CULTIVATE

FLORIDA HORTICULTURE FOR HEALTH NETWORK

Spring 2023 Volume 3 Issue 2 FLHort4Health@outlook.com
The Florida Horticulture for Health Network’s vision: To promote activities and connect organizations to each
other and resources that use horticulture to improve health including: therapeutic horticulture and horticultural
therapy, landscapes for health, nature, emerging professional support, allied horticulture and health services,
community and school gardens, and food action initiatives.

CONTENTS

1 A Framework for
Categorizing Healing
Gardens

6 Therapeutic Landscapes

9 Therapeutic Horticulture:
A Trauma-Informed
Approach to Mental
Well-Being within a
Psychiatric Hospital

12 Permaculture and Health:

What’s the Connection?

15 Sensory Garden and the

Built Environment at
Elks Children’s Eye A Framework for Categorizing
Clinic Healing Gardens
Text by Leah Diehl, RLA, HTM
Photos by L. Diehl, S.Y. Tham & L. Fleming

As the popularity of healing gardens has increased, various types

have emerged, many of which are hard to distinguish from one
another. Thus, it can be difficult to clearly and consistently describe
these various garden types. A framework for categorizing these
gardens is essential so one can speak intelligently about their
distinctions and avoid imprecise descriptions that thwart attempts to educate and persuade
stakeholders to embrace the importance of these settings.

The relationship between various types of healing gardens can be visualized as a hierarchy chart with
the broadest types at the top and the more specific types falling underneath them (see Figure 1). This
hierarchy chart is based on a garden’s primary intent, but because no two gardens are the same and
some have more than one purpose, not all gardens fit cleanly into a single healing garden type. The
following information serves as a primer for the categorization of healing-type gardens.
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

Landscapes for Health

The term healing garden is not, in fact, the broadest category at the top of the hierarchy tree but falls
lower down. The broadest category is landscapes for health, a term coined by Sachs (2008) and
defined as any natural or manipulated landscape that makes one feel good, and, more technically,
contributes to positive outcomes. Sachs’ examples include a stretch of beach, a community garden, a
clearing in the woods, or a lush, green indoor atrium in the middle of winter.

Landscapes for health refer to both natural and manipulated landscapes, and the first chart division
comes at that point. On one side are healing landscapes that promote health and healing: a natural
forest designated for forest bathing would be a good example. On the other side are healing gardens,
representing environments that have been created in some way to promote health and wellbeing. A
garden, by its very definition, is a space that has been manipulated or cultivated.

Landscapes for
Health

Healing Healing
Landscapes Gardens

Restorative
Enabling Gardens Gardens

Demonstration Eldercare Therapeutic Sanctuary Meditation/

Sensory Contemplation
Gardens Gardens Gardens Gardens Gardens Gardens
Physical
Alzheimer's Memory
Therapy
Care Gardens
Gardens
Gardens
Horticultural
Therapy
Gardens

Figure 1. Healing Gardens Hierarchy Chart © Elizabeth R.M. Diehl

Healing Gardens
The focus in this article is on the healing garden branch of the hierarchy chart, and according to AHTA’s
(2007) definition of a healing garden, it should be an environment of respite for all users, dominated
by plants, universally accessible, designated as healing by the associated facility, and designed to
create “beneficial effects.” While this definition provides some basic criteria, it is still fairly vague in
terms of what type of healing experiences and beneficial effects should take place. That is the role of
healing garden sub-categories, manifesting more specific criteria and effects.

Under the healing gardens level are two main branches: enabling gardens and restorative gardens.
These are two different categories of healing gardens with the enabling garden branch serving as the
more active track and the restorative garden branch serving as the more passive track. That is not to
say that experiences in restorative gardens cannot be active and vice versa; just that gardens designed
for restorative experiences tend to focus on physical access.

2
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

Restorative Gardens
Based on research by the Kaplans and others, an environment must include certain attributes to be
restorative, namely the manifestation of being away, extent, fascination, and compatibility (see
Kaplan, 1995 for more information). In the words of Gerlach-Spriggs and Healy (2010), “a restorative
space may best be described as a coherent design in a ‘place away,’ with gentle, undemanding stimuli
where an individual can do what he/she needs in order to recover.” The primary restoration taking
place in such an environment is cognitive, psychological, and/or emotional, not physical. There are
many physical concerns that can improve with the improvement of one’s mental capacity, but the
primary emphasis of healing in a restorative garden is mental health.

Restorative Garden Sub-Types

Gardens that fall under the restorative garden
branch include meditation gardens, contemplation
gardens, and sanctuary gardens. All three types
would incorporate the four components of the
restorative setting, but they would also likely
include design elements that facilitate their focus.
For example, meditation gardens and
contemplation gardens might both contain
symbolic or representative elements or views
that serve as catalysts in an individual’s quest for
a place of deeper thought toward emotional or
physical healing. Meditation is often defined as
looking inward and working toward the goal of
inner peace and healing. Contemplation, on the
other hand, is often defined as looking beyond
oneself and examining issues that are larger
than the human scale. This distinction
suggests a different design focus for each,
such as the screening or framing of long views
in the garden to facilitate either introspection
or extrospection. A sanctuary garden might
include physical elements that create a feeling of refuge, such
as the manipulation of spatial planes to create the sense of shelter or protection,
which then facilitates the opportunity for restoration in that context.

Enabling Gardens
Enabling gardens, the other main branch of healing gardens, runs parallel to restorative gardens and
represents gardens whose primary focus is accessibility and making the active garden experience
possible for all users. These are the garden types that aim at improving physical function: whatever
the physical challenge, the enabling garden aims to eliminate, or at least ease, that obstacle. And just
as in the restorative garden, where physical improvement often accompanies mental restoration, in
the enabling garden, once the physical barriers are eliminated then the door opens to many types of
healing experiences; psychological as well as physical.

3
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

Enabling Garden Sub-Types

There are at least three subcategories of the enabling garden: the demonstration garden, the eldercare
garden, and the therapeutic garden. The demonstration garden serves as a place to educate the public
on accessibility issues in gardening and often on the field of horticultural therapy. A demonstration
garden may incorporate programming for special groups, but its largest impact is in the demonstration
of different methods for making gardening accessible.

Eldercare gardens can be found in

nursing homes, assisted care facilities,
adult day care, and any other facility
that specializes in the care of older
adults. Because of the population they
serve, access is the first priority in an
eldercare garden, allowing movement
through the garden, comfortable
seating, and participation in gardening
activities. A sub-category of an eldercare
garden would be an Alzheimer’s care
garden. This type of healing garden
would have some additional design
criteria such as pathways that do not
require decisions or an unobtrusive
barrier that prevents unsafe wandering.

The third subcategory of an enabling garden, the therapeutic garden, has as its focus a therapeutic
intervention of some type that supports the prescribed treatment for a patient or client. A therapeutic
garden is designed for use as a component of a treatment program and may exist on its own as an
extension of an indoor therapeutic program area or it may be part of a larger healing garden.

A physical therapy garden is a

subcategory of a therapeutic garden and
is designed to support physical
rehabilitation, providing an environment
where goals could be set and measured
consistently. Accessibility is of primary
importance in this type of garden, but it
might also include graded physical
challenges in its design, including various
heights of raised beds as well as ramps,
stairs, and a variety of surface materials
to simulate real-world situations.

A horticultural therapy garden would also

be a sub-category of a therapeutic
garden, designed to accommodate client treatment goals primarily through horticultural activities and
managed by a trained horticultural therapy practitioner. Some horticultural therapy gardens are
4
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

completely barrier free so that nothing gets in the way of the people-plant experience, while others
may include graded challenges similar to the physical therapy garden.

Conclusion
To conclude, this is a framework for understanding the relationships and nuances between healing
garden types. As stated earlier, none of these garden types are absolute; not only is there bound to be
some overlap, but also many healing gardens are multipurpose in nature. Some garden types, like
sensory gardens, are less easy to categorize and can span both the active (enabling) and passive
(restorative) tracks depending on the primary users as well as the program and design goals. There
are additional garden types not mentioned here that could also be placed into this hierarchal
framework.

Defining healing environments based on a framework such as the one presented here makes it easier
to plan, design, and implement healing gardens, and just as importantly, compare and evaluate healing
garden settings as well as the activities and outcomes they support.
American Horticultural Therapy Association (2012). Definitions and positions.
http://ahta.org/sites/default/files/DefinitionsandPositions.pdf
Kaplan, S. (1995). The restorative benefit of nature: Toward an integrative framework. Journal of Environmental
Psychology, 15(3), 169-182.
Gerlach-Spriggs, N. & Healy, V. (2010, spring). The therapeutic garden: A definition. Healthcare and Therapeutic
Design Newsletter of the American Society of Landscape Architects.
http://www.asla.org/ppn/Article.aspx?id=25294
Sachs, N. (2008). Isn’t every garden a healing garden: Part I. Therapeutic Landscapes Network.
http://www.healinglandscapes.org/blog/2008/08/

Leah Diehl, RLA, HTM, is the Director of Therapeutic Horticulture at Wilmot Botanical Gardens at the
University of Florida. This article was first published in AHTA News Magazine, published by the American
Horticultural Therapy Association www.ahta.org.

5
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

Therapeutic Landscapes
Text & photos by Weishunhua Evey Zhang

Landscape architecture exists at the intersection of conservation and altering nature. The practice
appreciates nature and its beauty rather than encroaching on the essence of the place. The concept
of therapeutic landscapes was first developed in the early 1990s and is now commonly used in a variety
of medical and health-related settings (Brewster, 2014). When a landscape is created to fulfill the needs
of a person or a community, it is said to be therapeutic in nature.

A therapeutic landscape is a plant-dominated garden developed to encourage a human connection

with nature’s healing elements. The landscape provides a serene place, where one feels connected
with nature through rich, sensory experiences and can generate a sense of well-being. Therapeutic
landscapes serve many different purposes and include enabling gardens, healing gardens, restorative
gardens, and rehabilitation gardens, and have specific characteristics widely accepted within the
disciplines of horticultural therapy and landscape architecture (Diehl, 2013; Hazen, 2022).

Examining the history of gardens - cloister monastic gardens of the Middle Ages, Japanese Zen
gardens, and more recently, Ulrich’s 1984 study of the positive impact views of natural scenery had on
the rehabilitation of surgery patients, and Cooper Marcus and Sachs’ (2013) work on evidence-based
garden design in healthcare settings are important touchstones for current approaches to therapeutic
landscapes. The need for such settings appears to be expanding. Modern science and technological
advancements have reduced nature's role in the healing process, growth and development of urban
cities have destroyed some natural environments, and global warming caused by industrialization and
deforestation have endangered tree, plant and flower species.

Several key principles are now part of the

therapeutic landscape paradigm. Humans have
an inherent need to interact with nature and
other aspects of life, and designed spaces can
facilitate this while promoting wellness (Wilson,
1986; McCrorie et al., 2021; Devlin, 2018). The use
of therapeutic gardens and incorporation of the
natural environment for treatment programs at
healthcare facilities can improve
emotional/psychological reactions and
treatment outcomes (Stepansky et al., 2022;
Yilmaz et al., 2023). Functional landscape design
guides the space design, plant selection and
programming, focusing on the population who will be using the garden, for physical rehabilitation,
maternity patients, or people living with dementia for example (He et al., 2022). Cooper Marcus and
Sachs (2013) make the point that the landscape designer should consider the whole place as a healing
environment. Placemaking, referring to visitor’s response to the landscape, draws people in and
welcomes them on multiple levels, and can provide significant psychological positives, particularly for
therapeutic landscapes to build a sense of belonging and well-being. One example noted by Sampson

6
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

and Gifford (2010) was of recently arrived youth refugees and therapeutic landscapes during their
settlement process.

Additional research substantiates other benefits. Therapeutic landscapes can increase users' mental
and spiritual well-being (Munts, 2007). Therapeutic gardens in healthcare facilities have the capacity
to provide effective settings for a broad array of treatment and other medical services (infusion
treatment, play areas for children, food
gardens at hospitals or their affiliated
community gardens, nutrition/lifestyle
education programs) (Fleming et al., 2022).
They can improve patient care and
satisfaction, and contribute to effective
resource management (Fleming et al., 2022).
Studies are now examining how green
spaces and therapeutic landscaping can
contribute to health organizations’
effectiveness and clinical care quality using
post occupancy evaluations, with
measurable health benefits for patients,
families, friends, and workers (Jiang et al.,
2018). Strategies for cost-effective initiatives in hospitals, including gardens and therapeutic
landscapes also appear to be on the rise (Mazurenko et al., 2017; Cooper Marcus & Sachs, 2013).

Brewster, L. (2014). The public library as a therapeutic landscape: A qualitative case study. Health & Place, 26,
94-99.
Cooper Marcus, C. C. & Sachs, N.A. (2013). Therapeutic Landscapes: An Evidence-Based Approach to Designing
Healing Gardens and Restorative Outdoor Spaces. John Wiley & Sons.
Devlin, A. S. (2018). 1—Concepts, Theories, and Research Approaches. In A. S. Devlin (Ed.), Environmental
Psychology and Human Well-Being (pp. 1–28). Academic Press. https://doi.org/10.1016/B978-0-12-811481-
0.00001-9
Diehl, L. (2013). A framework for categorizing healing gardens. AHTA News Magazine, 41(2), 4-6.
He, M., Wang, Y., Wang, W. J. & Xie, Z. (2022). Therapeutic plant landscape design of urban forest parks based
on the Five Senses Theory: A case study of Stanley Park in Canada. International Journal of Geoheritage
and Parks, 10(1), 97–112. https://doi.org/10.1016/j.ijgeop.2022.02.004
Fleming, L., Zang, W. & Nelson, K. (2022). Horticulture for health activity in U.S. hospitals: Horticultural
therapy, nutrition-led programming, gardens at hospitals, and affiliated community gardens. Journal of
Therapeutic Horticulture, 32(1), 13-32.
Hazen, T. (2022). Therapeutic garden characteristics. American Horticultural Therapy Association.
https://www.ahta.org/assets/docs/therapeuticgardencharacteristics_ahtareprintpermission.pdf
Jiang, S., Stalock, K. & Kaljevic, S. (2018). Opportunities and barriers to using hospital gardens: Comparative
post occupancy evaluations of healthcare landscape environments. Journal of Therapeutic Horticulture,
28(2), 23-56.
McCrorie, P., Olsen, J.R., Caryl, F.M., Nicholls, N. & Mitchell, R. (2021). Neighbourhood natural space and the
narrowing of socioeconomic inequality in children’s social, emotional, and behavioural wellbeing.
Wellbeing, Space and Society, 2, 100051.
Mazurenko, O., Collum, T., Ferdinand, A. & Menachemi, N. (2017). Predictors of hospital patient satisfaction as
measured by HCAHPS. Journal of Healthcare Management, 62(4), 272-283 doi: 10.1097/JHM-D-15-00050

7
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

Munts, P. (2007). Healing goes beyond medicine: Gardens give patients bonus benefits. SpokesmanReview.com.
http://www.spokesmanreview.com/tools/story_pf.asp?ID=189344
Sampson, R. & Gifford, S.M. (2010). Place-making, settlement and well-being: The therapeutic landscapes of
recently arrived youth with refugee backgrounds. Health & Place, 16(1), 116–131.
Stepansky, K., Delbert, T. & Bucey, J.C. (2022). Active student engagement within a university’s therapeutic
sensory garden green space: Pilot study of utilization and student perceived quality of life. Urban
Forestry & Urban Greening, 67, 127452. https://doi.org/10.1016/j.ufug.2021.127452
Ulrich, R. (1984). View through a window may influence recovery from surgery. Science, 224(4647), 420-421. doi:
10.1126/science.6143402
Wilson, E.O. (1986). Biophilia. Harvard University Press.
Yilmaz, S., Vural, H. & Yilmaz, H. (2023). Effects of botanical gardens on student environmental perception.
Ecological Informatics, 73, 101942.

Weishunhua Evey Zhang, BID is a second year MLA student at University of Florida pursuing a major in
landscape architecture with particular interest in studying therapeutic landscapes, and the interplay
between the healing process, connections to nature, and impacts on communities. She co-authored a
Journal of Therapeutic Horticulture paper “Horticulture for Health Activity in U.S. Hospitals: Horticultural
Therapy, Nutrition-led Programming, Gardens at Hospitals, and Affiliated Community Gardens” (2022).

8
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

Therapeutic Horticulture: A Trauma-Informed Approach to

Mental Well-Being within a Psychiatric Hospital
By Joe Munson, Ph.D., LMHC, QS
Photos by N. Gunaydin. Unsplash & S.Y. Tham

University of Florida UF Health Shands Psychiatric Hospital, located in Gainesville Florida, is committed
to creating a Trauma-Informed behavioral health environment within the hospital. This commitment
means (1) developing a trauma-informed workforce, including recruiting, hiring and retaining trauma-
informed staff; (2) providing continuous training on evidenced based and emerging trauma-informed
best practices; (3) developing competencies specific to trauma-informed care and providing trauma-
informed supervision to all members of the workforce; (4) implementing trauma-informed policies;
and (5) adapting the physical environment to promote safe and trauma-informed spaces. Creation of
the trauma-informed behavioral health environment is based on key principles of safety,
trustworthiness and transparency, collaboration, empowerment, peer support and will consider
cultural, historical and gender issues (SAMHSA, 2014). UF Health Shands Psychiatric Hospital provides
trauma-informed care for children over the age of 9 and adults of all ages who are dealing with
psychiatric illnesses and addiction. In 2021, 3718 patients were treated at the Psychiatric Hospital, 77%
(2,863) of whom were there primarily due to mental health related problems.
The intent of the therapeutic horticulture
program was to improve mental well-being
for psychiatric hospital patients through a
holistic approach with the goal of promoting
overall health and quality of life. Therapeutic
horticulture (TH) is a process that uses plant-
related activities to improve patient
wellbeing through active and passive
participation (AHTA, 2023; Relf, 2006). This
process uses horticulture activities and
nature interaction as a therapeutic modality
to support program goals and has been
documented as early as the 19th century by
Dr. Benjamin Rush, recognized as the “father” of American psychiatry. He was first to document the
positive effect working in the garden had on individuals with mental illness (Williams, 2022). Suggested
to have a role in overall stress reduction in adults and older adults, TH has also been shown to promote
stress reduction in children as measured by a number of physiological criteria (Shao, Elsadek, & Liu,
2020). Horticultural activities have long-proven benefits for people experiencing mental health issues
and has been associated with significant improvement in quality of life, well-being, social relations, and
physical and cognitive outcomes (Nicholas et al., 2019). TH interventions for other patient groups have
led to significant decreases in depression and anxiety (Chen, 2021; Cipriani et al., 2022; Gonzalez et al.,
2010; Kim & Park, 2018; Lu et al., 2021; Pieters et al., 2018; Siu et al., 2020), as well as significant increases
in mood and self-esteem, life satisfaction, and improved interpersonal relationships, and state body
image (Waliczek, Zajicek, & Lineberger, 2005). TH interventions can facilitate these increases in well-
being and can do so through low-cost, non-intrusive methods that are inherently meaningful and
valued. Growing plants has purpose beyond oneself, helping individuals to connect with other people,
build self-esteem and self-efficacy, and become more emotionally resilient.

9
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

The program at UF Health Shands Psychiatric Hospital aimed to improve the mental wellbeing of adult
in-patient psychiatric patients by reducing symptoms of stress and anxiety, increasing positive social
engagement with one another through opportunities for interaction and collaboration, as well as by
equipping patients with meaningful knowledge and skills
that serve as healthy coping mechanisms to manage
stress related to their specific admission reasons. In line
with the trauma-informed approach, the program
emphasized the empowerment of the patients and
provided a safe and supportive environment for the
patients to express themselves freely and creatively
through horticulture and plant-related art. The 12-week
program was conducted from February to May 2022
where experts in TH came on-site from Wilmot Botanical
Gardens (at the University of Florida) to facilitate a 45-
minute TH group with patients from the mood disorder
unit and a 45-minute group with the thought disorder
unit each week. They facilitated these groups with
attendance and assistance from Peer Support Specialist
staff. These are individuals who have personal
experience with whole health recovery that includes
their previous hospitalization that addressed wellness of
both mind and body. The Peer Specialists were able to
bring insight in the experience of being a patient here at
the hospital while combating the stigma of mental
illness. They provide a unique position to develop a
relationship of trust to help facilitate an openness for
therapeutic opportunities. Participation in TH groups
were seen to foster both social interaction and
cooperative activities. Patients reported the activities as
enjoyable and relaxing, as well as perceiving the program
as beneficial and feeling satisfaction in what they
accomplished. During the 12 weeks of this program,
services were provided to 168 patients with full data
returned by 81 patients (data did not differ based on the
diagnosis or unit of the patient). The results of the
project include 89% of patients endorsed an improvement in mood either during or after the TH
groups, 83% of patients felt better about themselves either during or after the TH groups, and 90% of
patients reported willingness to participate in other therapy activities in the future (on the unit or
outpatient).
The therapeutic horticulture program delivered at UF Health Shands Psychiatric Hospital is one
of many programs and services addressing the health needs in the health provider’s catchment area.
Primarily Alachua County (52.7%), the hospital also serves neighboring counties within North Central
Florida (30.4%), with the remaining 16.9% of patients coming from across the state of Florida. Alachua
County is a mix of both urban (city of Gainesville) and rural communities. The Florida Department of
Health (DOH) reports that in 2019 there were 266,649 people living in Alachua County; where 70.8% of
population is composed of people aged 15-64, with the predominate age range of 25–44-year-olds
making up 26.6% of the population. Florida DOH also reports that 69.9% of the Alachua County

10
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

population is composed of racial demographic of White, 20.6% as Black, and 9.6% as Other.
Socioeconomic factors indicate that 21.8% of individuals earn below the poverty level, 6.1% are
unemployed, and 90.8% of individuals have health insurance. The economic status of the population is
represented by 36.7% having commercial insurance and 63.3% having either Medicaid/Medicare or
being fully indigent without any coverage.

American Horticultural Therapy Association. (2023). Definitions and positions. https://www.ahta.org/ahta-

definitions-and-positions
Chen, H. (2021). The effect of horticultural therapy in depression intervention. Journal of Landscape
Research, 13(6), 13-22.
Cipriani, J., Benz, A., Holmgren, A. et al. (2022). A systematic review of the effects of horticultural
therapy on persons with mental health conditions. Occupational Therapy Mental Health, 33(1), 47-69.
Gonzalez, M. T., Hartig, T., Patil, G. G., Martinsen, E. W., & Kirkevold, M. (2010). Therapeutic
horticulture in clinical depression: A prospective study of active components. Journal of Advanced
Nursing, 66(9), 2002-2013. https://doi.org/10.1111/j.1365-2648.2010.05383.x
Kim K.H, & Park S.A. (2018). Horticultural therapy program for middle-aged women’s depression, anxiety, and
self-identify. Complementary Therapies in Medicine, 39, 154 159. doi.org/10.1016/j.ctim.2018/06.008
Lu, S., Zhao, Y., Liu, J., Xu, F. & Wang, Z. (2021). Effectiveness of horticultural therapy in people with
schizophrenia: A systematic review and meta-analysis. Int J Environ Res Public Health. 18(3):964. doi:
10.3390/ijerph18030964
Nicholas, S. O., Giang, A. T., & Yap, P. L. K. (2019). The effectiveness of horticultural therapy on older
adults: A systematic review. Journal of the American Medical Directors Association, 20(10).
https://doi.org/10.1016/j.jamda.2019.06.021
Pieters, H.C, Ayala, L., Schneider, A., Wicks, N., Levine-Dickman, A. & Clinton, S. (2018). Gardening on
a psychiatric inpatient unit: Cultivating recovery. Archives of Psychiatric Nursing, 33(1), 57-64.
doi: 10.1016/j.apnu.2018.10.001
Relf, P.D. (2006). Theoretical models for research and program development in agriculture and health care:
Avoiding random acts of research. In: Hassink, J. & Van Dijk, M. (Eds.), Farming for Health: Green-care
Farming Across Europe and the United States of America (pp.1-20). Springer, Dordrecht.
https://doi.org/10.1007/1-4020-4541-7_1
SAMHSA. (2014). SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach.
https://ncsacw.acf.hhs.gov/userfiles/files/SAMHSA_Trauma.pdf
Shao, Y., Elsadek, M., & Liu, B. (2020). Horticultural activity: Its contribution to stress recovery and wellbeing
for children. International Journal of Environmental Research and Public Health, 17(4), 1229.
https://doi.org/10.3390/ijerph17041229
Siu, A.M.H., Kam, M. & Mok I. (2020). Horticultural therapy program for people with mental illness: A
mixed-method evaluation. International Journal Environ Res Public Health, 17(3), 711.
doi:10.3390/ijerph17030711
Waliczek, T. M., Zajicek, J. M., & Lineberger, R. D. (2005). The influence of gardening activities on consumer
perceptions of life satisfaction. HortScience, 40(5), 1360–1365.
https://doi.org/10.21273/hortsci.40.5.1360
Williams, S. (2022). History of horticultural therapy. American Horticultural Therapy Association.
https://www.ahta.org/history-of-horticultural-therapy

Dr. Joe Munson, Ph.D., LMHC, QS, is the Director of Clinical Services at UF Health’s Psychiatric Hospital
where he oversees clinical operations and serves as a member of the leadership team. Dr. Munson has
over 20 years’ experience specializing in Crisis Intervention, Suicide Prevention, Diagnosis and Assessment
of Mental Health disorders, in-patient treatment of mental illness, addiction recovery treatment, peer
recovery services, and Non-Profit Management. Notably, he is published in the Routledge International
Handbook of Clinical Suicide Research for his research on Post-Traumatic Growth in Survivors of Suicide.
11
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

Permaculture and Health: What’s the Connection?

Text and photos by Siang Yu Tham, MA

Hunting and gathering was Man’s mode of subsistence from as early as two million years ago. Hunter-
gatherer societies relied on hunting wild animals, fishing, and foraging wild plants for food. They were
nomadic and moved strategically to maintain good access to food. When resources were depleting,
they would move to a different location, allowing biodiversity to repopulate. However, the Neolithic
Revolution saw humans transition from a culture of hunting and gathering to a lifestyle of crop
cultivation and animal husbandry. Humans also formed permanent settlements. This wide-scale
transition led to a large impact on the environment. Today, numerous studies point to modern
agriculture as a key driver of declining biodiversity (Barros-Rodríguez et al., 2021), soil degradation
(Borrelli et al., 2017), climate change ((Lynch et al., 2021), and water and air pollution (Aneja et al., 2009;
Mateo-Sagasta et al., 2017).
In 1974, Bill Mollison and David Holmgren co-developed the concept of permaculture, which is “the
conscious design and maintenance of agriculturally productive ecosystems which have the diversity,
stability, and resilience of natural ecosystems” (Mollison, 1988, ix). Mollison was inspired by the
interconnectedness of nature while working for the Commonwealth Scientific and Industrial Research
Organization and was convinced that agricultural systems should be designed to mimic natural
ecosystems that were sustainable and syntropic. The teachings of Japanese farmer, philosopher and
author of “One Straw Revolution” Masanobu Fukuoka also influenced the permaculture movement.
He championed a more natural method of farming which involves minimal disturbance to the soil (no-
dig farming), the use of cover crops, and no use of pesticides and fertilizers. His farming method is
fondly referred to as “do nothing” farming or “lazy” farming.
Three ethics guide the practice of permaculture:
• Earth care
The Earth provides all our essential needs: air, water, food,
and shelter. It is therefore logical in our self-interest to take Earth
care of what provides for us to protect our survival. People care
care
• People care
Fair
Meeting the needs of people is important. This includes share
their essential needs, as well as psychological, emotional,
social, and physical needs.

• Fair share
Each person has a right to their fair share of resources and Permaculture
any surplus should be given back to Earth (the land) and
the people.

Mimicking natural ecosystems and working with nature rather than against it, as permaculture
advocates, can benefit our health in multiple ways. Permaculture promotes environmental health
through the promotion of biodiversity, regeneration of soil nutrients, minimization of waste, and
conservation of resources. It also benefits human health in terms of physical and social well-being.
Agricultural systems designed following permaculture ethics and principles encourage physical health
and provide access to healthy and nutritious food which are free from harmful chemicals.

12
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

Collaboration is vital in permaculture – knowledge, skills

and resources are shared through networks and diversity is
valued because of the different expertise or benefit that
each animal, plant and person can contribute to the system.
This fosters community engagement, cooperation and
learning from one another, which are beneficial to social
health.
Although the term “permaculture” was originally
conceptualized as a combination of the words
“permanent” and “agriculture,” and the examples of the
health benefits described above relate more closely to
agriculture, the notion of sustainable design systems is now
extended to all parts of life and many permaculturists now
identify permaculture as a combination of the words
“permanent” and “culture.” This means that permaculture
can be applied in many different areas of life: agriculture,
the economic system (Válek & Jašíková, 2013) and
management models (Vitari & David, 2017), to name a few.
By incorporating ethics and principles that value available resources, permaculture offers a
comprehensive and holistic approach to creating resilient and robust communities that integrate
different dimensions of health.

“Working in the garden...gives me a profound feeling of inner peace. Nothing here is in a hurry. There
is no rush toward accomplishment, no blowing of trumpets. Here is the great mystery of life and
growth. Everything is changing, growing, aiming at something, but silently, unboastfully, taking its
time.” (Ruth Stout, 1955, How to Have a Green Thumb Without an Aching Back)

13
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

Aneja, V. P., Schlesinger, W. H. & Erisman, J.W. (2009). Effects of agriculture upon the air quality and climate:
Research, policy, and regulations. Environmental Science & Technology, 43(12), 4234-4240.
https://doi.org/10.1021/es8024403
Barros-Rodríguez, A., Rangseekaew, P., Lasudee, K., Pathom-Aree, W., & Manzanera, M. (2021). Impacts of
agriculture on the environment and soil microbial biodiversity. Plants (Basel, Switzerland), 10(11), 2325.
https://doi.org/10.3390/plants10112325
Borrelli, P., Robinson, D. A., Fleischer, L. R., Lugato, E., Ballabio, C., Alewell, C., Meusburger, K., Modugno, S.,
Schütt, B., Ferro, V., Bagarello, V., Oost, K. V., Montanarella, L., & Panagos, P. (2017). An assessment of
the global impact of 21st century land use change on soil erosion. Nature Communications, 8(1).
https://doi.org/10.1038/s41467-017-02142-7
Lynch, J., Cain, M., Frame, D., & Pierrehumbert, R. (2021). Agriculture's contribution to climate change and role
in mitigation is distinct from predominantly fossil CO2-emitting sectors. Frontiers in Sustainable Food
Systems, 4. https://doi.org/10.3389/fsufs.2020.518039
Mateo-Sagasta, J., Zadeh, S., Turral, H. & Burke, J. (2017). Water Pollution from Agriculture: A global review.
Executive summary. FAO Colombo, Sri Lanka.
Permaculture Research Institute. (2015). What is Permaculture? https://www.permaculturenews.org/what-is-
permaculture/
Válek, L. & Jašíková, V. (2013). Time bank and sustainability: The Permaculture approach. Procedia - Social and
Behavioral Sciences, 92, 986-991. https://doi.org/10.1016/j.sbspro.2013.08.788
Vitari, C., & David, C. (2017). Sustainable management models: Innovating through Permaculture. Journal of
Management Development, 36(1), 14-36. https://doi.org/10.1108/jmd-10-2014-0121

Siang Yu Tham is a certified Permaculture Designer and has designed permaculture sites in Singapore,
Malaysia and France. She cultivated vegetables and herbs for restaurants and personal consumption using
natural farming techniques and favors perennial crops that facilitate “lazy gardening.”

14
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

Sensory Garden and the Built Environment

at Elks Children’s Eye Clinic
Text by Bree Stark
Photos by Canva

Adjacent to the Casey Eye Institute in Portland,

Oregon, connected by a sleek, modern glass sky
bridge, the Elks Children’s Eye Clinic became the first
free-standing pediatric unit in North America when
they opened their doors in December of 2020. The
facility was designed by NBBJ (Seattle).

In addition to the Elks’s accessible design elements

throughout the inside of the building, such as a railing
at the front desk which guides visitors to the
elevators and high-contrast signage throughout, the
contracted landscape architect Mayer/Reed
(Portland) developed an outdoor sensory garden and
art installation with input from the facility’s pediatric
eye specialists.

The pediatric eye specialists offered advice on tactile qualities and perceptions of color, noting that
people with sight differences can interpret vast variations in color. With that in mind, the landscape
firm emphasized native plants in the garden, with the team selecting cultivars that highlight Oregon’s
native biodiversity, along with providing contrasting colors, textures, pleasing scents, rustling foliage,
and varied canopy.

The native sensory landscape design continues into

the courtyard area, which provides a shaded and
contained retreat space for patients, families, and
staff. Overhead the shiny glass of the Marilyn and
Glenn Hart Sky Bridge reflects the colors of the
changing sky and clouds.

An art installation wall featuring a rainbow spectrum

of L-shaped glass elements leads to the main entry of
the building. Mayer/Reed commissioned the glass
sculptures from Bullseye Studio in Portland, who
custom-fabricated the colors. To achieve the specific
hue and transparency levels of each color group, the
studio employed a process called “frit tinting” in
which they slowly added different colored powders to
a clear glass base until reaching the desired results,
much the same way an artist mixes paint on their palette.

15
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

There are 14 color sets in all, each containing three

different sized components, for a total of 42 individual
installations. The smooth glass contrasts the rough-
textured concrete retaining wall upon which they are
draped, as if melting over the edge, inviting visitors to
touch and experience them close-up. All this at a height
accessible to a child’s reach, offering an opportunity to
explore and share their unique interpretation of the
colors they see. This ensures year-round visual and
sensory interest, around which the native landscape can
follow its cycle of waxing and waning.
Architizer. (2023). Elks Children’s Eye Clinic Sensory Garden.
https://architizer.com/projects/elks-childrens-eye-
clinic-sensory-garden/
Kahn, J. (2022). A site for sight: Oregon Elks Children's Eye Clinic opens its doors. Oregon Health & Science
University. https://www.ohsu.edu/casey-eye-institute/site-sight-oregon-elks-childrens-eye-clinic-opens-
its-doors
Nextportland. (2018). OHSU Elks Children’s Eye Clinic approved by design commission (images).
https://www.nextportland.com/2018/07/27/ohsu-elks-childrens-eye-clinic/

Bree Stark recently completed the Horticultural Therapy Certificate from the University of Florida. She is
the administrator of the Florida Horticulture for Health Network’s website and received their Professional
Service Award for her volunteer efforts.

Editor in Chief Siang Yu Tham

Editors Lesley Fleming & Bree Stark

Contributors
Leah Diehl, Weishunhua Evey Zhang, Joe Munson, N. Gunaydin, Unsplash, Canva

Florida Horticulture for Health Network

To receive Cultivate contact FLHort4Health@outlook.com

www.facebook.com/FloridaHort4Health

Upcoming Issue of Cultivate Summer 2023:

Aligning Plant Activities with Therapeutic Goals Used for Senior Populations

Products, services, references, and medical research contained herein are intended for informational
purposes only and do not imply endorsement or practice by FLHHN. Website URLs may be changed
without notice. Original and creative material is considered the intellectual property of FLHHN. We
respectively request credit for reprinted articles.

16