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GARDENS OF THE MIND:

NATURE, POWER AND DESIGN FOR MENTAL HEALTH.

Kathleen Connellan, Clemence Due, Damien Riggs

Universit y of Sout h Aust ralia, Universit y of Adelaide, Flinders Universit y.
kat [email protected]

ABSTRACT
Nature, gardens and greenery are necessary to the
healing of the mind. This paper discusses the
integration and use of open spaces and ‘gardens’
INTRODUCTION
in mental health units. There is ample evidence Though not hing can bring back t he hour
of spl endour in t he grass, or gl ory in t he f l ower;
that gardens and gardening can relieve stress but We wil l grieve not , rat her f ind
how are gardens designed into mental health units St rengt h in what remains behind;
to facilitate this known fact? (Cooper Marcus and
(Wordswort h, 1954, 157).
Barnes, 1995; Pretty, 2004; Simpson, 1998). The
results of an ethnographic observational study in a
We have called t his paper ‘ Gardens of t he mind’ wit h
purpose built mental health unit in Australia form
t he subt it le of nat ure, power and design for ment al
the basis for the discussion but this study is also
healt h, because of t he int imat e relat ionship bet ween
situated within global debates on design for
t he mind - it self a place of growt h incorporat ing all
improving mental health. One of the key issues
kinds of consciousness – and t he physical cont ext in
emerging from the literature is the importance of
which it exist s. In applying t he ideals of t he English
natural settings in the reduction of stress for
Romant ic poet William Wordswort h (who as a
mental health clients and clinicians (Daykin, et al.,
Pant heist , saw God in t he design of a flower), we
2008; Sitchler, 2008; Day, 2004; Ulrich, 2008;
invest igat e t he int erplay bet ween nat ure and t he
Andes and Shatell, 2006). We situate the
movement of t hose housed and working in purpose
discussion within the context of contemporary
designed ment al healt h unit s. In so doing we
debates, we also bear historical examples in mind,
comment upon t he effect s and usefulness of
especially in relation to power relations that are
part icular t ypes of garden (i.e. gardens designed in a
designed into the spaces. However our focus is the
specific way which do or do not correlat e wit h t he
contemporary purpose built mental health unit.
lines and language of t he archit ect ure). And we
The paper questions relationships between the
int errogat e t he power relat ions which might operat e
outside garden and the inside ward in terms of
in designed gardens. In t his way we quest ion if
power and healing. Specifically it looks at how
indeed such out side spaces can funct ion as places of
gardens operate as sites for healing in a harsh built
healing for t roubled minds.
environment. Additionally we ask how open
The chief source of our dat a is t aken from an
spaces are used by mental health clients and how
observat ional st udy conduct ed in a recent ly
the ‘gardens’ integrate with the overall
complet ed ment al healt h unit in Sout h Aust ralia (our
architectural design of mental health units.
research met hod is out lined in det ail below). One of
t he fact ors mot ivat ing t his research was t he fact t hat
Keywords: Gardens; Mental Health; Power.
exist ing research on t he relat ionship bet ween ment al
healt h and archit ect ure st ill lies wit hin t he broader
sphere of general healt h and archit ect ure, and as
such ment al healt h and archit ect ural design is an
DIVERSITY AND UNITY

area of research t hat requires more at t ent ion. Two Raphaelit e Brot herhood called back a lost medieval
lit erat ure reviews published in 2008 and 2010 open age celebrat ing t he myst ery and magnificence of
up t he breadt h of research t hat is necessary t o nat ure. A ret reat t o nat ure was seen as a def ence
develop healt hcare design. These are Ulrich et al. against t he onslaught of t he mechanical and
(2008) and Dobrohot off and Llewellyn-Jones (2010). indust rial revolut ion for anyone of a sensit ive
Ulrich et al. focus specifically on “ evidenced-based disposit ion. On t his point , however, Hickman not es
healt hcare design” (2008, p. 101), in which t hey not e t hat t here were class issues involved in t he responses
t hat t here is bot h a direct and indirect relat ionship t o nat ure as a curat ive measure, st at ing t hat t he
bet ween nat ure views and reduced depression; elit e and “ educat ed” classes were more suscept ible
reduced lengt h of st ay; increased pat ient t o t he benefit s of nat ure (Hickman, 2009, p.431).
sat isfact ion; decreased st aff st ress and increased
st aff sat isfact ion (2008, p.148). Dobrohot off and Many of t he asylums built in t he ninet eent h cent ury
Llewellyn-Jones st at e t hat key design issues such as were sit uat ed on elevat ed ground, t hus enhancing
direct access t o enclosed gardens and quiet areas t he views of rolling count ryside and t ranscending t he
result in a product ive environment (2010, p. 5). The feeling of walled gardens and court yards. Even t he
int ent ion of our paper is t o pose addit ional quest ions asylums built in t he cit ies t ended t o be posit ioned
and make some suggest ions regarding t he design and where t hey could benefit from t he vist as provided by
use of gardens, which can be used t o facilit at e ext ensive grounds. Large count ry house asylums were
cooperat ion bet ween archit ect ure, design and not only built in recognit ion of t he benefit s of clean
ment al healt h care. air, nat ure and generous space; t hey were also
st ereot ypical of t he powerful manor house on t he
THE ASYLUM IN A GARDEN hill, presiding over it s domain. The house may have
signalled t he shelt ered domest icit y of a home in a
Ninet eent h cent ury ment al inst it ut ions in England large garden on one level but large count ry houses
and it s colonies were more oft en t han not built in were symbols of t he ownership of more t han j ust
t he count ryside wit h large grounds for client s t o use. land. The house cont rolled t he lives, behaviour and
This was a t ime of height ened Vict orian awareness of bodies of many people not least t he family; t he
t he remediat ing qualit ies of count ry life. Hickman dramas incorporat ed in many of t hese hist ories are
(2009) not es t he emphasis placed upon nat ure and well est ablished in lit erat ure (Tromp, 2000). The
t he rolling landscape as a prevent ion for “ immoral hierarchy of class and posit ion were unflinching and
act ivit ies” (2009, p.435). It was believed t hat t he accordingly exploit ed by t hose ‘ above’ t hem. In t his
garden at mosphere inst illed a sense of t he “ Garden way t he design of t he count ry house asylum was
of Eden” and brought t he pat ient s closer t o God. caught up in t he language of imperialism, power and
Added t o t his was t he rural work et hic, wit h labour cont rol. Therefore whilst t he house might have been
in t he veget able gardens seen as a cleansing act ivit y. set in large grounds which conj ured up t he t ype of
The geographic dist ance from t he cit y was regarded romant ic past oral idyll longed for by t he art ist s
as essent ial because of prevailing beliefs t hat ment ioned above, it was also a darker got hic/
indust rialisat ion was a cause of insanit y (Hickman, romant icism of despair, cruelt y and isolat ion. The
2009, p.438). This view was support ed by English design was a facade for brut al syst ems of rest raint ,
Romant ic poet ry, landscape paint ing, and t he where people were seemingly commit t ed t o a life of
affiliat ed Pre Raphaelit e and Art s and Craft s peace in a gardened asylum but in realit y t he act ual
movement s. Poet s like William Wordswort h, John quart ers const it ut ed punit ive pract ices and ext reme
Keat s and John Dunn drew at t ent ion t o what t hey cruelt y. Philo (1997, p. 83) not es t hat such houses
believed was being lost as a result of urbanisat ion. where grounds were used f or apparent ly t herapeut ic
Wordswort h in part icular bemoaned t he loss of “ exercise” were in fact “ landscapes of fear” . It t ook
innocence gained from experience in a nat ural decades for t he malpract ices in secluded asylums t o
set t ing, and landscape art ist s such as John Const able be exposed and some cont inued well int o t he
port rayed rural idylls. Added t o t his t he Pre t went iet h cent ury (Morrall, 2000).

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 PRODEEDINGS IASDR2011

The cost of land and t he expense of upkeep for

gardens is an obvious issue in t he t went y-first
cent ury. Consequent ly t here is a growing movement
t owards t he development of dedicat ed “ healing
gardens” (Anant h & Smit h, 2008; Hart ig & Cooper
Marcus, 2006; Kahera, 2002; Munt & Hargreaves,
2009; Sherman, 2005; St ernberg, 2009; Ulrich, 2001).
In some inst ances t he healing garden incorporat es
Ancient East ern and Moorish influences wit h t he idea
of a garden “ cont aining an ent ire universe” (Kahera,
2002, p. 3), and in t hese inst ances imaginat ion is
Figure 1. A ninet eent h cent ury ment al healt h building in Sout h used t o creat e dept h and illusions of space wit h
Aust ralia.[1]
appropriat e plant s and wat er reflect ions. It appears,
THE RETREAT AND RETURN OF THE GARDEN IN however, t hat t he t erm is applied loosely and
MENTAL HEALTH ARCHITECTURE int erpret ed variously by landscape archit ect s and
landscapist and garden cont ract ors. In some
The t went iet h cent ury depart ure from examples of healing gardens included in archit ect ure
inst it ut ionalisat ion in ment al healt h was in many wit hin t he healt h sect or such as cancer wards,
ways a welcome exit from t he above ment ioned t hemes such as “ Friendship Garden” or “ Garden of
harsh t reat ment s and seclusions in t he era of Dreams” is used as a basis for sculpt ural feat ures,
asylums. Yet despit e t his much needed move away furnit ure and ot her man-made const ruct ions in t he
from sit uat ions of depravit y and const raint in many garden (Sherman et al., 2005, p.170). In t his and
asylums of t he ninet eent h cent ury, Curt is (2009) ot her examples, privat e donat ions t o commemorat e
not es t hat in t he t ransit ion from inst it ut ionalisat ion t he loss of loved ones help t o fund t he gardens.
t o communit y care pat ient s of t he older inst it ut ions Curt is (2009, p. 346) not es t hat maint enance of t he
report ed a love of t he large gardens and t hat t hey grounds are oft en t he responsibilit y of out side
had developed an at t achment t o t hem, so much so companies and not under t he direct cont rol of
t hat t hey ret urned t o walk in t hem where possible nat ional healt h. Such out -sourcing of services
(2009, p. 346). In one st udy conduct ed by Curt is in cont ribut es t o a lack of communicat ion and
East London, it is not ed t hat t he gardens in underst anding of t he holist ic healing qualit ies of
cont emporary ment al healt h set t ings are not ‘ real’ gardens. Generally t he lit erat ure indicat es t hat
gardens, because t hey are cramped and not large funding is already in short supply for life t hreat ening
enough for client s t o walk in and use. A respondent diseases and when it comes t o an addit ional MRI
who was a ment al healt h consult ant in Curt is’ st udy machine versus a garden, it is t he usually t he
says t he following about t he new hospit al sit e where machine t hat holds sway. Despit e t his, gardens and
t he st udy was conduct ed in East London: indoor greenery are becoming more prevalent in new
designs for hospit als. Gordon (2001, p. 191) writ es
… t his probabl y was a quit e barren piece of l and – t hat only now are hospit al administ rat ors and healt h
so t hey have pl ant ed a whol e l ot of t rees, but I do aut horit ies waking up t o t he realit y of mind body
f ind it import ant t o have a whol e l ot more greenery. healing and seeing t hat gardens which are used t o
What you j ust have, if a pat ient came out here, is a heal can also save money f or t he hospit als as t hey
car park t o wal k on. I t hink you can wal k behind t he are “ less expensive t han medical t echnology” and
back or what ever, again, it ’ s not a park, it ’ s not a help t o ret ain qualit y st aff .
l ovel y garden space t hat you can go and use … I
t hink t hat ’ s part of a need [t o] … al l ow peopl e t o go The int egrat ion of nat ure and t he built environment
out f or wal ks and t hat t hat t hey act ual l y have a generally are being t aken more seriously since t he
pl ace t o do t hat in (2009, p. 346). massive concret isat ion of cit ies in t he mid t o lat e
t went iet h cent ury wit h t he modernist emphasis on

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DIVERSITY AND UNITY

large powerf ul buildings as symbols of ‘ progress’ . The secure ward had a t ot al of 6 beds t hat were all
As such, t he benefit s of a growt h of ‘ landscape single rooms, and t hree bat hrooms wit h one disabled
archit ect ure’ are slowly making an impact . Ian bat hroom. The open ward cont ained 20 beds, and 10
McHarg wrot e in 1969 t hat we must design wit h bat hrooms wit h one disabled bat hroom and one
nat ure and not against it . More recent ly, Swaffield assist ed bat hroom. Bot h of t hese wards were
(2002) not es t hat t ypically full t hroughout t he st udy.

“ We need nat ure as much in t he cit y as in t he

ETHICS AND PARTICIPANTS
count ryside. In order t o endure we must maint ain
t he bount y of t hat great cornucopia which is our
Et hics approval was grant ed from bot h t he Universit y
inherit ance. It is clear t hat we must look deep t o t he
of Sout h Aust ralia’ s Human Research Et hics
values which we hold. These must be t ransformed if
Commit t ee and from t he Et hics Commit t ee of t he
we are t o reap t he bount y and creat e t hat fine
hospit al involved in t he st udy. Client s, st aff and
visage for t he home of t he brave and t he land of t he
visit ors at t he hospit al were informed of t he st udy
free. We need, not only a bet t er view of man and
t hrough informat ion sheet s t hat were placed around
nat ure, but a working met hod by which t he least of
t he ward. St aff speaking t o t he second aut hor were
us can ensure t hat t he product of his works is not
assured t hat anyt hing t hey said would remain st rict ly
more despoliat ion” (p. 173).
confident ial, and t he informat ion sheet similarly
st at ed t hat no ident ifying informat ion would be used
However landscape archit ect ure is not wit hout it s
in any publicat ions t hat arose from t he st udy. All
crit ics, for example Margo Huxley writ es, “ The
users of t he ward were inf ormed of t he t imes t hat
problems of t heory and pract ice in landscape
t he et hnography would t ake place (t ypically one day
archit ect ure are a direct consequence of it s origins,
a week for a t hree hour t ime slot ). The movement s
bot h t he in t he epist emological dominat ion of
of client s, st aff and visit ors were observed
masculinist rat ionalit y, t he obj ect ivism of
t hroughout t he et hnographic observat ions.
Enlight enment and modernit y, and in t he pract ice of
‘ landscaping’ in t he int erest s of landed arist ocracy,
PROCEDURE
newly-acquired capit al or t he st at e” (Huxley, 1994,
p. 36). Therefore, for design t o work well it needs t o The second aut hor carried out et hnographic
work wit h nat ure and not as an ext erior mechanism observat ions on t en occasions for t hree hours each,
of cont rol. Roger Fry, writ ing on design as polit ics, meaning t hat t his aut hor conduct ed a t ot al of 30
argues t hat “ unsust ainabilit y arrives by design, and hours of observat ions. These observat ions were
as such negat es fut ures” (Fry, 2011, p.19). Fry calls conduct ed during bot h t he morning and aft ernoon
t his t ype of design “ def ut uring” , and under such a over a t en week t ime-period, and t he t ime was split
regime ‘ beaut iful’ archit ect ural st ruct ures are evenly bet ween bot h t he secure and t he open ward.
erect ed “ under t he aura of elegance” (Fry, 2011, p. In t he open ward, t he second aut hor spent t ime bot h
27) which are decept ive. Wit h t hese debat es about wit hin and out side t he dut y st at ion, however in t he
archit ect ural innovat ion, concerns for healt h and t he secure ward t he maj orit y of t ime was spent
holist ic int egrat ion of nat ure int o unit s designed observing from wit hin t he dut y st at ion for securit y
specifically for ment al healt h in mind, we began our and et hical reasons. Brief not es were t aken during
st udy wit h syst emat ic observat ions of how client s observat ions, however in order t o reduce t he amount
and st aff moved in and used t he purpose built of t ime spent not e-t aking during observat ions t he
facilit ies. Our met hod is out lined below. maj orit y of t he field not es were writ t en immediat ely
aft er leaving t he hospit al premises. In addit ion t o
METHOD t hese 30 hours, t he first aut hor also conduct ed four
hours of et hnographic observat ions ent irely f rom
The st udy was conduct ed in t he ment al healt h unit
wit hin t he wards, including t he secure ward. These
of a large public hospit al in Sout h Aust ralia. Buildings
observat ions were conduct ed in order t o examine t he
were complet ed in st ages bet ween 2009 and 2010.

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 PRODEEDINGS IASDR2011

use of space from where t he client s’ experience it . use of garden spaces in bot h t he High Dependency
Bot h t he first and second aut hors remained neut ral Unit (HDU - t he locked ward) and t he open ward. Our
during t hese t imes, rarely asking quest ions of st aff et hnographic research not ed bot h similarit ies and
unless wishing t o gain clarificat ion in relat ion t o a differences bet ween t he use of gardens in t hese t wo
part icular procedure or space. Where client s or st aff spaces, which we discuss below.
asked eit her aut hor what t hey were doing, bot h
aut hors replied t hat t hey were observing t he use of ETHNOGRAPHIC OBSERVATIONS OF GARDEN USAGE
space and t he archit ect ure wit h t he ward.
The sit e of our st udy was a purpose designed ment al
Et hnography was chosen as t he met hodology for t his healt h unit complet ed in 2010, and t he gardens were
st udy due t o t he fact t hat t he lit erat ure has approximat ely six mont hs old when we commenced
ident ified it t o be appropriat e for use in healt hcare observat ions. The ent rance for visit ors and st aff is
set t ings, and has been used before (Johansson, via t he main ent rance t o t he ment al healt h ward,
Skärsät er & Danielson, 2006; Savage, 2000) In and is surrounded by a car park (figure 2). However,
part icular, et hnographic observat ions are t ypically t his ent rance is not used for t he admission of client s,
unobt rusive and allow t he researcher t o develop a who are inst ead admit t ed via an int ernal corridor
flexible approach t o bot h underst anding an from t he main hospit al (figure 3). When ent ering
environment , and t o gaining insight int o t he direct ly int o t he ward t hrough t he main ent rance,
relat ionships bet ween t hat environment and t he t he t ransit ion from ext ernal t o int ernal space
behaviour of t he people wit hin it . t hrough t he main ent rance is from light t o light and
upon ent ering one is immediat ely aware of an
ANALYTIC APPROACH adj acent enclosed garden. However t he j ourney
made by client s coming from t he emergency sect ion
Once t he observat ions were finalized, t he field not es or t he general wards of t he main hospit al int o t he
were analyzed using t hemat ic analysis, following t he ment al healt h ward is int ernal wit h lit t le t o no views
approach laid out by Braun and Clarke (2006). In of out side spaces. As client s j ourney int o t he ment al
t heir paper, Braun and Clarke (2006) provide rigorous healt h ward wit h st aff, t he first space t hey ent er is
guidelines for conduct ing t hemat ic analysis in t he seclusion corridor, which has doors opening int o
qualit at ive research wit hin t he broad st udy of rooms for st abilising client s. In t his corridor t here is
psychology and t hese guidelines were followed in only one high rect angular window, which offers a
each st age of t he analysis of t he field not e dat a. piece of sky wit h some wat t le branches and can be
Init ial analysis of t he ent ire corpus revealed a viewed whilst t he pat ient is escort ed t hrough t his
number of t hemes. These included (in order of area. The shut t ing off of nat ure seen in t his ent rance
significance): t he use of t he dut y st at ion by bot h can serve t wo purposes. First ly, it could be argued
st aff and client s; doors and passages; t he use of glass t hat being separat ed from out side space provides a
in bot h wards; t he use and effect s of gardens and sense of securit y from t he anxiet ies t hat client s
plant s; t he choice and posit ioning of visual art in t he st ruggle wit h on t he out side and t herefore helps
wards; and t he use of colour. Correspondingly t hem f eel safe especially if t hey are suicidal. On t he
ext ract s from t he dat a concerning t hese t hemes ot her hand, however, t he effect of t his seclusion
were f urt her analyzed in order t o reveal t he pat t erns may cause some client s t o feel claust rophobic. These
of use of t his space. Each t heme is researched as a lat t er client s may in fact benefit from a swift er
separat e paper and t he result s of t he analysis of t he t ransit ion int o t he HDU ment al healt h ward, where
use of gardens and plant s are present ed below. t here is ample light but also absolut e securit y from
t he ext erior. The language of t he archit ect ure
FINDINGS favours t hose who require more securit y.

As discussed above, a concern in relat ion t o t he

design of ment al healt h unit s is t he design of
gardens. In t he analysis t hat follows we examine t he

5
DIVERSITY AND UNITY

st at ion and out side t he ward. It is, however, not a

part of t he landscape design of t he int ernal gardens,
but rat her is merely a t ree wit h benches beneat h it
on t he edge of t he car park bet ween t he public road
and t he hospit al (see figure 4). The second aut hor
not ed t hat almost every t ime she came t o t he
hospit al t o conduct observat ions, t here were people
sit t ing smoking under t he t ree. The car park
adj acent t o t he t ree is relat ively busy and t herefore
t his ‘ t ree spot ’ does not offer a ret reat int o nat ure
but inst ead it offers an informal and unst ruct ured
Figure. 2. Main ent rance t o ment al healt h unit .
space for client s. It is almost direct ly opposit e t he
main ent rance t o t he ment al healt h unit and
t herefore a short walk t akes client s back inside.

Figure 3. Admissions corridor t o ment al healt h unit .

Once in t he ward(s), an abundance of glass in t he

open plan eat ing and recreat ion areas of bot h t he
HDU and open ward flood t he int erior wit h light in
most weat her condit ions. Large window walls look Figure 4. The t ree used f or smoking, chat t ing or relaxing
out upon all garden areas, irrespect ive of whet her beneat h.

t hey are accessible t o t he client s. One of t he result s

We will now describe t he t wo gardens designed for
of t he ext ensive use of glass is a feeling of openness
t he open ward and discuss t heir usage. We will refer
in t he shared spaces and a sense of int erior –ext erior
t o t hem as Garden 1 and Garden 2.
spat ial flow. Connellan et al. (2011) not e t he
ambiguous realit ies evoked by t he mult iple
The doors out t o Garden 1 are st urdy aluminium
reflect ions of nat ure and people in ment al healt h
framed glass doors wit h large handles. The area has
wards. The barriers of glass bet ween a garden which
t hree wat t le t rees t hat are st ill quit e small and six
is accessible t o client s and a garden which is
wooden benches in pairs under t he t rees. The area is
inaccessible t o client s are also a concern of t his
covered wit h pebble pat t erned concret e pavers and
paper because of t he ambiguous messages t hat such
art ificial grass. There are exercise bikes under an
archit ect ural feat ures might communicat e t o client s.
awning against red brick walls (figure 5). On one
THE OPEN WARD occasion a t able-t ennis t able was set up in t his area
but was not observed in use.
There are t wo dedicat ed out side areas locat ed
wit hin t he confines of t he ward which client s in t he
open ward have access t o, alt hough visit ors are not
permit t ed in t hese enclosed garden areas. Client s in
t his ward may also ask permission t o go out side t he
main ent rance t o sit beneat h a t ree alongside t he car
park. This t ree is a favourit e amongst client s, as it
Figure 5. Exercise equipment in Garden 1.
places t hem beyond t he surveillance of t he dut y

6
 PRODEEDINGS IASDR2011

The area has shrubs in neat rows under t he windows

and beside t he grey corrugat ed iron ext erior walls. Act ivit y Tot al % Max. %
The main building of t he general hospit al forms t he hrs people
backdrop on one side. This façade of t he main
Using 0.75 5% 2 30%
hospit al is covered wit h a grey grill rising up several
exercise
st oreys. It is not a soft leafy space but more like a equip.
court yard t hat is easy t o maint ain. The inclusion of
plant s echoes t he severe lines of t he building and Smoking/ 4.4 29% 5 83%
sit t ing/
repeat s t he st raight archit ect ural lines wit h narrow walking
rows of spiky grasses (figure 6). Garden 1 is clearly
visible from t he cent rally sit uat ed dut y st at ion in t he
open ward and alt hough cameras operat e Table 1. Garden 1 Open Ward usage.
t hroughout , it is easier for st aff t o look t hrough t he
glass windows t han t o survey t he client s in any ot her Psychiat rist s were not observed using t his space t o
way. Garden 1 was used by client s much more t han consult wit h t heir client s, nor were nursing st aff
Garden 2. observed relaxing in t his space.

Smoking is discussed below but it became quit e clear

at an early st age in t he observat ions t hat more
client s went out side t o t he garden areas t o smoke
t han t o do anyt hing else (see Table 1 above).
Records in t he observat ion not es frequent ly indicat e
t hat client s were seen eit her in small groups smoking
and t alking t oget her, or sit t ing alone and smoking.
Indeed, t he fact t hat t his was one of t he primary
reasons for going out side is reinforced by t he
observat ion t hat t he out side spaces were used less
Figure 6. Garden1. once smoking was banned in t he hospit al.

The t able below is ext ract ed from t he dat a which The second aut hor not ed t hat Garden 1 (see figures 5
recorded t he number of client s in specific spaces at and 6) was a very popular area for open ward client s,
15 minut e int ervals. This t able shows t he t ot al but not quit e as popular as t he t ables which are used
amount of t ime t hat spaces were used in t he 15 hour for chat t ing and/ or craft act ivit ies out side of meal
observat ion period per ward (over t he t ot al of 30 t imes. The open ward is larger t han t he closed
hours split bet ween wards). The t able does not ward, wit h t wo t elevision set s, a piano and a pool
summarise t he number of people over t he period t able. Client s can also make t heir own t ea and
because some people would be count ed more t han coffee, which t hey do on a regular basis.
once t hus skewing t he figures. However bearing in
Garden 2 (Figures 7 and) is slight ly f urt her from t he
mind t hat t he maximum number of occupant s at any
cent ral dut y st at ion and t herefore less visible t o
one t ime in t he open ward is 20, t he maximum
st aff. It has several large lavender bushes which
number in one 15 minut e slot is provided in t he
were in flower during t he period of our st udy. There
second column.
are five wat t le t rees which were st ill smallish at t hat
t ime, wit h a t ot al of eight wooden benches beneat h
t he t rees in t his area. This area is plant ed wit h hardy
geraniums, rows of nat ive grasses and ot her drought
resist ant plant s wit h long slender green leaves. One
of t he perimet ers is a blue grey corrugat ed iron

7
DIVERSITY AND UNITY

fence. There is a large expanse of sky above t his Whilst looking out , a client coming t hrough on his
area. way t o have a smoke under t he t ree approached t he
first aut hor ent husiast ically saying: “ Can you see t he
spider? The web is awesome!” He was proud of t he
web and it seemed t here was some propriet y in t he
spider and it s web; it was as if t his was t heir spider
t hat was making his way in life in t his small walled
garden. Upon furt her conversat ion wit h t he client , it
became clear t hat t his spider was a source of
int erest and j oy t o some of t he client s. Here was
somet hing wild making a home for it self
met hodically and beaut ifully bet ween t wo gloriously
flowering t rees. During t his t ime, an elderly client
from t he aged care unit ent ered t hat garden space
Figure 7. Garden 2.
and sat on a bench looking at t he spider’ s web. He
was st ill t here when t he aut hor left fift een minut es
lat er.

Figure 8 Garden 2.
Figure 9. View out of recept ion windows.
During t he course of our observat ions, client s hardly
ever went out t o t his space. As was t he case wit h
Garden 1, psychiat rist s did not use t his space t o
consult wit h t heir client s and nursing st aff were not
observed relaxing in t his space. The second aut hor
not ed t hat t he space might have been locked at
t imes. It appeared curious t hat t his space was
virt ually unused because alt hough t here is a lot of
hard concret e and plant s are laid out in a st rict ly
geomet ric order, t his garden is soft er and more
aest het ically pleasing t han Garden 1.
A final not at ion from t he et hnographic not es
Figure 10. The spider web bet ween t wo f lowering t rees.
highlight s t he significance of gardens for client s. The
first aut hor was wait ing in t he recept ion area and
looking out ont o t he rect angular garden which was
accessible t o t he aged care client s, and which HDU (High Dependency Unit / Closed Ward)
provided a garden view t hrough t he large glass walls
The out side area (figures 11 and 12) t hat is
of t he ment al healt h recept ion area (see figure 9).
accessible t o client s in t he HDU has no plant s. It is
An elaborat e spider web sparkled in t he light
covered wit h a circular design of concret e paving
bet ween t wo flowering peach t rees (see figure 10).

8
 PRODEEDINGS IASDR2011

which also has four ‘ pat hs’ off t he cent re (which is a Most cl ient s are out side [‘ out side’ is t he t erm used
sunken square drain). Bright green art ificial grass in t he not es for all ext erior spaces] when I arrive.
glist ens bet ween t he concret e paving. There are t wo They are al l pacing around and around t he
met al benches on t he far end of t he space. This court yard, but in dif f erent direct ions and at
court yard is surrounded by a barrel-curved t in dif f erent speeds.
overhanging roof support ed by aluminium pillars t hat
echo t he window frames of t he surrounding glass It could be suggest ed t hat t his t ype of walking was

walls. These cont rast wit h t he solid red brick more accept able out side as opposed t o inside, where

ext erior wall. Client s used t his space t o smoke, client s were more oft en observed walking slowly up

speak privat ely on t he t elephone when t hey had calls and down t he bedroom corridor or round and round

from family, and as a space t o sit or walk in. Client s t he recreat ion areas. One reason for t his could be

generally went out side alone but on occasions t hey t hat walking in t his manner could upset ot her client s

were observed speaking t o ot her client s. As visit ors inside, but nevert heless it is int erest ing t o not e t hat

were not allowed in t he HDU at all, t hey were also client s used t he out side space in t he HDU as a

not permit t ed t o ent er t his space. Psychiat rist s did pot ent ial space for release of frust rat ions, or t o be

not use t his space t o consult wit h client s (rat her, alone.

t hey made use of t he int erview rooms) and nursing

St ill on Day 2 t he ext ract below is t aken f rom
st aff only went int o t he space t o see t o t he needs of
observat ions in HDU by t he second aut hor and
client s.
isolat es t he act ivit ies of ‘ J’ a male client (t here
were only four client s in HDU on t his day of
observat ion):

2 men remain out side wal king around perimet er. J …

comes out (of his bedroom) and begins wal king up
and down t he corridor t rying al l t he doors and
l ooking inside t hem but not ent ering. He t hen wal ks
over t o where st af f are t aking S’ s bl ood and st art s
t al king t o st af f t here. I can’ t hear t heir conversat ion
but it seems t hey suggest t hat he go out side and
t hen 1 st af f member t akes him t o get him a drink.
Figure 11. The court yard in HDU.
Whil e she does t his he approaches t he nursing
st at ion door which hasn’ t cl osed properl y f rom
someone coming in (door cl oses quickl y at f irst but
t hen sl owl y at t he end and t his may t ake a second).
J comes up and pushes door open – anot her st af f
member says ‘ l eave it cl osed pl ease’ and pushes it
cl osed. J t hen t akes his drink f rom t he ot her st af f
member and t ips it out side. S paces corridor f or a
bit and t hen goes back out side. J approaches door
again and asks f or smokes, but wanders of f whil e
st af f member get s t hem. J wanders back up corridor
and punches gl ass wal l at end and nurse goes out t o
have conversat ion wit h him and t hen t akes him
Figure 12. The court yard in HDU. out side wit h his smokes. [A lit t le lat er] J get s
bored (I guess) and goes up t o where G is sit t ing at
On Day 2 of our st udy t he second aut hor not ed t hat t abl es and chairs, want ing t o give him a dr ink – but
when she commenced at 9.30 am in HDU, G doesn’ t want it . St af f go out t o int ervene and see
what is going on. … G get s up, wanders out side and J

9
DIVERSITY AND UNITY

t akes his seat wit h his drink. G goes out side and client s (K) was feeling t he heat on t hat day. Below is
st art s pacing around. an ext ract which illust rat es t he at mosphere:

J comes up t o [dut y st at ion] window f or a whil e wit h K t el l s me she is hot and t hat she has a swimming
his cup and pours cordial over t he bencht op. St af f pool . “ My husband um boyf riend l oves get t ing in and
immediat el y go out and t ake it f rom him. J t hen so do I” . Then she f ans hersel f and says ‘ It ’ s hot in
wanders out side and st art s t al king t o G again – a bit here’ and moves of f . Af t er a whil e K asks me if I
aggressivel y and t hen comes t o window again and want somet hing t o drink. She is very cheerf ul . Her
asks f or st af f who goes out and t el l s him t o st op psychiat rist arrives and t hey go t o an int erview
coming up and t o go f or a wal k inst ead. St af f comes room.
inside but J st ays out side door and doesn’ t go
Lat er she get s bol shy at t he nurses’ st at ion, she
anywhere, j ust wat ches what is going on.
want s t o t al k wit h her brot her and is event ual l y
The ext ract above is one example of a client in t he al l owed t o. She t el l s him how she was f ound wit h
HDU showing signs of frust rat ion. The int erior space cut s et c and t hen put int o a room and how she had
is relat ively small and if client s are rest less t heir needl es st uck int o her. A f ew minut es l at er K is
rest lessness fills t he space. Despit e t he illusion of crying, she bangs on t he door t o go out side and says
space creat ed by glass walls, client s in HDU do not she want s a smoke. Lat er K opens a l et t er t hat a
have many opt ions for movement or ent ert ainment . mal e nurse brings her. She opens it and says l oudl y:
During t he course of our observat ions, no organised “ Annie! [t he name we give t o t he senior nurse] ! I
act ivit ies (e.g. craft or cards) t ook place at t he have t o be here f or 7 days! Geez, he’ s st rict ” .
t ables locat ed wit hin t he HDU – alt hough client s Annie comes in and says “ t he way t o get out of here
were observed doing some drawing - and t he only is t o be l ow key and behave. The no-smoking t hing is
ot her ent ert ainment was offered by t he t elevision or a pol icy” .
some magazines on general t hemes piled on t he shelf
Again, t he space in t he HDU is remarkably small
in t he TV area. As is evident from t he above ext ract ,
when personalit ies as large as K’ s brim over. There
J was annoyed and might have felt rest rict ed and
are no ext ensive gardens t o wander in, no secluded
t hus became difficult . The out side space provided
shady areas t o cry in, and no real relief from t he
some relief but was clearly inadequat e.
heat t hat is generat ed from t he climat e and f rom
Therefore, it seems reasonable t o conclude t hat t he anger. K longed t o go back t o her boyfriend and
out side space in HDU is used as a t ime-out space family where it was clear t hat she had a great family
when client s were more t han usually irrit able, a support syst em, but also clear t hat she t est ed her
place for exercise (even pacing t he perimet er) and a loved ones t o t heir limit . K had a ‘ larger t han life’
place for smoking. (We not e below t hat smoking was personalit y coupled wit h her own part icular
banned on t he hospit al grounds t owards t he end of condit ion and t he space available for her t o heal in
our et hnographic st udy). did not suffice.

On one day when t he first aut hor was observing in Towards t he end of t he t hree mont h period of our
t he HDU, t here was a round ball resembling a soccer observat ions, a smoking ban was implement ed in all
ball lying in t he cent re, but no one used it for t he of t he hospit al buildings, int ernal court yards and
t hree hours of t he observat ion on t hat aft ernoon. It hospit al grounds. This had a direct effect upon t he
was a sult ry, overcast day wit h t he prevailing grey ment al healt h client s in t he HDU who were not
colours of t he aluminium and corrugat ed met al allowed out of t he secure unit . Almost all HDU
mixing wit h t he relat ively small sect ion of visible client s were smokers, and when t his ban was
grey sky. Despit e t he lack of plant s t o absorb t he implement ed, addit ional nicot ine t herapy was
heat , t he out side space in HDU does provide f resh as provided but t he out side area had now lost one of it s
opposed t o condit ioned air. One of t he female funct ions as a smoking space. The second aut hor

10
 PRODEEDINGS IASDR2011

not ed t hat t he out side space in t he HDU was used pict orial/ garden view. The quest ion is whet her t his
significant ly less aft er t he smoking ban. image of t he out side was t easing or soot hing for
client s; t here are benches j ust beyond t he plant ed
The t able below (like t he one above for t he open area for general seat ing (alt hough t hey were vacant
ward) is ext ract ed from t he dat a which recorded t he during our observat ions). Client s could look out ont o
number of client s in specific spaces at 15 minut e st rangers passing by or sit t ing on t he bench in a
int ervals. This t able shows t he t ot al amount of t ime garden which t hey knew t hey could not gain access
t hat t he out side space was used in t he 15 hour t o and t hose st rangers could also peer t hrough t he
observat ion period. As ment ioned for Table 1, t he foliage int o t he HDU ward, if so inclined. The power
t able below does not summarise t he number of of t he window t o bot h present and deny is a design
people over t he period because some people would feat ure which requires et hical considerat ion in t he
be count ed more t han once t hus skewing t he figures. case of acut e ment al healt h client s.
However bearing in mind t hat t he maximum number
of occupant s at any one t ime in HDU is 6, t he
maximum number of people in a 15 minut e slot is
provided in t he second column under ‘ people’ .

Act ivit y Tot al % Max. %

hours people

Smoking/ 5.25 35% 4 66%

sit t ing/ hrs
walking

Table 2. HDU court yard usage

Figure 13. The window in t he TV lounge of HDU.

To be out side for 35%of t heir waking hours is a lot of CONCLUSIONS

t ime for people who are all variously out of kilt er
wit h t he demands of t hemselves, t heir relat ionships Before embarking on our conclusions, it is import ant
and t he out side world. More conclusions will be t o consider t he limit at ions of t his st udy so t hat our
drawn at t he end of t his paper but at t his st age findings are not overst at ed. Consequent ly, our chief
suffice t o say t hat t he client s in HDU need more limit at ions lay in t he rest rict ions put upon us by t he
space t o ‘ get away’ . et hics commit t ees: i.e. we could not conduct
int erviews wit h st aff or client s, we could not observe
As ment ioned earlier, an ext ensive use of glass
client s’ bedrooms and we could not access client
creat es a light filled ward, but in some inst ances
records. Aft er t hese and ot her publicat ions from
provides views of gardens t hat are not accessible t o
t his, our pilot st udy, we are hopeful t o gain more
client s. One of t hese views is from t he TV lounge of
permissions for deeper st udies. These fut ure st udies
t he HDU ward which looks direct ly ont o a garden but
will look at dat a from different sit es comparat ively
also shows a view of t he main hospit al and includes
and also consider how client s connect wit h nat ure in
t he large car park (see figure 10 below). It is t he
more specific ways.
only view of t he out side world for HDU client s, yet
t his is an out side world t hat is bot h denied t o t hem Whilst in t he t it le of t his paper we refer t o t he
and simult aneously present ed t o t hem t hrough a out side spaces in t he ment al healt h unit in which we
large pict ure glass window wit h an at t ract ive garden undert ook our observat ions as ‘ gardens’ , as we
bed as a buffer. The plant s in t he garden direct ly progressed t hrough t he issues under discussion in t his
out side t he window were already quit e dense during paper it became more and more difficult t o call t he
our observat ion period. The foliage may also have spaces gardens wit h any kind of convict ion. Inst ead,
been plant ed t o obscure a deep view bot h inside and t hey became more like court yards, walled
out whilst st ill providing t he client s in HDU wit h a enclosures, or in t he case of t he HDU, j ust a yard.

11
DIVERSITY AND UNITY

These are meaner t erms and spaces t han t hose out door garden filled wit h plant s and t rees
evoked by t he generosit y of t he t erm ‘ garden’ . This indigenous t o Arizona, found improvement in t heir
was part icularly t he case in t he HDU, which oft en abilit y t o ret ain qualit y st aff by providing a place for
appeared t oo small t o cope wit h t he t ension t hat we t hem t o go t o overcome t he st ress of t he j ob” (2001,
were able t o see (t here were days when our p. 191). Addit ionally, ment al healt h facilit ies could
et hnography could not t ake place and had t o be include paint ings t hat include nat uralist ic gardens
rescheduled because we were advised t hat accessing which could complement nat ural places t hat client s
t he space would not be safe on t hat part icular day). could relat e t o, and more imaginat ive use could be
made of int erior plant s, combining different foliage
In t he open ward, only one court yard (garden 1) was and scales of plant s.
ut ilized, t hough it is likely t hat a st aff short age did
not make t he ot her one (garden 2) fully accessible t o To conclude, Wordswort h wrot e in his Ode t o
client s. The t ree out side t he front of recept ion was a Int imat ions on Immort al it y t hat we must regain
favourit e spot , and alt hough we do not have figures st rengt h in what remains behind. He was t alking
on t his as it was out side of our observat ions, t here about t he passage t hrough life and t he dist ance
were rarely occasions when we arrived during t he bet ween t he garden of childhood innocence and t he
t hree mont h period t o find t he benches under t he bleakness of adult responsibilit y. Wit hout over
t ree empt y. Somet imes client s would be lying on t he romant icising t he issue, it remains t o be asked
benches j ust looking at t he leaves and t he sky and whet her t he “ prison house” (1954, p.154) which
most t imes t hey would be smoking and chat t ing. But Wordswort h used as a met aphor for t he loss of
it was not only client s who used t his spot it was innocence can be circumvent ed in t he case of ment al
oft en used by clinicians and doct ors, especially if healt h inst it ut ions by ret aining and not losing nat ure.
t here were no client s t here. By ensuring t hat t he grass is real, t he plant s and
surfaces are varied and nat ural, and t he lines of
This example of client s and st aff t aking up any
out door space design are not exclusively st raight , it
opport unit y t o spend t ime in nat ure out side t he built
may be possible for such spaces t o t ruly be
environment suggest s t o us t hat illusions of nat ure
const it ut ed as gardens t hat can play a posit ive role
are insufficient . This is part icular of import given t he
in t he healing of client s in ment al healt h facilit ies.
fact t hat neit her st aff nor client s can alt er t he
st ruct ure of t he spaces t hey are required t o move in. NOTES
Therefore, alt hough t he cont emporary ment al healt h
1. All phot ographs in t his paper are t aken by t he
unit is a far cry f rom t he old punit ive asylum, it is
aut hor.
nonet heless t he case t hat t hey cont inue t o fail t o
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