’ opportunities for trained volunteers 45
    • Difficulties with garden workAll garden projects face challenges of working with a client base who have complexneeds, use medication, have varying capacities for physical work and may not haveany experience of gardening and horticulture. For most projects similar difficultiessurrounding issues of endurance, strength, concentration and adaptation werecommon in terms of training and working with volunteers. In the UK, and Scotland inparticular, the weather also determines the level of garden work which is possible, andall projects found that offering alternative activities (such as classes, workshops, artswork) were necessary to supplement the physical garden work in bad weather and inwinter time. For some projects, the gardening work carried out in public spaces wasdeemed extremely important in terms of the levels of local community acceptance.Therefore there is sometimes a pressure between the need to maintain visuallypleasing and productive gardens for the local residents, and working with people whoeasily damage beds and plants and are not always neat and tidy in their gardeningpractice. In one garden project there were also problems with volunteers and staff(allegedly) using project space for personal or illegitimate activities (like drinking anddrug-taking), which created controversy amongst other garden workers who felt localcommunity relations were at risk, as well as the mental health of other volunteers. In terms of working relations, staff expressed frustration when instructionswere not followed, needed to be repeated many times, when particular volunteersneeded intensive support or when gardening work required to be re-done aftervolunteers had left for the day. Ethnographic observations also recorded that somevolunteers were favoured as ‘good’ people to work with over others who were lesscompetent and compliant. There were occasionally conflicts amongst volunteers aboutwho got what task and where they were to be located in the garden. As volunteersbuilt up their own expertise, conflicts could arise with staff in terms of what was thebest plan for the garden, resulting in complicated social and power relations betweenthese garden workers, particularly when volunteers feel that garden work isdisorganised. 46
    • ‘Some say I don’t want them in my garden because they trample my flowers andplants –so – teach them!, teach them!, that’s the whole point, so what if they’ve beenhere 7 years, no one has taken the time to tell them where to put their feet, it takeshalf a second …’Staff‘I’ve got more gardening education than [the staff]. I’ve got a diploma and they justwant to do things their way. Apart from that, we need someone with quality andstamina and someone who can take the team, all of us, upstairs to talk about eachgarden and what needs done and then we’ve all got our own jobs to do or we all workwith 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 Other difficulties identified by project managers include the lack of or instabilityof block or core funding from health and social services and other organisations. Mostprojects exist on a complex amalgam of funding from a variety of sources, all ofwhich have competing demands in terms of demonstrable outcomes. In some othercases, funding follows the client and when the client moves away, the project risksbeing under-funded and hence acts as a disincentive to help volunteers achieve ‘nextsteps’. 47
    • 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• Resourcing, staffing and funding levels are a constant problem in terms of adequate support, expertise and equipment. 48
    • Section 4 ConclusionThe research findings of this study have demonstrated that garden and horticulturalprojects for people with mental health problems are rich social spaces that are activelyengaging a hard-to-reach group on a number of different criteria. In terms of the broadquestions that defined this study:• How does working with nature help to achieve social inclusion and stability for vulnerable groups?This research study demonstrates that gardening, in general, seems to offeropportunities to engage in activities that help people with mental health problems interms of maintaining their health and their perceptions about recovering frompsychological difficulties. In terms of conventional understandings of social inclusion(cf Sempik et al, 2003), garden work allows volunteers to further their capacity forconsumption (in terms of ‘wages’ which are distributed in some garden projects, andtheir access to healthy food). Volunteers also engage in production (gardening isunderstood as a socially valuable physical activity); social interaction (peer andcommunity social networks are strengthened) and to some small extent, politicalengagement (experience of committee work, conferences and similar activities). Interms of more generalised understandings of social inclusion and more particularlyhow people feel included in the daily rhythms of places they frequent or live, gardenwork is accompanied by feelings of worth, value and pride. These feelings are tied tothe sense that workers are making small, but important, differences to their localenvironments. Such feelings are partly emergent from the positive communityresponses to environmental and garden work, as well as from self, peer and staffvalidation. For people with mental health problems to feel useful and that they aremaking a difference to the world is a profound social act with positive psychologicalbenefits. Gardening projects may offer imaginative ways through which new versionsof social citizenship may be achieved and through which people with mental healthproblems feel socially included in community settings. Caution must be noted, 49
    • however, that garden projects spaces are not accessible to all and more work must bedone 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 inways which helped them gain perspectives on their own difficulties or some insightsinto their needs for recovery. As reported in the literature (Morris, 2003), physical,sensory, emotional and spiritual experiences seem to be enhanced by garden work, andvolunteers in this study validated this claim to some extent. For people whoexperienced themselves and their identities as fragmented and fragile, garden workprovided opportunities for them to feel more ‘grounded’ and secure through both thestructure of work patterns and through focusing on their multi-dimensionalrelationships with plant and wildlife. Apart from these complex relationships betweenthe self and nature, volunteers also gained opportunities to socialise with peers, staffand 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 gardenwork, both (primarily) positive and (less so) negative. To summarise, dominantfeelings of pride, hope, self-worth and self-esteem accompanied garden work,alongside an amalgam of emotional states that might broadly be expressed as versionsof nature-love or ‘biophilla’. These feelings helped to distract people from focusing onnegative aspects of their own lives or health problems. At the same time, nature workwas experienced as emotionally challenging with feelings of frustration, anger andsorrow accompanying some aspects of gardening. It is important to note that the emotions that are bound up with nature work areexperienced partly with reference to complicated human-nature relations and partlywith reference to the managing and structuring of garden project work and its place in 50
    • the wider life of the individual volunteer. For example, ‘hope’ may be a feelingexperienced in relation to the sensations, psychological effects and metaphoricalreadings prompted by seeing a seed grow into a plant, despite harsh weatherconditions. However, it may also be a feeling associated with a regular ability to getout of bed and go to ‘work’, the new social networks acquired through projectattendance, or aspirations to move on to train and work in different naturalenvironments.• Are there ways in which garden work might be best facilitated amongst this group?These following questions prompt more directive and summarised responses in termsof 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• Food production creates particular interest in gardeners, although consumption of healthy foods may only be assured when projects provide the meals 51
    • • 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• 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 52
    • • 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 healthIn this report gardening and horticultural projects for people with mental healthproblems 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 differdramatically in terms of their remit, locations, funding structures and workingpractices, and yet all seem to offer something of quite profound merit to the peoplewho access them. At present, despite the over-lapping and complementary nationalpolitical frameworks which can be argued to constitute a healthy climate for thedevelopment of environmentally friendly mental health care, there is no oneorganisation or lobby which is pushing this agenda forward. In addition, despite claimsabout joined-up thinking in the national and local state, there is little evidence thatthose 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 careand urban environmental regeneration. While there are effective national organisations such as Thrive who providenetworking opportunities between gardening projects, and valuable education andtraining for therapeutic horticulturalists, uptake is varied and many gardeners work inprojects without much or any mental health training. The status of ‘therapeutichorticulture’ (which Thrive promotes) is arguably not as integrated into mental healthor medical services as it is in other countries such as the United States. While this isnot necessarily a disadvantage in terms of community mental health, there remains agap 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 53
    • 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 tomental health care and public mental health issues. If sustainable community mentalhealth care in a consistently and core-funded voluntary sector works creativelytowards addressing the environmental needs of local communities (especially indisadvantaged inner-and-outer city areas), then the implications for public mentalhealth and the possibilities for reducing stigma are exciting. In asking whether wemight hope for sustainable communities in the UK in connection with mental healthcare issues, we could do worse than to look to gardening, horticulture andenvironmental work for innovative routes forward. In this visioning of inclusive,environmentally sustainable community work, the person with mental health problemsis an active citizen, working for their recovery of self as well as the community.Creating opportunities for simultaneous and integrated training and garden workamongst and with local residents would also further the inclusive potential of suchprojects. Such a vision, however, has be underlain with a realistic understanding of thedifficulties of garden work for this group, and also the risk of exploitation (as in someaspects 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 environmentallyprogressive public mental health programme may also require innovative re-thinkingin terms of the benefits system and ‘therapeutic earnings’ for those people who engagein such work (perhaps connected to ring-fenced local community taxation). Finally, in visioning the opportunities for ‘next step’ employment for peoplewith mental health problems who feel able to take on further challenges, green jobopportunities could be provided to them and other local residents through a re-invigorated ‘green social economy’. Here the local state might lead attempts toregenerate neglected urban natural spaces across our cities, while simultaneouslybuilding well-being and achieving senses of placed belonging amongst theirinhabitants. 54
    • Section 5 ReferencesBingley A and Milligan C (2004) Climbing Trees and Building Dens: Mental Healthand Well-Being in Young Adults and the Long-Term Experience of Childhood PlayExperiences (Institute for Health research, Lancaster University).Burchardt T, Le Grand J, Piachaud D, (2002) ‘Degrees of exclusion: developing amultidimensional measure’, in Understanding Social Exclusion (Eds) J Hills, J LeGrand and D Piachaud (Oxford University Press, New York) pp30-43.Cooper Marcus C, and Barnes M, (1999) Healing Gardens: Therapeutic Benefits andDesign Recommendations (John Wiley, New York).COST Action E39 Forests, trees and human health and well-being(cost.cordis.lu/src/action_detail.cfm?action=E39)Davis S, (1998) ‘Development of the profession of Horticultural Therapy’ inHorticulture as Therapy: Principles and Practice (Eds) S P Simpson, M C Straus (TheHaworth Press Inc, New York) pp 3-18.Digby A, (1985) Madness, Morality and Medicine: a Study of the York Retreat 1796-1914 (Cambridge University Press, Cambridge).Francis M, Lindsay P, Stone Rice J, (1994) The Healing Dimensions of People-PlantRelations: Proceeds of a Research Symposium (University of California, Davis).Fyfe N R, and Milligan C, (2003) ‘Out of the shadows: exploring contemporarygeographies of voluntarism’ Progress in Human Geography, 27, 4, pp397-413.Gesler W M, (1993) ‘Therapeutic landscapes: theory and a case study of Epidauros,Greece’ Environment and Planning D: Society and Space, 11, pp171-189.Gesler W M, and Kearns R, (2002) Culture/Place/Health Routledge, London.Goodban A, Goodban D, (1990a) ‘Horticultural therapy: a growing concern, Part 1’British Journal of Occupational Therapy 53 425-429.Goodban A, Goodban D, (1990b) ‘Horticultural therapy: a growing concern, Part 2’British Journal of Occupational Therapy 53 468-470.Henderson G, (2004) Presentation to the ‘Public Mental Health: Four Nations Debate’Conference, Edinburgh, October, 2004. 55
    • Holland L, (2004) ‘Diversity and connections in community gardens: a contribution tolocal sustainability’ Local Environment, 9, 3, pp285-305.Kaplan S, (1995) ‘The restorative benefits of nature: toward an integrative framework’Journal of Environmental Psychology, 15, pp169-182.Kaplan R, and Kaplan S, (1990) ‘Restorative experience: the healing power of nearbynature’ in The Meaning of Gardens (Eds) M Francis and R T Hester, (Cambridge, MITPress), pp238-243.Kurtz H, (2001) ‘Differentiating multiple meanings of garden and community’ UrbanGeography, 22, 7, pp656-670.Lindon S, and Grut J, (2002) The Healing Fields: Working with Psychotherapy andNature to Rebuild Shattered lives (Frances Lincoln, London).Maller C, Townsend M, Brown P, and Leger L, (2002) Healthy Parks, Healthy People:the Health Benefits of Contact with Nature in a Park Context (Social and MentalHealth Priority Area Occasional Paper Series, Volume 1, University of Melbourne).Morris N, (2003) Health, Well-Being and Open Space: Literature Review (Openspace,Edinburgh).Nahring J, Hill R, (1995) The Blackthorn Garden Project (Sainsbury Centre forMental Health, London).National Service Framework For Mental Health (1999), Department of Health,London.Parr H, (2000) Ecoworks: An Evaluative Report (unpublished report).Parr H, (forthcoming 2005) ‘Mental Health, Nature and Social Inclusion’ Environmentand Planning D: Society and SpacePaterson C, (1997) ‘Rationales for the use of occupational therapy in 19th centuryasylums’ British Journal of Occupational Therapy, 60, 4, pp179-183.Philo C, (2004) A Geographical History of Institutional Provision for the Insane fromMedieval Times to the 1860s in England and Wales: The Space Reserved for Insanity(Edwin Mellon Press, Lampeter).Relf D, (1992) The Role of Horticulture in Human Well-Being and SocialDevelopment (Timber Press, Portland Ore).Sainsbury Centre for Mental Health, (2002) Working for Inclusion, Sainsbury Centrefor Mental Health, London).Scottish Executive, (2003a) Social Exclusion in Rural Areas: a Literature Review andConceptual Framework (Central Research Office, Edinburgh). 56
    • Scottish Executive, (2003b) Partnership for Care White Paper.Scottish Executive, (2003c) Building Community Well-Being: an Exploration ofThemes and Issues.Scottish Office, (1999) Social Inclusion: Opening the Door to a Better Scotland, TheScottish Office, Edinburgh.Sempik, J, Alridge J, and Becker S, (2003) Social and Therapeutic Horticulture:Evidence and Messages from Research (Thrive, in association with LoughboroughUniversity).Simpson S, Straus M, (eds) (1998) Horticulture as Therapy: Principles and Practices(New York, Haworth Press).Social Exclusion Unit (2001) Preventing Social Exclusion Social Exclusion Unit,London.Social Exclusion Unit (2004) Mental Health and Social Exclusion Office of theDeputy Prime Minister, London.Ulrich R S, (1983) ‘View through a window may influence recovery from surgery’Science, 224, pp420-421. 57
    • To offer feedback or to seek further information, please contact:Dr Hester ParrDepartment of Geography,University of Dundee,DundeeDD1 4HN01382 344434H.Parr@dundee.ac.uk 58