Viewpoint: Value of Landscaping on Health

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Yuli Toh: Value of Landscaping on Health; Facts, Therapy, and Inspiration from UK and Japan

Yuli Toh’s review of Value of Landscaping on Health; Facts, Therapy, and Inspiration from UK and Japan, an Event presented by Architects for Health in association with The Daiwa Anglo-Japanese Foundation

Architects for Health’s June Event titled The Value of Landscaping on Health; Facts, Therapy and Inspiration from UK and Japan, co-hosted by the Daiwa Anglo-Japanese Foundation, gave an insight into landscape design through the personal experiences of five invited speakers. The topics and points of view were diverse, intimately presented and engaging.

The speakers were Dr Clare Hickman (Art and History University of Bristol), Jane Stoneham (Sensory Trust), Rose Moore (Blackthorn Trust), David Buck (David Buck Landscape Architects) and Takashi Sawano (Japanese Floral and Garden Designer) – their biographies given separately. Jeremy Barraud, Director of Programmes (Daiwa Anglo-Japanese Foundation) introduced the Foundation and their programme of events; this year on the theme of Demographic Change. Jeremy welcomed the speakers and members and Ann Noble, Chair (AfH) thanked the Foundation for their support of this Event.

The presentations gave different perspectives on the powerful role of landscape as a social and therapeutic tool. The speakers revealed examples of its value, both qualitative and quantifiable. However, the collective realisation that emerged from the evening was how under-valued and neglected this aspect of healthcare design is today.

Dr Clare Hickman was the opening speaker who guided us in a re-examination of our not so distant past and what we appear to have known but lost sometime during the last 200 years; the garden, as a part of a private mental asylum, “was just what they did”. Clare shared with us a privileged resume of her thesis and of her prize-winning essay on Brislington House, Bristol. Brislington House, founded by Dr Fox, was an early institution that pioneered moral therapy and treatment, a shift from physical restraint. It was a mild regime, believing that the patient suffered mis-association and thus there was hope for recovery. The landscape and location of the asylum was very important, as it was a part of the therapeutic regime, including open-air entertainments, exercise and gardening. The asylum building’s windows looked onto walled ‘airing courts’, to literally take the air, which were intensively landscaped with contemporary designs of the day such as snail mounts. But patients were able to see beyond the walls to the wider landscape and were encouraged to go out to physically interact with it. A stroll round this aesthetically designed landscape took one past ferns, grotto, battery summer house (rustic shelter), stones, picturesque Swiss cottage, farm and cliff top walk. By the mid nineteenth century, the asylum is to “command an extensive view” (Isaac Ray) and what you see you can also walk in. By 1872, a public asylum like the City and County Asylum, Hereford, spent money on impressive gardens. Clare’s well illustrated talk engendered from the audience at Q&A many observations on how the present day equivalent institutions are but a poor shadow of the visions and application of our Victorian past.

Our second speaker was Jane Stoneham from the Sensory Trust, where they believe people have a basic fundamental need to connect with the external environment. There are groups in society with no easy access to this, for many reasons such as lack of transport and money or disability, or an emotional disengagement with the outdoors due to lack of confidence, fear or not feeling they belong there. Jane shows an image of a girl with a dog on a patch of grass surrounded by tarmac and with a backdrop of high-rise tenement blocks. It is a bleak but sadly common sight. Landscape has certainly dropped off the agenda, since the nineteenth century. Yet GPs prescribe fresh air as part of healthy living programmes and, with demographic change, our older selves will need landscapes to evolve in response.

So, how do we get that back on the agenda? How do we prove that landscape is good for people? Jane directs us to evidence based research available, including Human Well-being, Natural Landscapes and Wildlife in Urban Areas, a Review by CLE Rohde and AD Kendle, published by English Nature Science. Also, others such as Rachel Hind, Roger Ulrich and even Jamie Oliver in a different context, have shown that evidence exists and have got the issue out for public discussion. Where landscape was an integral part of design, people got better faster and that equated to savings. Jane went on to give examples of many ways to use the landscape; how a park was not used until residents were consulted and allowed BBQs into the evenings, perfect for large family gatherings; how OAPs went on extreme rambling trips; to sitting in Kings Garden, Copenhagen with its spectacular block planting of herbaceous material and good details throughout (that is high capital spend but maintenance low) and to a sensory garden in Osaka, Japan with its xylophone on a bridge.

Jane in her own designs considered therapy within the familiar garden, but the challenge is to translate high maintenance designs into low. She also used conservatories and other transitional spaces, where the indoor and outdoor start and finish was blurred. Hospital gardens also have the physiotherapy element tied-in. In a Cornwall community, when the gardens were in decline the people themselves declined and with the renewal of the gardens they also felt vibrant. Jane concludes by giving the Eden Project as an example of the renewal of a place made successful by bringing people into it, to be a part of it and showing them that change is not scary and can be good.

Rose Moore is a gardener and understands the garden in its most intimate way. She says, “The work is the therapy”. She has been sharing this insight and work with others at the Blackthorn Trust for the last 14 years. Rose explained the idea is to engage with the healthy part of the person and “leave the ill one out of it for a while”. The prescribed work means the patient is a not passive recipient of therapy and the work, from gardening, garden produce, cooking and baking to crafts is all based on nature. The work engages with a group and the wider community, so the patient can forget “how am I?” for a while; “the grace of self-forgetting”. Rose would like architects to think of the garden as having a space and time dimension (that buildings being finite do not have). Nature has her objective laws of ’cause and effect’ and her cycles and rhythms. Although a medical doctor taking medicine away from just drugs started the Blackthorn Trust, Rose does not describe themselves as therapists (though later she concedes to being grassroots therapists). She loves gardening and the cook loves cooking, and with others they provide a secure, safe physical environment for those with chronic or terminal illness. They work with people of all ages, some with mental health challenges, including 16-19 year old who may be excluded from school, to become more balanced and move away from the extremities, through reconnecting with nature. They inherited, from what was the headquarters of the maintenance team of the old hospital, some greenhouses, underground rainwater tanks and a lot of neglected ground. Rose presented images of the work gone into creating the “chaotic but beautiful vegetable field”; the 24hours sponsored dig in the beginning to the harvesting of several metric tons of organic produce annually. The produce ranges from potatoes to herbs, bread baked daily, chutneys and jams. They also run a café open to the public. Rose was interested to hear Clare talk of the nineteenth century therapeutic gardens and felt their work at the Trust had “come full circle”.

David Buck‘s talk was titled East of the Sun West of the Moon, named after a Japanese song, presenting ‘cultural coordinates’ in Japanese landscapes. David’s own built work is an exploration of ways to reconfigure traditional Japanese landscapes, which were private and religious spaces such as the temple and shrine, into secular and public contemporary spaces. He was studying at Kobe University at the time of the 1995 earthquake, an event that showed him how nature, trees and open spaces survived and could protect buildings and people and was formative in a positive way to his design for a campus park. Although he claimed it was difficult to prepare for this short talk referring to 2000 years of history, he gave us an accessible presentation using elegant slides of his completed urban park paired with images of fragments of traditional Japanese gardens and representations of gardens, while explaining its traditional significance and his re-interpretation. A folding screen carries a symbolic stylised image of nature, while the self-referential gardens are a series of interlinked spaces with no centre, nor perspective. There is no distinction between us (people) and nature and we are at the centre of nature. A hidden logic or sequence exists. We can enter a space visually, such as a rock garden in Kyoto. Surface patterns are boundary-less and precision in placement of objects can achieve continuity yet on-going change. A most memorable image is of a simple sand mound out-scaled by tall-forested mountains – yet it dominated the space. These are some of the thoughts and visions David evoked in his talk, taking the audience to a strange land yet always bringing them back to a present day application. He stressed that his urban park was a “forum for people to enjoy the changing seasons of nature”. He closed his talk with a quote from jazz pianist Bill Evans “the further you look into the future the further you see into the past”.

Takashi Sawano followed with his talk titled Japanese Gardens in the UK – “why are Japanese gardens therapeutic?” He sought to create a feeling of calm, silence and the “slowing of the senses”. He based his talk on his experiences of implementing two Japanese gardens within the UK and, to an almost disbelieving audience, within NHS premises! The first garden is on a quarter acre in the grounds of the North East London Mental Health Trust NHS mental hospital. Takashi involved all in the making with the “ceremony for the garden”. The ground-breaking ceremony was followed by the naming and tree planting ceremony. He explained to staff, patients, visitors and construction workers that “making was not just physical but important mental way too”. The design of this compact garden was in the form of yin and yo, with 50 cherry trees outside. The patients volunteered to become part of its making, and since, in much of the on-going maintenance. The second garden is in Scotland on 4 acres. Here, he involved school children and the non abled. He used water for depth, movement and sound, such that the blind can touch and the deaf can hear. The dry garden, Takashi explains, is a philosophical mental way of garden, where a rock is an island in a sea of sand, giving calm and peace. The flowering cherry trees are ‘calling’ to the people from early to late spring. Only a short section of wall make up the boundary, the remaining formed of beech trees. The garden is now nearing its 5-year ceremony. Takashi gave his answer to “why are Japanese gardens therapeutic?” by referring to Sakuteiki-Visions of the Japanese Garden. It was written 1000 years ago and remains the ‘bible’ of Japanese design. Takashi designs to the natural ways, nature being his teacher and master, always with and in nature.

During The Question and Answer Section, Takashi answered that Goodmays was mostly funded by a private donation from an individual doctor, with the NHS providing the site within its grounds, 50 tons of top soil and 4 gardeners. The project cost approx £50,000, with design done voluntarily. Maintenance cost is about £2000 per year but with most of the work done by the patients. Takashi chose the site, from 3 he was given, for its possibilities in the spiritual way.

Jeremy asked about the possibilities at The Royal London Hospital, Whitechapel. Opportunities for the creation of roof gardens and small spaces were discussed.

Ann Noble made an observation that today the site location of a hospital is not seen as prime importance for consideration, unlike the examples Clare gave, where getting the site right was vitally important. Jane, for example, has experienced a project sited in woodland where there was pressure to cut the trees down.

Rose was asked why their work was not common knowledge. Rose stated that they have been visited by Prince Charles, community groups, and NHS personnel but not much by planners and designers. They have been called a ‘blueprint’ but Rose asked rhetorically could something, implemented by people who care so much, be repeated. Their work is based on anthroposophical medicine and therapy, with the gardening and farming inspired by those ideas.

A. Murray observed that the NHS is very poor at passing round good practice, as there is no system for doing it.

Jeremy Barraud thanked the speakers for showing us a historical perspective, the social roles, an experience in Japan and implementation in the UK of the value of landscaping on health.

Yuli Toh – Toh Shimazaki Architecture

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