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Nature’s Impact in Mental Health Facilities

Elements of nature have always been used for healing purposes, to help people restore their health both physically and mentally. We’ve all experienced the rejuvenating benefits of nature, and often look to find ways of incorporating it into our everyday life, including within healthcare facilities and hospital design.

A brief history of nature and healthcare designs

In Canada by the 1880s, there was a shift to creating facilities with gardens, farms, and outdoor spaces that encouraged participation in sports and nature as part of the healing process.

In the 1890s, the Mimico Branch Asylum, also known as the Lakeshore Psychiatric Hospital, was built west of Toronto, and included a farm and views of Lake Ontario. In 1914, the Hospital for the Mind at Mount Coquitlam was built east of Vancouver; it later became the Riverview Hospital. Together with Colony Farm, it was intended to provide a sanctuary where the mentally ill could live “purposeful lives” with therapy that included horticultural work, food production, and outdoor activities.

By the 1950s, however, access to nature had been edged out of hospital design, with a shift in emphasis towards efficiency, pharmaceuticals, technology, and cost saving practices. For mental health patients, the transition meant an increase in the use of alternative therapies and drugs. This was also combined with efforts to move people with mental health issues from contained facilities, back into their communities.

Nature in modern healthcare facilities

Today, nature is back—with scientific research to document its benefit. A leading proponent of gardens and nature in healthcare is environmental psychologist Roger Ulrich. In a 2002 paper entitled Health Benefits of Gardens in Hospitals, he states there is considerable evidence that shows restorative effects of nature scenes are manifested within only a few minutes, reducing negative emotions such as fear, anger, and sadness.

Similar results to those described by Ulrich have even been documented when individuals view videos displaying natural images, realistic nature photos, or a piece of artwork with a nature theme. Outdoor patios and gardens are also being incorporated into all aspects of hospital design, no longer reserved for foyers or entry levels, but on multiple building levels to be accessible directly from patient wings and staff areas.

“Well-designed hospital gardens not only provide calming and pleasant nature views but can also reduce stress and improve clinical outcomes through other mechanisms,” says Ulrich. It’s not just patients and families who benefit from access to nature, but also staff in the mentally demanding world of medical workers. Multiple studies provide evidence that hospital gardens are heavily used by healthcare staff and increase employee satisfaction, which in turn plays a role in staff retention.

Using nature effectively

A study published in the Journal of Affective Disorders demonstrates that daylight exposure can help to reduce patients’ depression. To meet this need for integrating nature into healthcare design, hospital designers are working to provide access to abundant natural light and views of nature with larger windows in all patient rooms, staff rooms, corridors and in common spaces. Where views are not available, recognizable images of nature are being incorporated into waiting areas, lobbies, and windowless rooms, used as wayfinding tools that help to create a connection to nature for all facility users—patients, families, and staff.

Using findings by Ulrich and other researchers, basic recommendations for therapeutic or healing gardens are summarized in a paper, Therapeutic Responses to Natural Environments Using Gardens to Improve Health Care By Stephen Mitrione, M.D., M.L.A. and include:

  1. Provide a variety of spaces
  2. Provide for social support
  3. Allow for physical movement and exercise
  4. Provide access to nature and positive distractions
  5. Minimize ambiguity
  6. Minimize intrusive stimuli


  1. Ulrich R. Effects of Gardens on Health Outcomes: Theory and Research. In: Healing Gardens: Therapeutic Benefits and Design Guidelines. Eds. Clare Cooper-Marcus and outdoor Marni Barnes. New York, NY: John Wiley; 1999: 27-86.

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