evidenceissue6
Social and Therapeutic
Horticulture: evidence and
messages from research
A summary of the main findings of a review of the literature on
social and therapeutic horticulture ­ the use of horticulture and
gardening to promote health, well-being and social inclusion
among vulnerable people.
 Although horticulture in many different forms has been
used as a therapy or as an adjunct to therapy, hard
evidence as to its effectiveness is scant and of variable
quality.
 From the available literature the review examined the
use of social and therapeutic horticulture for a number
of different client groups and analysed emergent
messages and themes including the benefits of
gardening and horticulture to these groups.
 Groups include those recovering from major illness or
injury, those with physical disabilities, learning
disabilities and mental health problems, older people,
offenders and those who misuse drugs or alcohol.
 The reported benefits of social and therapeutic
horticulture include increased self-esteem and selfconfidence,
the development of horticultural, social and
work skills, literacy and numeracy skills, an increased
sense of general well-being and the opportunity for
social interaction and the development of
independence.
 In some instances involvement in social and therapeutic
horticulture programmes can also lead to employment
or further training or education.
`Horticultural therapy is the use of plants
by a trained professional as a medium
through which certain clinically defined
goals may be meť.
`Therapeutic horticulture is the process by
which individuals may develop well-being
using plants and horticulture. This is
achieved by active or passive involvemenť
(Growth Point, 1999, p. 4).
Social and therapeutic horticulture is the
term now used by the charity Thrive.
The literature in context
The literature review forms part of a larger study which
aims to examine how social and therapeutic horticulture
promotes social inclusion, health and well-being for
vulnerable adults. More than 300 articles were examined
in detail in the course of the review from approximately
1000 available titles. These were identified by searching
library databases, references from known published work
and by consulting with researchers in the field. It is
possible to identify some broad themes in the literature
relating to rehabilitation, horticultural therapy and
psychology, including landscape and environmental
psychology.
The reported benefits and
outcomes of therapeutic
horticulture
Benefits and outcomes of social and therapeutic
horticulture are reported among a wide range of
individuals and groups of vulnerable or socially excluded
people. Although less evidence is available on the
beneficial effects of horticulture and gardening in terms
of improvement of physical health, a number of studies
have looked at outcomes here for stroke patients, those
with aphasia, the victims of car accidents and children
with cerebral palsy for example. One study looking at
aphasia concluded:
`Most endeavours require some degree of
verbal skill, and it is always a challenge to
find recreational activities which are
suitable for individual with aphasia. Clearly,
the nature of horticultural activities lend
themselves easily to communicative
disabled individuals'
(Sarno and Chambers, 1997, p. 89).
Evidence is more widely available concerning the impact
of horticulture and gardening in terms of improving mental
health. In 1955, O'Reilly and Handforth were among the
first authors to examine the value of horticulture as a
therapy for psychiatric patients. They evaluated the
efficacy of a horticultural programme for 14 women
patients who had been considered refractory to all forms
of treatment.
`Of the 14 patients who participated in our
pilot project, only one has failed to show a
striking degree of improvemenť (p. 766).
Improving self esteem, self confidence and social
interaction are also seen as significant outcomes for
people with mental health problems and those with
learning difficulties.
Smith and Aldous (1994) for example found students with
learning disabilities increased their
`feelings of value and worth in that they
considered themselves more desirable than
before as individuals. Therapeutic
horticulture provided each individual with
the opportunity to express themselves in a
positive way...'(p. 217).
The link between physical activity and health in older
people has been extensively researched and there is a
mass of evidence which suggests that physical activity is
associated with good health and reduced risk factors for
heart disease and other illnesses. However, gardening is
seen as only one of many factors here and few studies
have looked specifically at the benefits, both physical and
psychological of gardening itself.
Among other identified groups to benefit from social and
therapeutic horticulture are offenders and those who
misuse alcohol or substances. Some studies had specific
objectives in terms of teaching horticulture and other
skills in prisons, for example, particularly for training in
life skills. The range of positive outcomes here are
described as: providing meaningful activity and work; food
production; providing skills (for example, in responsibility,
social skills, work ethic) to succeed in horticultural and
other activities. In one study of horticultural programmes
for juvenile offenders, the authors concluded:
`This research indicates that this vocational
horticulture curriculum may be a tool to
improve social bonding of juvenile offenders,
[and that such vocational training could be]
effective at evoking certain changes in
attitudes about personal success and
individual perceptions of personal job
preparedness'
(McGuin and Relf, 2001, p. 432).
A further outcome of social and therapeutic horticulture,
which isn't referred to explicitly but which can be inferred
from some of the studies, is that social inclusion can be a
positive consequence of participating in horticultural
projects. The four dimensions of social inclusion relate to
consumption, production, social interaction and political
engagement. The extent to which these dimensions can
be influenced by horticulture and gardening will vary from
group to group and person to person, so for example,
gardening may promote social interaction among older
people while the production dimension can be addressed
by gardening programmes seeking to provide employment,
work discipline, development of skills and socially useful
activities.
Mechanisms of therapeutic
horticulture
The theoretical framework that underpins therapeutic
horticulture relates to the ways in which landscape and
nature can influence emotions, health and behaviour.
Environmental psychology has provided considerable
information about the restorative qualities of natural
environments and both cognitive (reasoned) and
evolutionary (inherited) components may be present. Two
key areas of research here focus on attention fatigue and
centre for child and family research evidenceissue6
its restoration by the natural environment, and the role of
the natural environment in recovery from stress. Studies
look at mental fatigue and how it arises as a result of the
effort involved in inhibiting competing influences when
attention is directed towards a specific task. The natural
environment is said to stimulate involuntary attention
which requires no effort and is therefore restorative. A
further example is the study of the preference for
different types of landscape and on the effects of
landscape on recovery from physical and psychological
stress (for example, the view from a hospital window and
its impact on recovery processes, see Ulrich, 1984).
A model of activities, processes
and outcomes
From the examination of the literature on social and
therapeutic horticulture it is possible to construct a
model (shown in figure 1) which illustrates the main
activities, processes and outcomes as drawn from the
available evidence. At the base of the model lie the
underlying foundations which determine the inherent
appeal of the natural environment. This has also been
centre for child and family research evidenceissue6
called `Biophilia' (Wilson, 1984) and suggests that human
beings possess an innate attraction to nature. The origin
of this attraction is still under debate. It may be
evolutionary; it may be learned or acquired. But whatever
its nature it supports both the passive appreciation of
landscape and the active participation in horticulture and
gardening. Within the divisions of `active' and `passive'
there are many processes and activities which are interrelated
and which provide rehabilitation, acceptance and
inclusion on one side and tranquillity, peace and
spirituality on the other. These are represented as two
distinct groupings ­ but nonetheless connected. The
reason for separate groups is that the former,
rehabilitation, acceptance and inclusion are frequently the
goals of active programmes whilst passive appreciation of
nature is often associated with tranquillity, peace and
spirituality. This division is not a `hard and fasť rule of
any sort but an attempt to show the diversity of the aims
of different programmes. The two groups of attributes are
shown to be interconnected as one can lead to the other
and vice versa. In most cases this exchange is desirable
and intended; acceptance and inclusion should lead to
peace and tranquillity; and peace and tranquillity can be
Passive:
Nature Appreciation
Food, Cultivation,
Consumption
Employment
Skills
Development Physical Activity
Attention
Restoration,
Recovery
from Stress
Social Processes,
Interaction,
Esteem-Building
Health, Well-being
Rehabilitation,Acceptance,
Social Inclusion
Tranquillity, Peace,
Spirituality
Innate Factors ­ Evolutionary ­ Biophilia
Active:
Horticulture, Gardening
Figure 1. Health and Well-being Through Nature and Horticulture:
a simple model of some of the processes, activities and outcomes of social and therapeutic
horticulture as described in the literature showing the interconnectedness of all elements.
evidenceissue6
Research Partner
Thrive, The Geoffrey Udall Centre, Beech Hill, Reading
RG7 2AT
Funder
Community Fund
Where to find more evidence
Sempik, J., Aldridge, J. and Becker, S. (2002) Social and
Therapeutic Horticulture: evidence and messages from
research, Thrive (in association with the Centre for Child
and Family Research): Reading.
www.growingtogether.org.uk
Full details of other outputs can be found in the CCFR
brochure or on the website:
www.ycrg.org.uk
This paper was written by: Jo Aldridge and Joe Sempik,
December 2002
For further information about the CCFR please contact:
Dr Harriet Ward
Director
H.Ward@lboro.ac.uk
Professor Saul Becker
Associate Director
S.Becker@lboro.ac.uk
Suzanne Dexter
Administrator
S.Dexter@lboro.ac.uk
Centre for Child and Family Research
Department of Social Sciences
Loughborough University
Leicestershire LE11 3TU UK
+44 (0)1509 228355
+44 (0)1509 223943
www.ccfr.org.uk
This CCFR Evidence paper forms part of the
CCFR Family and Environment research programme
the steps to acceptance, inclusion and rehabilitation. The
final components of the model are health and well-being,
at its summit. This is the ultimate goal of social and
therapeutic horticulture and represents a major part of all
interpretations of `quality of life'.
The data reviewed in the literature on social and
therapeutic horticulture provide evidence for the
effectiveness of horticulture and gardening in a number of
different therapeutic settings. However, there is a need
for more research in this area which examines outcomes
in greater detail, and with a range of different groups.
This would provide robust evidence in support of
therapeutic horticulture for a wide range of vulnerable
groups and individuals.
References
Growth Point (1999) `Your future starts here:
practitioners determine the way aheaď, Growth Point, vol.
79, pp. 4-5.
McGuinn, C. and Relf, P.D. (2001) `A profile of juvenile
offenders in a vocational horticultural curriculum',
HortTechnology, vol. 11, (3, Jul-Sep), pp. 427-468.
O'Reilly, P.O. and Handforth, J.R. (1955) `Occupational
therapy with `refractory' patients', American Journal of
Psychiatry, vol. 111, pp. 763-766.
Sarno, M.T. and Chambers, N. (1997) `A horticultural
therapy program for individuals with acquired aphasia',
Activities, Adaptation & Aging, vol. 22,
(1-2), pp.81-93.
Smith, V.D. and Aldous, D.E. (1994) `Effect of therapeutic
horticulture on the self concept of the mildly intellectually
disabled studenť, in: The Healing Dimensions of PeoplePlant
Relations, Francis, M., Lindsey, P. and Rice, J.S.
(eds), UC Davis, CA: Centre for Design Research, pp. 215-
221.
Ulrich, R.S. (1984) `View through a window may influence
recovery from surgery', Science, vol. 224, pp. 420-421.
Wilson, E.O. (1984) Biophilia: The Human Bond with Other
Species, Cambridge: Harvard University Press.
Principal researchers
 Joe Sempik, Research Fellow CCFR
 Jo Aldridge, Research Fellow CCFR
 Saul Becker, Associate Director CCFR