Greenspaces of psychiatric clinics and patient perceptions: A mixed-methods exploration

Why does this study matter?
Research shows that outdoor features such as plants, trees, water features, and open areas can benefit patients, but details are missing regarding “what it is” about these natural elements that evoke a positive response. Mapping outdoor features to the established dimension they reflect, is a novel consideration that links aesthetics to human needs. Findings from this study suggest ways that multifunctional greenspaces outside of psychiatric clinics can be designed to create a relaxing atmosphere, foster a connection between people and with nature, and enhance the well-being of patients.  

How was the study done?
Researchers conducted this qualitative, interview-based study at two psychiatric clinics in Germany. They approached people who were using the semipublic, outdoor greenspaces and asked them to share their perceptions of outdoor features. Each of the four sites – two sites at each facility – was visited twice during weekdays and twice on weekends. At the Gütersloh facility, researchers collected patient perceptions of both a large, grassy lawn and a pond. At the Paderborn clinic, researchers recorded patient perspectives about a lawn with trees and an area featuring sports equipment.  A total of 34 patients - 17 female and 17 male - were interviewed. Their ages ranged from 18 to greater than 80.     

So what do we learn from the study?
Regarding the Gütersloh lawn, patients appreciated the expansive view of the lawns, established trees and plants, animals, and outdoor smells and sounds which corresponded most with the PSD model categories of natural, serene, diverse, and open. Patients shared negative reactions to garbage and construction sites and sounds in the natural and cultural dimensions.
Patients perceived the following aspects of the Gütersloh pond area favorably: water and water sounds; plant density, animal sights and sounds, and an overall sense of wellbeing. These elements most reflected the natural, diverse, and serene dimensions. Unhealthy looking trees and the construction site left a negative impression on patients representing the natural and cultural dimensions.

At the Paderborn lawn, among the many features appreciated by participants were the overall greenness and coherence of the space, arrangements of plants that fostered a sense of privacy,
benches, and the manicured appearance of the landscaping were perceived favorably. The model dimensions most represented included natural, serene, cultural, sheltered, and diverse. Things that patients perceived negatively included an insufficient number of flowering plants garbage, and noise from cars and sirens which most reflected the natural and social dimensions.
Finally, the Paderborn outdoor sports area was perceived positively due to greenspaces and birdsong, but negatively due to the lack of flowering plants and poorly trimmed hedges representing the
natural and cultural (329) dimensions respectively.

Can we say the results are definitive?
We can’t consider the findings from this study to be definitive due to the exploratory design and because they only collected data about two locations. The exclusion of perspectives from patients who could not venture outdoors and the fact that only two people provided input regarding the Paderborn sports area were other noted limitations. Finally, because researchers manually documented participant responses, our interpretations rely heavily on accurate note-taking such that errors or omissions cannot be ruled out.  

What’s the takeaway?
Rather than recommending specific features, researchers suggest incorporating multifunctional elements to support diverse needs and preferences. Examples include mature trees, blooming vegetation, manicured lawns, plant-based noise barriers, water features, tree-lined paths, flexible seating accommodations protected from elements, and habitats for birds and animals.   
 

Summary of:
Schmid, H.-L., Nowak, A., Oeljeklaus, L., McCall, T., Hornberg, C., Caspers, B. A., & Zerbe, S. (2024) Greenspaces of psychiatric clinics and patient perceptions: A mixed-methods exploration. People and Nature, Pages In Press

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