By Jeanette Kingsley, RN
In the enclosed courtyard behind the Admissions Building at McLean Hospital, where others see an expanse of ugly crabgrass, I see the potential for a huge garden bursting with fragrant, colorful perennials. I imagine a labyrinth that patients and staff can walk through to soothe their thoughts and a pathway that weaves through different sections of a natural oasis.
My dreams are starting to come true.
Magical things happen every day when you’re in a garden. It draws individuals out and puts them in a more positive frame of mind.
I know from experience. In 2013, I took over a modestly sized courtyard flower garden that had been tended for many years. With the help of a colleague, I slowly added more flowers to the garden, including zinnias, lilacs, and hibiscuses, and cared for it with the help of staff and patients. Many people witnessed the progress, as that area gets a lot of foot traffic and is visible from many of the Admissions Building’s windows.
During the second season, I recruited a teenager—who was struggling considerably with her mental illness at the time—to plant a bunch of sunflower seeds with me and used the process as metaphor. We would talk about how plants grow and then how sometimes they have to go through a difficult period, maybe losing a branch and then growing another one. The premise of garden therapy is that people can see how nature works and heals itself and how it continues on, despite the setbacks. That young patient was so calm when we were in the garden.
After several years of witnessing the positive effects of the garden on patients and staff, I have decided to take my horticultural project to the next level.
Unfortunately, after our Admissions Building was renovated last year, its once verdant courtyard was looking somewhat ragged. I, however, saw this as an opportunity to further expand the plantings, beautify the courtyard, and get more patients and staff involved.
Kelly Carlson, PhD, PMHNP-BC, McLean’s Nursing professional development specialist, immediately embraced this plan. Carlson, who has been working on nurse-led quality improvement projects around the hospital, saw this garden project as a perfect way to educate staff about grounding techniques—a therapeutic skillset for improving patient care.
Therapeutic gardening can be a powerful way to ground psychiatric patients because it puts them in contact with nature and other people and gets their bodies moving. Grounding techniques help people detach from emotional pain by reconnecting with the external world and the present moment. While researchers are still learning exactly how tending plants affects the brain, what is known is that gardening reduces stress by decreasing the production of cortisol. And some research studies have confirmed its beneficial effects—particularly on elderly individuals and people with developmental delays.
I can tell you that I continue to personally observe these positive effects over and over. For instance, a young woman who was experiencing suicidal thoughts did some planting with me recently and she reported that our work in the garden was the only positive thing in her day.
Another young man whose aggression had been worrying staff reluctantly agreed to come out to the garden with me. Once there, he began talking enthusiastically about how he used to help his grandmother in her garden and asked me whether it would be okay to help me. He turned out to be a tremendous worker—weeding, raking, digging, and planting. He and another challenging teenage boy bonded through their experiences in the garden, working together and experiencing a calmness they had not demonstrated before while in treatment.
While many patients get their hands dirty on a regular basis, others simply enjoy the garden from a seat on the patio or from a window in their room. There was the very depressed man who, for months, would silently watch others at work in the garden from the adjacent patio. After a while, he began identifying the plants as well as the weeds and sharing his own long history with horticulture. When he was discharged, he donated flowers to the garden.
I am not the only staff member who is trying to bring more green into mental health care. The Schizophrenia and Bipolar Disorder Inpatient Program has a vegetable garden next to mine and a nurse from Geriatric Psychiatry Inpatient Services plans to create a garden for the program. Meanwhile, a behavior therapist who is pursuing a certification in horticultural therapy is hoping to plant herbs—with information explaining their therapeutic properties—outside the McLean building that houses our cafeteria, welcoming people to smell, touch, and enjoy them.
All of these horticultural therapy projects fit in well with McLean’s long history of capitalizing on its beautiful landscape for the benefit of patients. In fact, famed landscape architect Frederick Law Olmsted helped to pick out the location for our main campus and walked its grounds as a patient.
We have long used grounding techniques in this environment as a way to wake up individuals’ senses, helping them to come out of their painful places and connect with the outside world, whether by taking a walk, looking at a colorful tree, or picking up an aromatic pinecone. We look forward to continuing and building on this therapeutic tradition.