He would often be very agitated and would find it difficult to concentrate for more than a few minutes, responding badly to complex tasks.
But even though he had no particular interest in gardening, being given the responsibility of looking after plants at the rehabilitation unit he attended changed things.
Watering and checking moisture levels each day provided a useful role which earned positive feedback from staff and other service users.
Ray’s self-esteem rose and he gained increasing pleasure from seeing plants grow. Gardening became a topic of conversation with relatives and people at the unit, while fund holders could see his improvements.
Ray has ‘flowered’ as a result of interacting with gardening, says Anna Hamer, a specialist occupational therapist who has worked with Ray at the unit in Stockport.
‘Essentially he became happier, more compliant with staff and more likely to engage with therapists in more challenging work,’ says Anna.
Another measure of the change in Ray as a result of gardening is his ability to concentrate. He’s been making plans for a raised bed in the unit’s garden, considering where it should be sited, how it should be wheelchair-friendly and the quantity of materials that will be needed.
Although lockdown stopped these plans moving forward, the fact that Ray made them in the first place is significant: ‘This is the man who was so easily distracted initially, it took 40 minutes to get him from his room to the unit kitchen before even starting a functional task,’ recalls Anna.
Depression caused Ray to disengage from rehabilitation. When his mood improved, his cognitive improvements remained: 'Even if he were to never garden again, the horticultural therapy was certainly the vehicle for his cognitive improvements,’ says Anna.
People attending the Stockport unit tend to have complex needs arising from trauma to the brain, for example following road accidents, falls, strokes and drug overdoses.
This can result in people being sight-impaired, having limited limb use, being in wheelchairs, and having communication difficulties. People with an acquired brain injury frequently have both physical and cognitive impairments often with additional mood and behavioural issues.
‘It’s very complex and fulfilling work,’ says Anna, who has been an OT for more than 25 years, now specialising in neurology. ‘Probably the best part is you have to build a relationship on honesty and trust. We often ask service users to participate in challenging tasks – if they do not trust you as a therapist they will not engage. Horticulture is very non-threatening, so good to use.
Potential tasks are huge and they can all be adapted for individual requirements and goals.Anna Hamer
‘Horticultural therapy offers a wide variety of tasks that be adapted easily for any individual’s abilities and graded to target improvements in physical, psychological, cognitive, social and behavioural domains.’
Gardeners with dementia
Anna started her career in a dementia unit working with many men that had been gardeners on large country estates.
‘It was fabulous for them to tap into their previously learnt experience as these practical skills were still intact. They would succeed easily in the tasks, hold stimulating conversations about past stories, produce something viable, socialise and really boost self-esteem. For that time, they were the people they used to be. I gained lots of knowledge from them.
‘These elements stand true for the use of horticulture with individuals with virtually any impairment as the number of potential tasks are huge and they can all be adapted for individual requirements and goals.’
I have become more determined to integrate a formal horticultural format into my therapy practiceAnna Hamer
Increasingly Anna has been using horticultural therapy, working with clients at an allotment, small groups and individuals, all with different levels of activities according to needs.
Over the last two years Anna’s interest in horticultural therapy has grown, coinciding with greater promotion of horticulture as a specialist interest group within the Royal College of Occupational Therapists, as well as new research showing the benefits of connecting with nature.
Personal experience has been important too. Anna obtained an allotment three years ago and she noticed how it changed her mood when she went through depression. It is also proving a useful place to expand her horticultural knowledge.
Discovering the work of Thrive has been pivotal too, and she has taken online and face-to-face courses and discovered new ideas from visiting Thrive Reading’s gardens.
‘I have become more determined to integrate a formal horticultural format into my therapy practice and promote it as such,’ says Anna.
‘There are good resources from Thrive available online and a knowledgeable voice at the end of a phone.’
Encouragingly, Anna believes there is more acceptance of horticultural therapy’s value within health services, but also adds a note of realism that many in the STH sector will echo:
‘I would have to say that horticultural therapy is still perceived by funders as “soft”. I think there is still a long way to go in terms of education.’