Open-air therapy: how new rehabilitation format works for service members and war veterans
New approaches to rehabilitation for service members and war veterans are emerging in Ukraine. These are programs that combine physical recovery, psychotherapy and work with the environment. One such area is therapeutic horticulture, which has been used effectively around the world for many years.
In Ukraine, during the full-scale war, spaces have gradually begun to appear on the grounds of rehabilitation centres, at hospitals and in city parks that combine modern rehabilitation, psychosocial and educational programmes for war veterans, service members and civilians affected by the war. This year in Kyiv, the concept of a Therapeutic Garden was presented and implemented. It is a pilot project created with the support of PrivatBank, Visa, the Ukrainian Red Cross Society and other partners to provide recovery and sensory relief for service members, war veterans, their families and the families of fallen heroes. After the successful testing of the pilot project at VDNG, such therapeutic gardens may become part of the rehabilitation and post-rehabilitation process in Ukraine.
HOW DOES HORTICULTURAL THERAPY WORK?
The therapeutic garden at VDNG interacts with visitors through the five senses — sight, smell, hearing, touch and taste — and encourages interaction, creativity and physical activity. Its main idea is to restore health through contact with nature. To this end, a therapeutic gardening area, an adaptive sports ground, a physical practice area, a green room called "Circle of Warmth," a place for group meetings, and a playground for children whose parents participate in the programmes have been set up here.
The methodology of recreational therapy, which includes the therapeutic horticulture programme, is being developed by the NGO Centre for Expert Solutions and Advocacy with the support of international donors, in partnership with the President’s Advisor and Commissioner for Barrier-Free Access, Tetiana Lomakina.
"When service members hear about horticultural therapy, they often ask: ‘So you’re going to make me plant potatoes?’ Or there may be another reaction: ‘I’ve done enough digging in the tree lines, I don’t need any of that,’" says project lead Lada Mendrukh. "But horticultural therapy and therapeutic horticulture are practices that cover a lot of ground. Therapeutic horticulture is more focused on improving a person’s overall well-being, reducing stress symptoms, alleviating anxiety and so on. Therapy as such is different in that it is developed for a specific person or a group of people with similar clinical symptoms and is carried out under the supervision and with the participation of a horticultural therapist.
In the Therapeutic Garden, we are talking specifically about therapeutic horticulture, because this project was created primarily for veterans, but they are not the only ones who now need recovery, calming, reduced anxiety and lower stress levels. Therapeutic horticulture is a less clinical approach that combines very different activities depending on the audience that comes to them. The difference from ‘just planting something in pots or in the garden at home’ is that there is a structured therapeutic process. There are specialists trained to design and deliver such programmes, and they create a programme tailored to a specific audience with a specific request – one that meets their needs and takes into account the participants’ wishes and strengths.
We don’t always have to plant something to get a therapeutic effect. The garden interacts with visitors through the five senses and is designed so that you can be alone with yourself or with the therapist working with you and feel your condition improve. The garden also has areas for group activities. This is important because we know that veterans often experience a sense of isolation, and this is one of the methods that can help bring them back into interaction with other people."
We also understand that many people now have very high levels of anxiety and stress and often lack the motivation to do something beneficial for themselves, both physically and mentally. And a garden like this draws attention, and even simply observing it can help improve how you feel."
According to Lada Mendrukh, therapeutic horticulture has a scientific basis grounded in several theories. One of them is attention restoration theory. It explains that when we focus on something, we expend energy on it and it can be difficult to maintain that focus for long. Nature, however, gently and effortlessly captures our attention and our gaze. Such relaxed observation actually reduces tension and lowers anxiety levels.
Another theory underlying therapeutic horticulture is the biophilia hypothesis. It posits that people are evolutionarily drawn to the living world. We feel better when we are surrounded by plants and natural elements. "There are even studies by British specialists on how people recovered after strokes and traumatic brain injuries. Those who stayed in hospital wards with windows overlooking a garden needed 30% less pain medication," Lada Mendrukh continues. "And they recovered faster than those whose ward windows looked out onto the wall of another building.
There are many such studies. They usually examine very specific things. So if we put all of this together, it becomes clear that this approach works.
On top of that, for veterans – and this has also been scientifically proven – a holistic approach should be used. In other words, during rehabilitation we do not focus on one specific aspect, but on the person as an entire system. And on their interaction with the environment, whatever it may be: natural, social, and so on. Within this approach, nature helps us do this in an environment that is as comfortable as possible.
– Why does this work better in public spaces like VDNG than just taking care of plants at home in the garden?
– The Therapeutic Garden at VDNG is, first and foremost, a place with barrier-free access. It is a natural environment, but it has been designed in an artificial way so that it is accessible and comfortable for everyone, and so that the garden functions as a site where rehabilitation takes place.
It offers opportunities for a very wide range of activities. This matters, because gardening itself is not the only rehabilitation method.
We can also hold group meetings in the open air. In the warm season, this is a great option. Service members we have spoken to say they would gladly do art in the green rooms we have built. A green room is a kind of terrace surrounded by tall shrubs and trees that create a sense of walls. But you are still outdoors. You hear the birds, you hear the rustle of the leaves. And all of this prompts you to look closely, to pay attention. But it is not like when occupational therapists are making you learn how to hold a pen or a fork. It is an effortless kind of attention that does not require strain.
We also involved art therapy specialists and landscape architects in the design so that this space would be multi-purpose. For example, there is a fire pit area where group sessions can be held in combination with psychotherapy.
From the experience of the Lisova Polyana rehabilitation centre, which in many ways is a pioneer in rehabilitation, we know that the fire pit area is one of the favourite places for the war veterans who stay there. It is a space where you can relax and chat with your own people. No one will be forcing you to do anything; therapy can take place in a friendly, calm circle that does not create extra tension. Psychotherapy on its own is quite a demanding process, and the garden makes it somewhat more comfortable.
Our garden also has places for solitude. You can sit alone and simply look at the nature around you and listen to the birds.
There are two large lawns where you can just sit under the trees and stay for a while. They are quite cosy.
Overall, the garden is a place to simply be in an environment that, as I have already said, does not force you to do anything. Active-duty service members live under constant demands and challenges, while here the only "challenge" is choosing whether to lie on the grass a bit longer or to leave already. This is a place with no schedule, only nature’s timetable as it changes over time.
– What impact does horticultural therapy have on the mental health of service members, veterans and civilians? Are there studies on how this works in other countries?
– There are many clinical studies on this conducted in hospitals and rehabilitation centres in European countries, the US and Canada. In the UK, for example, a Defence Gardens programme focusing on veterans’ rehabilitation has been running for more than 20 years. And their results are fantastic.
Therapeutic horticulture began to be used in the 1800s. Initially, it was designed for specific categories of people, and now it is literally used for everyone.
There are many such programmes. A very strong effect – already demonstrated clinically – has been shown in children and adolescents with autism spectrum disorder.
So this approach, because it is as natural as possible, has a positive impact on any audience.
– Do you take into account that some sounds can be triggering for a service member or veteran?
– First, we create an environment that supports a person’s recovery so that they can feel comfortable in the modern world. And the modern world is full of triggers – even for civilians. Therapists, including those from Lisova Polyana, with whom we discussed this, told us that we are preparing veterans to return not to an entirely clinical environment. So it is important for them to learn how to cope with the reactions that triggers cause.
Second, when we come to the garden, we understand that there may be some noise nearby – we are in a city, after all. There may be construction somewhere, or loud machinery operating. And in therapy with veterans, it is normal practice to warn them in advance that there may be such sounds. In other words, we prepare them. And if a trigger is activated, the person can learn to overcome their reaction.
– Is this garden open to absolutely everyone?
– Yes, this space is open to everyone, including the therapeutic gardening area. It attracts an enormous amount of attention because it is beautiful – people want to come closer and see what is growing there. They also ask when and what can be planted there.
There, everything has been thought through down to the smallest detail. For example, there are ergonomic tools that people with different abilities can comfortably use. There are kneeling stools that help a person get down on their knees and then stand up easily, as well as garden cushions so they do not have to kneel directly on the ground. Such equipment is widely available around the world, but in Ukraine it is unfortunately still lacking. We need to ensure that these tools are manufactured here. Since this is a pilot programme, we will do everything possible to expand it and bring in partners. It is extremely important that this equipment is accessible.
The veterans who attended the opening and planted the first plants tried out all the tools. They said: "This one is cool, this one is heavy, and this one needs to be designed differently." They were ready to help us refine the tools and explain what would make them easier to use. The same applies to other garden equipment.
For example, there are special beds for people with amputations. The garden has one of these. We call it a mobile bed. It is essentially a table on wheels that can be moved around the therapeutic gardening area. It also functions as a raised bed. Plants in pots stand in the sun on it. When the group arrives to work with them, all four sides fold down. A person in a wheelchair, or someone who simply prefers to sit on a chair, can take their place at this improvised table and work with the plants. Afterwards, everything is closed back up and remains that way until the same group returns.
According to Lada Mendrukh, therapeutic programmes are now being developed that specialists will use when working with service members, veterans, their families and civilians undergoing rehabilitation. At the same time, the area will remain open to all visitors year-round.
All plants in the Garden provide positive effects. They are arranged without strict lines or symmetry, replicating natural conditions, and have different blooming periods to keep the space vibrant and engaging throughout the year.
OBSERVING THE LIVING WORLD
Therapeutic gardens for service members and veterans are common in many countries. Among them is the intensive therapeutic garden at the Walter Reed National Military Medical Center (USA), designed for the rehabilitation of service members who have experienced severe injuries and amputations. It is equipped with specialised paths and training devices that help restore physical functions and reduce stress levels.
The Naval Medical Center in Portsmouth also uses a therapeutic garden to support service members recovering from PTSD and other mental health conditions. It includes designed spaces for meditation and relaxation, which form an important part of their therapeutic programme.
Gardening also became part of the therapeutic programme at the Ukrainian rehabilitation centre Lisova Polyana, whose specialists helped create the therapeutic garden at VDNG. Speaking with service members who underwent rehabilitation at Lisova Polyana, I heard many warm words about the psychologists who introduced horticultural therapy.
"I’m from a village, I love gardening," says service member Volodymyr Kucherevskyi. In response to my question about how this therapy differs from regular plant growing, he explains that in principle it is very similar, only during therapy all the processes are discussed aloud. "We usually treat each tree or plant with warmth, expecting it to take root and eventually give some fruit. And at Lisova Polyana, this is verbalised for people who have never done gardening before. A person understands why they are doing something and can not only observe how something living grows, but also has the chance to return to their plant over time."
At the same time, he says, no one is forced into these activities. "A group gathers in a separate room, everything is discussed," he explains. "Because the guys are different in terms of psychology and character: some like it, others are withdrawn and do not want to talk. That’s how it was with us. We discussed it, and those who wanted to take part went to choose trees. For example, I really love sweet cherries, so that’s what I planted.
The guys were all pleased when they planted the trees. They made plaques and wrote their names or call signs on them.
This kind of therapy provides psychological relief. It’s like going fishing – it helps you switch off. Some like painting, some like sculpting, and some like planting trees.
When the weather was bad, we worked with potted plants. Someone repotted a cactus, someone a flower, some planted seeds. Another group of service members who will undergo rehabilitation at the centre later will be able to plant outdoors whatever grows from those seeds."
When I asked whether such activities irritate some fighters, Volodymyr replied that if such people exist, there are not more than 2 percent. "Overall, the guys were interested and approached everything with heart," he says. "I believe this is good therapy. It’s important to use it to give service members psychological relief."
Volodymyr Kucherevskyi has served since 2010, so he has been fighting since the first days of the full-scale invasion. When we spoke, he was undergoing a medical evaluation because the injuries he suffered two years ago had consequences for his health. "We were driving in a vehicle and hit an anti-tank mine. Usually, you don’t survive that. But afterwards the guys told us: ‘You’ve got an angel on your shoulders. If you’re alive, it means you’re still needed somewhere.’ But the blast hit me hard. My leg was broken, my ribs were fractured, my spine was affected, my spleen was damaged. The guys were badly injured too. And they couldn’t evacuate us for two hours because everything around was mined. This was in the Zaporizhzhia direction."
He also said that previously he thought post-traumatic stress did not apply to him, but later he began reading about it and changed his mind. Many issues, he notes, also come from concussions. "A lot depends on the severity of the concussion: mild, moderate or severe. Everyone experiences it differently, and people underestimate the consequences. I thought it wouldn’t affect me either, but it hits very hard. You get depression, mood swings, your blood pressure jumps, you may have dizziness, poor sleep. And all this surfaces after 2–3 years. At firs,t you don’t pay attention, but eventually it makes itself known."
Therefore, he stresses the importance of listening to your body and taking care of your health.
He also supports the development of therapeutic horticulture both at the centre where he underwent rehabilitation and in other cities.
Another person I spoke to is veteran of the Russian-Ukrainian war Serhii Maksymishyn, call sign Bison. Before the full-scale invasion, he worked at PrivatBank, and he mobilised into the Armed Forces of Ukraine on the very first day of Russia’s attack.
He defended Kyiv and took part in the counteroffensive in the Zaporizhzhia direction as part of the 31st Separate Mechanised Brigade.
After completing studies at the Military Academy, he received the rank of junior lieutenant and returned to his brigade as a platoon commander of mechanised units. "I had three squads under my command," he says. "And each squad is a separate fighting vehicle."
Together with his comrades, Serhii took part in the defence near Avdiivka, close to Vodiane, where he suffered a blast injury, a severe fracture of his right arm and multiple shrapnel wounds.
For the battles near Avdiivka, he was awarded the Defence Cross by Ukraine’s Minister of Defence.
After lengthy treatment and rehabilitation, he returned to work at PrivatBank, where considerable attention is paid to veteran reintegration programmes.
"Before my service, I worked in cash collection, and that’s the job I came back to, but now my duties are lighter than they used to be," he says. "I have a Group III disability, I can’t fully bend my arm and I can’t fully straighten it either. On top of that, the nerves are damaged, so I constantly get shooting pains. It’s like when you hit your elbow on the edge of a table – it feels like an electric shock. If I twist my wrist, I get these ‘discharges’. There is numbness because the facial nerve was damaged. Plus I have pain in my elbow.
I have another surgery ahead, they will try to make my arm more mobile. Even before the full-scale invasion, I wanted to start my own business – a forge. Now, unfortunately, I won’t be able to do that.
I used to do sports as well. I’m still trying to stay active. Recovery is very important to me."
He says PrivatBank provides financial assistance that can be used for rehabilitation and to buy medicines. There is also a psychological support programme, and staff can get individual counselling from a psychologist.
Serhii heard the term "horticultural therapy" for the first time from me, but it turned out the concept was already close to him in practice, because he had recently started growing plants.
"I go to my wife’s village and plant shrubs and trees there," he says. "Overall, after returning from the front, I became interested in how to grow a tree from a cutting. And my tree-growing therapy began with a thuja. First, the twig grew roots, then I planted it in a pot, and later in the ground. Then we went to the Carpathians and collected beech seeds. One out of ten sprouted. But it did sprout, and now a small beech is growing on the windowsill. There is also a spruce growing there."
NO ONE ASKS ABOUT THE WAR HERE
The Therapeutic Gardens project is being implemented by VDNG together with the Ministry for Veterans Affairs as part of the National Strategy for Creating a Barrier-Free Space in Ukraine, an initiative of First Lady Olena Zelenska, with the support of Visa, PrivatBank, Work.ua, Expolight and the Ukrainian Red Cross. It is being designed by the urban bureau Big City Lab in partnership with the architectural bureau PUPA.
In a comment to Censor.NET, PrivatBank board member Dmytro Musiienko said that supporting the Therapeutic Gardens project is an important step for the bank in implementing its barrier-free strategy and an opportunity to support Ukrainians affected by the war.
"We believe that nature has powerful restorative potential for physical and mental health. Creating such spaces is our way of supporting people who are living through war, often under shelling, losing loved ones, their property, their businesses, and who need somewhere to draw strength to keep going," he notes. "Investing in the mental and physical health of Ukrainians is strategically important for our country’s future, and PrivatBank is ready to continue supporting such initiatives."
Lada Mendrukh also stresses that the educational component is an important part of the therapeutic garden. Quite often, because of their health, a veteran cannot return to their previous profession, or they want a change. And it is necessary to decide what he or she will do in civilian life. The activities held in therapeutic gardens can inspire veterans to become gardeners. In Europe, it is quite common for veterans who complete such programmes to choose a new profession this way.
"Often when a person returns from the front, they feel they have no purpose; there is no clear schedule, no specific orders from the command," says Lada Mendrukh. "Here, a person plants a plant and starts taking responsibility for it. And they are surrounded by people who are just as interested in this activity. Social ties that may have been lost because of the war, displacement or the death of comrades begin to re-emerge, built around a shared interest in gardening. American and British experience shows that veterans are fantastically motivated to learn, and some even become professional gardeners and landscape designers."
Representatives of the business community who have supported this project, like its authors, hope that the veterans’ movement will rally around this idea of horticultural therapy. And the garden will become a space where people can come, look around and learn something new. It may also become a launchpad for a new profession in Ukraine – horticultural therapists working both with service members and civilians.
The project pays no less attention to the mental health of civilians. According to a survey conducted by the Kyiv International Institute of Sociology, 78% of Ukrainians have family members or friends who have been wounded or killed as a result of Russia’s full-scale invasion of Ukraine. And according to a study published in The Lancet, 93% of Ukrainians face at least one moderate or severe mental health problem. For comparison, only 20–27% of respondents had diagnosed mental health issues before the full-scale invasion.
In Ukraine, where the number of people in need of recovery is growing every day, a therapeutic garden can become an important element of the rehabilitation and post-rehabilitation infrastructure.
"The programme is not just an activity a person chooses and then simply does. Before it begins, participants undergo various tests that measure their stress and anxiety levels and overall well-being. And there are measurements again at the end of the programme. We do this so that, first, we can see how effective it is and, second, so that people who have taken part in the programme can see in numbers how their condition has changed," explains Lada Mendrukh. "When you see the measurements, you perceive everything differently."
Tetiana Bodnia, Censor.NET
