Rantings of a frustrated therapeutic landscape advocate

Thank goodness! Two good images of therapeutic landscapes:
 Stream at McKee Medical Center, courtesy BHA Design Incorporated 

Okay, I’m annoyed. Maybe even more than annoyed. I just looked online at more than 15 sites of landscape architects who design therapeutic landscapes, searching for nice pictures to put on this blog, and I found three. What’s up with that? Why are so many healing gardens so ugly? Or is it just the photographs that make them look bad? You’d think that these big design firms – and some of them are big, award-winning design firms – would make the effort to take really kick-ass photos of their projects. Great colors, high resolution, clean the dead leaves off the walkway before taking the picture… Sigh. How are we supposed to convince others that therapeutic landscapes are worth building when we designers can’t even portray them well on our own websites? Granted, the outcomes are what matter most – if the people served by the garden/s benefit, that’s the most important thing. These outcomes are not usually measured in any sort of quantifiable way, but that’s another story for another time. What I’m talking about here is pure and simple marketing – to other designers, to hospitals, to clients. Maybe the first motto is “build it and they will come,” but the second one is “make it look good and the money will come.”
Here are some possible explanations for what I view as a real flaw. Some have to do with the aesthetics and efforts of the designer, which are easier to remedy, while others are problems that are much harder to control, and therefore to alleviate. I spend almost all of my time celebrating and advocating for therapeutic landscapes, so humor me while I explore ask, and try to answer, some tough questions. I hope that rather than just being a downer, this post creates some serious discussion about what we can do better in the future.
1. It’s the documentation that’s ugly, not the gardens themselves
Landscape architects often don’t have big budgets for healthcare projects. In fact, many are “pro bono,” meaning that the LA firm donates their time. The less corporate the institution, the more they rely on the generosity of the designer, the builder, and members of the community for “sweat equity” of one kind or another. So if the designer has already donated hundreds of hours in programming, design, and construction oversight, there’s not a lot left for high-quality documentation, which is really what’s needed. Instead, someone from the firm goes out with a simple digital camera and does his or her best at taking pictures, and they get put on the website. Also, of course, if a lot of the material and labor is donated, the final design may not be quite as aesthetically pleasing as the designer – or even the client – intended. But people make do, and are often grateful for what they get. Heck, it’s better than a big empty yard full of dirt, they figure. And it is! But it still doesn’t look very good in pictures. 
2. Bad visuals in general
You’d be surprised how many designers’ websites themselves are hideous. I mean, these are visual people! What are they thinking? If a designer puts so little effort into their online presence, then it’s not surprising that images of their projects are not exactly stellar, either. Maybe their printed material is better. Maybe they just believe that “you have to be there” and that’s that.
3. Privacy, and shiny happy people
To get permission to photograph patients and their families anywhere in a healthcare environment is very, very difficult. Often it’s impossible. All sorts of issues with HEPA and privacy and liability. So here you have these landscapes that were designed for people, and you can’t take pictures of those people using the space. And if you do get permission, you’ve got the challenge of making people who are unwell look good. I’m sorry, I know that doesn’t sound very nice. But think about it: Our society is terrified of death and disease. We don’t want to see old or sick people. It makes us feel scared and icky. We want to see well children – the hope of the future! – bouncing around and playing happily in some idyllic park-like setting. That is, I think, why the Children & Nature Network, which I very much respect, has been so successful. Just as polar bears are easier to support than some weird-looking toad, children are easier to rally around than the people our society would rather pretend aren’t there. Landscape Architecture Magazine published an article about the St. Louis Children’s Garden several years ago, and I so admire them for taking pictures of people using the space. The images were beautiful and compassionate, of a beautiful garden, with all sorts of different people, including those in wheelchairs and bandages and IV poles, enjoying and benefiting from the space. Really moving and well done. But again, they have the budget to overcome privacy hurdles, to art direct, and to use the right equipment to portray the project in the best light.
4. Maintenance
Maintenance, in general, is the bane of the landscape architect’s existence, but it’s even more of an issue in places where improper or insufficient maintenance can run from actually creating a dangerous situation for users (like cracked pavement, broken benches, or water fountains that aren’t cleaned the way they should be) to just being ugly (which, in an environment where beauty and life combat the stress of being sick, is another kind of dangerous). Let’s say you’re a design firm, and you finish a project at a medium-sized healthcare facility, one that raised a goodly sum for the design and construction of a “healing garden.” You don’t want to take pictures right after the garden is installed because the plantings need time to fill in, so you wait until the next season, or the next year, to go back and document. Meanwhile, it’s all fallen apart, or at least hasn’t been kept up to where taking great pictures is an option. You’d be surprised at how few fundraising campaigns budget for ongoing maintenance. Usually there’s little or no money new annual plantings, or tools, or a dedicated maintenance person/team. Often the upkeep falls upon the already over-burdened medical staff (nurses, horticultural therapists, volunteers). I once saw a dead tree in a pot in a “healing garden.” Maybe it looked lovely when that tree was alive, but the message when I saw it was not very confidence-inspiring: “If they can’t take care of a simple tree, what does that say about how they’re going to treat me or my loved one?” Do us a favor. Take the tree away. Or here’s another example, from an undisclosed hospital’s “rose garden.” Once upon a time, this pocket was filled with pamphlets that guided visitors through the rose garden, informing and inspiring them as they stopped to smell the roses. Now it’s just a cesspool of dirty water, and a clear indicator that someone is not paying attention.

4. Too much hardscape, not enough plants
Therapeutic landscapes require a fair amount of hardscape to be universally accessible, and hardscape – as opposed to planted “softscape” of lawns, big planting beds, mulch paths, etc. – don’t photograph well. But here is an example of a problem in which the photos give us some very clear insight: If we’ve learned one thing in the thirty years of quantitative research on what gardens have the most beneficial impact in the healthcare setting, it’s that the more green and lushly planted the garden, the better the outcome for patients, visitors, and staff. After all, the landscape is providing a contrast to the scary, sterile, hospital or clinic environment. It is supposed to literally be a breath of fresh air, and the more “nature” people encounter when they step out those hospital doors, the better. So if we’re seeing lots of pavement and other hard surfaces in pictures, that’s a clear indication that there’s not enough plant material to soften the effect. This, in my opinion, is a major flaw in design and execution, one that has serious ramifications for users, not just for marketing.
I’m sure there are other reasons for the dearth of good photos of therapeutic landscapes. Feel free to weigh in! Comments please! How much of this is really a problem and how much is just annoying? Who knows? I would love to see the following studies:
1. How good documentation of successful design projects increases the likelihood of more such projects being built in the future. 
2.  How maintenance – the good, the bad, and the non-existent – affects user outcomes in the healthcare environment.