The idea that farm work and gardening is appropriate and beneficial for those with mental illness or mental impairment fell out of favour in the UK in the 1950s after having held sway within the world of institutional care for a long time.
In the nineteenth century it was an established practice for ‘lunatics’ and ‘idiots’ to be ‘farmed out’ to relatives and others to be cared for. In many cases the process quite literally led to them working as labourers on farms.
When the new asylums were built in the nineteenth century many had farms and market gardens and these were an important part of hospital life. They supplied food for patients and staff and also occupation.
‘We find that the patients derive more benefit from employment in the garden than anywhere else, and this is natural, because they have the advantage of fresh air as well as occupation.’
Nottingham Borough Asylum inspectors, 1881
Their ‘therapeutic’ value was recognised in various reports of the time. For example, in a review of the Nottingham Borough Asylum in 1881, the inspectors observed:
‘We find that the patients derive more benefit from employment in the garden than anywhere else, and this is natural, because they have the advantage of fresh air as well as occupation.’
American influence
The value of occupation and particularly outdoor work for men such as ‘cutting wood, making fires, and digging in a garden’ had already been noted in 1812 by Benjamin Rush, an American physician and signatory of the American Declaration of Independence who is often regarded as father of therapeutic horticulture.
In the UK, the extent of farming and gardening had expanded to such an extent by the early 1950s that a Ministry of Health report of 1954 showed that 190 hospitals were working 39,859 acres of farm, 3,884 of market garden and there were a further 4,083 acres of woodland.
This was considered incompatible with the aims of the modern National Health Service which had just been created (1948), and the government sought to close these farms and gardens.
Occupational therapy
The introduction of modern drugs was also considered to render ‘therapeutic’ outdoor activities obsolete.
Many of those who saw the value of farming and gardening for health were not so easily put off and gardening found a place within occupational therapy as it developed.
Gardening projects were also created independently of hospitals by some of those who had experience of the old hospital farms and gardens.
The term Horticultural Therapy first appeared in the US in the 1950s and the practice gradually developed into a formalised and structured intervention, leading to the formation of the American Horticultural Therapy Association in 1973.
The UK was not far behind and the Society for Horticultural Therapy, later to become Thrive, was founded in 1975. In the UK the term Social and Therapeutic Horticulture (STH) is generally used and this reflects the supportive social environment in which the intervention takes place.
Since the 1970s, STH practice has become firmly established in the UK. A survey in 2003 showed that there were around 1,000 garden projects which supported around 22,000 clients each week and provided almost one million sessions each year.
There is no evidence that this level has declined.
Other approaches that use nature as a therapeutic medium have also developed and these include ‘care farming’, ‘green exercise’, animal-assisted interventions, the use of nature conservation as a therapeutic intervention and other approaches.
In the early 2000s, the term ‘Green Care’ was coined to describe these structured nature-based approaches for health and wellbeing and this has been the subject of much academic research and publications.
Green Care and STH in particular has been accepted as an effective therapeutic approach for improving the health and wellbeing of people with a wide range of physical, mental and social difficulties including those with mental health problems, learning difficulties, substance abuse problems, challenging behaviours and other problems.
More recently, it has been used by occupational therapists working in the field of palliative and end of life care.
From the old hospital gardens to the present-day STH projects, horticulture has shown itself to be a valuable tool in helping recovery and promoting health and wellbeing.