Journal of Therapeutic Horticulture

Table 1.
Participants’ demographic data

substance abuse, ADHD, and autism. Non-suicidal self-injury and suicide attempts were also reported but to a lesser extent since most of these issues happen as a result of a more serious underlying mental health illness. Even elementary counselors reported being alarmed by the current state of mental health with their population. Participant 5 said, “I’ve noticed an increase in…self-harm within the elementary population”.

Most participants confirmed that many students suffer from trauma due to sexual assault, temporary housing, foster care, displacement, and other dysfunctional environments. Anxiety due to academics was also reported. Participants also believe stress is increasing because schools are putting too much pressure on students, especially in passing the state’s standardized exams. However, many students from low-income communities do not have the age appropriate literacy level that is required to meet these benchmarks, so students start feeling overwhelmed by these unrealistic demands. Participant 12 reiterated the literacy issues of this population: “A lot of our students are academically behind, especially in my class. I’m in a 12 to 1 [student- to-teacher ratio] setting, and only one student is actually reading on grade level, and…can comprehend what they’re reading”.

One of the emerging subthemes that the researcher was not expecting to find was related to the negative impacts of technology as a possible cause to what participant 10 claimed is “an alarming number of students that are coming forward with mental health issues”. This phenomenon can be explored through the lens of ecopsychology which posits the addiction to technology and the massive expansion of urban development as a “pathological alienation” to the natural world which results in the “madness” of the psyche (cited in Roszak, Gomes, & Kanner, 1995). Participant 13 belabored on this issue:

I would say, more in the last two or three years, I’m getting…more and more students with behavioral issues…Internet addiction it’s going to be the new wave of things that are going to be impacting the counseling field. To get those kids to disconnect, that is like an atrocity. It’s part of the coping skills that they’re losing.

The demographic data also provided information regarding how many participants’ schools offered an outside area for recreation. Surprisingly, 9 out of 13 schools in these low-income communities, especially middle school, do not have open playgrounds. The NVivo query comparing participants’ attitudes regarding mental health issues and schools who had no outdoor areas demonstrated a clear increase in the amount of mental health references from participants who work in schools that have no outdoor common spaces (See Table 1). The comparison between schools that offer concrete or green spaces was not significant.

(RQ1)Theme Two: Mental Health Barriers

The most common mental health barriers that emerged from participants’ responses was understaffing of school mental health professionals with 12 of the 13 participants sharing their opinions on the subject. Clearly, the student-to-school counselor ratio is quite high in most of the participants’ schools. The ASCA model recommends a ratio of 250 to 1, but even in schools that have this ratio or less, participants reported being unable to complete their caseloads due to the daily crisis interventions they must attend. Participant 1 reported the highest student to counselor ratio at 942 to 1.

Some participants’ schools have the benefit of having a clinic on site, but even if this is the case there are long waiting times when students are referred to these outside services. Participant 13 has a Montefiore clinic in her school building, but she still claimed that there is a long waiting list. Consequently, school counselors are forced to refer outside the school, but the long waiting lists are still an issue of concern, especially in high school when the student does not have four years to wait for an appointment. Participant 13 reported:

There’s a three to four year waiting list…to get a student checked by a mental health facility…So, in four years, the kids are supposed to graduate in four years. What am I supposed to do in the interim, if I can’t get the kid to come to school?

Participant 4 also made a compelling case regarding the mental health needs of students in low-income communities.

Well, the Bronx is the borough that has the highest–the most need for mental health and there are not enough agencies that can provide mental health services in a timely fashion. For example, if I were to call the clinic down the block from my school for an appointment for one of my students, they will give me, I’m going to say, 8 to 10 weeks wait time for an appointment.

Finally, 7 participants reported cultural stigma associated with mental health issues.

Many parents will not give their consent for their children to receive services or many students just refuse to accept services. The demographic population of most low-income schools in New York City include Latinx and African or African-American students. Research on these populations has shown that cultural stigma regarding mental health is salient in these ethnic groups (Craft DeFreitas, Crone, DeLeon, & Ajayi, 2018).

Overall, participants’ perceptions of school mental health confirmed that youth mental health issues are on the rise; and, though schools are making attempts to deal with this crisis by hiring social workers and even (with some schools) offering school-based clinics, the insurmountable amount of mental health needs makes it hard to service all students in a timely and equitable manner. Cultural stigma and the inaccessibility to community mental health resources also put a high toll on the academic success of low-income students.

Furthermore, the sudden increase in mental health concerns stemming from a lack of coping and social skills can be analyzed through the theory of ecopsychology. The dramatic rise in urban development and the use of technology have had detrimental effects on human interaction with nature, land, community, and people. Ecopsychology is a theory that transcends individualism and recognizes the inextricable bond that connects humans with the wilderness. This bond provides a holistic foundation that helps humans have healthy interactions with others. Therefore, the theory of ecopsychology makes a convincing case for the urgent need of environmental therapy such as plant therapy, forest therapy, or other therapeutic horticultural activities to counterattack the negative effects of the fast-paced urban life in which humans are currently immersed. This current technological ethos has built a social organization that consists of autonomic principles of standardization and production that has made humans lose perspective and control of this fabricated man-made universe, thereby hindering the optimal development of human psychological processes and resulting in a mental health epidemic (Roszak, Gomes, & Kanner, 1995).

Research Question Two (RQ2)

The aim was to find out if school counseling professionals were aware of the healing benefits of horticultural activities in mental health. From this question two themes emerged: the need to educate counseling professionals on the therapeutic benefits of horticultural activities and anecdotal evidence confirming the theory of biophilia.

(RQ2)Theme One: Educating School Counselors in the Therapeutic Benefits of Plants.

From the 13 participants, only 1 had knowledge of horticultural therapy and therapeutic horticulture (HT/ TH), and that was because she had a special interest in the subject. She was also the only counselor who applied TH using a tower garden (TG) with her student population. Participant 10 had some awareness but was not able to fully describe the therapeutic benefits of plants.

Since mental health issues are increasing and school counselors are understaffed, it seems imperative for school counseling programs to educate future counselors in alternative modes of therapy, especially in the therapeutic benefits of plants. This seems a viable solution for schools located in low-income communities where students do not have access to a lot of open green areas.

(RQ2) Theme Two: Anecdotal Evidence and Biophilia

Once the researcher explained the concepts of HT and TH, the participants were able to report anecdotal evidence regarding the healing powers of plants. Therefore, the researcher decided to explore these findings within the context of biophilia. Seven participants were able to share their anecdotal experiences regarding the benefits of plants.

Participant 6 recalled how her students made a connection with a plant that she coincidentally bought for her students to tend:

They were so involved. I couldn’t remember any of the watering because there were so many other things in my mind, but they would remember when to water it; they would go together. So, it became a little social group…with this one plant…and they were just so into it. So, I could definitely see even the social benefits of something like this.

When the researcher shared the data with participants regarding the therapeutic benefits of horticulture with the elderly and incarcerated populations, most participants immediately acknowledged the natural inclination that humans have with the natural world. Participant 1 exemplified the biophilia hypothesis during her interview:

I’m not very good at [taking care of plants]. But I think that it’s something that is a skill and a beautiful thing. If more people would do it, I think that they would feel more connected to the environment and to people. I think it’s something very earthy, very natural. I don’t know how to say it. But I just think that it just brings us back to our roots, for lack of a better word, to a time where people were nicer to each other, and I think that when you do that, you become better people.

The data collected from the 13 interviews revealed that school counseling programs need to provide more instruction in terms of a more holistic approach to overall well-being. This approach should incorporate alternative therapeutic models that can give students in schools more access to services; and, at the same time, eliminate barriers such as cultural stigma. If mental health services could be provided in more subtle ways such as an extracurricular activity or even integrated to the curriculum, more students would be able to reap the benefits. Additionally, the anecdotal evidence of participants’ direct or indirect experiences with plants lays the foundational framework for the biophilia hypothesis to be considered a theory that supports the assumptions of ecopsychological theory.

Third Research Question (RQ3)

The goal of the third research question was to find out what kinds of holistic benefits do SC/SCT envision regarding horticultural activities for students. Even if participants had never heard of horticulture or had previous knowledge of the data related to HT/TH, the researcher still wanted to explore participants’ perceptions regarding the possible benefits of plants for students as related to overall social, emotional, and mental well-being. The findings to this research question concur that TH may be a helpful intervention to most of the mental concerns that were reported by participants in research question 1.

(RQ3) Theme One: Emotional/Personal Benefits

This theme had a total of 34 references and it was reported by 11 participants. There were various subthemes that emerged including benefits related to developing empathy, caring, responsibility, connection with nature, and building self-esteem and self- confidence. However, mindfulness (meditation, peace, tranquility, and patience) was the most prevalent subtheme, with 8 participants emphasizing its benefits.

Participants reported that watching a seed grow into a plant and taking care of it helps students take responsibility and be accountable for the life of that plant. As this relationship is established, students start developing empathy and caring. Participant 5 said, “They name the plants; they water the plants; so, they take responsibility. And you can tell that whatever we’re doing with the plants translates with people…You start a conversation and you show the children different ways to care and to build empathy”.

Participants also mentioned that low-income students do not get a lot of opportunities to interact with nature. In this way, a TG can be an alternative tool to bring an indoor garden to schools that fail to offer outdoor green spaces. Finally, most participants agreed that plants and plant related activities can help build perseverance and patience. Additionally, plants create a soothing environment that invites students to meditate and find inner peace. (RQ3)Theme Two: Academic Benefits.

The academic benefits of gardening activities were a common theme among participants. A total of 10 participants reported benefits in science related subjects, health, nutrition, marketable skills, and even making learning more tactile and relevant. The findings of this theme also match the scientific findings that demonstrate the many academic benefits of school garden programs (Williams & Dixon, 2013).

(RQ3) Theme Three: Social Benefits and Adlerian Individual Psychology Theory

There were 6 participants who reported plant related activities as having social benefits that involve the community, family, and peers. They also viewed this positive interconnectedness as helping students develop a sense of belonging and purpose in the world. Overall the most frequent phrases made by participants in this theme included “a sense of accomplishment,” “student happiness”, “coming together”, “family involvement”, and “community involvement”. Participant 2 mentioned that students involved in her school’s TG program give away the harvests to the community. Sharing the harvests with the community not only helps students feel they are accomplishing good deeds, but it also allows the school to create strong bonds with the community. These positive feelings are directly connected to Adler’s theory that mental health and happiness are determined by social interest (Adler, 1964). Adler felt that one of the main goals of human functioning is to strive for a sense of belonging and identification with others (Curlettte & Kern, 2010), and the development of social interest involves the ability to feel empathy with others (Clark, 2007; Watts, 1996). Since humans are genetically predisposed to being social beings, human behavior and emotions are best understood if explored through the social context (Kopp, 2003). Therefore if students have a high level of social interest, they will psychologically be better adjusted.

Research Question 4 (RQ4)

The purpose of the last research question was to explore the perceptions of SC/SCT in low-income communities regarding the potential use of TGs as ecopsychological tools that can provide the therapeutic benefits of horticultural activities as additional interventions to school mental health programs.

Table 3.

Reviewed codes

(RQ4) Theme One: Positive Perceptions in the use of TGs for School Mental Health

When participants were asked if they knew what a TG was, 8 responded they did not know; 2 (when shown a photograph of a TG) recognized having seen one; and only three participants knew about TGs because their schools owned one. From the 3 participants, only 1 uses the TG as a therapeutic tool. Despite, the lack of knowledge and awareness regarding TGs and the therapeutic benefits of plants, the results showed mostly positive perceptions.

Overall, 10 participants welcomed the idea. Participant 9 best summarizes the overall perceptions of SC/SCT regarding the implementation of TGs as therapeutic tools:

I would [consider this program]. Yes. I think this is a great idea. Anything to help our students, you know, anything to bring out the best in them and build on their skills and self-esteem or confidence, because… all of that really plays a big role in their academics and their performance… I would do anything to help them.

(RQ4) Theme Two: Skeptical Perceptions in the use of TGs for School Mental Health

Participant 10 raised objections regarding the differences in soil gardening versus aeroponic gardening. She reported that soil gardening is a more natural process than tower gardening; therefore, the health benefits found in research regarding soil gardening do not necessarily correlate to tower gardening. Participant 7 also raised the same point by saying, “But, I think, it’s a different experience when the students are more involved, like maybe watering the plants themselves”. These comments confirm the need to have data regarding tower gardening and its potential benefits.

(RQ4) Theme Three: Suggestions for Implementation and Next Steps

A total of 3 participants shared their views regarding possible ways to implement a tower gardening program. All three participants agreed that teachers could run a once a week extra-curricular activity with small groups and build conversations and metaphors regarding the plant growing process. Participant 5, who is the only counselor who uses this mode of therapy, said that due to an absence of an established protocol she uses her creativity and makes the sessions specifically individually based. Nine participants expressed the need for further research, a protocol, and even training. It is clear from the interviews that to successfully implement TGs as ecopsychological tools, school counselors need to have the data that could place this type of program as an evidenced based intervention that directly impacts student learning and overall success.

There is an urgent need to increase awareness in the mental health professions regarding the theories of ecopsychology and biophilia. These theories are intrinsically connected to overall mental health and may provide insight into creative ways of treatment that can be attractive and engaging in school settings. Moreover, to understand the rapid increase in mental health disorders, it is necessary to examine not only how people have become disconnected from nature but also how nature’s gradual destruction plays an important role in the current mental health crisis.

There is also the need to include courses on alternative therapies in school counseling programs. Alternative therapies offer a powerful way to communicate with clients who have difficulty in communicating verbally especially young populations who might not have the developmental age to articulate their thoughts and emotions. In addition, alternative therapies can be promising in school settings where there is a need to eliminate cultural stigma and provide brief interventions (Bastemur, Dursun-Bilgin, Yildiz, & Ucar, 2016).

Finally, there is a need to disseminate data regarding the mental health benefits of therapeutic horticulture and how TGs may provide feasible alternatives to school gardens. There is also the need to provide education on the benefits of ecotherapy as a modality that gathers nature-based techniques and practices to re-establish the inherent human-nature connection (biophilia) that has been severed by technological obsession (technophilia). Ecotherapy is the applied form of ecopsychology in which both the passive and active participation with nature has healing properties, particularly with anxiety (Mackay & Neill 2010), depression (Barker & Dawson 1999), stress (Kam & Siu 2010), as well as improves self- esteem (Pretty, Peacock, Sellens, & Griffin, 2005) and concentration (Duvall 2011).

Implications and Conclusions

Results from this generic qualitative study offer several opportunities for further research. Future studies should expand the pool of participants to include other school mental health professionals, such as social workers and school psychologists, as well as school administrative personnel and teachers. The location of this study was also limited which means there is a need to broaden the geographical location and include both schools from low-income communities and affluent communities. It would be interesting to compare if there are differences in the perceptions of school mental health professionals who work with students from different socio-economic backgrounds when it comes to the topics of common youth mental health concerns, school mental health services, and the possible use of TGs as expanded school mental health programs.

Future research can also include mixed methods designs since a combination of qualitative and quantitative data will provide a more complete analysis. Qualitative research may include biases and is not statistically quantifiable, whereas quantitative data will fail to understand the context and setting of the study. Therefore, by providing both methods and including inductive and deductive reasoning the results are further validated within the study and the findings will appeal to a wider audience of professionals, practitioners, and academics.

Randomized controlled experiments are key in trying to uncover whether an intervention or program had a causal impact on a group of participants. These are the types of studies that have been limited in HT/TH programs. The benefits in mental health from either passive or active involvement with plants have until the present time only shown a correlation, but have yet to prove causation. However, it is also clear that randomized controlled trials will be extremely difficult to replicate in a school settings, especially because there is no guarantee there will be strict fidelity in the implementation of the program.

Another important factor in educational research is that it is not feasible to use individualized randomization since too much information is shared within the school community; instead, whole groups have to be randomized in a cluster randomization trial (CRT) to provide more accurate results. Even though, CRT will require larger samples and more complex methods for statistical analysis, it is worthwhile to include these types of studies since optimal impact to youth mental health care programs must be embedded within the whole- school as a multimodal approach (Clarke & Barry, 2015).

Finally, scientific studies on tower gardening need to investigate if this activity has similar effects in well-being compared to traditional gardening. The need to have evidence- based research regarding the implementation of a protocol for therapeutic tower gardening is an urgent recommendation for future research. In order to have evidence-based research in this topic, the literature must provide data from a range of studies including meta-analyses, randomized controlled trials, longitudinal studies, as well as information obtained from single- case reports, systematic case studies, qualitative and quantitative research, and clinical observation (Cook, Schwartz, & Kaslow, 2017). The future evidence-based research arising from the present study might even develop tower gardening as a trending psychotherapy modality in school mental health care.

BIOGRAPHY

Ana Bahamonde has been an educator for over 28 years and has taught internationally as well as in North American inner-city schools. She received her PsyD in Clinical Psychology from California Southern University, Costa Mesa, CA, and her Master of Arts in Education from the University of Toronto, Canada (OISE). Her research interests are in the fields of education and counseling psychology. Dr. Bahamonde is a member of the American Horticultural Therapy Association, American School Counselor Association, International Honor Society for Counseling Students, and the Golden Key International Honor Society.