Gardens and Mental Health: a summary of the Kings Fund report

by Layla McCay, Director, Centre for Urban Design and Mental Health

This week UK healthcare think tank The Kings Fund published a report on gardens and health, commissioned by the National Gardens Scheme. The report reviews the evidence for the impact of public and private gardens and gardening on health. This UD/MH summary focuses on the aspects identified in the report as being most relevant to mental health. Read the full report here.

Theories of how gardens impact on mental health
Gardens were a feature of the earliest psychiatric institutions. The main theories around the links between gardens and mental health are summarised by Clatworthy et al, 2013:

• Attention restoration: gardens can provide 'fascination', non-goal orientated and effortless attention, providing restorative effects to mental state.
• Stress reduction: exposure to natural settings has been associated with reductions in the body's physical manifestations of stress.
• Social connections and exercise: gardens promote social interactions and physical exercise.

The report author, David Buck, notes that high quality research in this field is currently rather limited.

Main impacts of gardens on mental health
The evidence for benefits of gardens on mental health is closely related to the body of research on green space. The proportion of green and open space in a neighbourhood has been linked to better childhood cognition and adult mental welbeing, (Barton and Pretty 2010) for all ages and socio-economic groups, and  exercising in green spaces has been linked to better mental wellbeing. (Alcock et al 2014; White et al 2013). The effects seem to be related to  improving companionship, a sense of identity and belonging (Pinder et al 2009) and happiness (White et al 2013).

Young people and gardens
Young people have reported feeling a sense of personal achievement, pride and empowerment through growing food and being involved with gardening, and experiencing positive social interactions. Children with learning of behavioural difficulties particularly valued gardening, commenting that gardens were peaceful and relaxing places. (Ohly et al 2016)

Older people and gardens
The report identifies gardening as helping to support social connections, alleviating loneliness (Pettigrew and Roberts 2008), having psychological importance for some older people in creating responsibility for something, going so far as to represent 'a meaningful reason for existence.' (Wright and Wadsworth 2014). The report proposes that since up to 13% of Alzheimer's dementia may  be attributed to a sedentary lifestyle (Raji et al 2016), by encouraging physical activity, gardens further play a role in dementia prevention. Gardens may also be helpful in supporting good mental health for people with dementia. Carers report that people with dementia who have access to a garden show less agitation and aggression. (Whear et al, 2014). Garden access also had positive impacts on the social interactions between people with dementia and their carers, friends and family. Mechanisms by which these benefits were achieved were not studied, but staff members suggested the gardens keep people with dementia's 'senses alive', offer a connection with life, reignite childhood memories, and give a sense of purpose and ownership and freedom from the confines of an institutional setting. However, staff also expressed concerns about the risk of falls in gardens.

The business case for gardens and mental health
The report concludes that while access to green space seems to be able to reduce admissions to hospital for mental health problems (Wheater et al 2007),  the diversity of needs and approaches means no simple general case can prove the business case for gardening. However it does identify some attempts to value gardens in mental health.  The New Economics Foundation (2014) estimated a programme offering gardening for people with mental health problems in England to be around £7,000 per person through reduced healthcare costs, welfare benefit reductions and increased tax contributions. Prescribing woodland activity programmes for people with mental health problems in Scotland was valued at  £8,600 per quality-adjusted life-year (QALY)– a highly cost-effective intervention. ( Willis et al 2016) In terms of benefits to businesses, retailers report an increase of trade of 40-80% where places are more walkable, including through small urban parks and greener walkways.  (Ross and Chang 2014)

Equity of access to green space
People who live in the most deprived communities in the UK were found to be 10 times less likely to live in the greenest areas compared to people who live in the most affluent communities (Balfour and Allen 2014). Minority ethnic groups, urban deprived populations, more disadvantaged social groups, those aged over 65 and disabled people were reportedly less likely to visit green spaces than the national average. Reasons suggested that contribute to this effect include poor maintenance, inadequate facilities, and safety concerns. (Natural England 2015)

Key policy implications proposed by the report

• Ministries of Health, Environment, Local Communities, and Directors of Public Health should integrate gardens as a tool to help deliver their policy objectives. They should collaborate to ensure population access to well-designed gardens, recognising this particularly as a public health activity, and an intervention to support people with dementia.
  
• Key organisations working on gardens should collaborate to develop and align a joint strategy that supports practical policy recommendations at national and local levels.
  
• Collaborations, partnerships and other innovative funding mechanisms should be considered to secure public access to well-designed gardens.
  
• More research is needed: particularly, what specifically works, and for whom? More economic evaluation data would also be helpful.
  

Cooltan Arts programme - Gardening for positive mental health and  wellbeing, London