Bethlem Royal Hospital was founded in London in 1247, as a priory dedicated to St Mary of Bethlehem. For most of its history, it has been a hospital for the care and treatment of people with mental illness, becoming the world’s first psychiatric hospital in 1403. It moved to its present Beckenham site in 1930 and since 1999 has been part of the South London and Maudsley NHS Foundation Trust. The Hospital offers a range of specialist services for people from across the UK including people with anxiety disorders, eating disorders, autism and psychosis. There is an Older Adults service, a mother and baby unit and a medium-secure forensic unit. There are many different kinds of therapy available, as shown in this award-winning Occupational Activities brochure, and a picture gallery is open to the pub-lic, showcasing art work from people involved with the hospital.

The Bethlem Royal is based in 270 acres of green space, a mixture of lawns, trees and beautiful orchards. Leaflets are available for walks and activities around the site, including this Traditional Orchards Nature Trail.

A jewel in the crown is the walled kitchen garden, which occupies about an acre and was developed for horticul-tural activities. These have been shown to be effective in reducing stress, anxiety and depression in people with psychiatric illness*. The garden was completed in 2007, although it took some time to get up to full production. Its development was assisted by extra funding from the Big Lottery and Maudsley charity.

It has developed iteratively, responding in part to the needs of the patients and includes a building for indoor activities. Split into various components, about half of the garden is given over to growing fruit, vegetables and

flowers, while the rest compromises a natural area for biodiversity that includes a pond; a sensory garden; quiet areas with benches and a polytunnel.

To use the gardens, service users need to be referred and risk assessed as being: safe to use tools, able to partici-pate in a group setting and not a threat to themselves or others.

They engage with the environment in different ways and the diversity of the garden reflects their different inter-ests. Some gravitate towards the natural area, others like planting fruit, vegetables and flowers. The sensory garden was added a couple of years ago for those who just like experiencing what the garden can offer. Most Fridays a sensory group runs where people come and look at the different qualities of the plants – the textures, smells, movement and how they change over time. Meanwhile on Wednesdays, between 12 and 1, anyone can come and

Bethlem Royal Hospital

Case Study by the Centre for Sustainable Healthcare

buy the produce. This allows patients to practise how to weigh and package.

Apart from the benefits of leaving the ward and being out in fresh air and sunshine, the garden provides various therapeutic benefits. Spe-cialist Horticultural Instructor Sara Miller said: “This is not just about engaging in horticulture. It is an opportunity to challenge a person’s own illness or belief systems or thoughts or abilities. Their confidence is so reduced, not just because of illness, but also stigma. So many things can eat away at confidence, so by coming here, using a tool, digging a hole properly, it makes them feel capable.”

The garden is also used as a research facility. Thrive, a charity that uses gardening for social and therapeutic purposes, has developed the Thrive Insight Measure and the staff are using this tool to monitor the direct and indirect benefits of the garden for service users. They meas-ure outcomes in the service users’ social interaction, engagement with tasks, motivation, anxiety expressed during performance, their memory and cognitive ability, also how much they can do inde-pendently. Thrive’s goal is to generate a larger evidence base to show the quantifiable benefits of social and therapeutic horticulture.

A programme of practical, seasonally themed horticultural activities take place throughout the year, adapted by group facilitators to enable inpatient participation. For example, teenagers have made edible salad bags with flowers to take back to the ward and share. This year they also planted leeks, pumpkins and squashes and a pumpkin carving day was about to take place. A mother from the mother and baby unit came to pick fresh carrots for her child this year, while someone from the autism unit who struggled with most of the tasks loved doing the watering, helping build their confidence. The garden helps those with dementia or Alzheimers as exercises can prompt memories of certain plants or the changing seasons.

The garden links to indoor activities in the hospital. The produce is used in occupational therapy cooking groups. Every year there is an apple pressing day where the various apples from the different or-chards are made into apple juice. A food-drying project also runs in the kitchen in the main occupational therapy department, using a food dehydrator to dry apples, herbs and teas. These are then packaged and sold in the community centre shop.

When the NHS Forest visited in mid-October, it was a beautiful, sunny day, warm enough to sit outside on the bench; the beds a riot of colour and plants at different stages of development. The main room inside had a table laden with produce showing what this fertile space had provided during the year. What a fantastic therapeutic environment!

For more information on the garden and other projects at the Bethlem Royal , please contact Peter O’Hare, Head of Occupational Therapy.

*NHS Forest would like to thank Sara Miller for letting us use her essay The Benefits of Social and Therapeutic Horticulture for service-users within an inpatient mental health setting, for parts of this report. Her paper discusses the mental health support needs of adult psychiatric inpatients; and how Social and Therapeutic Horticulture can address these needs. For anyone wishing to read the full paper, please contact Peter O’Hare.