The Relationship Between Horticulture, Recovery and Occupational Therapy in Mental Health: A Scoping Review

Figures & data

Table 1. Characteristics of Included Sources of Evidence.

Author(s), year	Country	Setting	Duration	Facilitator	Participants (n)	Aim(s)	Methods	Outcome measures	Findings
Cipriani et al. (2018)	USA	In-patient facility	Unspecified	Occupational therapists (n = 2)	n = 8	To explore the value and meaning and investigate the effects of the Greenhouse Program on the achievement of recovery goals	Qualitative: semi-structured interviews; empirical, phenomenological, psychological (EPP) method	None	The programme facilitated achievement of recovery goals, increased socialization, self-esteem, and new skills.
Han et al. (2018)	South Korea	Farm	90 Mins weekly 10 sessions 10 weeks	Master’s students of horticultural therapy (n = 4), social worker (n = 1) and unidentified staff	Control (n = 14) Therapy (n = 14)	To determine the effects of a horticultural therapy programme on stress levels and physical functional ability of older adults with mental health problems	Quantitative: random assignment to therapy and control; pre- and post-test	Salivary cortisol levels; Senior Fitness Test	Horticultural therapy facilitated significantly decreased stress and increased physical health.
He et al. (2021)	China	In-patient unit	60 Mins weekly 6 sessions 6 weeks	Horticultural therapist (n = 1) and volunteer (n = 1)	Control (n = 20) Therapy (n = 20)	To investigate the effect of edible horticultural therapy on extrapyramidal symptoms in patients with schizophrenia	Quantitative: random assignment to therapy and control; pre- and post-test	Positive and Negative Syndrome Scale (PANSS); Rating Scale for Extrapyramidal Side Effects (RSESE); Life Satisfaction Index A scale (LSIA)	Horticultural therapy facilitated significantly improved symptomatology and life satisfaction.
Kam and Siu (2010)	China	Sheltered workshop	60 Mins daily 10 sessions 2 weeks	Occupational therapist (n = 1)	Control (n = 12) Therapy (n = 12)	To examine the effect of a horticultural programme on stress coping skills, work behavior and quality of life of persons with psychiatric illness	Quantitative: single-blinded RCT	Depression Anxiety Stress Scale (DASS21); Personal Wellbeing Index (PWI-C); Work Behavior Assessment (WBA)	Horticultural therapy facilitated improved social skills and networks, self-confidence and new skills.
Kenmochi et al. (2019)	Japan	In-patient facility	60 Mins weekly 11 sessions 12 weeks	Horticultural therapist (n = 1)	Control (n = 12) Therapy (n = 11)	To investigate the effect of horticultural therapy on psychiatric symptoms and future perspectives and hope of patients with chronic schizophrenia	Quantitative: pre- and post-test	Positive and Negative Syndrome Scale (PANSS); Beck Hopelessness Scale (BHS); The Schizophrenia Quality of Life Scale (J-SQLS)	The therapy group demonstrated no significant change in future perspectives and hope.
Monroe (2015)	USA	Out-patient mental health clinic	Weekly unspecified	Therapist (n = 1)	n = 5	This pilot programme aimed to increase physical activity, social skills, cooperation and engagement of participants.	Qualitative: descriptive	Observation	Participants demonstrated enhanced social skills, self-worth, and use of metaphor as a useful coping technique.
Najjar et al. (2018)	Iran	Out-patient hospital garden	120 Mins twice a week 10 sessions 2 weeks	Unknown	Control (n = 15) Therapy (n = 15)	To assess if horticultural therapy is effective in improving conceptual organization function, memory and psychological symptoms of chronic depressed male outpatients	Quantitative: pre- and post-test	Rey-Osterrieth Complex Figure Test (ROCF); Depression Anxiety and Stress Scale (DASS-44)	Horticultural therapy facilitated significantly improved symptomatology and cognitive function.
Oh et al. (2018)	South Korea	Farm	120 Mins weekly 10 sessions 10 weeks	Horticultural therapists (n = 2) and volunteer (n = 1)	Control (n = 13) Therapy (n = 15)	To assess the psychopathological effects of participation in horticultural therapy in patients with schizophrenia	Quantitative: voluntarily assignment to control and therapy, pre- and post-test	Positive and Negative Syndrome Scale (PANSS); Brief Psychiatric Rating Scale (BPRS)	Horticultural therapy facilitated significantly improved symptomatology.
Parkinson et al. (2011)	UK	Multiple	Unspecified	Unknown	n = 50	To determine the aspects of horticultural projects that confer the greatest therapeutic benefit, specifically in relation to motivation, to the service users	Mixed methods: interviews; structured observations	Work Environment Impact Scale (WEIS); Volitional Questionnaire (VQ)	Horticultural therapy required careful facilitation.
Perrins-Margalis et al. (2000)	USA	Clubhouse	Twice a week 12 sessions 6 weeks	Graduate occupational therapy students (n = 2)	n = 10	To study the impact of horticulture as a purposeful activity on quality of life from the perspective of persons with chronic mental illness	Qualitative: Hermeneutic phenomenology; Journals and field notes; Semi-structured interviews	None	Participants demonstrated positive group dynamics, sharing, learning new skills, and valuing choice.
Pieters et al. (2019)	USA	In-patient unit	45 Mins weekly unspecified	Occupational therapists (n = 2)	n = 25	To explore and describe the experiences of gardening among adults in an acute psychiatric inpatient setting in the participants’ own words	Qualitative description inquiry; Semi-structured open-ended interviews; Observational field notes	None	The participants experienced enhanced socialization, new knowledge, sense of community, use of gardening metaphors, and feeling productive.
Sinnott and Rowlís (2021)	Ireland	Out-patient community mental health center	90 Mins weekly 8 sessions 8 weeks	Occupational therapist (n = 1) and horticulture and trade skills (HTS) facilitator (n = 1)	n = 7	To develop and conduct an occupation-focused and recovery-oriented evaluation of a therapeutic gardening and woodwork programme for adult community mental health service users	Mixed methods: pre- and post-test; qualitative data post-evaluation	Goal Attainment Scale (GAS); Feedback form	Horticultural therapy facilitated achievement of individual recovery goals.
Siu et al. (2020)	China	Out-patient	8 Sessions unspecified	Horticultural therapist (n=?) and rehabilitation worker (n=?)	Control (n = 41) Therapy (n = 41)	To evaluate the effectiveness of a standardized horticultural therapy programme for individuals with schizophrenia	Mixed methods: random assignment to therapy and control; pre- and post-test; two-week follow-up	Depression Anxiety Stress Scale (DASS21); Short Warwick-Edinburgh Mental Well-Being Scale (C-WEMWBS); Engagement in Meaningful Activities Survey (EMAS); Social Exchange and Support Measure (SESM); Observational ratings; Focus groups	No change in social exchange was found.
Smidl et al. (2017)	USA	Out-patient community mental health center	1 Year	Graduate occupational therapy students (n = 4)	n = 20	To explore the value of a therapeutic gardening project as part of the psychosocial recovery curriculum provided at a community mental health center	Mixed methods: weekly data collection; follow-up	Interviews; Volitional Questionnaire (VQ); Visual Analog Mood Scale (VAMS); Journaling; Attendance records; Recovery-Enhancing Environment Measure	Horticultural therapy supported recovery by enhancing sense of pride, self-worth, and socialization.
Zhu et al. (2016)	China	In-patient unit	90 Mins 3 times per week 36 sessions 12 weeks	Rehabilitation therapists (n = 2)	Control (n = 55) Therapy (n = 55)	To investigate treatment effect of horticultural therapy on patients with schizophrenia and its possibility of standardized application in psychiatric hospitals	Quantitative: randomized assessment-blind case-controlled trial; pre- and post-test	Positive and Negative Syndrome Scale (PANSS)	Horticultural therapy improved symptomatology in combination with antipsychotic medication in comparison to medication alone.

Figure 1. PRISMA flow diagram. From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71. For more information, visit: http://www.prisma-statement.org/

Table 2. Horticultural Therapy and the Recovery Principles.

	Setting		Diagnosis									Duration							Recovery principles
Study	In- patient	Out- patient	Unspecified	Depression^a	Anxiety^b	Schizophrenia^c	Mood disorder	Personality disorder	Bipolar disorder	Alcohol / substance use disorder^d	Other^e	Unspecified	2 Weeks	6 Weeks	8 Weeks	10 Weeks	12 Weeks	1 Year	Holistic	Peer support	Respect	Hope	Person driven	Strengths/ Responsibility	Culture	Addresses trauma	Relational	Many pathways
Cipriani et al. (2018)	x		x									x							x	x	x	x	x	x		x	x	x
Han et al. (2018)		x		x	x											x
He et al. (2021)	x					x								x
Kam and Siu (2010)		x	x			x							x								x			x			x
Kenmochi et al. (2019)	x					x											x					x
Monroe (2015)		x		x		x	x		x			x								x	x		x	x	x	x	x	x
Najjar et al. (2018)		x		x									x
Oh et al. (2018)		x	x	x		x										x
Parkinson et al. (2011)	x	x	x									x											x		x		x
Perrins-Margalis et al. (2000)		x	x											x						x	x		x	x			x
Pieters et al. (2019)	x			x	x	x	x	x	x	x	x	x								x			x	x		x	x
Sinnott and Rowlís (2021)		x			x	x		x		x					x								x	x			x
Siu et al. (2020)		x	x			x						x							x					x			x	x
Smidl et al. (2017)		x				x	x											x	x	x	x		x	x
Zhu et al. (2016)	x					x											x

^a Major depressive disorder (Monroe, 2015; Pieters et al., 2019), depressive disorder (Han et al., 2018; Pieters et al., 2019), depression (Najjar et al., 2018; Oh et al., 2018).

^b Anxiety disorder (Han et al., 2018; Pieters et al., 2019), generalized anxiety disorder (Sinnott & Rowlís, 2021).

^c Schizophrenia (He et al., 2021; Kam & Siu, 2010; Kenmochi et al., 2019; Oh et al., 2018; Sinnott & Rowlís, 2021; Siu et al., 2020; Smidl et al., 2017; Zhu et al., 2016), schizoaffective disorder (Monroe, 2015; Sinnott & Rowlís, 2021; Smidl et al., 2017), psychotic disorder (Pieters et al., 2019), paranoid schizophrenia (Sinnott & Rowlís, 2021).

^d Alcohol dependency syndrome (Sinnott & Rowlís, 2021), alcohol use disorder, cocaine use disorder, THC use disorder (Pieters et al., 2019).

^e OCD, PTSD, gender dysphoria, ASD, unspecified eating disorder (Pieters et al., 2019).

Figure 2. Horticultural therapy and the recovery principles.

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