Therapeutic Landscape Design

Recent rapid urbanization is associated with increased stress and reduced sense of well-being. The environment where one lives, works, learns and plays affects us. Overwhelming research now links nature contact with positive mental and physical health and social outcomes. Healing landscapes provide the necessary nature contact. By combining new scientific evidence and ancient intuitive wisdom the potential of a healing landscape can be realised. Evidence-based therapeutic landscapes impact diverse outcomes, including heart disease, dementia and depression. Co-benefits of design for well-being accumulate upstream and down. Addressing socio-environmental factors through design interventions leads to better health outcomes, faster. Standard design practice no longer matches the multi-disciplinary theories that intersect at well-being, requiring a focused, new design culture to offset and mitigate impacts of urbanization. This chapter reviews the evidence to show well-being as a sound principle of design, to create a design paradigm on which designers are prepared to act.

Biophilic Design is an applied science that takes into account the most recent findings on the relationship between human beings and Nature to render artificial spaces more coherent with innate human biophilia. It is well known that the application of Biophilic Design reduces stress, stimulates creativity and clear thinking, improves physical and psychological wellbeing and accelerates healing. Considering the relentless process of global urbanization, these benefits will become increasingly important in the design of our urban spaces, buildings and interiors. The aim of the present study is to develop a conceptual framework for Biophilic Design, reducing the gap between scientific research and its translation into functional applications.

The importance of green infrastructure within urban areas, as well as the ecological and environmental benefits, has the scope of preventing and improving some illnesses and afflictions ever more frequent developing within our increasingly anthropized communities. The paper explores the different lessons learned from nature as horticultural therapist, working with patients with a variety of physical and mental disorders, multiple benefits gained through contact with nature; improvements in listening skills and in relating to other people, to the improvement in working within a team, the containment of aggression, etc.. The final aim of the activity is not only to improve some aspects of the individual patient, but the quality of life as a whole, in order to increase exponentially the possibility of entering the community of reference. The complexity of life and the continuous exposure to stressful situations, frequently leads to experiencing temporary periods of difficulty.. The article describes the techniques used as part of this therapy also within companies, which need to re-integrate employees after prolonged periods of illness and who had lost their role and their sense of belonging within the company. Through the shared planning and setting up of a small garden, it has been possible for the participants to re-discover the value of solidarity, which is often compromised by strong competitiveness dynamics. The high performance that is increasingly requested in today's lifestyle requires to think and foresee the possibility of creating more green spaces accessible to everyone, where people can regenerate and recharge themselves both physically and mentally.

The importance of therapeutic green spaces in healthcare facilities has been scientifically demonstrated by international experiences. The well-being resulting from a garden designed for healing offers social, physical and psychological benefits, since the therapeutic green: (1) creates opportunities for active movement and physical activity; (2) offers the chance to make choices, in both terms of privacy and sense of control experience; (3) provides access to the nature and to other positive distractions, like situations that encourage people to come together in favour of social support’s experiences. Moreover, a comfortable healthcare environment, associated with a green space is beneficial for patient care, improving the management quality of healthcare facilities, reducing the time of hospitalization and saving healthcare costs. Nowadays, in Italy, few case studies represent and integrate the Healing Gardens’ principles. The Healing Gardens can represent a key role in supporting the traditional treatments when realized within acute care facilities, such as hospitals and healthcare facilities, but also in places hosting medium and long-term hospitalization or residential low-care structures such as Hospice, Alzheimer centers, day-care centers and nursing homes. The purpose of the chapter is to define useful design strategies and indications for Healing Gardens.

Several Evidence Based Design studies highlighted the impact of natural elements in the form of Healing or Therapeutic Gardens on patients health and wellbeing. A significant number of users within hospitals and socio-sanitary facilities is represented by medical doctors and nurses. They also spend a significant amount of time inside healthcare buildings and are subject to different risks factors, such as burnout. Aim of the research is to investigate the impact that Healing Gardens have on doctors and nurses perceived wellbeing and to provide tools and strategies for design implementations. A qualitative empirical study has been conducted on a sample of seven case studies selected among national and international Therapeutic Gardens inside socio-sanitary facilities or nursing homes. Both primary and secondary data have been used. The study demonstrates that Therapeutic Gardens can have a positive impact on hospital staff perceived satisfaction, relax improvement and willingness to work with the patients. Different recommendations and design suggestions have been proposed for the improvement of therapeutic open spaces usage. Future research on the topic are encouraged to involve a wider and more various sample.

Dementia is perhaps the most disturbing problem associated with aging, not only for the person concerned but also for relatives. In this setting, given the absence, to date, of drugs that can stop or reverse the clinical course of the disease, non-pharmacological approaches have become more important than pharmacological treatments. The disability of dementia sufferers is characterised not by impaired or reduced movement, but rather by marked behavioural problems in daily life. Although these problems are, for carers, among the most difficult to manage, changes in the environment can certainly help to alleviate them. An appropriately adapted physical space, reflecting a good understanding of the cognitive and sensory modifications induced by the disease, can serve as a “prosthesis” able to compensate for the loss of cognitive abilities associated with dementia. The primary purpose of an “environmental prosthesis”, however, is to reduce the stress levels and improve the well-being of affected individuals and their caregivers. Importantly, this environment, in addition to being accessible and user-friendly, must be safe, flexible, comfortable and unambiguous. A physical space adapted to the needs of dementia sufferers may act as a non-pharmacological intervention able to reduce the impact of behavioural problems and improve the quality of life of these individuals and their families.

Among the possible mechanisms utilized by living organisms to favor synchronization and adaptation to the environment, circadian (around 24 h) rhythms represent a crucial point. The day-night cycle, with light–dark alternation, is the strongest external circadian synchronizer for humans, capable to deeply influence also human individual differences (chronotype). However, since the 19th century, artificial light assumed an important role in regulating human life, including working activities (shift work). On one hand, satellite images have documented a worldwide increment of night-time illumination, and exposure to artificial Light-At-Night (LAN) is associated with a variegate spectrum of health problems. On the other hand, the growing use (and abuse) of technological devices (mostly emitting blue light, a powerful melatonin inhibitor), is transforming our society toward a progressive ‘eveningness’, with consequences on chronotype, sleep, lifestyle habits, and health.

The environment determinants of health are important factors that, together with genetics aspects, sex, socio-economic status and education, affect population wellbeing. Environmental aspects are important also in fighting against health inequalities. Parks, tree-lined avenues, parks for games with free access, urban gardens and all the various typological declinations of green urban areas, constitute a “nudging” which also facilitates the approach and use of the territory for the most disadvantaged people. It is currently recognized that urban spaces with the presence of greenery and cycle paths are an excellent prevention investment, for example, in reducing the risk of coronary diseases. In line with the European guidelines, it is fundamental the activation of territorial networks where green planning or green infrastructure have multiple impacts on the impelling issue of climate change and the heat island effect phenomenon. In this context, green spaces perform multiple functions of prevention and protection of the population health, also determining an increase in terms of territorial social capital. Therefore, although there are many variables to be tackled, in the assessment of urban spatial planning, the aspects linked to the presence of green infrastructures along which social areas and slow mobility must be evaluated, measured, and verified.

The emerging Active Cities approach enhances the opportunities to be physically active by promoting active lifestyles in the urban environment to fight against inactivity-related health issues like non-communicable-diseases. Despite this approach dates to the Nineteen-seventies, the most fragile group of citizens from the independent mobility point of view (children, elderly and disabled people) are still encountering difficulties in moving autonomously around the urban realm, with a negative impact on their opportunities to learn, socialize and be physically active in the day-to-day routine. The decline in children’s autonomy is a recognized concern, with a clear north–south gradient throughout Europe seeing Italy ranking last, and a direct relation to inactivity rates, overweight and obesity among Italian children. Therefore, a quali-quantitative three years longitudinal research-intervention had been conducted in the Italian town of Cassino, investigating children's active and independent mobility. Findings show alarming results concerning children’s autonomy (only 3% go to school independently) and active lifestyles (only 17% go to school in active ways). A conceptual model based on the classification of children's physical activity as either “independent” or “non-independent” has been developed, showing that a large part of physical activity in children should be considered as an epiphenomenon of their independent mobility and roaming opportunities in the public space. To enhance activity levels in children, the focus of decision makers should be directed to all their potential realms of experience, also considering the infrastructural and socio-educational determinants of active lifestyles.

The transformation of today’s society generates an increase in users’ needs in terms of use, with impact on the physical, cognitive and psychological well-being for the greatest number of people. In addition, different scientific studies demonstrate that the physical environment can influence people behavior, performance and well-being. For this reason, ‘Design for All’ strategy was defined as the design for human diversity, inclusion and equality by the EIDD-Design for All Europe. This strategy is based on the concept that good design enables and bad design disables all people regardless their age, gender, culture, abilities or disabilities. The article addresses Design for All in relation to the built environment, focusing on healthcare facilities to clearly describe how to enhance different users’ benefits and positive outcomes such as usability, well-being and social inclusion. The current study provides both a theoretical background and practical information to integrate Design for All within the design process and solutions of the architectural field by means of a descriptive approach. In particular, two case studies of healthcare facilities (hospitals and therapeutic gardens) were analyzed to highlight how Design for All can be integrated to achieve more inclusive and healthier environment.