Stratheden case study
Stratheden Hospital, Fife
Stratheden Hospital sits in a large estate located in the beautiful Eden Valley country side in the Scottish county of Fife. It occupies extensive landscaped grounds providing a wide range of mental health services to people in Fife. Most recently acclaimed for its new architectural award winning inpatient unit for elderly people with dementia. Hospital staff now have ambitions to bring the extensive grounds back into use, once again, for therapeutic purposes. The first phase of work has already started and is illustrated here.
Stratheden grounds are currently laid out as close-mown lawns with occasional specimen trees. Remnants of historic hedgerows mark old field boundaries.
The facility first opened as Fife and Kinross District Asylum in 1866, and right up until the 1980s the grounds were used intensively for a wide range of therapeutic purposes. Prior to the introduction of new drugs in the 1950s for treatment of psychiatric conditions, being outdoors in the natural environment and particularly taking part in meaningful work, including farming activities, and of course horticultural therapy, was the bed-rock of the mental health system. The asylum functioned as a self-contained community and supplied much of its own food, and even operated a cement works.
With the advent of these new medications for the treatment of mental illness and changing legislation designed to prevent exploitation of people with mental illness the focus changed to getting better ‘indoors’. As patients received less therapy in the outdoor space there was a shift away from hospitalization to care in the community. This lead to a gradual a reduction in the budget for grounds maintenance and much of the outdoor estate gradually fell into disuse.
Enthusiasm from hospital staff and the local community have helped develop new plans to restore the grounds to active use, with the aim being to create a new exemplar in Fife of a therapeutic space which is available for the whole community to use – encouraging everyone to think about ‘staying well’, rather than just getting better when they are already ill. Termed ‘Recovering Eden,’ this exciting project has one theme – ‘recovery’- with three aspects:
- Recovery of ‘self’ after illness and developing resilience using the outdoors environment;
- Recovery of the grounds (their ‘restoration’);
- Recovery of the grounds as a more natural green space than is the case now (Eden).
A landscape architect was appointed to help with the survey and appraisal of the grounds, and to develop a ‘master plan’ for the whole site. Work has now begun with restoring some of the courtyard gardens. There are also aspirations for including sculpture and other art-works, orchards, meadows and allotments throughout the grounds, which will also be opened up for public use. Existing roads round the site which are too narrow for modern-day traffic requirements could be re-invented as a network of ‘leisure routes’ for walking, cycling and horse-riding.
There are even ideas to re-use some of the buildings which have fallen into disuse, for example using the former chapel as a quiet space for activities like yoga.
The current treatments which rely heavily on medication are acknowledged by many clinicians and patients to be only part of what is needed for full recovery. In addition an approach to mental health and wellbeing which looks at the ‘whole person’ and which encompasses contact with the natural environment as well as engagement with purposeful activities is likely to be even more effective – and very unlikely to be harmful.
Patients and also former patients are helping with the practical work restoring the grounds. This horticultural therapy delivers the twin benefits of being outdoors and engaging in meaningful tasks, as well as associated benefits of increased social contacts.
Being involved in outdoor tasks which have a visible end result involves learning new skills – this all helps improve self-worth and self-confidence, essential for people in recovery from mental ill-health , especially those with depression.
A clinician’ view
“It’s great we still have this superb estate and that it is totally devoted to improving mental health and wellbeing. We are starting to take a second look at our Victorian inheritance and are rediscovering some of the ideas that our forbears had about how to improve our mental health. Common sense tells us that contact with the natural environment and making a contribution to someone or something beyond our own desires is good for us and research is starting to produce evidence to affirm this.”
Graham Buchanan, Child and Adolescent Mental Health Service, NHS Fife
- A forgotten expertise in using the benefits of being outdoors in a natural environment has been identified as a potential barrier to greater use of the grounds, so the horticultural therapy organisation Trellis will be engaged to deliver a training programme for staff.
- The project is ambitious, in scale and in its scope – establishing partnerships with other local organisations such as the Allotment Society, Cupar Fruit-growers Society has been essential to get the project established and will be essential in the future too to makes sure that it is sustainable.
- Though the grounds are seen as an essential part of the healing environment, and worthy of investment, it is also important that maintenance costs are kept at a realistic level. It is expected that there will for instance be a saving in grass-cutting costs with the partial replacement of close mown lawn with meadow areas. It is planned to plough back any savings made into site to work with the resident community, as well as the visiting public.
Acting Clinical Services Manager
Child and Adolescent Mental Health Service (CAMHS) and Clinical Effectiveness (Mental Health)
Tel: 01334 696251 (ext 56251)