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GARDENS OF THE MIND:

NATURE, POWER AND DESIGN FOR MENTAL HEALTH.

Kathleen Connellan, Clemence Due, Damien Riggs

Universit y of Sout h Aust ralia, Universit y of Adelaide, Flinders Universit y.
kat hleen.connellan@unisa.edu.au

ABSTRACT
Nature, gardens and greenery are necessary to the
healing of the mind. This paper discusses the
integration and use of open spaces and ‘gardens’
INTRODUCTION
in mental health units. There is ample evidence Though not hing can bring back t he hour
of spl endour in t he grass, or gl ory in t he f l ower;
that gardens and gardening can relieve stress but We wil l grieve not , rat her f ind
how are gardens designed into mental health units St rengt h in what remains behind;
to facilitate this known fact? (Cooper Marcus and
(Wordswort h, 1954, 157).
Barnes, 1995; Pretty, 2004; Simpson, 1998). The
results of an ethnographic observational study in a
We have called t his paper ‘ Gardens of t he mind’ wit h
purpose built mental health unit in Australia form
t he subt it le of nat ure, power and design for ment al
the basis for the discussion but this study is also
healt h, because of t he int imat e relat ionship bet ween
situated within global debates on design for
t he mind - it self a place of growt h incorporat ing all
improving mental health. One of the key issues
kinds of consciousness – and t he physical cont ext in
emerging from the literature is the importance of
which it exist s. In applying t he ideals of t he English
natural settings in the reduction of stress for
Romant ic poet William Wordswort h (who as a
mental health clients and clinicians (Daykin, et al.,
Pant heist , saw God in t he design of a flower), we
2008; Sitchler, 2008; Day, 2004; Ulrich, 2008;
invest igat e t he int erplay bet ween nat ure and t he
Andes and Shatell, 2006). We situate the
movement of t hose housed and working in purpose
discussion within the context of contemporary
designed ment al healt h unit s. In so doing we
debates, we also bear historical examples in mind,
comment upon t he effect s and usefulness of
especially in relation to power relations that are
part icular t ypes of garden (i.e. gardens designed in a
designed into the spaces. However our focus is the
specific way which do or do not correlat e wit h t he
contemporary purpose built mental health unit.
lines and language of t he archit ect ure). And we
The paper questions relationships between the
int errogat e t he power relat ions which might operat e
outside garden and the inside ward in terms of
in designed gardens. In t his way we quest ion if
power and healing. Specifically it looks at how
indeed such out side spaces can funct ion as places of
gardens operate as sites for healing in a harsh built
healing for t roubled minds.
environment. Additionally we ask how open
The chief source of our dat a is t aken from an
spaces are used by mental health clients and how
observat ional st udy conduct ed in a recent ly
the ‘gardens’ integrate with the overall
complet ed ment al healt h unit in Sout h Aust ralia (our
architectural design of mental health units.
research met hod is out lined in det ail below). One of
t he fact ors mot ivat ing t his research was t he fact t hat
Keywords: Gardens; Mental Health; Power.
exist ing research on t he relat ionship bet ween ment al
healt h and archit ect ure st ill lies wit hin t he broader
sphere of general healt h and archit ect ure, and as
such ment al healt h and archit ect ural design is an
DIVERSITY AND UNITY
area of research t hat requires more at t ent ion. Two
lit erat ure reviews published in 2008 and 2010 open
up t he breadt h of research t hat is necessary t o
develop healt hcare design. These are Ulrich et al.
(2008) and Dobrohot off and Llewellyn-Jones (2010).
Ulrich et al. focus specifically on “ evidenced-based
healt hcare design” (2008, p. 101), in which t hey not e
t hat t here is bot h a direct and indirect relat ionship
bet ween nat ure views and reduced depression;
reduced lengt h of st ay; increased pat ient
sat isfact ion; decreased st aff st ress and increased
st aff sat isfact ion (2008, p.148). Dobrohot off and
Llewellyn-Jones st at e t hat key design issues such as
direct access t o enclosed gardens and quiet areas
result in a product ive environment (2010, p. 5). The
int ent ion of our paper is t o pose addit ional quest ions
and make some suggest ions regarding t he design and
use of gardens, which can be used t o facilit at e
cooperat ion bet ween archit ect ure, design and
ment al healt h care.
THE ASYLUM IN A GARDEN
Ninet eent h cent ury ment al inst it ut ions in England
and it s colonies were more oft en t han not built in
t he count ryside wit h large grounds for client s t o use.
This was a t ime of height ened Vict orian awareness of
t he remediat ing qualit ies of count ry life. Hickman
(2009) not es t he emphasis placed upon nat ure and
t he rolling landscape as a prevent ion for “ immoral
act ivit ies” (2009, p.435). It was believed t hat t he
garden at mosphere inst illed a sense of t he “ Garden
of Eden” and brought t he pat ient s closer t o God.
Added t o t his was t he rural work et hic, wit h labour
in t he veget able gardens seen as a cleansing act ivit y.
The geographic dist ance from t he cit y was regarded
as essent ial because of prevailing beliefs t hat
indust rialisat ion was a cause of insanit y (Hickman,
2009, p.438). This view was support ed by English
Romant ic poet ry, landscape paint ing, and t he
affiliat ed Pre Raphaelit e and Art s and Craft s
movement s. Poet s like William Wordswort h, John
Keat s and John Dunn drew at t ent ion t o what t hey
believed was being lost as a result of urbanisat ion.
Wordswort h in part icular bemoaned t he loss of
innocence gained from experience in a nat ural
set t ing, and landscape art ist s such as John Const able
port rayed rural idylls. Added t o t his t he Pre
2
Raphaelit e Brot herhood called back a lost medieval
age celebrat ing t he myst ery and magnificence of
nat ure. A ret reat t o nat ure was seen as a def ence
against t he onslaught of t he mechanical and
indust rial revolut ion for anyone of a sensit ive
disposit ion. On t his point , however, Hickman not es
t hat t here were class issues involved in t he responses
t o nat ure as a curat ive measure, st at ing t hat t he
elit e and “ educat ed” classes were more suscept ible
t o t he benefit s of nat ure (Hickman, 2009, p.431).
Many of t he asylums built in t he ninet eent h cent ury
were sit uat ed on elevat ed ground, t hus enhancing
t he views of rolling count ryside and t ranscending t he
feeling of walled gardens and court yards. Even t he
asylums built in t he cit ies t ended t o be posit ioned
where t hey could benefit from t he vist as provided by
ext ensive grounds. Large count ry house asylums were
not only built in recognit ion of t he benefit s of clean
air, nat ure and generous space; t hey were also
st ereot ypical of t he powerful manor house on t he
hill, presiding over it s domain. The house may have
signalled t he shelt ered domest icit y of a home in a
large garden on one level but large count ry houses
were symbols of t he ownership of more t han j ust
land. The house cont rolled t he lives, behaviour and
bodies of many people not least t he family; t he
dramas incorporat ed in many of t hese hist ories are
well est ablished in lit erat ure (Tromp, 2000). The
hierarchy of class and posit ion were unflinching and
accordingly exploit ed by t hose ‘ above’ t hem. In t his
way t he design of t he count ry house asylum was
caught up in t he language of imperialism, power and
cont rol. Therefore whilst t he house might have been
set in large grounds which conj ured up t he t ype of
romant ic past oral idyll longed for by t he art ist s
ment ioned above, it was also a darker got hic/
romant icism of despair, cruelt y and isolat ion. The
design was a facade for brut al syst ems of rest raint ,
where people were seemingly commit t ed t o a life of
peace in a gardened asylum but in realit y t he act ual
quart ers const it ut ed punit ive pract ices and ext reme
cruelt y. Philo (1997, p. 83) not es t hat such houses
where grounds were used f or apparent ly t herapeut ic
“ exercise” were in fact “ landscapes of fear” . It t ook
decades for t he malpract ices in secluded asylums t o
be exposed and some cont inued well int o t he
t went iet h cent ury (Morrall, 2000).

Figure 1. A ninet eent h cent ury ment al healt h building in Sout h
Aust ralia.[1]
THE RETREAT AND RETURN OF THE GARDEN IN
MENTAL HEALTH ARCHITECTURE
The t went iet h cent ury depart ure from
inst it ut ionalisat ion in ment al healt h was in many
ways a welcome exit from t he above ment ioned
harsh t reat ment s and seclusions in t he era of
asylums. Yet despit e t his much needed move away
from sit uat ions of depravit y and const raint in many
asylums of t he ninet eent h cent ury, Curt is (2009)
not es t hat in t he t ransit ion from inst it ut ionalisat ion
t o communit y care pat ient s of t he older inst it ut ions
report ed a love of t he large gardens and t hat t hey
had developed an at t achment t o t hem, so much so
t hat t hey ret urned t o walk in t hem where possible
(2009, p. 346). In one st udy conduct ed by Curt is in
East London, it is not ed t hat t he gardens in
cont emporary ment al healt h set t ings are not ‘ real’
gardens, because t hey are cramped and not large
enough for client s t o walk in and use. A respondent
who was a ment al healt h consult ant in Curt is’ st udy
says t he following about t he new hospit al sit e where
t he st udy was conduct ed in East London:
… t his probabl y was a quit e barren piece of l and –
so t hey have pl ant ed a whol e l ot of t rees, but I do
f ind it import ant t o have a whol e l ot more greenery.
What you j ust have, if a pat ient came out here, is a
car park t o wal k on. I t hink you can wal k behind t he
back or what ever, again, it ’ s not a park, it ’ s not a
l ovel y garden space t hat you can go and use … I
t hink t hat ’ s part of a need [t o] … al l ow peopl e t o go
out f or wal ks and t hat t hat t hey act ual l y have a
pl ace t o do t hat in (2009, p. 346).
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PRODEEDINGS IASDR2011
The cost of land and t he expense of upkeep for
gardens is an obvious issue in t he t went y-first
cent ury. Consequent ly t here is a growing movement
t owards t he development of dedicat ed “ healing
gardens” (Anant h & Smit h, 2008; Hart ig & Cooper
Marcus, 2006; Kahera, 2002; Munt & Hargreaves,
2009; Sherman, 2005; St ernberg, 2009; Ulrich, 2001).
In some inst ances t he healing garden incorporat es
Ancient East ern and Moorish influences wit h t he idea
of a garden “ cont aining an ent ire universe” (Kahera,
2002, p. 3), and in t hese inst ances imaginat ion is
used t o creat e dept h and illusions of space wit h
appropriat e plant s and wat er reflect ions. It appears,
however, t hat t he t erm is applied loosely and
int erpret ed variously by landscape archit ect s and
landscapist and garden cont ract ors. In some
examples of healing gardens included in archit ect ure
wit hin t he healt h sect or such as cancer wards,
t hemes such as “ Friendship Garden” or “ Garden of
Dreams” is used as a basis for sculpt ural feat ures,
furnit ure and ot her man-made const ruct ions in t he
garden (Sherman et al., 2005, p.170). In t his and
ot her examples, privat e donat ions t o commemorat e
t he loss of loved ones help t o fund t he gardens.
Curt is (2009, p. 346) not es t hat maint enance of t he
grounds are oft en t he responsibilit y of out side
companies and not under t he direct cont rol of
nat ional healt h. Such out -sourcing of services
cont ribut es t o a lack of communicat ion and
underst anding of t he holist ic healing qualit ies of
gardens. Generally t he lit erat ure indicat es t hat
funding is already in short supply for life t hreat ening
diseases and when it comes t o an addit ional MRI
machine versus a garden, it is t he usually t he
machine t hat holds sway. Despit e t his, gardens and
indoor greenery are becoming more prevalent in new
designs for hospit als. Gordon (2001, p. 191) writ es
t hat only now are hospit al administ rat ors and healt h
aut horit ies waking up t o t he realit y of mind body
healing and seeing t hat gardens which are used t o
heal can also save money f or t he hospit als as t hey
are “ less expensive t han medical t echnology” and
help t o ret ain qualit y st aff .
The int egrat ion of nat ure and t he built environment
generally are being t aken more seriously since t he
massive concret isat ion of cit ies in t he mid t o lat e
t went iet h cent ury wit h t he modernist emphasis on
DIVERSITY AND UNITY
large powerf ul buildings as symbols of ‘ progress’ .
As such, t he benefit s of a growt h of ‘ landscape
archit ect ure’ are slowly making an impact . Ian
McHarg wrot e in 1969 t hat we must design wit h
nat ure and not against it . More recent ly, Swaffield
(2002) not es t hat
“ We need nat ure as much in t he cit y as in t he
count ryside. In order t o endure we must maint ain
t he bount y of t hat great cornucopia which is our
inherit ance. It is clear t hat we must look deep t o t he
values which we hold. These must be t ransformed if
we are t o reap t he bount y and creat e t hat fine
visage for t he home of t he brave and t he land of t he
free. We need, not only a bet t er view of man and
nat ure, but a working met hod by which t he least of
us can ensure t hat t he product of his works is not
more despoliat ion” (p. 173).
However landscape archit ect ure is not wit hout it s
crit ics, for example Margo Huxley writ es, “ The
problems of t heory and pract ice in landscape
archit ect ure are a direct consequence of it s origins,
bot h t he in t he epist emological dominat ion of
masculinist rat ionalit y, t he obj ect ivism of
Enlight enment and modernit y, and in t he pract ice of
‘ landscaping’ in t he int erest s of landed arist ocracy,
newly-acquired capit al or t he st at e” (Huxley, 1994,
p. 36). Therefore, for design t o work well it needs t o
work wit h nat ure and not as an ext erior mechanism
of cont rol. Roger Fry, writ ing on design as polit ics,
argues t hat “ unsust ainabilit y arrives by design, and
as such negat es fut ures” (Fry, 2011, p.19). Fry calls
t his t ype of design “ def ut uring” , and under such a
regime ‘ beaut iful’ archit ect ural st ruct ures are
erect ed “ under t he aura of elegance” (Fry, 2011, p.
27) which are decept ive. Wit h t hese debat es about
archit ect ural innovat ion, concerns for healt h and t he
holist ic int egrat ion of nat ure int o unit s designed
specifically for ment al healt h in mind, we began our
st udy wit h syst emat ic observat ions of how client s
and st aff moved in and used t he purpose built
facilit ies. Our met hod is out lined below.
METHOD
The st udy was conduct ed in t he ment al healt h unit
of a large public hospit al in Sout h Aust ralia. Buildings
were complet ed in st ages bet ween 2009 and 2010.
4
The secure ward had a t ot al of 6 beds t hat were all
single rooms, and t hree bat hrooms wit h one disabled
bat hroom. The open ward cont ained 20 beds, and 10
bat hrooms wit h one disabled bat hroom and one
assist ed bat hroom. Bot h of t hese wards were
t ypically full t hroughout t he st udy.
ETHICS AND PARTICIPANTS
Et hics approval was grant ed from bot h t he Universit y
of Sout h Aust ralia’ s Human Research Et hics
Commit t ee and from t he Et hics Commit t ee of t he
hospit al involved in t he st udy. Client s, st aff and
visit ors at t he hospit al were informed of t he st udy
t hrough informat ion sheet s t hat were placed around
t he ward. St aff speaking t o t he second aut hor were
assured t hat anyt hing t hey said would remain st rict ly
confident ial, and t he informat ion sheet similarly
st at ed t hat no ident ifying informat ion would be used
in any publicat ions t hat arose from t he st udy. All
users of t he ward were inf ormed of t he t imes t hat
t he et hnography would t ake place (t ypically one day
a week for a t hree hour t ime slot ). The movement s
of client s, st aff and visit ors were observed
t hroughout t he et hnographic observat ions.
PROCEDURE
The second aut hor carried out et hnographic
observat ions on t en occasions for t hree hours each,
meaning t hat t his aut hor conduct ed a t ot al of 30
hours of observat ions. These observat ions were
conduct ed during bot h t he morning and aft ernoon
over a t en week t ime-period, and t he t ime was split
evenly bet ween bot h t he secure and t he open ward.
In t he open ward, t he second aut hor spent t ime bot h
wit hin and out side t he dut y st at ion, however in t he
secure ward t he maj orit y of t ime was spent
observing from wit hin t he dut y st at ion for securit y
and et hical reasons. Brief not es were t aken during
observat ions, however in order t o reduce t he amount
of t ime spent not e-t aking during observat ions t he
maj orit y of t he field not es were writ t en immediat ely
aft er leaving t he hospit al premises. In addit ion t o
t hese 30 hours, t he first aut hor also conduct ed four
hours of et hnographic observat ions ent irely f rom
wit hin t he wards, including t he secure ward. These
observat ions were conduct ed in order t o examine t he

use of space from where t he client s’ experience it .
Bot h t he first and second aut hors remained neut ral
during t hese t imes, rarely asking quest ions of st aff
unless wishing t o gain clarificat ion in relat ion t o a
part icular procedure or space. Where client s or st aff
asked eit her aut hor what t hey were doing, bot h
aut hors replied t hat t hey were observing t he use of
space and t he archit ect ure wit h t he ward.
Et hnography was chosen as t he met hodology for t his
st udy due t o t he fact t hat t he lit erat ure has
ident ified it t o be appropriat e for use in healt hcare
set t ings, and has been used before (Johansson,
Skärsät er & Danielson, 2006; Savage, 2000) In
part icular, et hnographic observat ions are t ypically
unobt rusive and allow t he researcher t o develop a
flexible approach t o bot h underst anding an
environment , and t o gaining insight int o t he
relat ionships bet ween t hat environment and t he
behaviour of t he people wit hin it .
ANALYTIC APPROACH
Once t he observat ions were finalized, t he field not es
were analyzed using t hemat ic analysis, following t he
approach laid out by Braun and Clarke (2006). In
t heir paper, Braun and Clarke (2006) provide rigorous
guidelines for conduct ing t hemat ic analysis in
qualit at ive research wit hin t he broad st udy of
psychology and t hese guidelines were followed in
each st age of t he analysis of t he field not e dat a.
Init ial analysis of t he ent ire corpus revealed a
number of t hemes. These included (in order of
significance): t he use of t he dut y st at ion by bot h
st aff and client s; doors and passages; t he use of glass
in bot h wards; t he use and effect s of gardens and
plant s; t he choice and posit ioning of visual art in t he
wards; and t he use of colour. Correspondingly
ext ract s from t he dat a concerning t hese t hemes
were f urt her analyzed in order t o reveal t he pat t erns
of use of t his space. Each t heme is researched as a
separat e paper and t he result s of t he analysis of t he
use of gardens and plant s are present ed below.
FINDINGS
As discussed above, a concern in relat ion t o t he
design of ment al healt h unit s is t he design of
gardens. In t he analysis t hat follows we examine t he
5
PRODEEDINGS IASDR2011
use of garden spaces in bot h t he High Dependency
Unit (HDU - t he locked ward) and t he open ward. Our
et hnographic research not ed bot h similarit ies and
differences bet ween t he use of gardens in t hese t wo
spaces, which we discuss below.
ETHNOGRAPHIC OBSERVATIONS OF GARDEN USAGE
The sit e of our st udy was a purpose designed ment al
healt h unit complet ed in 2010, and t he gardens were
approximat ely six mont hs old when we commenced
observat ions. The ent rance for visit ors and st aff is
via t he main ent rance t o t he ment al healt h ward,
and is surrounded by a car park (figure 2). However,
t his ent rance is not used for t he admission of client s,
who are inst ead admit t ed via an int ernal corridor
from t he main hospit al (figure 3). When ent ering
direct ly int o t he ward t hrough t he main ent rance,
t he t ransit ion from ext ernal t o int ernal space
t hrough t he main ent rance is from light t o light and
upon ent ering one is immediat ely aware of an
adj acent enclosed garden. However t he j ourney
made by client s coming from t he emergency sect ion
or t he general wards of t he main hospit al int o t he
ment al healt h ward is int ernal wit h lit t le t o no views
of out side spaces. As client s j ourney int o t he ment al
healt h ward wit h st aff, t he first space t hey ent er is
t he seclusion corridor, which has doors opening int o
rooms for st abilising client s. In t his corridor t here is
only one high rect angular window, which offers a
piece of sky wit h some wat t le branches and can be
viewed whilst t he pat ient is escort ed t hrough t his
area. The shut t ing off of nat ure seen in t his ent rance
can serve t wo purposes. First ly, it could be argued
t hat being separat ed from out side space provides a
sense of securit y from t he anxiet ies t hat client s
st ruggle wit h on t he out side and t herefore helps
t hem f eel safe especially if t hey are suicidal. On t he
ot her hand, however, t he effect of t his seclusion
may cause some client s t o feel claust rophobic. These
lat t er client s may in fact benefit from a swift er
t ransit ion int o t he HDU ment al healt h ward, where
t here is ample light but also absolut e securit y from
t he ext erior. The language of t he archit ect ure
favours t hose who require more securit y.
DIVERSITY AND UNITY

st at ion and out side t he ward. It is, however, not a

part of t he landscape design of t he int ernal gardens,
but rat her is merely a t ree wit h benches beneat h it
on t he edge of t he car park bet ween t he public road
and t he hospit al (see figure 4). The second aut hor
not ed t hat almost every t ime she came t o t he
hospit al t o conduct observat ions, t here were people
sit t ing smoking under t he t ree. The car park
adj acent t o t he t ree is relat ively busy and t herefore
t his ‘ t ree spot ’ does not offer a ret reat int o nat ure
but inst ead it offers an informal and unst ruct ured
Figure. 2. Main ent rance t o ment al healt h unit .
space for client s. It is almost direct ly opposit e t he
main ent rance t o t he ment al healt h unit and
t herefore a short walk t akes client s back inside.

Figure 3. Admissions corridor t o ment al healt h unit .

Once in t he ward(s), an abundance of glass in t he

open plan eat ing and recreat ion areas of bot h t he
HDU and open ward flood t he int erior wit h light in
most weat her condit ions. Large window walls look Figure 4. The t ree used f or smoking, chat t ing or relaxing
out upon all garden areas, irrespect ive of whet her beneat h.

t hey are accessible t o t he client s. One of t he result s

We will now describe t he t wo gardens designed for
of t he ext ensive use of glass is a feeling of openness
t he open ward and discuss t heir usage. We will refer
in t he shared spaces and a sense of int erior –ext erior
t o t hem as Garden 1 and Garden 2.
spat ial flow. Connellan et al. (2011) not e t he
ambiguous realit ies evoked by t he mult iple
The doors out t o Garden 1 are st urdy aluminium
reflect ions of nat ure and people in ment al healt h
framed glass doors wit h large handles. The area has
wards. The barriers of glass bet ween a garden which
t hree wat t le t rees t hat are st ill quit e small and six
is accessible t o client s and a garden which is
wooden benches in pairs under t he t rees. The area is
inaccessible t o client s are also a concern of t his
covered wit h pebble pat t erned concret e pavers and
paper because of t he ambiguous messages t hat such
art ificial grass. There are exercise bikes under an
archit ect ural feat ures might communicat e t o client s.
awning against red brick walls (figure 5). On one
THE OPEN WARD occasion a t able-t ennis t able was set up in t his area
but was not observed in use.
There are t wo dedicat ed out side areas locat ed
wit hin t he confines of t he ward which client s in t he
open ward have access t o, alt hough visit ors are not
permit t ed in t hese enclosed garden areas. Client s in
t his ward may also ask permission t o go out side t he
main ent rance t o sit beneat h a t ree alongside t he car
park. This t ree is a favourit e amongst client s, as it
Figure 5. Exercise equipment in Garden 1.
places t hem beyond t he surveillance of t he dut y

6

The area has shrubs in neat rows under t he windows
and beside t he grey corrugat ed iron ext erior walls.
The main building of t he general hospit al forms t he
backdrop on one side. This façade of t he main
hospit al is covered wit h a grey grill rising up several
st oreys. It is not a soft leafy space but more like a
court yard t hat is easy t o maint ain. The inclusion of
plant s echoes t he severe lines of t he building and
repeat s t he st raight archit ect ural lines wit h narrow
rows of spiky grasses (figure 6). Garden 1 is clearly
visible from t he cent rally sit uat ed dut y st at ion in t he
open ward and alt hough cameras operat e
t hroughout , it is easier for st aff t o look t hrough t he
glass windows t han t o survey t he client s in any ot her
way. Garden 1 was used by client s much more t han
Garden 2.
Figure 6. Garden1.
The t able below is ext ract ed from t he dat a which
recorded t he number of client s in specific spaces at
15 minut e int ervals. This t able shows t he t ot al
amount of t ime t hat spaces were used in t he 15 hour
observat ion period per ward (over t he t ot al of 30
hours split bet ween wards). The t able does not
summarise t he number of people over t he period
because some people would be count ed more t han
once t hus skewing t he figures. However bearing in
mind t hat t he maximum number of occupant s at any
one t ime in t he open ward is 20, t he maximum
number in one 15 minut e slot is provided in t he
second column.
7
PRODEEDINGS IASDR2011
Act ivit y Tot al % Max. %
hrs people
Using 0.75 5% 2 30%
exercise
equip.
Smoking/ 4.4 29% 5 83%
sit t ing/
walking
Table 1. Garden 1 Open Ward usage.
Psychiat rist s were not observed using t his space t o
consult wit h t heir client s, nor were nursing st aff
observed relaxing in t his space.
Smoking is discussed below but it became quit e clear
at an early st age in t he observat ions t hat more
client s went out side t o t he garden areas t o smoke
t han t o do anyt hing else (see Table 1 above).
Records in t he observat ion not es frequent ly indicat e
t hat client s were seen eit her in small groups smoking
and t alking t oget her, or sit t ing alone and smoking.
Indeed, t he fact t hat t his was one of t he primary
reasons for going out side is reinforced by t he
observat ion t hat t he out side spaces were used less
once smoking was banned in t he hospit al.
The second aut hor not ed t hat Garden 1 (see figures 5
and 6) was a very popular area for open ward client s,
but not quit e as popular as t he t ables which are used
for chat t ing and/ or craft act ivit ies out side of meal
t imes. The open ward is larger t han t he closed
ward, wit h t wo t elevision set s, a piano and a pool
t able. Client s can also make t heir own t ea and
coffee, which t hey do on a regular basis.
Garden 2 (Figures 7 and) is slight ly f urt her from t he
cent ral dut y st at ion and t herefore less visible t o
st aff. It has several large lavender bushes which
were in flower during t he period of our st udy. There
are five wat t le t rees which were st ill smallish at t hat
t ime, wit h a t ot al of eight wooden benches beneat h
t he t rees in t his area. This area is plant ed wit h hardy
geraniums, rows of nat ive grasses and ot her drought
resist ant plant s wit h long slender green leaves. One
of t he perimet ers is a blue grey corrugat ed iron
DIVERSITY AND UNITY

fence. There is a large expanse of sky above t his Whilst looking out , a client coming t hrough on his
area. way t o have a smoke under t he t ree approached t he
first aut hor ent husiast ically saying: “ Can you see t he
spider? The web is awesome!” He was proud of t he
web and it seemed t here was some propriet y in t he
spider and it s web; it was as if t his was t heir spider
t hat was making his way in life in t his small walled
garden. Upon furt her conversat ion wit h t he client , it
became clear t hat t his spider was a source of
int erest and j oy t o some of t he client s. Here was
somet hing wild making a home for it self
met hodically and beaut ifully bet ween t wo gloriously
flowering t rees. During t his t ime, an elderly client
from t he aged care unit ent ered t hat garden space
Figure 7. Garden 2.
and sat on a bench looking at t he spider’ s web. He
was st ill t here when t he aut hor left fift een minut es
lat er.

Figure 8 Garden 2.
Figure 9. View out of recept ion windows.
During t he course of our observat ions, client s hardly
ever went out t o t his space. As was t he case wit h
Garden 1, psychiat rist s did not use t his space t o
consult wit h t heir client s and nursing st aff were not
observed relaxing in t his space. The second aut hor
not ed t hat t he space might have been locked at
t imes. It appeared curious t hat t his space was
virt ually unused because alt hough t here is a lot of
hard concret e and plant s are laid out in a st rict ly
geomet ric order, t his garden is soft er and more
aest het ically pleasing t han Garden 1.
A final not at ion from t he et hnographic not es
Figure 10. The spider web bet ween t wo f lowering t rees.
highlight s t he significance of gardens for client s. The
first aut hor was wait ing in t he recept ion area and
looking out ont o t he rect angular garden which was
accessible t o t he aged care client s, and which HDU (High Dependency Unit / Closed Ward)
provided a garden view t hrough t he large glass walls
The out side area (figures 11 and 12) t hat is
of t he ment al healt h recept ion area (see figure 9).
accessible t o client s in t he HDU has no plant s. It is
An elaborat e spider web sparkled in t he light
covered wit h a circular design of concret e paving
bet ween t wo flowering peach t rees (see figure 10).

8

which also has four ‘ pat hs’ off t he cent re (which is a
sunken square drain). Bright green art ificial grass
glist ens bet ween t he concret e paving. There are t wo
met al benches on t he far end of t he space. This
court yard is surrounded by a barrel-curved t in
overhanging roof support ed by aluminium pillars t hat
echo t he window frames of t he surrounding glass
walls. These cont rast wit h t he solid red brick
ext erior wall. Client s used t his space t o smoke,
speak privat ely on t he t elephone when t hey had calls
from family, and as a space t o sit or walk in. Client s
generally went out side alone but on occasions t hey
were observed speaking t o ot her client s. As visit ors
were not allowed in t he HDU at all, t hey were also
not permit t ed t o ent er t his space. Psychiat rist s did
not use t his space t o consult wit h client s (rat her,
t hey made use of t he int erview rooms) and nursing
st aff only went int o t he space t o see t o t he needs of
client s.
Figure 11. The court yard in HDU.
Figure 12. The court yard in HDU.
On Day 2 of our st udy t he second aut hor not ed t hat
when she commenced at 9.30 am in HDU,
9
PRODEEDINGS IASDR2011
Most cl ient s are out side [‘ out side’ is t he t erm used
in t he not es for all ext erior spaces] when I arrive.
They are al l pacing around and around t he
court yard, but in dif f erent direct ions and at
dif f erent speeds.
It could be suggest ed t hat t his t ype of walking was
more accept able out side as opposed t o inside, where
client s were more oft en observed walking slowly up
and down t he bedroom corridor or round and round
t he recreat ion areas. One reason for t his could be
t hat walking in t his manner could upset ot her client s
inside, but nevert heless it is int erest ing t o not e t hat
client s used t he out side space in t he HDU as a
pot ent ial space for release of frust rat ions, or t o be
alone.
St ill on Day 2 t he ext ract below is t aken f rom
observat ions in HDU by t he second aut hor and
isolat es t he act ivit ies of ‘ J’ a male client (t here
were only four client s in HDU on t his day of
observat ion):
2 men remain out side wal king around perimet er. J …
comes out (of his bedroom) and begins wal king up
and down t he corridor t rying al l t he doors and
l ooking inside t hem but not ent ering. He t hen wal ks
over t o where st af f are t aking S’ s bl ood and st art s
t al king t o st af f t here. I can’ t hear t heir conversat ion
but it seems t hey suggest t hat he go out side and
t hen 1 st af f member t akes him t o get him a drink.
Whil e she does t his he approaches t he nursing
st at ion door which hasn’ t cl osed properl y f rom
someone coming in (door cl oses quickl y at f irst but
t hen sl owl y at t he end and t his may t ake a second).
J comes up and pushes door open – anot her st af f
member says ‘ l eave it cl osed pl ease’ and pushes it
cl osed. J t hen t akes his drink f rom t he ot her st af f
member and t ips it out side. S paces corridor f or a
bit and t hen goes back out side. J approaches door
again and asks f or smokes, but wanders of f whil e
st af f member get s t hem. J wanders back up corridor
and punches gl ass wal l at end and nurse goes out t o
have conversat ion wit h him and t hen t akes him
out side wit h his smokes. [A lit t le lat er] J get s
bored (I guess) and goes up t o where G is sit t ing at
t abl es and chairs, want ing t o give him a dr ink – but
G doesn’ t want it . St af f go out t o int ervene and see
what is going on. … G get s up, wanders out side and J
DIVERSITY AND UNITY
t akes his seat wit h his drink. G goes out side and
st art s pacing around.
J comes up t o [dut y st at ion] window f or a whil e wit h
his cup and pours cordial over t he bencht op. St af f
immediat el y go out and t ake it f rom him. J t hen
wanders out side and st art s t al king t o G again – a bit
aggressivel y and t hen comes t o window again and
asks f or st af f who goes out and t el l s him t o st op
coming up and t o go f or a wal k inst ead. St af f comes
inside but J st ays out side door and doesn’ t go
anywhere, j ust wat ches what is going on.
The ext ract above is one example of a client in t he
HDU showing signs of frust rat ion. The int erior space
is relat ively small and if client s are rest less t heir
rest lessness fills t he space. Despit e t he illusion of
space creat ed by glass walls, client s in HDU do not
have many opt ions for movement or ent ert ainment .
During t he course of our observat ions, no organised
act ivit ies (e.g. craft or cards) t ook place at t he
t ables locat ed wit hin t he HDU – alt hough client s
were observed doing some drawing - and t he only
ot her ent ert ainment was offered by t he t elevision or
some magazines on general t hemes piled on t he shelf
in t he TV area. As is evident from t he above ext ract ,
J was annoyed and might have felt rest rict ed and
t hus became difficult . The out side space provided
some relief but was clearly inadequat e.
Therefore, it seems reasonable t o conclude t hat t he
out side space in HDU is used as a t ime-out space
when client s were more t han usually irrit able, a
place for exercise (even pacing t he perimet er) and a
place for smoking. (We not e below t hat smoking was
banned on t he hospit al grounds t owards t he end of
our et hnographic st udy).
On one day when t he first aut hor was observing in
t he HDU, t here was a round ball resembling a soccer
ball lying in t he cent re, but no one used it for t he
t hree hours of t he observat ion on t hat aft ernoon. It
was a sult ry, overcast day wit h t he prevailing grey
colours of t he aluminium and corrugat ed met al
mixing wit h t he relat ively small sect ion of visible
grey sky. Despit e t he lack of plant s t o absorb t he
heat , t he out side space in HDU does provide f resh as
opposed t o condit ioned air. One of t he female
10
client s (K) was feeling t he heat on t hat day. Below is
an ext ract which illust rat es t he at mosphere:
K t el l s me she is hot and t hat she has a swimming
pool . “ My husband um boyf riend l oves get t ing in and
so do I” . Then she f ans hersel f and says ‘ It ’ s hot in
here’ and moves of f . Af t er a whil e K asks me if I
want somet hing t o drink. She is very cheerf ul . Her
psychiat rist arrives and t hey go t o an int erview
room.
Lat er she get s bol shy at t he nurses’ st at ion, she
want s t o t al k wit h her brot her and is event ual l y
al l owed t o. She t el l s him how she was f ound wit h
cut s et c and t hen put int o a room and how she had
needl es st uck int o her. A f ew minut es l at er K is
crying, she bangs on t he door t o go out side and says
she want s a smoke. Lat er K opens a l et t er t hat a
mal e nurse brings her. She opens it and says l oudl y:
“ Annie! [t he name we give t o t he senior nurse] ! I
have t o be here f or 7 days! Geez, he’ s st rict ” .
Annie comes in and says “ t he way t o get out of here
is t o be l ow key and behave. The no-smoking t hing is
a pol icy” .
Again, t he space in t he HDU is remarkably small
when personalit ies as large as K’ s brim over. There
are no ext ensive gardens t o wander in, no secluded
shady areas t o cry in, and no real relief from t he
heat t hat is generat ed from t he climat e and f rom
anger. K longed t o go back t o her boyfriend and
family where it was clear t hat she had a great family
support syst em, but also clear t hat she t est ed her
loved ones t o t heir limit . K had a ‘ larger t han life’
personalit y coupled wit h her own part icular
condit ion and t he space available for her t o heal in
did not suffice.
Towards t he end of t he t hree mont h period of our
observat ions, a smoking ban was implement ed in all
of t he hospit al buildings, int ernal court yards and
hospit al grounds. This had a direct effect upon t he
ment al healt h client s in t he HDU who were not
allowed out of t he secure unit . Almost all HDU
client s were smokers, and when t his ban was
implement ed, addit ional nicot ine t herapy was
provided but t he out side area had now lost one of it s
funct ions as a smoking space. The second aut hor

not ed t hat t he out side space in t he HDU was used
significant ly less aft er t he smoking ban.
The t able below (like t he one above for t he open
ward) is ext ract ed from t he dat a which recorded t he
number of client s in specific spaces at 15 minut e
int ervals. This t able shows t he t ot al amount of t ime
t hat t he out side space was used in t he 15 hour
observat ion period. As ment ioned for Table 1, t he
t able below does not summarise t he number of
people over t he period because some people would
be count ed more t han once t hus skewing t he figures.
However bearing in mind t hat t he maximum number
of occupant s at any one t ime in HDU is 6, t he
maximum number of people in a 15 minut e slot is
provided in t he second column under ‘ people’ .
Act ivit y Tot al % Max. %
hours people
Smoking/ 5.25 35% 4 66%
sit t ing/ hrs
walking
Table 2. HDU court yard usage
To be out side for 35%of t heir waking hours is a lot of
t ime for people who are all variously out of kilt er
wit h t he demands of t hemselves, t heir relat ionships
and t he out side world. More conclusions will be
drawn at t he end of t his paper but at t his st age
suffice t o say t hat t he client s in HDU need more
space t o ‘ get away’ .
As ment ioned earlier, an ext ensive use of glass
creat es a light filled ward, but in some inst ances
provides views of gardens t hat are not accessible t o
client s. One of t hese views is from t he TV lounge of
t he HDU ward which looks direct ly ont o a garden but
also shows a view of t he main hospit al and includes
t he large car park (see figure 10 below). It is t he
only view of t he out side world for HDU client s, yet
t his is an out side world t hat is bot h denied t o t hem
and simult aneously present ed t o t hem t hrough a
large pict ure glass window wit h an at t ract ive garden
bed as a buffer. The plant s in t he garden direct ly
out side t he window were already quit e dense during
our observat ion period. The foliage may also have
been plant ed t o obscure a deep view bot h inside and
out whilst st ill providing t he client s in HDU wit h a
11
PRODEEDINGS IASDR2011
pict orial/ garden view. The quest ion is whet her t his
image of t he out side was t easing or soot hing for
client s; t here are benches j ust beyond t he plant ed
area for general seat ing (alt hough t hey were vacant
during our observat ions). Client s could look out ont o
st rangers passing by or sit t ing on t he bench in a
garden which t hey knew t hey could not gain access
t o and t hose st rangers could also peer t hrough t he
foliage int o t he HDU ward, if so inclined. The power
of t he window t o bot h present and deny is a design
feat ure which requires et hical considerat ion in t he
case of acut e ment al healt h client s.
Figure 13. The window in t he TV lounge of HDU.
CONCLUSIONS
Before embarking on our conclusions, it is import ant
t o consider t he limit at ions of t his st udy so t hat our
findings are not overst at ed. Consequent ly, our chief
limit at ions lay in t he rest rict ions put upon us by t he
et hics commit t ees: i.e. we could not conduct
int erviews wit h st aff or client s, we could not observe
client s’ bedrooms and we could not access client
records. Aft er t hese and ot her publicat ions from
t his, our pilot st udy, we are hopeful t o gain more
permissions for deeper st udies. These fut ure st udies
will look at dat a from different sit es comparat ively
and also consider how client s connect wit h nat ure in
more specific ways.
Whilst in t he t it le of t his paper we refer t o t he
out side spaces in t he ment al healt h unit in which we
undert ook our observat ions as ‘ gardens’ , as we
progressed t hrough t he issues under discussion in t his
paper it became more and more difficult t o call t he
spaces gardens wit h any kind of convict ion. Inst ead,
t hey became more like court yards, walled
enclosures, or in t he case of t he HDU, j ust a yard.
DIVERSITY AND UNITY
These are meaner t erms and spaces t han t hose
evoked by t he generosit y of t he t erm ‘ garden’ . This
was part icularly t he case in t he HDU, which oft en
appeared t oo small t o cope wit h t he t ension t hat we
were able t o see (t here were days when our
et hnography could not t ake place and had t o be
rescheduled because we were advised t hat accessing
t he space would not be safe on t hat part icular day).
In t he open ward, only one court yard (garden 1) was
ut ilized, t hough it is likely t hat a st aff short age did
not make t he ot her one (garden 2) fully accessible t o
client s. The t ree out side t he front of recept ion was a
favourit e spot , and alt hough we do not have figures
on t his as it was out side of our observat ions, t here
were rarely occasions when we arrived during t he
t hree mont h period t o find t he benches under t he
t ree empt y. Somet imes client s would be lying on t he
benches j ust looking at t he leaves and t he sky and
most t imes t hey would be smoking and chat t ing. But
it was not only client s who used t his spot it was
oft en used by clinicians and doct ors, especially if
t here were no client s t here.
This example of client s and st aff t aking up any
opport unit y t o spend t ime in nat ure out side t he built
environment suggest s t o us t hat illusions of nat ure
are insufficient . This is part icular of import given t he
fact t hat neit her st aff nor client s can alt er t he
st ruct ure of t he spaces t hey are required t o move in.
Therefore, alt hough t he cont emporary ment al healt h
unit is a far cry f rom t he old punit ive asylum, it is
nonet heless t he case t hat t hey cont inue t o fail t o
meet some of t he basic needs of bot h client s and
st aff t o have an ongoing connect ion t o t he world
beyond t he walls of t he inst it ut ion.
As a correct ive t o t his failure, we suggest t hat t here
should be gardens for st aff and for client s and t hese
could have f eat ures including (where appropriat e)
sculpt ure, wat er, nooks for quiet ref lect ion and grass
t o lie and sit on. Gordon’ s (2001) research suggest s
t hat healing gardens are in fact a cost saving device
because client s heal more quickly and t here is less
st aff t urnover. Gordon draws on Cooper Marcus’ work
and not es t hat “ healing gardens are a ‘ lot less
expensive t han t he lat est medical
t echnology’ ” (2001, p. 191) and t hat a 697 bed
medical cent er in Phoneix found t hat t heir “ large
12
out door garden filled wit h plant s and t rees
indigenous t o Arizona, found improvement in t heir
abilit y t o ret ain qualit y st aff by providing a place for
t hem t o go t o overcome t he st ress of t he j ob” (2001,
p. 191). Addit ionally, ment al healt h facilit ies could
include paint ings t hat include nat uralist ic gardens
which could complement nat ural places t hat client s
could relat e t o, and more imaginat ive use could be
made of int erior plant s, combining different foliage
and scales of plant s.
To conclude, Wordswort h wrot e in his Ode t o
Int imat ions on Immort al it y t hat we must regain
st rengt h in what remains behind. He was t alking
about t he passage t hrough life and t he dist ance
bet ween t he garden of childhood innocence and t he
bleakness of adult responsibilit y. Wit hout over
romant icising t he issue, it remains t o be asked
whet her t he “ prison house” (1954, p.154) which
Wordswort h used as a met aphor for t he loss of
innocence can be circumvent ed in t he case of ment al
healt h inst it ut ions by ret aining and not losing nat ure.
By ensuring t hat t he grass is real, t he plant s and
surfaces are varied and nat ural, and t he lines of
out door space design are not exclusively st raight , it
may be possible for such spaces t o t ruly be
const it ut ed as gardens t hat can play a posit ive role
in t he healing of client s in ment al healt h facilit ies.
NOTES
1. All phot ographs in t his paper are t aken by t he
aut hor.
REFERENCES
Anant h, S., Smit h. K. (2008) Hospit al init iat ives: a pilot survey of
healing programs. Explore, Vol. 4, No. 5, 332- 334.
Andes, M., Shat t ell, M.M. (2006) An explorat ion of t he meanings of
space and place in acut e psychiat ric care. Issues in Ment al Healt h
Nursing, Vol. 27, 699-707.
Braun, V., Clarke, V. (2006) Using t hemat ic analysis in psychology.
Qualit at ive Research in Psychology, Vol. 3, 77-101.
Connellan et al. (2011) Light Lies: How does glass communicat e in
a ment al healt h unit ? In: G. Goggin & C. Loeser (Eds.), ANZCA
2011: Communicat ion on t he edge: Shif t ing boundaries and
ident it ies, July 6-8 July, Hamilt on, New Zealand, in press.
Cooper Marcus, C., Barnes, M. (1999) Gardens in healt hcare
f acilit ies: t herapeut ic benef it s, and design recommendat ions.
Hoboken: John Wiley.
 PRODEEDINGS IASDR2011

Curt is, S. et al. (2009) New spaces of inpat ient care for people
wit h ment al illness: A complex ‘ rebirt h’ of t he clinic? Healt h
&Place, Vol. 15, 340–348.
Day, C. (2004). Places of t he Soul: Archit ect ure and
Environment al Design as a Healing Art . Oxford: Archit ect ural
Press.
Daykin, N., Byrne,E., Sot eriou,T., O'Connor, S. (2008) Review: The
impact of art , design and environment in ment al healt hcare: a
syst emat ic review of t he lit erat ure. The Journal of t he Royal
Societ y f or t he Promot ion of Healt h. Vol. 128, No. 2, 85 – 94.
Simpson, S. P., St raus, M. C. (1998). Hort icult ure as Therapy:
principles and pract ice. New York: Hawort h.
St ichler, J.F. (2008) Healing by design, Journal of Nursing
Administ rat ion, Vol. 38, No. 12, 505 -509.
St ernberg, E. (2009) Healing Spaces: The Science of Place and
Well-Being. Cambridge, MA: Belknap Press of Harvard Universit y
Press.
Swaffield, S. (2002) Theory in landscape archit ect ure: A reader.
Philadelphia: Universit y of Pennsylvania Press.

Dobrohot off, J. T., Llewellyn-Jones , R. H. (2010) Psychogeriat ric Tromp, M., Gilbert , P & Haynie, A. Beyond Sensat ion: Mary
inpat ient unit design: a lit erat ure review. Int ernat ional Elizabet h Braddon in Cont ext . (2000) New York: St at e Universit y
Psychogeriat rics, Vol. 23, No. 2, 174-189. of New York.

Fry, R. (2011). Design as polit ics. Oxford: Berg.
Gordon, R. J. (2001) Hospit al Init iat ives and complement ary
healt h pract ices. Complement ary Healt h Pract ice Review, Vol. 6,
No. 3, 191- 192.
Ulrich, R. (2001) Effect s of Healt hcare Environment al Design on
Medical Out comes. Proceedings of t he Second Int ernat ional
Conf erence on Design and Healt h. Proceedings of t he Second
Int ernat ional Conf erence on Design and Healt h, St ockholm,
Sweden, 49- 59.

Hart ig, T., Cooper Marcus, C. (2006) Healing gardens-places for Ulrich, R., et al. (2008) A review of t he research lit erat ure on
nat ure in healt h care. The Lancet : Medicine and Creat ivit y, Vol. evidence-based healt hcare design. Healt h Environment s Research
368, 36-37. & Design Journal, Vol. 1, No. 3, 61-125.

Hickman, C. (2009) Cheerful prospect s and t ranquil rest orat ion: Wordswort h, W. (1954) Int imat ions of immort alit y from
t he visual experience of landscape as part of t he t herapeut ic recollect ions of early childhood, 1802-1804. In C. Baker (ed).
regime of t he Brit ish asylum, 1800–60. Hist ory of Psychiat ry, Vol. William Wordswort h: The Prelude, select ed Poems and Sonnet s,
20, No. 4, 425–441. New York: Rinehart , 152- 158.

Huxley, M. (1994). Escaping t he cult ure: Landscape archit ect ure

and praxes of empowerment . In: H. Edquist & V. Bird (Eds.), The
Cult ure of Landscape. Melbourne: Edge, 35 – 42.

Johansson, I. M., Skärsät er, I. & Danielson, E. (2006) The healt h-

care environment on a locked psychiat ric ward: An et hnographic
st udy. Int ernat ional Journal of Ment al Healt h Nursing. Vol. 15,
242–250.

Kahera, A. I. (2002) Gardens of t he right eous: Sacred Space in

Judaism, Christ ianit y. Crosscurrent s, Vol. 52, No. 3, 328 – 341.

McHarg, I. (1995). Design wit h Nat ure. 25t h edit ion. New York:
John Wiley.

Morrall, P., Hazelt on, M. (2000) Archit ect ure signifying social
cont rol: The rest orat ion of asylumdom in ment al healt h care?
Aust ralian and New Zealand Journal of Ment al Healt h Care, Vol.
9, 89- 96.

Munt , D., Hargreaves, J. (2009) Aest het ic, Emot ion and
Empat het ic Imaginat ion: Beyond Innovat ion t o Creat ivit y in t he
Healt h and Social Care Workforce. Healt h Care Analysis , Vol. 17,
285–295.

Philo, P. (1997) Across t he wat er: reviewing geographical st udies

of asylums and ot her ment al healt h facilit ies. Healt h and Place,
Vol. 3, No.2, 73 – 89.

Pret t y, J. ( 2004) How nat ure cont ribut es t o ment al and physical
healt h, Spirit ualit y and Healt h Int ernat ional , Vol. 5, No. 2, 68–78.

Savage, J. (2000) Et hnography and healt h care. BMJ , Vol. 321,

No. 2, 1400- 1402

Sherman, S. A., Varni, J. W., Ulrich, R.S., Malcarne, V. L. (2005)

Post -occupancy evaluat ion of healing gardens in a pediat ric cancer
cent er. Landscape and Urban Planning, Vol. 73, 167–183.

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