Evidence


Gardens are intimately connected to our health and wellbeing across the life-course. There is much more that the health and social care system can do to take advantage of our love affair with gardening, but there are four specific areas of good practice: in social prescribing; community gardens, volunteering and recovery from illness; dementia care; and end-of-life care.
— The Kings Fund, Gardens and Health, Implications for Policy and Practice, 2016

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The King's Fund is an independent charity working to improve health and care in England. They help to shape policy and practice through research and analysis; develop individuals, teams and organisations; promote understanding of the health and social care system; and bring people together to learn, share knowledge and debate. 


In the 2014 fourth annual Royal Horticultural Society (RHS) John MacLeod Lecture, Dr William Bird, a practicing GP in the UK, and a specialist in ‘Natural Health Services’, and Dr Matilda van den Bosch from the Swedish University of Agricultural Sciences, made the case for gardening and horticulture to be available on the NHS.

Here are excerpts from their talk on Health, Wellbeing and Horticulture, looking at the beneficial role of ornamental plants, gardening and gardens to people and society:

Apart from preventing diseases, horticulture and horticulture therapy are used to treat many conditions of ill-health, including cancer rehabilitation, depression, post-traumatic stress disorders, and various behavioural disturbances.

Horticultural Therapy is a professionally conducted client-centred treatment modality that utilises horticultural activities to meet specific therapeutic or rehabilitive goals of its participants. The focus is to maximise social, cognitive, physical and or psychological functioning and/or enhance general health and wellness.

There is now enough evidence to include gardening and nature in the health care agenda. The key point is that gardening, plants and horticultural activities are excellent tools for creating a healthier society where the costs of health care and human suffering can be substantially reduced.

We could see at least a £5 health benefit for every £1 spent. Since about £60 billion is spent on long-term conditions, 80 per cent of which could be prevented by a healthier lifestyle, there is a significant incentive to develop a programme that includes horticulture.
— Dr Matilda van den Bosch & Dr William Bird (MBE)

Research by Professor Tim Lang of the Centre for Food Policy at City University London in 2014, showed that regular involvement in gardening or community food growing projects, or formal horticultural therapy, can:

  • Increase overall levels of physical activity and fitness, burn more calories and hence contribute to healthy weight management and reducing the risk of obesity.
  • Increase healthy fruit and vegetable consumption, for adults that grow food, and among schoolchildren participating in food-growing activities at school – as well as improving young people’s attitudes to healthy eating.
  • Reduce physical pain, and help with rehabilitation or recovery from surgery or other medical interventions.
  • Help people cope with physically challenging circumstances, such as intensive cancer treatment or learning how to live with chronic conditions such as asthma or severe allergies.

To improve mental health, for people with acute or persistent mental health problems, or especially difficult personal circumstances, regular involvement in gardening or community food-growing projects, or formal horticultural therapy, can:

  • Contribute to improved social interactions and community cohesion.Reduce the occurrence of episodes of stress, and the severity of stress and associated depression.
  • Reduce reliance on medication, self-harming behaviour, and visits to psychiatric services, whilst also improving alertness, cognitive abilities and social skills.
  • Alleviate symptoms of dementia and Alzheimer’s disease, such as agitation and aggressive behaviour, which can in turn improve circumstances for carers.
  • Provide productive manual activity and beneficial social interaction for people tackling drug and alcohol dependency.
  • Help people manage the distress associated with mentally challenging circumstances, such as making the end of life more peaceful, sociable and enjoyable for hospice patients.

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Gardening with dementia

Being in a garden and taking part in horticultural activities has been shown to be of benefit for people with dementia, with structured therapeutic gardening activities having a positive impact on sense of wellbeing, cognitive abilities, communication and engagement. Detweiler et al, 2012 and Hewitt et al, 2013. 

The National Institute for Health and Care Excellence (NICE) recommends that care plans should address activities of daily living that maximise independent activity, adapt and enhance function, and minimise need for support (NICE, 2011).

The garden and the activity of gardening provides a non-pharmacological approach to address these goals and horticultural therapy can be utilised to improve the quality of life for the ageing population and yielding high patient/carer satisfaction, possibly reducing costs of long-term assisted living and dementia unit residents (Detweiler et al, 2012; Gitlin et al, 2012)


A review of nature-based interventions for mental health care. Natural England Commissioned Report NECR204, Feb 2016

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The prevalence of mental ill-health is on the rise in the UK with an estimated one in four people experiencing a 'significant’ mental health problem in any one year. With the prescription of anti-depressants at record levels and a huge demand for Cognitive Behaviour Therapy and other psychological therapies, health and social care commissioners are examining and commissioning different options for cost effective services for mental health. At the same time there is increasing recognition of the importance of nature and place as a determinant of individuals’ mental health. Nature-based interventions are operating throughout the UK, working with a wide range of vulnerable groups helping to positively benefit health and wellbeing outcomes.

These nature-based interventions (also called green care and ecotherapy) could be part of a new solution for mental health care. However increasing awareness and access to these interventions is challenging given the number of organisations delivering nature-based projects and services, the variety of terms and language used to describe their activity and benefits and the variation in delivery models which use different impact measures. This research seeks to explore these issues and set out the steps required to enable a greater number of nature-based interventions to be commissioned in mental health care.


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A Report of the Working Group on the Health Benefits of Green Care

April 2010

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The creation of a conceptual model and theoretical framework for ‘green care’ is one of the first ‘milestones’ for the working group on the health benefits of green care within COST Action 866 (Green care in Agriculture). This report brings together work from many researchers from across Europe in a published volume under the imprint of COST. It is the result of over two years of cooperation and deliberation. It puts green care into the wider context of social and psychological theory and enquiry and provides a number of different viewpoints from which to look at the field.