While a walk in the woods can boost mental health and emotional well-being, forest bathing isn’t always feasible for more vulnerable populations that could positively benefit from such experiences. Specifically in healthcare facilities, where sterile aesthetics replace trees, plants and flowers, nature-based interventions can support the well-being of patients and staff who spend much of their time indoors.

Amelia Fletcher, workplace health promotion coordinator at Nova Scotia Health, helped launch a hospital wellness garden, located on a public patio between the Abbie J. Lane Memorial building and Camp Hill Veterans Memorial building at QEII Health Sciences Centre in Halifax. She described the project during a recent discussion, hosted by the Canadian Coalition for Green Health Care, which featured perspectives about the convergence of health, nature and climate action.

Creating the green oasis was a team effort between patients and staff, with funding through the Nova Scotia Mental Health Foundation. The plan entails partnering with the mental health and addictions program and inpatient psychiatry, jumpstarting a native pollinator garden this spring and building accessible raised beds from recycled materials through a partnership with Lake City Works, an alternative vocational program that supports adults living with severe and persistent mental illness.

“The garden created an opportunity to access the evidence-based benefits of nature on physiological, cognitive and physical health in an urban setting,” said Fletcher. “Some of these benefits include self-esteem, mood, mental fatigue, attention, memory, problem solving, social connection, cortisol reduction and decreased length of recovery and pain management.”

Users are able to access healthy food choices, boost physical activity and social skills, learn about food insecurity, and then transition these skills into the community. “We worked with clients in the early spring to identify flowers and vegetables they would like to see grown in the garden beds and pots, and we incorporated daily gardening maintenance and harvesting into pre-existing programs and groups,” she added.

Some of these programs are mindfulness and cooking groups. Through an indoor gardening group, patients can plant seedlings from the facility’s plant library and receive nature-based coping strategies, such as accessing community gardens and green spaces after leaving the facility.

“Each month, clients would prepare a meal and the produce from our garden to donate to Shelter Nova Scotia,” Fletcher added. “Our garden also facilitated opportunities to build and practice sensory-based coping through mindfulness prompts and aromatherapy.”

Green spaces also improve employee health and well-being, from better job satisfaction and attention to support for mental fatigue and anxiety. “Word traveled quickly about our little garden, so we noticed people from all buildings and programs within the QE2 Health Science Centre coming to enjoy their breaks and their lunch,” said Fletcher. “You could often see staff reading, sunbathing or engaging with the mindfulness prompts that we had posted around the garden.”

From a sustainability viewpoint, the project fuelled larger discussions around carbon sequestration, biodiversity, composting and recycling, water use, climate change and making greener lifestyle choices. As she noted, feeling more connected with nature is linked to pro-conservation behaviours.

A garden experience year-round

To bring nature-based therapies inside healthcare facilities, the Forget For a Moment Foundation raises funds to finance the construction of natural structures in these settings, specifically creating restorative spaces through living green walls and healthcare planters.

“We do this to break down isolation and improve the physical and mental health of patients, residents, their families and caregivers alike, and to bring awareness of the healing power and benefit of bringing nature indoors,” said Michel Gauthier, the president and CEO.

Last year, a pandemic-inspired healthcare planter program was launched, with innovative garden planters that are mobile, adjustable and maintenance friendly. Designed with residents, patients and healthcare staff in mind, they feature a capillary watering system to prevent soil spillage. So far, 30 planters were distributed to healthcare and long-term care residences across Ottawa and Eastern Ontario.

The planters serve many purposes, such as creating a comforting atmosphere, stress reduction, opportunities for therapeutic horticulture, social connection and physical activity all year round, said Gauthier. Their versatility extends to seasonal and thematic arrangements, with seedling choices that can be transplanted in the outdoor wellness garden. The planters also bring a sense of hope, purpose and belonging for older populations who once enjoyed their at-home gardens.

A future goal is to establish a community of collaborators who engage with healthcare planter recipients. To date, the foundation has also brought four living green walls to healthcare facilities, such as a 30-by-10-foot installation completed during the pandemic at Montfort’s Aline-Chrétien Health Hub in Orleans.

Embedding planetary health principles

As a planetary health lead at Fraser Health Authority, which serves more than two million people in British Columbia, Darryl Quantz has helped coordinate various climate and planetary health-related projects and oversees the planetary health strategy.

“By taking a planetary health perspective, we recognize the ecological crisis that we’re facing and the loss of biodiversity and degradation and how this impacts people’s health and well-being,” he said. “We also recognize that reconciliation is not possible without environmental reconciliation and the importance of traditional ecological knowledge as essential to our solutions.”

Addressing the buildings’ carbon footprint and associated waste is crucial for an estimated 85 per cent of patients within Fraser Health’s facilities. Embedded in the strategy is a regional goal to develop new and existing spaces to protect and regenerate the natural environment.

Fraser Health created various working groups for its planetary health strategy, including a natural environment working group. Members also come from an Indigenous health team, public health, the facilities, interested clinicians and a health and well-being team.

Partnerships with local university students have also spurred opportunities to improve the natural environment, including a site analysis from Katie Mcpartlin, a graduate student in landscape architecture at UBC. Last summer, she visited six acute and long-term care sites to help re-imagine green spaces.

During one visit, she examined a forest that was overgrown with many invasive species and never developed due a steep slope and setback regulations. There were few entry or viewing points. Noticing the potential for stewardship and restoration, her site recommendations included creating a forest management plan with help from community partners, while using volunteers to take on some maintenance work.

Adding boardwalks and viewing platforms around the edge and adding interpretative educational signage will encourage positive natural connections. Increasing green space throughout the hospital grounds can also reduce disturbance to the sensitive forest habitat, in turn, boosting resilience against climate-related events.

Yet another challenges was a lack of diversity, with monoculture ground cover or shrub layer dominating planted areas. Street trees consisted primarily of a non-native maple species. To increase biodiversity in an urban setting, Mcpartlin identified opportunities to plant more native species and a greater variety of street trees.

This site analysis also brought an opportunity to consider temporary green spaces during construction, said Quantz. As healthcare projects evolve, reviewing how landscaping contracts impact decision-making is another critical piece, as well as understanding the role of facilities. “This project was a real opportunity to engage our facility staff and leaders,” Quantz acknowledged. “We know how busy they are, so we really need to understand what we’re asking from them.”

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