Sustainable Communities?

Nature Work and Mental Health

Hester Parr Department of Geography University of Dundee

Sustainable Communities? Nature Work and Mental Health Hester Parr, University of Dundee Contents
Page Introduction and acknowledgements Executive summary 2 3-5

Full Report
Section 1: Aims and objectives of research Methods Case study project profiles and visuals Section 2 Literature and policy review Section 3 Research Findings Accessing garden projects Gardening as a therapeutic activity Gardening as a social activity Gardening as a physical experience Achieving social and community integration through urban nature work Gardening as work and work training Difficulties with garden work Section 4 Conclusion Visioning sustainable public mental health Section 5 Reference list 55 49 53 24 24 27 31 35 37 42 46 16 6 7 9

Sustainable Communities? Nature Work and Mental Health

Introduction This report documents the findings from an Economic and Social Research Council (ESRC) funded research project (RES-000-27-0043) on mental health, nature and social inclusion. It draws on small-scale qualitative research conducted during 2004 with a range of organisations in the UK, but predominantly in Scotland, that facilitate gardening work by people with severe and enduring mental health problems. The executive summary highlights the main findings from the project as well as highlights recommendations for policy and good practice. Acknowledgements This research was made possible by a grant awarded by the ESRC and I wish to thank them for their support. I would like to thank the participating projects for their time. In particular, I would like to thank the staff and volunteers of each project for sharing their thoughts and giving their generous assistance. January 2005.

Executive Summary
Study and methods 5 Garden projects across the UK were accessed in order to understand the role of community garden work in assisting people with severe and enduring mental health problems to achieve social inclusion and stability. 40 taped in-depth interviews with garden workers were carried out: 20 volunteers (people with mental health problems) and 20 paid support staff. 18 non-taped interviews were also carried out with volunteers. Ethnographic observations over a period of 6 months were carried out in 2 garden projects (averaging at 2 days per week over the period). Summary of Findings Access to garden projects The gender and ethnic constitution of garden projects are dominated by white British males Access to garden projects is dependent on adequate knowledge and awareness amongst other mental health service providers Gardening as a therapeutic activity Gardens, gardening and nature are generally experienced as therapeutic by volunteers and staff The therapeutic effects include a variety of positive emotions and behaviours Volunteers experience the therapeutic effects of gardens in both active and passive ways Gardening as a social activity Gardening activities involve a range of social opportunities for isolated volunteers Garden work can involve senses of shifting social roles for volunteers Staff and client relationships can benefit from joint garden work

Gardening as a physical experience Garden work helps raise levels of physical activity amongst a sedentary group Different physicals skills and strengths may be developed Physical activity can help in the management of symptoms of ill health Healthy eating levels may be increased
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Achieving integration through urban nature work The location and layout of garden projects affects the opportunities for community contact and integration Local communities integrate with garden projects in a range of practical ways Volunteers can feel increased senses of belonging as a result of garden work

Gardening as work and work training Most garden projects offer horticultural training and qualifications are highly valued amongst volunteers There are perceived barriers to volunteers moving on from garden project work, particularly into mainstream employment There are few next step opportunities for trained volunteers

Difficulties with garden work

Gardening work is physically and socially demanding for staff and volunteers UK garden projects are limited in their activity by weather and need to diverse into other areas Resourcing, staffing and funding levels are a constant problem in terms of adequate support, expertise and equipment.

Conclusions Garden work helps people with mental health problems achieve social inclusion and stability Garden work seems to be most effective in terms of widening opportunities for social inclusion and social networking when garden space is located in or near to residential areas Contact with both nature and people facilitate stabilising effects People with mental health problems feel a range of primarily positive emotions when engaged in garden work Participating in garden work brings opportunities to rework stereotypical constructions of the mental patient through active citizenship in local communities

Recommendations Gardening and mental health projects need to create better access routes for women and ethnic minorities, especially in Scotland Horticultural therapy and social and therapeutic horticulture need a higher profile with social and health care services at a national level National level good-practice guidelines need to be developed and co-ordinated across all types of gardening projects Local authorities could develop innovative approaches to social inclusion and social care by linking these to urban environmental regeneration Visioning the future opportunities for next step employment for people with mental health problems and other groups could be tied into a re-invigorated green social economy

Section 1 Aims and objectives of research

Academic context This work is part of a larger funded research programme [ESRC RES-000-27-0043] about mental health and social inclusion and concerns how people with mental health problems experience social stability through participating in different kinds of spaces. The spaces under investigation are categorised as natural, artistic and technological. What this means in practice is that the research programme looks at examples of innovative community programmes and projects that facilitate the participation of people with mental health problems in (i) gardening activities, (ii) art and performance work and (iii) the use of the internet for social support. The research programme is primarily academic in orientation and designed to facilitate the writing of a book about mental health and social space by Dr Hester Parr of the University of Dundee. However, the research conducted as part of this programme also has implications for users of service, practitioners and policy makers. As such the results are being made available in easily accessible formats in terms of printed reports, a web-site with further information and data (http://www.dundee.ac.uk/geography/inclusion/) and a short video film (distributed by the National Programme for Mental Health and Well-Being in Scotland)1. Objectives This study set out to investigate the relationship between community gardening activities and people with severe and enduring mental health problems in terms of the following overall questions and in the context of the voluntary sector projects that organised this activity: How does working with nature help to achieve social inclusion and stability for vulnerable groups? How are unstable identities positively changed through physical interactions with land? What do people with enduring mental health problems feel about garden work?

Are there ways in which garden work might be best facilitated amongst this group? What are the key outcomes of garden work for this group? Are there any wider implications for public mental health?

This research was also directed primarily by academic questions about human selves and identities in everyday social life and spaces, although the more user and policy friendly findings are reported here. Methods A pilot study had taken place in March 2000 in the Ecoworks garden project in Nottingham whereby staff and volunteers2 had been interviewed about the advantages and disadvantages of garden work for people with severe and enduring mental health problems (Parr, 2000). The findings from this project (Parr, 2000) were used as a basis for designing and researching the current research programme on community gardening for and by people with mental health problems. Ethical permission from The Tayside Committee on Medical Research Ethics (and permission from the local health authorities in which the participating garden projects were based) was attained in January 2004 for the new research, itself facilitated by funding from the ESRC. New research work took place between April 2004 and November 2004 involving 5 garden projects across the UK and sited in Glasgow, Edinburgh, Perth, Nottingham and London (project profiles are below). In each project paid staff and volunteers were interviewed about their role in the garden, their gardening experiences and feelings about the work in which they participated. Semi-structured interview schedules were used in each project that covered a variety of relevant key themes such as:
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History of garden project attendance Expectations of garden projects

The film will be finished in June 2005. Details from the author. In many voluntary sector projects, people with mental health problems are termed users or clients. In many garden work projects for this group, however, other labels are used such as volunteers or workers or staff. For the projects accessed as part of this research, this was because it was felt that such terms avoided stigmatising those involved in garden work. This report will adopt the term volunteer when referring to people with mental health problems, and staff when referring to those workers who are paid to support gardeners with mental health problems. It is recognised that non-hierarchical ways of working means that some projects do not differentiate between gardeners in this way.
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Outcomes of garden work Reflections on therapeutic aspects of garden work Reflections on the social and practical skills gained as a result of garden work Experiences of work and training for work Managing and funding gardening and gardeners Future prospects and visions

Interviews were between 30 minutes and 1.5 hours long, were mostly taped and carried out on-site in the garden projects. The taped interviews were then transcribed and analysed for key themes using a basic coding framework through the NVIVO software data management package. In all, 40 taped interviews were carried out with staff and volunteers across the 5 garden projects. This included 20 taped interviews with volunteers and 20 interviews with staff (with a wide range of roles and connections to the projects concerned). A further 18 shorter non-taped interviews with volunteers took place in the context of ethnographic (participant observation) work over the course of the research period at several projects (but mostly focused on Ecoworks, Nottingham and The Coach House Trust, Glasgow). Taped interviews with volunteers included 18 with males and 2 with females and informal non-taped interviews included 2 with females. In terms of staff, 10 females and 10 males participated in interviews. All participants in this research project except one were white British in terms of ethnic background. Ethnographic research Ethnographic research is otherwise known as participant observation, whereby the researcher participates in the activities and social worlds under study and then records observations and reflections in a research diary. This is then used to triangulate and verify claims made by interviewees in verbal disclosures. The ethnographic work in this project was concentrated in two sites over a period of 6 months. Recorded observations are not re-presented as data in this report, but serve to contextualise some of the more general comments on how garden projects operate and their characteristics. Please note that all quotations from volunteers and staff in the report are anonymised or attributed to pseudonyms.

Brief Garden Project Profiles

The ESRC research programme looked at 5 gardening projects for people with severe and enduring mental health problems in 2004. 2 were sited in England and 3 were sited in Scotland. Although there are considerable differences between each project in terms of location, range of activities, client base, size and funding, for the purposes of this report, common themes will be drawn out which apply to all. Academic and conceptual implications of the research are reported in more depth elsewhere in Parr (forthcoming, 2005). Broad types/categories of garden space Allotments in residential areas Allotments on wild common land/allotment site Removed garden spaces (walled gardens) Community gardens (predominantly used for project work, but with public access) Community gardening, landscaping and recycling projects

Ecoworks, Nottingham Location: Inner city, St Anns, Nottingham Type: Allotment (on wild common land/allotment site) Annual Income: (2003-4) Approximately 55,000 Major Funders: County and City Social Services; NOF Healthy Living Centre; The Community Fund; The Scarman Trust; Esme Fairbairn Foundation and other charitable sources. Service users: 6 (current) 30 [varied numbers of volunteers and staffing over 10 year period]. Predominately white British client base, 90% male clients [previously other ethnic minority groups have been involved]. Staff currently employed: 3 part time posts Remit: to provide gardening opportunities for disadvantaged people, including those with mental health difficulties, and to promote integration between different people and groups through garden work.

The Coach House Trust, Glasgow Location: Residential area, West End, Glasgow (with multiple sites across North West and South Glasgow) Type: Community gardening and recycling project/community garden Projected Annual Turnover 2004: 800,000 Main funders: Scottish Executive Strategic Waste Fund Not For Profit Sector; Greater Glasgow Health Board; Social Work Department, Glasgow City council; New Opportunities Fund; ERDF (European Regional Development Fund); other charitable trusts. Service users: 60 [98% male, 99% white British]. Volunteers: 19 Staff employees: 30 Remit: To counter social exclusion amongst a range of groups (those who are unemployed and those with learning difficulties, drug and alcohol addiction and mental health difficulties) through participation in a range of activities and training for work opportunities.

The Walled Garden, Perth Location: grounds of Murray Royal Hospital, Perth. Type: Removed walled garden Budget: (est/approx): 140, 000 Main Funders: Social Services; NHS Health Department. Service users: 35 [80% male, 20% female, 100% White British] Staff employees: 5 Remit: To provide a supportive horticultural work environment for those with mental health problems.

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Redhall Gardens, Edinburgh Location: residential/conservation area, South Edinburgh Type: Removed walled garden Budget: (est/approx) 138,000 Main funders: Social Work Department, City of Edinburgh and NHS Lothian. Service users: 36 [60% male, 30% female, 5% ethnic minority representation] Staff employees: 5 full time, 1 part-time Remit: To provide a supportive horticultural work environment for those with mental health problems.

St Marys Garden, Hackney, London. Location: Inner city/residential/warehouse district, Hackney Type: Community garden Budget: (est/approx) 110,000 Main funders: Thrive; The Learning Trust, Hackney; Social Services (Learning Disability Service and Community Mental Health Teams; Neighbourhood Renewal Fund; New Deal for Communities, varied charitable trusts. Service users: 30 (Male 62% Female 38%, 63% from black and ethnic minority groups] 2 full time staff, 2 part time staff Remit: To provide therapeutic horticultural and work training opportunities for those with mental health problems, learning disability, HIV and young offenders. To also provide a community garden for the local community with a resident key holder scheme.

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Different gardening project spaces

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Section 2 Context for the study: A brief literature and policy review
Nature and health There is a multi-disciplinary and international literature base that has long evaluated the varied connections between nature and health. Writing and research from environmental psychology, nursing, ecopsychology, planning, wilderness therapy, therapeutic horticulture, human ecology and human geography have all contributed to a rich, if diverse, evidence base about perceived beneficial connections between a range of nature-spaces and a range of aspects of human well-being (Kaplan et al, 1990; Kaplan, 1995; Maller et al, 2002; Morris, 2003; Sempik et al, 2003; Gesler, 1993; Gesler and Kearns, 2002). From early environmental psychology studies which famously highlight the benefits of nearby nature for post-operative hospital patients (Ulrich, 1983) to more recent work on the positive mental health implications of woodland play for children (Bingley and Milligan, 2004), to the reported benefits of gardening for refugees and survivors of torture (Lindon and Grut, 2002), health-nature relationships are deemed important across many disciplines and international contexts in terms of building human well-being and social and psychological capital. Although it is impossible to do full justice to this literature base here, some common themes emerge from research work that has looked at nature-health relations and these serve to connect individual human health with local community and global community health issues. There is hence a dominant message from this literature that nature can be generically understood a resource for human health on several different scales and in connection with a range of issues. The following list summarises just some of the big picture themes that traverse the nature-health literature in terms of perceived key benefits:

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Table 1: Nature use/relations and individual/community health benefits Restorative properties for general human mental and physical health and wellbeing Therapeutic properties for a range of groups with different mental health and physical health needs Building social capital and strong/er communities through collective uses of nature Environmental impacts and eco-sensitive awareness raising Global and local sustainability issues Food security and alleviating poverty

These benefits are potentially accessed through a range of different kinds of activities and relations in different kinds of nature spaces: Table 2: Diverse nature spaces Parks Urban nature spaces Forests and woodlands Farm and agricultural land Community gardens Allotments Private gardens Wilderness areas Seascapes and watery landscapes Institutional natures (in hospitals, workplaces, schools, prisons, clinics etc)

The benefits of cultivating, living near, using, being and playing in nature in its varied forms, but particularly in urban spaces of population concentration, is fuelling research efforts to better understand the beneficial outcomes summarised above. Recent EU initiatives, for example, are attempting to harness the research capacity that exists to link nature spaces and human health (COST E39, 2004-2008). Current funding strategies include facilitating collaborative engagements between different

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academics and practitioners in order to collate the evidence base relating to health and nature across Europe (see also policy context below). There are also a wide range of NGOs who contribute to our understanding of the practical capacities of nature spaces in terms of the broad benefits to individual and community health. Gardening, horticulture and health One very specific aspect of the relationship between nature and health has formed the basic context for this study. Gardening and horticulture3 has received considerable attention in recent debates over the health-giving capacities of nature (Francis et al, 1994; Relf, 1992; Cooper Marcus et al, 1999; Simpson et al 1998, Sempik et al, 2003). While the health implications of gardening and horticulture are thought to be relevant for the general population as well as specific groups (such as the elderly, children, people who are ill, offend, have dementia, learning difficulties or physical disabilities), it is those with mental health issues who are privileged here. Indeed, the known relationship between domesticated nature (gardens, landscaped park land, farm land) and health can be argued to have specific roots in institutional health care for people with mental health problems. Gardens and gardening were recognised as a therapeutic medium for institutionalised populations since the late 1700s both in the UK and the US where the benefits of field labour for asylum patients were noted by contemporary psychiatrists of that period (Davis 1998; Paterson, 1997; Digby, 1985; Philo, 2004, Parr 2005). In the 20th century, and building on asylum practices in the 19th century, occupational and rehabilitation practitioners of various persuasions have extensively adopted what has been termed either horticultural therapy or therapeutic horticulture in relation to a range of vulnerable groups and settings (Goodban and Goodban, 1990ab; Kaplan, 1995; Nehring and Hill, 1995; Seller et al, 1999; Simpson and Strauss, 1998). These terms respectively refer to the use of plants and garden work to meet clinically defined goals (a treatment strategy), and more generally, the well-being that may develop from gardening in both active or passive ways:

Horticulture refers to the practice of cultivating plants, while gardening can more generally refer to other activities such as weeding, landscaping, creating beds for plants, harvesting and so on.
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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 UKs community welfare infrastructure, Sempik et al (2003) settle on the term social and therapeutic horticulture. This term is used to indicate that horticultural activity with disadvantaged groups is not often strictly clinically orientated, but rather is aimed at providing opportunities to improve the well-being of the individual in a more generalised way (ibid, p4). The commonalities across different disciplines and studies in terms of a convincing, but largely unacknowledged, evidence base for the health-promoting dimensions to horticulture and gardening are summarised below and can be seen to crystallise around the benefits of gardening in terms of individual and collective health and social improvements: Table 3: Some reported benefits of garden work amongst vulnerable groups (after Sempik et al, 2003 and Morris 2003) Improved self-esteem and self confidence Development of work and social skills Development of independence Opportunities for emotional expression and reflection Enhanced spiritual and sensory awareness Useful employment Increased physical activity and exercise Consumption of healthy food in sociable ways Improved opportunities for social cohesion and behavioural improvements Accessing to opportunities for social inclusion

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Despite the positive messages from most research on horticulture and health, caution must be also exerted in terms of thinking through how and under what circumstances such benefits are achieved for particular participants. For example, many institutional gardens may not provide the same opportunities for social cohesion and healthy eating as a community based garden. Community gardening projects are also often predominantly male spaces, as this research indicates, and there maybe multiple access issues concerning different natural spaces (see below and Kurtz, 2001). Any benefits must therefore also be understood alongside the local conditions and circumstances through which garden work happens, as well as considering what national guidelines might help to ensure the above outcomes for all (see concluding comments). One of the key points of interest for practitioners and policy makers is how gardening and horticultural work facilitates social inclusion for vulnerable or excluded groupings. In arguing how this work often involves key components of social inclusion, Sempik et al (2003) suggest that collective gardening, enacted through community social welfare projects, enables gardeners with mental health and other difficulties to participate in processes of i) ii) iii) iv) Consumption [buying/consuming the goods that other people buy/consume] Production [engagement in socially valuable activity] Social interaction [the building of social networks and identity] Political engagement [self-determination and empowerment]

These elements are argued to be key dimensions of social inclusion (after Burchardt et al, 2002 and cited in Sempik et al, 2003, p37) and processes from which people with severe and enduring mental health problems (for example) may have been distanced through institutionalisation. In this view, engagements with domesticated nature and gardening are powerfully associated with current social policy goals, those being the integration and normalisation of previously excluded people in everyday society. Political and community contexts Mental health and mental health care have been recently linked with major policy initiatives in the UK connected with social inclusion. Both the EU and the UK
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can be seen to be pursuing a raft of policies connected to this concept. In current political discourse the buzzword of social inclusion is associated with access to employment, good housing and health, education and participation in a wide variety of social and economic arenas (Scottish Office, 1999; Scottish Executive, 2003a), while conversely social exclusion is associated with unemployment, poor housing, illhealth, crime and lack of community participation (Social Exclusion Unit, 2001). In terms of mental health it is clear that policy makers link social inclusion, participation and the improvement of clinical outcomes (Sainsbury Centre for Mental Health (SCMH), 2002, p2; National Service Framework, 1999), and so promote links between inclusion outcomes and mental well-being. For both ensuring and maintaining mental well-being amongst the general population, then, and specific improvements in terms of people who have experienced illness, opportunities for community participation, education and inclusion are thought to be key dimensions to success. In the UK more generally there is a current political emphasis on active participatory citizenship, facilitated by multifarious funded partnerships between the state and communities (Fyfe and Milligan, 2003). This coincides with health care policies that have sought to relocate the everyday lives of people with severe and enduring mental health problems within community settings in order to end isolating and stigmatising institutionalised care (Scottish Executive, 2003b). Simultaneously, the drive to counter exclusionary processes and positions that many people in living in poverty and disadvantaged communities find themselves located within has been politically important (Social Exclusion Unit, 2001, 2004). The role of nature in this broad political context is complicated, but has in various ways provided a platform upon and through which politicians, communities, organisations and individuals have claimed rights, sought participation, attained resources and articulated global and traditional local community values in the search for an improved society. Combined, the influences cited above are all driving factors as to why nature generally, and horticulture for those with mental health problems specifically, is currently of interest in UK communities and voluntary sector organisations. There are also now significant national forums for the promotion of inclusive nature spaces (for example, Thrive, The Sensory Trust, The Federation of City Farms, Greenspace and Greenspace (Scotland)) and which can be understood to be broadly attempting to facilitate new links between citizenship, well-being and nature.
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Community gardens are increasingly popular in UK cities and are open spaces managed and operated by members of the local community for a variety of purposes (Holland, 2004) including vegetable growing, recreation, training, education and health promotion. Ideally community gardens exist to maintain or facilitate senses of community in particular places and the aims of community participation and empowerment is what (potentially) links the community garden idea with horticulture for mental health. However, despite the growth in community gardens, and some examples of integrated community work, most gardening work undertaken by people with mental health problems occurs in special project spaces, which can hence potentially limit the claimed advantages for social inclusion. Nonetheless, there is some evidence of a greening of social policy and a greening of the voluntary and community sector, a development surely framed by wider national and global politics of environmentalism and sustainability. Such a national UK political context can be argued to be conducive to the more widespread development and funding of horticultural and community gardening work by people with mental health problems. In Scotland The National Programme to Improve the Mental Health and Well Being of the Scottish Population (and Action Plan 2003-6) reportedly flows from the Scottish Executive's commitments to social justice and health improvement. Demonstrating an interest to exploring innovative means to build community wellbeing (Scottish Executive, 2003c) as well as dismantling stigma about mental health issues, the role of diverse nature spaces are arguably under-explored as a means through which social inclusion and participation might be achieved. However, given the stated commitments to joined up thinking and action across mental health promotion, prevention and treatment sectors (Henderson, 2004), there are possibilities for the natural urban environment to be an imaginative focal point for action relating to public mental health. In disadvantaged communities with poor social housing stock, for example, the development of community garden work and accessible natural spaces (by people with mental health problems amongst others) could assist in building public mental health by facilitating safe participatory spaces of everyday community life.

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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 current development of community garden work and the adoption of urban natural spaces as an innovative means of achieving and maintaining health amongst both general and specific population groups.

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Section 3 Research Findings

Accessing garden projects There is no one route to participating in gardening and mental health projects and volunteers were variously referred by CPNs, GPs, social workers and from in-patient care. Informal access can also occur with self and social network referral being commonly cited as pathways to gardening. Once referred applicants are usually interviewed for their suitability for horticultural work and formal funding is applied for. On the whole, most schemes sought clients or volunteers who were relatively mentally stable and physically mobile, although some (varied) provision was made in all schemes for wheelchair access. The diagnostic categories and labels applied to the garden workers who contributed to this study are not recorded in detail, but ranged from schizophrenia to bi-polar and to depressive and anxious conditions. Well I actually heard about the Coach House when it was just beginning to start up. I had a friend that stayed near here that knew about it and she showed me it. But also my young sister helped arranged the funding for this when it was Belmont Gardens, before it became the Coach House Mel, Volunteer4 My GP had mentioned it just in passing and so I had no preconceived ideas Halley, Volunteer Most volunteers report having few expectations at the point of project access, beyond wanting to change isolated social positions, although some are at a point of wanting to develop skills and participate in training after months or more usually years of mental health care. However, many volunteers talked about the fear they felt at entering a gardening project and the challenge of beginning work in an environment of which they had little knowledge or expertise. What is valued at the point of access is a supportive and clearly structured introduction to gardening tasks. Working in peer teams where there are a range of abilities and levels of expertise is
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Please note that all quotations from volunteers and staff in the report are anonymised or attributed to pseudonyms.
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also valued at initial access points. Women volunteers (few as they are) discuss the challenge of entering male dominated work spaces and the importance of ensuring women friendly spaces as well as the flexibility of working alone in gardens. I was referred by my CPN who thought it would help, but when I came here I had never been near a garden in my life and I didnt know anyone and I didnt like it Kim, Volunteer Basically I was looking for it as a permanent job, something I could do and develop in and utilise my skills and learn new ones Bill, Volunteer Staff report how important it is to have good relationships with a range for service providers in order to raise the profile of gardening and horticulture as viable community activities for people with mental health problems. Some projects, however, face major difficulties in maintaining consistent referral patterns for several reasons: the perception of gardening as a luxury service in already stretched mainstream service budgets a lack of awareness amongst primary care providers (such as GPs) and the difficulties of accessing them to raise awareness the unstable nature of funding sources in the voluntary sector resulting in fluctuating staff numbers with knock on effects in terms of referrals. In terms gender imbalance issues, garden project staff often locate the problem at the point of referral with service providers outside the project perceiving gardening and outdoor work as predominantly male activities and thus targeting those clients. For long-established projects with a predominately male client base, few specific strategies are employed to widen access to women. Only one project in the study had specific women-friendly access routes and women-only garden spaces and activities. When the project first started there was a lot of heavy work involved and so it tended to be men who came and now if you speak to women who come and see round the place, you can see that they are intimidated by the amount of men, particularly when theres young men for example. It is difficult. The ethnic mix is the same we only have 1 black person and 1 Asian person Staff
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We mail shot all the GPs in the borough its about 60 and then followed up with phone calls with GPs or practice managers or whoever we could talk to and we got a positive response but not a single GP has referred anyone to us Staff In terms of ethnic minority participation in garden projects there are different factors that may contribute to gardening projects being predominantly white spaces, including a general lack of integrative mental health service provision across different ethnic groups (which may influence referral patterns) and differing culturally based gardening practices and experiences of cultivation amongst particular ethnic groups. In respect to the latter point, however, some sectors of ethnic minority groups place particular cultural importance on cultivation (such as some older Black Caribbean men) and so shared gardening and allotment work could act as an important resource in addressing ethnic ghettos in mental health care. Similarly, refugees and asylum seekers often arrive in the UK from land-based economies and may benefit from mental health services that are focused on cultivation. Ecoworks in Nottingham is one project from this study that had active involvement with a group of asylum seekers before their deportation in 2003. St Marys in London is a project that attracts the attention of multiple ethnic groups in the locality and who also use the space as a community garden. Natural space arguably therefore holds the potential to act as a bridge to hard-to-reach groups who may have complex mental health needs. Key summary points Access to garden projects is dependent on knowledge and awareness amongst other mental health service providers Volunteers are often fearful at point-of-entry to garden projects if they lack horticultural experience The gender and ethnic constitution of garden projects is dominated by white British males Women-friendly access routes to project garden spaces are few Gardening as a focus for culturally sensitive mental health service delivery for ethnicity minority groups is under-explored

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Gardening as a therapeutic activity Volunteers come to gardening projects with a range of experience of natural and cultivational spaces, but with most having some exposure to these in association with their mental health care. For some, this can mean an ambivalent relationship with nature work, and something they associate with difficult times of their lives, or services that did not suit them or gave them little choice. For others, who have little experience, the work involved and the knowledge it requires can seem daunting. Although there may be latent beliefs about health giving capacities of nature that may underlie their initial decisions to access garden projects, few volunteers were conscious of this affecting their access routes. It is common for volunteers to discuss how they gradually came to experience nature and nature work (gardening and horticulture) as therapeutic only after some time with the projects concerned. Of the 38 volunteers interviewed as part of this study, 90% of them discussed what might be summarised as broad therapeutic effects of garden work. These effects can be summarised as follows (using vocabulary by volunteers): Terms used by volunteers to explain the therapeutic effects of garden work Therapeutic Calming Grounding Occupying Distracting Focusing Healing

A large majority of the volunteers discussed how general interactions with the natural world and gardening activity in particular had helped them recover from mental health problems, or at least helped to maintain their health status. Ethnographic observations carried out as part of this study confirms that garden work sometimes helped to calm erratic behaviour and provided a focus for negative energy and anger in difficult times.

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When you feel angry you just dig furiously, I associate gardening with getting anger out of the system more than anything else its about getting rid of energy into the soil somehow. There is something about releasing anger into the soil Josh, Volunteer, Between leaving the house and walking up here you feel different, youre glad you came. As soon as you come up here it does have an effect on you a positive effect of leaving behind stuff it helps to break the rhythm of stress Mandy, Volunteer There are two dominant ways in which nature and garden work are deemed beneficial for volunteers: as a passive sensory environmental experience that prompts positive reactions and as a medium for action (physical, social, psychological) through which the volunteer creatively works for their own health. In other words, volunteers both held or developed beliefs about nature and gardens as inherently healthy (automatically benefiting them) and as a medium for creative healthy action (non-automatic health benefits). Particularly important in terms of the therapeutic benefit of the garden projects was horticulture itself, ie the cultivation of plants. This may be both because the practice of plant growing is in itself experienced as therapeutically beneficial, and also because plant growing features heavily in staff explanations of the benefits of garden projects, and volunteers are influenced by these discourses. For example, plant growing was discussed by many volunteers as: Involving care and concern beyond the self Helping to ground confused thinking Involving positive emotions such as hope, pride and love

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You have to focus on the plant, you have to go with that and it helps you, it just helps to ground you John, Volunteer If you plant something its dependent on you, you have to slow your thoughts down to the speed of the plant and whats happening to it. It fixes you its quite a responsibility to care for the garden Kyle, Volunteer Plants and plant growing are also often used as metaphors by both staff and volunteers to discuss social and psychological difficulties. While this is a recognised feature of horticultural therapy, many project staff do not claim to be practising such a formal programmatic approach to garden work with mental health services users. Rather, garden staff (often who are not trained mental health specialists) refer to the natural healing capacity of gardens and garden work that they merely facilitate in a generalised way. theres lots of little magical spaces that people have here, where you just wander around and it just fills you up really and I suppose its allowing nature to heal you really ... Colin, Volunteer The garden and gardening is healing really. Its about the earth, it grounds you when you are totally disorientated by the world around you Peta, Volunteer Staff in garden projects unsurprisingly held strong beliefs about the inherent healing qualities of nature, as well as the social and educational capacities of natural spaces for skills training (see below). Garden staff, therefore, play an important role in terms of how gardens and gardening are experienced as therapeutic by volunteers. Garden staff and garden projects differ in terms of their emphasis on structured work programmes, the amount of therapeutic talk using plant metaphors, their discussion of the natural healing power of nature and this all influences the experience of gardening for volunteers. In general, where volunteers had relative freedom to develop areas of the garden, or had responsibility for their own part of a plot for growing, they were more likely to discuss at length the therapeutic effects of nature and gardening. Where volunteers were more used to general landscaping and gardening in teams
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or with close supervision, they were more likely to discuss at length the beneficial social effects of gardening with others, rather than the therapeutic capacities of nature per se. I think that gardening is therapeutic for a lot of people ill or not, disabled or not it is basically using gardening whether it is self administered therapy or with the help of someone else to affect positive changes in lives Staff We are organic and we are encouraging life to come in. Thats an interesting thought really, actually encouraging life into the site is the same as the life in the people as well its about allowing people to express their energy, in the way that they want to Staff I think particularly if youre suffering like Ive done with severe depressive episodes, its hard to think beyond surviving in the minute. Youre just wanting to get through the next minute almost or next few seconds. To actually look at a piece of ground and think, thats what it is like now, and then in 3 weeks time this will be like this, and then in 3 weeks time it will be like this, and then in 3 months time it will be like this. Youve actually started to create a future with the bit of earth thats in front of you, and for yourself, which is something you dont have Andrew, Volunteer Finally, garden space itself is seen as importantly bound up with the therapeutic experience of nature. Project gardens and allotments were primarily seen by volunteers as variously: Safe spaces Creative spaces Tranquil spaces Spaces of retreat Social spaces Community spaces

The geography of garden spaces was also important with zoned gardens being the most successful in creating accessible space suitable for use by people in different psychological and physical states.

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I like the patterns on the worms, the patterns, they look like floaters in your eyes the worms. I like the noise of the bees buzzing outside, I like the sound of the wildlife outside, aye. Callum, Volunteer Key summary points Gardens, gardening and nature are generally experienced as therapeutic by volunteers and staff The therapeutic effects include a variety of positive emotions and behaviours Volunteers experience the therapeutic effects of gardens in both active and passive ways Plant cultivation is particularly important in discourses of healing Garden staff are also positive about the healing potential of gardens and garden work and their beliefs and practices can influence volunteers Gardening as a social activity While most collective activities in community mental health services involve opportunities for socialising (and garden work is no different here); there may be particular aspects to the social activities that constitute this work that are worth noting: Social dimensions of community garden work Peer network opportunities Neighbourhood social contact opportunities Staff and client social contact Team working opportunities Food and social eating events Role shifting To pick up on just a few of the above list, the seasonal rhythms of garden work means that work is differently paced throughout the year with a variety of tasks. This not only tends to keep volunteers interested, as well as allowing for both able and less able workers, it also lends itself to the creation of social opportunities based around garden work. In summer times, and at times of harvest, when produce is plentiful,

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most garden projects have social events both for workers and for wider neighbourhood users (see below). The social significance of groups of people eating produce grown by volunteers is particularly meaningful, and contributes to feelings of pride and satisfaction, as well as providing a focus for conversation. When I took manic depression and was classed as ill and hospitalised, I lost all my friends and even most of my family. They cut me off and I wasnt included in anything anymore. So Ive been having to try and start again at the Coach House. Not necessarily at the Coach House, but at that level. The Coach House now has basically replaced all the ones that Ive lost Kevin, Volunteer In terms of staff and client contact, garden work provides (some) opportunities for collaborative engagement, rather than just top-down support and/or instruction from the staff to the client. Volunteers also felt that their own service providers saw them differently as a result of their garden work, as well as being able to (eventually) provide semi-expert horticultural support to paid garden staff. In some projects the atmosphere of collaborative equality established through garden work translates to a work place atmosphere, whereby staff and volunteers often celebrate the end of a working day or week with a visit to the local pub. Some other aspects of garden work also allow volunteers opportunities to see themselves in rather different social roles, moving from positions of dependence to becoming more independent and embodying a status of responsible worker. Such a move is discussed as being facilitated (for example) by the use of power tools like saws and lawn-movers. Volunteers discuss the importance being trusted to use such equipment, as for people with severe and enduring mental health problems, trust is a particularly meaningful relation. The guy again with the fuchsias is quite knowledgeable and he in the past has taken a great deal of the responsibility of the garden himself, he could partly run this place himself as could a few others Staff Many of the decisions on whats planted and how its planted is done jointly within the garden team Staff I can feel that I can be trusted with a lawnmower Jack, Volunteer
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They (the CPNs) see me differently, they see me more settled ... getting on with my life and being motivated .. Tim, Volunteer Team working is also a feature of many garden projects, especially where there is not space to allow individual gardening plots. Team working was especially helpful to new project members as it enabled peer instruction and support to take place. Volunteers also felt that team work enabled friendships to be more easily established. For volunteers who were established members of garden projects, the peer support and instruction helped them to achieve senses of self-worth and job satisfaction, as their roles shifted from just patient to garden worker. If Im feeling depressed, its nice to go out and work in the team along with the support staff I feel that Im in a safe environment, in amongst a safe crowd, theres nobody sort of looking or talking or doing anything, and Im working along with a lot of other people, volunteers and staff and whatever that are in the same boat Mick, Volunteer Im quicker and Ive got experience, but youve got to allow for others, youve got to work together and some people are faster, some people are slower . Sometimes I help them out, perhaps theyre having difficulty or whatever ... I just give them a hand to get it done Tim, Volunteer In addition, primary care workers (CPNs or support workers) beyond the garden projects were sometimes invited in to work alongside volunteers in the gardens or allotments. This was considered a beneficial practice as volunteers could demonstrate activity, concentration and expertise to care workers who may have only regarded them in the passive patient role previously. In some projects there are mixed working teams of people with mental health problems and people from the local community (although this is not common), and here there are opportunities for social integration that stretches beyond peer and staff networks (see also below). In such schemes, it is important to stress the equality of all volunteers, regardless of ability.

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Ecoworks have a policy of calling everyone a volunteer and I might be on the management committee and helping with funding raising and someone else might need help with keeping his jumper on in the garden, but were both called volunteers and no one ever makes a distinction about ability or mental health status or anything Kit, Volunteer Staff report that garden work can make differences to the social skills of volunteers. Volunteers are commonly discussed in terms of their progression from withdrawn and isolated social states to a point at which they are able to socially engage with others. Staff often use the environment as a way to encourage conversation with quieter members of gardening teams, arguing that the shared nature of garden work and the ability to focus on natural surroundings reduces the pressure on people who find socialising and maintaining relationships and conversations difficult: Its 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 thats flowering or whatever and that provides visual distractions that are useful. It makes it an easy setting to talk to people Staff As reported in the literature, there is some evidence from this study that people involved in garden work subsequently gain experience of new social roles, partly tied to increased political awareness of their roles as consumers of mental health services. Some volunteers participate in garden management committees, team meetings and planning processes associated with garden work. Others present talks on mental health to interested parties or get involved with national conferences on horticultural or mental health issues. While garden work does not seem to be particularly notable for the raising of political awareness and participation amongst its volunteers, there is evidence that this does occur. Key summary points Gardening activities involve a range of social opportunities for isolated volunteers Garden work can involve senses of shifting social roles for volunteers Socialising and routine conversations can be linked to the natural environment Teamwork in garden can involve peer support Staff and client relationships can benefit from joint garden work

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Gardening as a physical experience An important part of garden work is the benefit gained by increasing the physical activity of people who lead very sedentary lifestyles. For many people with severe and enduring mental health problems, medication use and lack of daily activities and structure in their lives can mean that they are not usually physically active. This has implications both for physical fitness and psychological health. Staff in garden projects point out that the lifestyles of people who live in institutional care, or who are predominantly bound into mental health care networks, often feature what are conventionally understood as unhealthy characteristics such as: High rates of smoking Low rates of physical activity Diets lacking in nutrients

Engaging in garden work can raise levels of physical activity to levels that suit the abilities of the worker involved. Many volunteers in this study reported beneficial effects of physical activity in terms of the impact on mental health and sleeping patterns (possibly reducing medication use):
If its winter time and youre digging youre going to dig like mad to keep warm

Kim, Volunteer Gardening is a very good piece of exercise and its like having relaxation Mick, Volunteer Its physical and I enjoy it, at the end of the day to be quite frank I get a good nights sleep, because Ive been moving and active Tim, Volunteer Youre that tired you realise, oh I got that anger out you know. The frustration you take it out Jock, Volunteer Both staff and volunteers point out that garden work can mean not only increasing the amounts and levels of physical activity, but also the development of different physical strength and skills as they develop through particular tasks such as:

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Manual dexterity with seedling and plants Handling complex garden equipment with care Building muscle strength with lifting and digging Visual focusing on seeds, plants and wildlife

For some volunteers, the physical benefits acquired from garden work are not only tied into strength, relaxation and skills, but also connect to the acquiring of different sensual and sensory experiences, which simply expand and improve their sense of quality of life. Particularly for those garden workers who work in allotment environments, where they are exposed to prolonged experiences of wood-smoke, fires, rain, cold and heat, physical experiences can be quite profound: People for instance living in a residential home, it can tend to be a very stifled and claustrophobic environment. So people having the opportunity to come to somewhere like this, where it is open, and they can get out in the fresh air and get wet through if its raining, and get muddy, is actually quite an unusual thing. To have somewhere to sit by the fire and all this sort of stuff, I think is important. Ade, Volunteer Its about getting dirty, its about shoving your hands in the ground. Steve, Volunteer In times of ill-health the physical dimensions of garden work can take on more meaning in terms of both the difficulties and the relief that this can bring. For those who have experienced disabling levels of depression, for example, the challenge of garden work can seem too physically demanding at points. For others, acute phases of illness involve different physical experiences of garden work. For those with bi-polar illness for example, frenetic and high-speed garden work can help to channel energy, although this pace of work can be disruptive and alarming to others. Zoning garden work can help to alleviate this problem.

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You can suit a job to how youre physically feeling. If Im really tired and got no energy I can sit and sort seedlings Dave, Volunteer I was once in the garden helping to mix some compost, and the big bin was oozing and they were doing it on a tarpaulin, but I was a bit hyper that I did it so hard and fast that I stretched the entire tarpaulin beneath it and around it. But the staff were fine about it, they were understanding. I got the work done fast though Mick, Volunteer Garden project staff also argue that improved healthy eating is a key physical outcome for participants who have mental health problems. For those newly resident in community settings, or who live in institutional care, diets are often poor due either to levels of cost or a lack of skills in terms of the preparation and consumption of fresh fruit and vegetables. All of the garden projects in this study provide food for their volunteers on a daily basis, and most used produce from the garden or allotment (although not consistently throughout the year). This practice results in the double benefit of raising consumption of nutritious (often organic) food and celebrating and sharing the result of communal work efforts. Key summary points People with mental health problems may have conventionally unhealthy lifestyles Garden work helps raise levels of physical activity Different physicals skills and strengths may be developed New sensory experiences may be acquired Physical activity can help in the management of symptoms of ill health Healthy eating levels may be increased

Achieving social and community integration through urban nature work People with mental health problems who work in gardening and horticultural projects report in general that their social networks are often strengthened as a result of their participation. While there may be particular features of the social relations that are created and maintained in garden projects (see above), there is a sense in which any collective community activity amongst mental health service users will be likely to strengthen peer networking to some extent. Beyond the formation of social

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networking and development of social integration with other project users and project staff, it is useful to discuss the wider potential for community integration. In terms of wider social and community integration, the projects that took part in this study had developed in different ways. For the projects based on allotment sites or removed nature spaces, the potential for integration with community residents was diminished, although relationships between individual and other plot-holders workers were in evidence/had the possibility of being created5. For garden projects based in densely populated locations, the integration between the project, its workers and the local community is particularly important and forms the basis of commentary in this section. The garden projects under study comprised the following types of garden space: Broad types/categories of garden space Allotments in residential areas Allotments on wild common land/allotment sites Removed garden spaces (walled gardens) Community gardens (predominantly used for project work, but with public access) Community gardening, landscaping and recycling projects

In general, the latter two types provide most opportunity for face-to-face interactions between volunteers and local community members. The allotments and removed gardens provide less opportunity for daily contact with local community members (based on reported and ethnographic observations) due to their less accessible physical locations and site features (such as high border hedges or walls). In terms of the community gardens and community landscaping projects, being literally placed within well used residential and commercial spaces offered multiple opportunities for volunteers to build senses of belonging and community in place. The function of such spaces and schemes (ie. regenerating and creating usable and visually pleasing green spaces) increase the sense in which volunteers are seen as useful citizens providing local services, instead of just receiving services. Both staff and workers agree that (in particular) the transformation of wild or wasteful
5

These projects did hold well-attended social and open events for local communities.
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urban nature into manicured and aesthetically pleasing public spaces is a powerful symbol of the purpose and capacity of people with mental health problems. Such symbolic transformations of space serve a dual purpose; as they involve the practical re-skilling of a deskilled population: and help to convince local residents that people with mental health problems contribute to the improvement of community life: The people round about are great, they see what a great job the Coach House does and I think it helps empower everyone thats here because the people around dont look at the negative side of people, they look at the positive side and they dont look and say, well because theyre disabled they cant do that there are some people in here, myself included, that are classed as being not able to live in society, and weve got our problems, but the level of knowledge and the things they [we] can do is incredible youve seen yourself Terry, Volunteer What were trying to do here is help people realise their full potential as opposed to everyone being at the lowest common denominator . A lot of people from the local community are in and out the building all the time, or theyre in the shop, or they see people round the lanes and they can see what people are doing, and they just get involved. They [the volunteers] all speak to people, the people coming to do their recycling or coming to buy their herbs, so its all part of the community, its about breaking the fear factor . Staff While community landscaping, and community gardens provide value for the local community, which helps the acceptance of mental health services (breaking down the NIMBY factor), organic food production also benefits residents and provides points of interest for nearby schools and so on. Such contact is important in terms of breaking down barriers to integration due to stigma and negative attitudes towards mental health issues. Community garden projects help local people understand that people with enduring mental health problems can work, are able and can interact in friendly, sociable ways on an everyday basis. Urban gardening projects, then, can be argued to help to engineer change in the social status of this group. More pragmatically, for the people involved, gardening in community settings helps them in becoming more confident literally to be and to socialise within these spaces. As a result, shifting expectations and relations are traceable in the neighbourhood streets around which these kinds of activities are based:

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It [the garden work] does change attitudes, it does, because you become more socialised, you get to meet people, talk to people, it becomes therapeutic as I say, you get to know people and it helps you a lot. Its a familiar place with familiar faces and you get to know them you know Gavin, Volunteer Evidence of levels of integration between volunteers, projects and local communities included the encouraged patronage local pubs after work, the support of the local residents committees, sharing sheds and tools with neighbours, operating local resident key holder schemes, selling garden produce, having significant local support for open days and gaining commissions for private landscaping and garden work. Such examples suggest that fear and stigma are not the dominant ways in which project workers are understood. Examples of integrative social relations between garden projects and communities Local resident committee support Routine community use of garden project space Routine conversations between community members and volunteers Sharing tools and garden sheds with neighbours Local key holder schemes Garden produce sales Collective use of local cafs and pubs by project workers Commissions for garden work Large numbers at open days Ethnographic work over several months at one garden project confirms that local residents do interact with garden workers on a daily basis, and that in some cases casual friendships are formed between certain residents and workers that are sedimented by routinised visits and conversational exchanges in the gardens. However, there are limits to these inclusionary relations in that not many (if any) volunteers appear to have built sustainable friendships that cross the communityproject divide that involve private home visits or phone calls (although this true of most work-place settings). Despite this, some workers feel valued as a result of their
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work in local community settings. These are very unusual words from someone with severe and enduring mental health problems: Youre not isolated in a wee box on your own, youre part of the general community and well respected Mike, Volunteer Volunteers seem to feel most pronounced senses of local integration when they have worked on community gardens or private garden spaces through contract work. Examples of social integration can occur on allotment sites, however, whereby fellow plot holders share produce and advice about growing, visit project space and/or offer visits to their plots. However, allotment spaces, like some community gardens can risk isolation if their physical layout is not conducive to casual community encounters, or if they are located away from busy allotment roadways or residential areas. Such gardens and allotment sites offer other advantages in terms of protective or restorative space for garden work while also still acting as important spaces of social contact amongst volunteers6. Gardens and allotments can occasionally be the focus of negative community actions with acts of vandalism being recorded in some projects that formed this study. There is little to suggest that these are the result of negative attitudes towards mental health issues. Moreover, it is suggested that there may be beneficial implications for wider public mental health, as discussed below. Key summary points The location and layout of garden projects affects the opportunities for community contact and integration Community garden work offers the potential to change attitudes to mental health issues Local communities integrate with garden projects in a range of ways Volunteers can feel increased senses of belonging as a result of garden work

It is important to note that these spaces are not asocial when it comes to community contact, they simply do not have the same amount of casual, daily encounters with local residents as other garden spaces. This does not make them any less of a valuable resource.
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Gardening as work and work training 4 of the 5 garden projects that contributed to this study claimed that their project was in part orientated towards work and work training. For garden staff and project managers training for mainstream work is often important in terms of funding and the criteria under which this is acquired. Managers claim that health and social services (often core funders for such projects) are understanding about the needs and skills of the client base, but that they also require attempts to move volunteers on from projects after a set period of time to further education, training or work. This depends, however, on the client and the funding stream. Volunteers encountered in this study had attended projects from between 1 month to 8 years, with the majority attending for 3 years or more. There were no formal pathways to work in any of the projects in the study and only a handful of examples of volunteers who had moved onto full time mainstream work were cited by project staff. In terms of formal training, all the garden projects had, at some point in their history, offered horticultural training qualifications (such as SVQs, City and Guilds, NVQs and John Muir Trust Awards). Approximately 30% of the interviewees in this study had acquired some sort of qualification as a result of their participation in the projects they attended7. For those that discussed the gaining of qualifications, this resulted in feeling of achievement and pride, although not always directly in any further education, training or work. In terms of ambitions, most volunteers aspired to mainstream work, although not in always in gardening and horticulture. However, they were also realistic in terms of their self-assessed low likelihood of success. Staff were also pessimistic about the reality of moving volunteers into mainstream work and pointed to the contradiction of external pressures to train volunteers for job markets that are not likely to accommodate their needs. Green jobs relating to gardening and horticulture are also in short-supply in the mainstream economy. For some projects the solution to this problem is to create paid jobs for volunteers (and there were examples of people who had moved on within particular organisations); although the barriers to doing so are keenly felt by both staff and volunteers alike in terms of:

Some volunteers could not remember or did not know.

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Losing benefits and access to supported accommodation Being exposed to workplace performance pressures Coping in a work environment where other people have mental health problems

Turning to the garden work itself, some volunteers understood their gardening activity as real work, and not as recreation, therapy, education or training. In some projects expenses are paid to volunteers (a maximum of 20 per week) and these are regarded as wages, reinforcing the notion of (some, but not all) garden projects as primarily work spaces. I see it as a real job for me I see it as a lot of responsibility and I have to get out of my bed to come in you know and sometimes I struggle with that. Im still on medication and that makes me tired in the morning Peter, Volunteer I think a lot of people will just stay here. I dont think its like you come here and learn stuff and just move on, although I might look at that one day you know not that I would know how or anything but I dont want to run before I can walk you know I am fortunate to be here in the first place Rodney, Volunteer I cant earn anymore than 20 or my benefits would be affected its something to look forward to. Tim, Volunteer For some projects (such as The Coach House Trust), who attain money from other sources than health and social services for environmental regeneration work, the emphasis on work is justified by staff and volunteers by claiming that they are funded to provide a local green community service. Many volunteers here discuss their work in these terms. I do feel like I am providing a service through the Coach House to help the local environment and how to protect the Glasgows district environment they pay your wages, they give you 20 a week and thats good money. I work here Tuesday, Wednesday and Fridays 1-4pm for that. Tony, Volunteer Conversely, to other volunteers, the garden work seems easy compared to what they know or imagine of mainstream employment and it is conceived more as therapy or

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even relaxing recreation. Some volunteers see gardening as an escape from the pressures of mainstream work. In one project there was attempts to provide two different but linked gardening experiences relating to these perceptions by zoning some garden spaces for therapeutic and restorative work and some as highly productive or highly landscaped training spaces. However, only having formal or clearly defined progression routes from one to the other enables this strategy to work effectively. Garden staff across the 5 projects differed in their approach to gardening as work and work training. While some garden programmes are well structured with defined tasks and clear daily, weekly, monthly and seasonal planning, with rotated working roles for particular individuals and teams, other projects are adhoc and seemingly disorganised about working roles, training and schedules. For some staff, this latter situation is a principled approach to working with people with mental health problems, while for others it is a source of frustration as mainstream work ethics do not seem to define garden project spaces: If youve got a job you feel more part of society, you can hold your head up, you can speak to people easier, you discuss the Coach House. And the Coach House is quite well known now so whenever you do discuss it you always get into a pretty good conversation Kevin, Volunteer My job is getting people job ready and I cant get people job ready if lunch is supposed to stop at 12.45 and people arent getting to work until 1pm or 1.15pm theres sitting down for a couple of fags before they get going you know? In a real job would that happen no! your boss would come in and order them to work Staff If somebodys saying I dont want to do this, Im not about to say well, youre doing it. Thats not right. I wouldnt stand for that, so I dont see why anyone else should, you know. But if they come along and do a bit then thats great. Its whatever level people are contributing, its valued. Staff For all staff working with people who use strong medication, who may not be physically strong and who lose concentration easily, training can be challenging and there are numerous ways in which they seek to engage volunteers in gardening work tasks:

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Providing clear instruction and explanation Repeating instructions and explanations Demonstrating the task Matching volunteers with appropriate tasks Creating understanding of task duration (start, process, end) Supporting and supervising the worker Being flexible with work speed and breaks

For projects that provide private garden contracting work, such levels of support may be impossible to balance with the needs of the commissioning client, and one difficulty is clearly maintaining this income stream and work experience base for volunteers at the same time as providing a viable commercial service. Project managers bemoan the lack of opportunities for green employment as a next step for their volunteers. Staff suggest that proactive local state employment policies might look to the social care sector for the provision of trained workers who could then benefit regeneration initiatives, simultaneously addressing unemployment levels amongst people with mental health problems, tackling stigma and improving the environment. Key summary points Gardening is understood as work and work training by most staff and some volunteers Most garden projects offer horticultural training and qualifications are highly valued amongst volunteers There are perceived barriers to volunteers moving on from garden project work, particularly into mainstream employment Volunteers sometimes value garden work as a service to the local community and think of their expenses as wages Garden projects differ widely in terms of their organisation of work and philosophies about working amongst people with mental health problems Combining supportive work amongst people with severe mental health problems with commercial contracting services is not easily achieved There are few next step opportunities for trained volunteers

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Difficulties with garden work All garden projects face challenges of working with a client base who have complex needs, use medication, have varying capacities for physical work and may not have any experience of gardening and horticulture. For most projects similar difficulties surrounding issues of endurance, strength, concentration and adaptation were common in terms of training and working with volunteers. In the UK, and Scotland in particular, the weather also determines the level of garden work which is possible, and all projects found that offering alternative activities (such as classes, workshops, arts work) were necessary to supplement the physical garden work in bad weather and in winter time. For some projects, the gardening work carried out in public spaces was deemed extremely important in terms of the levels of local community acceptance. Therefore there is sometimes a pressure between the need to maintain visually pleasing and productive gardens for the local residents, and working with people who easily damage beds and plants and are not always neat and tidy in their gardening practice. In one garden project there were also problems with volunteers and staff (allegedly) using project space for personal or illegitimate activities (like drinking and drug-taking), which created controversy amongst other garden workers who felt local community relations were at risk, as well as the mental health of other volunteers. In terms of working relations, staff expressed frustration when instructions were not followed, needed to be repeated many times, when particular volunteers needed intensive support or when gardening work required to be re-done after volunteers had left for the day. Ethnographic observations also recorded that some volunteers were favoured as good people to work with over others who were less competent and compliant. There were occasionally conflicts amongst volunteers about who got what task and where they were to be located in the garden. As volunteers built up their own expertise, conflicts could arise with staff in terms of what was the best plan for the garden, resulting in complicated social and power relations between these garden workers, particularly when volunteers feel that garden work is disorganised.

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Some say I dont want them in my garden because they trample my flowers and plants so teach them!, teach them!, thats the whole point, so what if theyve been here 7 years, no one has taken the time to tell them where to put their feet, it takes half a second Staff Ive got more gardening education than [the staff]. Ive got a diploma and they just want to do things their way. Apart from that, we need someone with quality and stamina and someone who can take the team, all of us, upstairs to talk about each garden and what needs done and then weve all got our own jobs to do or we all work with each other Rodney, Volunteer General difficulties with garden work: volunteers perspectives Working in cold and wet weather Working when feeling ill Working in disorganised ways Feeling powerless over garden planning Lacking education about horticulture Unpleasant textures of nature

General difficulties with garden work: staff perspectives Working with demanding volunteers with complex needs Balancing the demands of garden work with support work Limited staffing and relevant expertise Limited equipment Limited funding Other difficulties identified by project managers include the lack of or instability of block or core funding from health and social services and other organisations. Most projects exist on a complex amalgam of funding from a variety of sources, all of which have competing demands in terms of demonstrable outcomes. In some other cases, funding follows the client and when the client moves away, the project risks being under-funded and hence acts as a disincentive to help volunteers achieve next steps.

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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.

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Section 4 Conclusion
The research findings of this study have demonstrated that garden and horticultural projects for people with mental health problems are rich social spaces that are actively engaging a hard-to-reach group on a number of different criteria. In terms of the broad questions that defined this study: How does working with nature help to achieve social inclusion and stability for vulnerable groups? This research study demonstrates that gardening, in general, seems to offer opportunities to engage in activities that help people with mental health problems in terms of maintaining their health and their perceptions about recovering from psychological difficulties. In terms of conventional understandings of social inclusion (cf Sempik et al, 2003), garden work allows volunteers to further their capacity for consumption (in terms of wages which are distributed in some garden projects, and their access to healthy food). Volunteers also engage in production (gardening is understood as a socially valuable physical activity); social interaction (peer and community social networks are strengthened) and to some small extent, political engagement (experience of committee work, conferences and similar activities). In terms of more generalised understandings of social inclusion and more particularly how people feel included in the daily rhythms of places they frequent or live, garden work is accompanied by feelings of worth, value and pride. These feelings are tied to the sense that workers are making small, but important, differences to their local environments. Such feelings are partly emergent from the positive community responses to environmental and garden work, as well as from self, peer and staff validation. For people with mental health problems to feel useful and that they are making a difference to the world is a profound social act with positive psychological benefits. Gardening projects may offer imaginative ways through which new versions of social citizenship may be achieved and through which people with mental health problems feel socially included in community settings. Caution must be noted,

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however, that garden projects spaces are not accessible to all and more work must be done to increase numbers of women and ethnic minority participants. How are unstable identities positively changed through physical interactions with land? Many volunteers clearly found the gardening and horticultural work therapeutic and in ways which helped them gain perspectives on their own difficulties or some insights into their needs for recovery. As reported in the literature (Morris, 2003), physical, sensory, emotional and spiritual experiences seem to be enhanced by garden work, and volunteers in this study validated this claim to some extent. For people who experienced themselves and their identities as fragmented and fragile, garden work provided opportunities for them to feel more grounded and secure through both the structure of work patterns and through focusing on their multi-dimensional relationships with plant and wildlife. Apart from these complex relationships between the self and nature, volunteers also gained opportunities to socialise with peers, staff and local resident in different ways, which offered them access to (potentially) supportive and sustainable relationships in ways beneficial to senses of self-identity. What do people with enduring mental health problems feel about garden work? Volunteers who participated in this study expressed a range of feelings about garden work, both (primarily) positive and (less so) negative. To summarise, dominant feelings of pride, hope, self-worth and self-esteem accompanied garden work, alongside an amalgam of emotional states that might broadly be expressed as versions of nature-love or biophilla. These feelings helped to distract people from focusing on negative aspects of their own lives or health problems. At the same time, nature work was experienced as emotionally challenging with feelings of frustration, anger and sorrow accompanying some aspects of gardening. It is important to note that the emotions that are bound up with nature work are experienced partly with reference to complicated human-nature relations and partly with reference to the managing and structuring of garden project work and its place in

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the wider life of the individual volunteer. For example, hope may be a feeling experienced in relation to the sensations, psychological effects and metaphorical readings prompted by seeing a seed grow into a plant, despite harsh weather conditions. However, it may also be a feeling associated with a regular ability to get out of bed and go to work, the new social networks acquired through project attendance, or aspirations to move on to train and work in different natural environments. Are there ways in which garden work might be best facilitated amongst this group? These following questions prompt more directive and summarised responses in terms of conclusions: Garden work seems to be most effective in terms of widening opportunities for social inclusion and social networking when garden space is located in or near to residential areas Removed locations for nature work (walled gardens and allotments for example) can provide important experiences of retreat and asylum, as well as increase peer social contact and contact with communities of interest In general, well-structured garden work with clearly assigned working roles most obviously benefits volunteers Combining practical work with education and joint-planning helps volunteers feel ownership over garden space Combining individual and team working patterns offers a broad range of work and social experiences Flexible working speeds, tasks and durations benefit volunteers Trusting volunteers with equipment like chain-saws and lawn-mowers is highly valued and helps build their skills-base Combining individual plots with collective plots allows for different preferences to be expressed and skills to be practised Food production creates particular interest in gardeners, although consumption of healthy foods may only be assured when projects provide the meals

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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

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The work by people with mental health problems to provide such spaces simultaneously helps to change public attitudes to mental health as garden workers are seen to be active, useful and expert

Combining environmental regeneration with education about mental health offers the opportunity to both raise levels of public mental health and reduce stigma Visioning sustainable public mental health

In this report gardening and horticultural projects for people with mental health problems are shown to benefit this group on a range of different criteria. However, even a small study such as this one highlights the fact that garden projects differ dramatically in terms of their remit, locations, funding structures and working practices, and yet all seem to offer something of quite profound merit to the people who access them. At present, despite the over-lapping and complementary national political frameworks which can be argued to constitute a healthy climate for the development of environmentally friendly mental health care, there is no one organisation or lobby which is pushing this agenda forward. In addition, despite claims about joined-up thinking in the national and local state, there is little evidence that those authorities responsible for shaping the environment and mental health care have a co-ordinated agenda for tackling individual and public mental health issues. This is arguably a missed opportunity to develop an innovative approach to social care and urban environmental regeneration. While there are effective national organisations such as Thrive who provide networking opportunities between gardening projects, and valuable education and training for therapeutic horticulturalists, uptake is varied and many gardeners work in projects without much or any mental health training. The status of therapeutic horticulture (which Thrive promotes) is arguably not as integrated into mental health or medical services as it is in other countries such as the United States. While this is not necessarily a disadvantage in terms of community mental health, there remains a gap for a strong organisational voice to be pushing a national political agenda for a coordinated environmental mental health care at different scales. Developing nationallevel good practice guidelines for garden and mental health projects, and linking this

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into local core funding requirements and regulation might be one step along this road (see Sempik et al, 2003). In the future, a challenge remains for policy makers, civil servants, funders, service providers and green pressure groups to establish a co-ordinated approach to mental health care and public mental health issues. If sustainable community mental health care in a consistently and core-funded voluntary sector works creatively towards addressing the environmental needs of local communities (especially in disadvantaged inner-and-outer city areas), then the implications for public mental health and the possibilities for reducing stigma are exciting. In asking whether we might hope for sustainable communities in the UK in connection with mental health care issues, we could do worse than to look to gardening, horticulture and environmental work for innovative routes forward. In this visioning of inclusive, environmentally sustainable community work, the person with mental health problems is an active citizen, working for their recovery of self as well as the community. Creating opportunities for simultaneous and integrated training and garden work amongst and with local residents would also further the inclusive potential of such projects. Such a vision, however, has be underlain with a realistic understanding of the difficulties of garden work for this group, and also the risk of exploitation (as in some aspects of the history of asylum-based horticulture), as well as the risk of de-valuing restorative nature work which primarily benefits the self or the volunteer community. Rethinking sustainable communities and opportunities for an environmentally progressive public mental health programme may also require innovative re-thinking in terms of the benefits system and therapeutic earnings for those people who engage in such work (perhaps connected to ring-fenced local community taxation). Finally, in visioning the opportunities for next step employment for people with mental health problems who feel able to take on further challenges, green job opportunities could be provided to them and other local residents through a reinvigorated green social economy. Here the local state might lead attempts to regenerate neglected urban natural spaces across our cities, while simultaneously building well-being and achieving senses of placed belonging amongst their inhabitants.

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Section 5 References
Bingley A and Milligan C (2004) Climbing Trees and Building Dens: Mental Health and Well-Being in Young Adults and the Long-Term Experience of Childhood Play Experiences (Institute for Health research, Lancaster University). Burchardt T, Le Grand J, Piachaud D, (2002) Degrees of exclusion: developing a multidimensional measure, in Understanding Social Exclusion (Eds) J Hills, J Le Grand and D Piachaud (Oxford University Press, New York) pp30-43. Cooper Marcus C, and Barnes M, (1999) Healing Gardens: Therapeutic Benefits and Design 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 in Horticulture as Therapy: Principles and Practice (Eds) S P Simpson, M C Straus (The Haworth Press Inc, New York) pp 3-18. Digby A, (1985) Madness, Morality and Medicine: a Study of the York Retreat 17961914 (Cambridge University Press, Cambridge). Francis M, Lindsay P, Stone Rice J, (1994) The Healing Dimensions of People-Plant Relations: Proceeds of a Research Symposium (University of California, Davis). Fyfe N R, and Milligan C, (2003) Out of the shadows: exploring contemporary geographies 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.

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Holland L, (2004) Diversity and connections in community gardens: a contribution to local 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 nearby nature in The Meaning of Gardens (Eds) M Francis and R T Hester, (Cambridge, MIT Press), pp238-243. Kurtz H, (2001) Differentiating multiple meanings of garden and community Urban Geography, 22, 7, pp656-670. Lindon S, and Grut J, (2002) The Healing Fields: Working with Psychotherapy and Nature 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 Mental Health 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 for Mental 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 Environment and Planning D: Society and Space Paterson C, (1997) Rationales for the use of occupational therapy in 19th century asylums British Journal of Occupational Therapy, 60, 4, pp179-183. Philo C, (2004) A Geographical History of Institutional Provision for the Insane from Medieval 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 Social Development (Timber Press, Portland Ore). Sainsbury Centre for Mental Health, (2002) Working for Inclusion, Sainsbury Centre for Mental Health, London). Scottish Executive, (2003a) Social Exclusion in Rural Areas: a Literature Review and Conceptual Framework (Central Research Office, Edinburgh).
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Scottish Executive, (2003b) Partnership for Care White Paper. Scottish Executive, (2003c) Building Community Well-Being: an Exploration of Themes and Issues. Scottish Office, (1999) Social Inclusion: Opening the Door to a Better Scotland, The Scottish Office, Edinburgh. Sempik, J, Alridge J, and Becker S, (2003) Social and Therapeutic Horticulture: Evidence and Messages from Research (Thrive, in association with Loughborough University). 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 the Deputy Prime Minister, London. Ulrich R S, (1983) View through a window may influence recovery from surgery Science, 224, pp420-421.

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To offer feedback or to seek further information, please contact: Dr Hester Parr Department of Geography, University of Dundee, Dundee DD1 4HN 01382 344434 H.Parr@dundee.ac.uk

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