Growing People First: Emerging Best Practices from a Mental Health and Gardening Knowledge Swap

Contents

I Introduction
II Background
III Process
IV Examples of gardening and mental health programs
V Best practices
VI Evidence
VII Evaluation
VIII Next steps
IX Conclusion
X References and resources

-- Submitted by Linor David, BSc, Health Promoter- Central Toronto Community Health Centres

I Introduction

In December 2012, Central Toronto Community Health Centres (CTCHC) hosted a Gardening and Mental Health Knowledge Swap. The purpose of this day was to provide a venue for individuals working within this field to exchange ideas and knowledge on best practice, evidence, and evaluation as they related to mental health and gardening. The event revealed that this is a growing field, with over fifty people attending and more on the wait list and organizations such as Centre for Addiction and Mental Health (CAMH), Canadian Mental Health Association (CMHA) and various community health centres integrating gardening programs as a way of addressing mental health issues. The event was organized by Central Toronto Community Food Centres with the help of Live Green Toronto Community Animators, The Stop Community Food Centre and input from Access Alliance Community Health Centre and House of Compassion. Through this event, participants shared areas of strength as well as areas where further research and advocacy are needed.

II Background
 

Central Toronto CHC Community Garden

Central Toronto CHC Community Garden

In 2009, Central Toronto Community Health Centres (CTCHC) turned an unused piece of land at the side of its building into a garden. CTCHC begun a gardening program and quickly noted that the comments and feedback about the garden were related to people’s mental health. Participants in the program highlighted the themes of hopefulness, pride, and connection. Through a Healthy Communities Fund grant from the Government of Ontario, the program was expanded to deliver workshops, field trips, and activities to another two health centres, and was geared to address healthy eating, physical activity and mental health.

The use of gardening to promote mental health is referenced in a number of different areas.  In the 1950s many hospitals opened greenhouses, and horticultural therapy was used with war veterans to deal with trauma. The impact of nature on mental health and healing has been documented in studies looking at the difference in recovery time for patients with a view of nature compared with those without (Ulrich, 1984). Richard Louv, who coined the term Nature Deficit Disorder, highlights the importance of spending time in nature for both adults and children and links it to the reduction of stress (Louv, 2011). In an extensive literature review done of community gardens in the United States, community gardening was shown to decrease social isolation, increase social capital and improve both mental and physical health (Draper and Freedman, 2010).

In gardening and mental health programs across Toronto, participants report feeling more motivated, less depressed, and less socially isolated as a result of gardening programs. In gardening programs run through Central Toronto Community Health Centres, outcome evaluations showed that people reported a decrease in stress levels after gardening groups.  In addition to mental health benefits, gardens also provide the added benefit of increasing participants’ access to fresh, healthy food. As well, converting unused spaces to gardens provides an environmental benefit to the community.  Many programs and community gardens have run successfully for years and many more are being added as organizations see the benefit in this low cost activity that has the potential to influence outcomes across multiple areas of health promotion.

III Process

The Mental Health and Gardening Knowledge Swap was structured to showcase the knowledge and experience in the room. Rather than having a conference with expert speakers, short presentations by participants highlighted the diversity in programs and approaches.  The participatory model allowed for an exchange of ideas and a chance to speak about future directions, and allowed for time to network and share. Three main areas were explored: best practices, evidence and evaluation. The event ended with a dotmacracy exercise that enabled participants to collectively choose some priority areas to work on in the future.

IV Examples of gardening and mental health programs
 

Flemingdon Park Community Health Centre's Community Garden

Flemingdon Park CHC Community Garden

There was a wide variety of the types of programs represented at the event. People came from largely from the GTA but there were also attendees from surrounding areas like Hamilton and Caledon. The organizations represented ranged from the Toronto Botanical garden, to small community gardens led by community based organizations, to larger health-based organizations. Participants had time to meet and share with others about their gardens, and five different programs were highlighted. Among them was Peace Ranch, a community mental health agency in Caledon that utilizes horticulture and animal husbandry in a therapeutic way; Sketch Arts, an environmental arts programming where youth lead workshops for peers and other gardeners in a community garden, and the Sunshine Garden at CAMH, a recreational and therapeutic gardening program where food is sold at a small market stand. These presentations were filmed and are posted on the Stop Community Food Centre’s Learning Network.

V Best practices

The need to emphasize process over product was a recurring theme throughout the day.  This can sometimes mean sacrificing the plants or harvest to allow people to have time and space to take on leadership roles, take risks, and try new things in safety and comfort. Emphasizing the process can also extend to the garden’s ability to act as a food security resource, and it was noted that it is important not to think the garden will provide an answer to the food security challenges in a community. Many gardens come from an urban agriculture framework which seeks to increase production; focusing on mental health means moving the focus to “growing people.”

Having a flexible, client-centered approach was seen as essential to ensuring success.  It was recognized that people who have mental health challenges very often have physical challenges, sometime related to medications or to chronic health conditions. Focusing on accessibility of activities and the space is instrumental to having a successful program. There was also discussion of the need to acknowledge that people’s backgrounds and temperaments might not always be a fit for gardening. Some people come to gardening filled with positive associations from their childhoods, while others approach with fear or resentment due to previous negative associations. Being conscious of participants’ experiences and being able to adapt the program are key elements of success.

Lastly, there was a discussion of the importance of collaboration and community capacity building. Because gardening and mental health is still a new area, it is often underfunded and under resourced. Participants spoke of the need to work together to share knowledge, resources, and skills. Organizations and communities need to support each other’s efforts; as someone said “it’s always a knowledge swap!” The ability of gardening to be a catalyst for community capacity building was also brought up. Participants emphasized that gardeners need to be given opportunities to take ownership and be given mentoring roles where appropriate. A number of projects showcased best practices models of peer based approaches in their gardens.

VI Evidence

In order to provide a richer discussion on evidence, participants at the swap were asked to bring in a piece of evidence (books, websites or articles) that they felt supported their work. The research brought in was compiled, and is now available on the Stop’s Learning Network. There were strong pieces of evidence that looked at nature deficit disorder, positive impacts of community gardens, and mental health with respect to healthy food, physical activity and social isolation. A few pieces focused specifically on the link between community gardening and mental health. There was agreement that through years of gardening, many of the staff had gathered lots of anecdotal evidence which linked gardening and mental health promotion. There was interest in seeing more research done on the effects of gardening and mental health, particularly looking at the synergies of nature, healthy eating, physical activity, and reduced social isolation. Overall, the nature of the programs meant they were not able to carry out that type of large scale research.

VII Evaluation
 

Garden Program Evaluation Using Photographs As Tools

Using Photographs for Evaluation

Most attendees were practicing a variety of process evaluations and using the feedback to improve their programs. Overall, outcome evaluations were largely tied to funding and as such there was little uniformity around them. Challenges such as the different areas of outcomes were cited. For example, a program could conceivably have outcomes in food security, physical and mental health. Lack of time, resources and access to a good tool were also brought up. Fred Victor Community Centre staff presented a video they had made of their program, where participants reflected on their experiences gardening. The process of making the video provided feedback on the program, but in addition, the video itself was an excellent advocacy tool. This highlighted the need to make evaluation a living document that could be used to both explain and support the work being done. Central Toronto Community Health Centres reflected on its attempt to craft an evaluation which looked at the areas of mental health, healthy eating and skill development, and the challenges of looking at multiple outcomes. A few proposals were suggested, including using The Most Significant Change tool as a way of addressing the many areas that gardening could be affecting change. It was proposed that evaluation for mental health and gardening programs could be an area for future research.

VIII Next steps

A number of areas were identified as next steps. There was a great deal of enthusiasm around creating ways of staying in touch, sharing, and networking. There was a desire to see more of what people were doing in their specific settings and many offers of tours were made. It was also noted that in order to work well in the field there is a need to combine knowledge of growing and gardening with mental health and it was challenging to become knowledgeable in both, as such there was a desire for further educational opportunities. Finally, there was a desire to craft evaluation tools that could be used by programs to measure outcomes; these were especially desired by those working in a health setting where the emphasis on evidence informed practice was greater.  

IX Conclusion

In conclusion, people responded that they benefitted from the event. When asked what they found most useful professionally, the majority answered networking. In the words of one participants, what was the most useful was, “having the opportunity to connect with others doing similar work, sharing resources, knowing we don’t have to reinvent the wheel.” Overall, the swap concluded that using gardening as a tool to promote mental health has a number of evidence informed benefits and which can easily be combined with other goals and purposes of community development and health promotion. As such, we should continue to develop further programs and support those that already exist.

X References and resources

SKETCH (http://www.sketch.ca) is a community arts initiative engaging young people who live homeless or on the margins to:

  • experience the transformative power of the arts
  • build leadership and self-sufficiency in the arts
  • cultivate social and environmental change through the arts.

Peace Ranch is a community mental health agency offering supportive housing and social recreational rehabilitation programs to individuals with serious mental illness as well as those who are dealing with co-occurring addiction challenges: http://www.peaceranch.com.

In spring of 2002 FoodShare established the Sunshine Garden, a 6000 sq ft urban market garden on the grounds of the Centre for Addiction and Mental Health (CAMH) at 1001 Queen Street West in Toronto: http://www.foodshare.net/sunshine-garden-and-market. In fall 2006, that original garden made way for the CAMH redevelopment, but a new garden, the Lasagna Garden, was created to carry on the tradition of urban agriculture in the heart of Toronto. From 2002 to 2009, programming in these gardens was focused on providing employment through gardening with the "Growing Green Jobs” program.

Most Significant Change publication is aimed at organisations, community groups, students and academics who wish to use MSC to help monitor and evaluate their social change programs and projects, or to learn more about how it can be used. The technique is applicable in many different sectors, including agriculture, education and health, and especially in development programs. It is also applicable to many different cultural contexts. Visit http://www.mande.co.uk/docs/MSCGuide.htm for more information.

The Learning Network was created to provide a venue for sharing resources, learning and best practices relating to Community Food Centres. All of the content available on this site is free and in exchange, users are asked to create a profile: http://www.learningnetwork.thestop.org/.

Minding our Bodies: healthy eating and physical activity for mental health website includes the resource The CMHA Grey Bruce Experience: Community Gardening as Part of the Therapeutic Process and to Provide Employment: http://www.mindingourbodies.ca/toolkit/resources/gardening_for_food_and_....

Print Resources

Draper, Carrie and Freedman, Darcy (2010): Review and Analysis of the Benefits, Purposes and Motivations Associated with Community Gardening in the United States, Journal of Community Practice, 18:4, 458-492.

Louv, Richard (2011) The Nature Principle: Human Restoration and the End of Nature Deficit Disorder. Algonquin Books of Chapel Hill, North Carolina.

Ulrich, Roger (1984): View through a Window May Influence Recovery. Surgery, Science, New Series, Volume 224, Issue 4647, 420-421.