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Therapeutic landscapes

by Mike Westley
Therapeutic design is another important aspect of designing for health. It can yield great results for relatively low budgets as three projects for the Royal Cornwall Hospital Trust in Truro show. 
As a landscape architect passionate about working in health and social care settings, I am inspired by the possibility
that places I help create can be deliberately designed to deliver opportunities for human healing and for specific wellbeing outcomes.

However, despite recent advances, it is hard not to be frustrated by the low level of understanding which still exists around the subject. For many people, therapeutic landscape design is still just a fancy way of describing a ‘sensory garden’, which, as everyone knows, is a place where lavender grows politely around a sundial and nothing else very exciting happens.

Sadly, this misleading view still holds, even amongst many commissioning bodies for healthcare service. Despite 30 years of international research and innovative practice pointing to well-established connections between improved human health and human well being, the vast majority of healthcare environments are devoid of the heartening humanity displayed by the people who work within them to care for us. Yet intuitively most people readily recognise the principle, embodied in Erich Fromm’s notion of Biophilia as ‘love of life or living systems’ and developed further by Edward Wilson, who hypothesised an instinctive bond between human beings and other living systems.

It is my experience that a landscape architect must approach therapeutic landscape design in a manner that firstly, ensures buy-in from austerity-strapped health sector clients by connecting with their specific agendas and outcome needs. Secondly we must upskill to embrace creative design process working within the complexity of the social healthcare context. Lastly our approach must recognise the need for design solutions that deliver on many practical performance needs, whilst maintaining a sense of its own particular place and integrity.

Critically, landscape professionals who are designing for clients in the field of health and wellbeing must be in detailed command of the evidence base supporting their proposals, so as to effectively advance the argument for investment in greenspace as the best-value solution to delivering general wellbeing and its maintenance in people throughout healthcare settings.

To gain a permanent seat at the healthcare table, with the resources necessary to make a difference, we must effectively build a bridge of confidence for health service commissioners connecting our art to the scientific basis underpinning our work.

My experience has been that ‘action research’ activity into the theoretical basis for our work has paid dividends in terms of the richness of experience it brings into my own design process and our practice culture. To pursue this aim, my practice has been working with researchers from the European Centre for Environment and Human Health, funded through its ‘In Residence’ award, to explore how we can use a targeted evidence base to underpin collaborative greenspace design and management processes, which communities can effectively use in planning the delivery of wellbeing from their own local greenspace infrastructure.

Anyone spending a significant amount of time observing healthcare environments can’t fail to note their resemblance both to ants’ nests and to a society in miniature, with their diverse communities of stakeholders, including varieties of service providers and service users, managers, support staff, external suppliers and regulating bodies and interest groups.

This means that even a seemingly anonymous and unused space generally contains complex patterns of stakeholder relationships and agendas. Each will rival the other to test the project designer’s skills of diplomacy and equity in arguing for their own agenda’s pole position on the design brief grid!

Although each setting is unique, the most effective and inclusive consultation always results where the process most creatively uses the often widely different capacities and possibilities for stakeholder response.   We have used a range of such approaches on three projects.

Dolphin House Courtyard is a small courtyard within a special-school setting on the Royal Cornwall Hospital campus, which delivers a clinical treatment and learning play programme to a diverse range of children with learning difficulties and behavioural issues arising from different underlying medical conditions, and varying degrees of severity.

The complex learning / play brief requirements eventually resulted in a single, playful piece of sculpture furnishing, which formed the focal point of the courtyard and also divided the space around it into sub-spaces of varied character and use potential. In clinical use the staff team is able to select from a range of kinetic, proprioceptive, creative and selective-sensory-stimulating spaces, so as to tailor a unique, appropriate experience for each child.

Play 4 Life is a multi-use greenspace at the heart of the hospital campus, delivering outdoor learning for the Hospital school pupils and specific therapeutic programmes for a range of clinical departments. It is also a ‘playful’ healing place for respite, relaxation and wellbeing promotion for a diverse users profile drawn from across the hospital community.

The Play 4 Life project has a carefully designed spatial quality to suit different ages and conditions of users. This was delivered by reinterpreting the site’s existing qualities and attributes; hedges and mature trees were retained, and demolition material retained and massed to create mounds, defining spaces, creating space for many to achieve relative therapeutic solitude and encourage exploration. The circulation system delivers a range of challenges in terms of step height, surface texture, speed, secrecy, direction and gradient.

This delivers flexibility and diversity for simultaneous use by families, clinicians and school staff of a series of defined spaces with particular play leaning / healing possibilities. At first glance however the impression is of a richly varied garden, rather than a playground, encouraging more inclusive use by a wider spectrum of users.

Grenville Ward Courtyard was a therapeutic garden treatment facility, serving a post-operative elder care and stroke recovery ward. It also provided amenity and respite space serving both ward staff and patients’ families and carers. At the Grenville Ward Courtyard, this sense of layering is present in a serpentine route, which added a softening curvilinear movement, articulating the subspaces along the length of an otherwise harshly rectilinear courtyard. This element doubled as a handrail and distance guide along which OT’s could accompany stroke recovery patients in exercises aimed at reinvesting a sensing of distance, and aiding the recovery of walking.

I consider that a design which merely systematically answers function with form only answers half the challenge. At some level, every therapeutic landscape must retain the overall sense of refuge. It must
be somewhere that inspires with its simple beauty and contains qualities that are innately supportive of general wellbeing.

For me this is at once the greatest challenge and pleasure; to produce a design that will simultaneously meet the needs of: a busy nurse seeking a few moments of private respite in a sheltered corner, an O.T. working with their patient on a specialist element of furnishing as part of their clinical programme, a family group, escaping the unfamiliar environment of the ward with their patient relative to enjoy the sensory stimulating qualities the planting and the calming sounds of water gently falling.

To achieve this requires the design of each of the specifically functional design elements to be, to a degree, disguised. Whether this functionality is being delivered by furnishing, surfacing, structure or planting, with their intrinsic design qualities; taken together, each element should be supportive of the other if the aesthetic integrity of the whole space is to be achieved. In this way the design can be seen as a complex of layers, some sharing common elements; each layer able to be recognised intuitively by each specific user group and utilised.

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