The teens in the rehab program can’t have drugs, so they use the waterfall instead.
That’s how Lily Mank BSLA’15 explains the fact that when patients first visit the healing garden at the Rosecrance Griffin Williamson adolescent substance abuse facility in Rockford, Ill., they choose to sit near the cascading water.
“I think the drugs numb their emotions, and when they don’t have access to drugs, they become very raw, very sensitive to their thoughts,” says Mank. “They need the stimulation of the waterfall, the white noise, to quiet themselves down.
“They move away from the waterfall as they become more comfortable with their thoughts and more able to be balanced within themselves,” she says. “That’s a sign that they’re getting ready to leave the program.”
Mank doesn’t know if her explanation is right, but she plans to find out in her ongoing research of nature restoration.
The five-acre garden, designed by master Japanese landscape designer Hoichi Kurisu, is incorporated into every part of the highly successful 12-step addiction treatment program at the Rosecrance facility. It’s a powerful tool for clearing the minds of the 12- to 18-year-old patients.
It was also powerful for Mank. Since working in the garden as an intern in her junior year of the CALS landscape architecture program, she has made healing landscapes her career focus. She went on to do a senior thesis focused on improving nature access at a Wisconsin mental health hospital. She also earned a certificate in health care garden design at the Chicago Botanical Gardens and interned at Ziegler Design Associates, a company owned by Steve Ziegler BS’83 and Joan Werner-Ziegler BS’78, CALS alums who specialize in designing healing spaces.
Mank still thinks about the waterfall. How, exactly, she wonders, does spending time in the Rosecrance garden—or in any peaceful outdoor space—help settle an unsettled mind?
That’s a great question, says Sam Dennis. It’s right at the heart of what he studies as a professor and director of the Environmental Design Laboratory (EDL) in the CALS Department of Landscape Architecture (LA). While the LA department is best known for its work on environmental restoration—techniques people can use to heal damaged natural environments—Dennis and his team at the EDL flip that around. They’re finding ways to incorporate nature into human-made environments to restore the health of people. Dennis’s projects employ thoughtful outdoor design to help people eat better and get more exercise and to create safer, calmer and more cohesive neighborhoods.
Health-conscious design has always been on the department’s radar. In 1981, 10 years before the passage of the Americans with Disabilities Act, Steve Ziegler was encouraged to do his senior thesis on barrier-free design in elder care facilities. But today the topic is getting much more attention.
As one example, assistant professor Kristin Thorleifsdottir has been reworking the curriculum to make sure students get a good grounding in the burgeoning area of science that looks at connections between health and the built environment.
The native Icelander offers three classes on the topic, including a new sophomore-level design class in landscape architecture and a graduate seminar that attracts students from landscape architecture, interior architecture, urban and regional planning,health care and other disciplines. She touches on history—from the cities of the ancient Greeks to the urban squalor of the Industrial Revolution—but most of what she covers starts in the 1980s.
In a 1984 study, Texas A&M design professor Roger Ulrich found that postsurgical patients who had a view of trees from their hospital windows were released sooner, took less pain medication and experienced fewer complications than did patients who had a view of a blank wall.
“Ulrich’s study was the first that looked at health and design,” she says. “Since then there have been a lot more.” Those studies span diverse disciplines—urban planning, public health, pediatrics, psychology, gerontology, neurobiology, art, horticulture and forestry, to name a few—which means those who study the topic must learn several lexicons.
“The fields of public health and design speak very different languages,” Thorleifsdottir notes. “Design researchers tend to take a more qualitative approach—they look at how people experience the environment. Public health is very much into quantitative measures.”
Her own research focuses on health at the community level, including studies on neighborhood design and children’s outdoor physical activities. She’s embarking on two new studies, one of them on the quality of public city parks and the availability of settings for mental restoration, a collaborative project with research partners in Sweden and Serbia.
Sam Dennis has become pretty fluent in the language of public health. As part of UW–Madison’s campus-wide Obesity Prevention Initiative, his partners include researchers in nutritional sciences and family medicine. Body mass index (BMI) is a common research metric, and a recent study involved drawing blood. That project, a collaboration with the Madison-based nonprofit Community Groundworks, used a garden-based curriculum to teach young people to eat better.
“Rather than ask how much the students eat, the researchers took a blood sample. You could tell by levels of serum carotenoids in blood whether they were eating fruits and vegetables,” Dennis explains.
Dennis doesn’t wield the syringes. While his collaborators collect data on human health, he assesses how well the urban landscape supports it. He works with residents of underserved urban neighborhoods to identify features that either facilitate or impede physical activity, healthy eating and safety.
To collect the data, the EDL team has developed an innovative (and now widely replicated) tool that they dubbed “participatory photo mapping.” The researchers ask neighborhood residents—often kids—to photograph things that they see as barriers to healthy living, and then ask them to write stories explaining the photos.
“They tell the stories, then we geo-locate the stories and photos with GIS, so we can overlay their stories and images with, say, traffic data, or data about pedestrians and bicyclists getting hit by cars, or crime rates.”
Often the stories lead to simple fixes, such as repainting crosswalks, adding pedestrian signals or hiring a playground supervisor so that parents feel reassured about their kids using a local park.
But residents also point out problems that are pretty surprising—and tough to solve. Dennis recounts what Latino kids in South Madison had to say about a nearby city bike path.
“They say they’re not welcome there because the bike path is for white people—that you’ve got to be rich and have a special kind of bike,” Dennis says. “The literature says the presence of a bike trail significantly reduces the body mass index of everyone around it, but the kids aren’t using it because they don’t see it as their space. Instead, they ride on busy streets.”
“They’re very sensitive to where they feel welcome,” Dennis notes. “Mapping that is part of mapping their well-being.”
Stories like these are important, Dennis says, because they point to health problems that can’t be diagnosed by calculating body mass or drawing blood.
“Physiological things like body mass index are important, but so is our mental well-being,” Dennis says. “There’s a lot of research suggesting that chronic stress experienced by people with low incomes helps explains disparities in health across different environments. As environmental design researchers, we try to figure out the source of that stress and then see what we can do to reduce it through changes in the built environment.”
Spending time in a natural setting can relieve stress, but that’s not guaranteed. That was underscored by another of Dennis’ projects, a survey that looks at the benefits of natural outdoor classrooms at more than 200 early childhood care facilities across the U.S. and Canada.
Rapid staff turnover is a problem among early childhood care providers, due to low wages and very high stress. But according to the teachers surveyed, spending time in a green, natural environment during the workday helped compensate for the downsides.
“Their mental well-being is better supported when they can spend time in these natural settings,” Dennis says. He attributes this to a process known as attention restoration: We become mentally exhausted in situations where we have to make ourselves pay attention; our minds recover when doing things that are so inherently interesting that paying attention is effortless. Engaging with the natural world fits the latter category. But you really have to engage.
“The natural environment supports attention restoration if the teachers were using all of their senses to experience the natural environment in a loosely focused way, as opposed to the tight focus they give to their indoor lessons,” Dennis says. “It’s important that they aren’t ‘traffic cops’ or hypervigilant monitors like they typically are in a traditional playground setting—that they can engage with kids as they play in nature.”
Job stress is part of the job for caregivers at the UnityPoint Health–Meriter Child and Adolescent Psychiatric (CAP) Hospital, even though there’s plenty of nature nearby. The facility sits on a secluded wooded hilltop on the western edge of Madison. But while things outside are quiet and serene, inside a very different story plays out. The young patients who come here struggle with attention and impulsivity disorders, anxiety and depression—conditions that have made it hard to function in everyday life. Many, especially the teenagers, are at risk for suicide.
“We hear a lot of hard stories here,” says Karen Larson, the CAP program nurse manager. Mental illness in children can be as hard on families and staff as it is on the children, she points out.
Hospital staff members were excited when the program moved to this bucolic spot from its former downtown location in 2004. But they soon realized that there wasn’t a way to incorporate the green surroundings into the treatment of their emotionally fragile patients.
“We started looking at the evidence about the impact of a natural environment on depression, anxiety and well-being, and what it could mean to our patients,” Larson says, “and we realized how much better it could be.”
With research in hand, the Child and Adolescent team contacted their employer’s philanthropic partners—the Meriter Foundation and Friends of Meriter—about raising funds to create a healing space for the patients. She emphasized that she wasn’t asking for landscaping.
“I compared it to purchasing an orthopedic tool that would allow somebody to have their hip replaced,” Larson recalls. “In psychiatry, one tool is the engagement of patients and staff in their environment. The more beautiful, less stressful and skillfully planned the environment, the better the tool.”
After a successful fundraising campaign, Meriter hired Ziegler Design Associates to create the healing garden. It was a good fit. The firm has worked extensively with caregiving facilities and has developed many creative outdoor spaces for youth for schools.
“It was a very special opportunity, to be able to bring healing into the landscape for kids and families and staff who needed it so badly,” says Steve Ziegler. “But it was also a complicated design challenge. A typical hospital healing garden wouldn’t work here.”
“In a psychiatric population, safety is a primary concern,” Larson says. “And a psychiatric population of minors is vulnerable on so many levels. We needed to make the space beautiful and usable and child-friendly and calming—and also safe and secure.”
This garden wouldn’t have secluded spots for quiet contemplation. There couldn’t be any trees big enough or grass tall enough to screen a staff member’s view of patients. No sharp edges, no loose objects that could be thrown (bricks were glued together). Joan Werner-Ziegler, the firm’s perennial plant specialist, researched plants for toxicity and potential reactions with medications. Steve Ziegler spent several days looking for nicely rounded boulders with serene colors.
“I stayed away from bright colors,” he says. “If you’re under psychological stress, abrupt changes can trigger a lot more emotion than they would in you or me. Our colors are wonderful, but not jarring. We chose pavements that didn’t reflect glare, because some drugs make patients’ eyes sensitive.”
They ended up with a space that’s compact enough for careful supervision while offering a variety of places to be or wander. There’s a “traditional” garden (to remind patients of home), a stepping garden with pathways through the plants, a grass garden, a prairie sensory garden and a separate garden for horticultural therapy.
You can tell the space works, says Larson, by watching the patients: “They just naturally settle. They settle into the chairs, they sit on the boulders, they sprawl on the ground, they kick balls around. They just settle into the space.”
More important, Larson adds, the garden helps get the kids talking.
“When you work with kids who are psychiatrically hospitalized, you’re trying to help them express their feelings,” she says. “If you just start asking questions, they are likely to shut down.
But if you go for a walk, they’re more likely to start talking. It’s true for all of us: If we’re feeling comfortable, we can talk about things that are really hard to talk about. And that’s what we have to do here.”
The healing garden also works wonders for the staff.
“When you work in a caregiving field, you give so much,” Larson says. “Your successes can be small and the challenges can be huge. You have to bring your best self every day. And then many of us go home to stressful lives. So if part of your workday can be restorative, it’s a wonderful gift.”
Meanwhile, Lily Mank is still intrigued by that waterfall. Now a CALS grad student, she’s teaming up with Sam Dennis and Kristin Thorleifsdottir on research to understand how all elements of a garden ease patients’ minds as they address their addiction issues.
Her goal is to help designers view healing gardens not just as a collection of streams, pathways, plantings and benches, but also in terms of how those features allow patients to interact with nature. At the waterfall, a patient may simultaneously be sensing rushing water, the breeze, the coolness of shade, light dappling through the leaves and fish moving in the nearby pool. There are many possible interactions with nature, she says, and they can combine in many ways to evoke different emotions.
“I’m trying to find out how different interactions with nature make patients feel. If I understand that, it can be another way to think about garden design,” she says.
And if patients have a better understanding about how their interactions with nature make them feel, they can use that to continue healing when they get back home.
“They won’t have access to a garden like the one at Rosecrance, but they can still seek out places that let them encounter nature in ways that make them feel calm,” Mank says. “A healing garden can be anywhere.”
This story was originally posted on the Grow magazine website. Three sidebars are available to read there, titled “Healing with a hoe,” “Why nature makes us feel better,” and “Tips for creating your own healing garden.”