Psychiatric hospitals: land as therapy

What do chillies and brinjals have to do with a psychiatric hospital? In Tanjung Rambutan, Perak, the answer all boils down to land. But how are land and psychiatric patients related to each other?

In January 2024, a farming project grew both crops, along with a few others such as lemongrass and sugar cane, on 20 acres of land at Hospital Bahagia Ulu Kinta. At that size, the project occupied only a small fraction of the hospital’s 504-acre estate, leaving ample room for further expansion.

But how did Hospital Bahagia come to occupy all that land? It goes back to 1906 when it was first established as the Federal Lunatic Asylum.

The land parcel was selected based on three requirements: first, it needed to be a large area of government land in a healthy district, as the asylum was intended to have various forms of agricultural activities and poultry rearing. Second, it had to be on a main railway line connected to most states. Last but not least, the land had to be near a big town.

Interestingly, some of what patients grow on hospital land make its way to a farmers’ market. They don’t have to go very far to sell the produce either since the market is on the hospital grounds.

According to a January 2024 article in The Star, Hospital Bahagia deputy director Dr Ahmad Qabil Khalib noted that supervised agrotherapy patients raised farm animals, planted trees and subsequently harvested and sold their yield at the hospital’s on-site market.

The programme gives patients meaningful roles throughout the entire process, spanning cultivation right through to customer interaction.

Some of that work took place on the water, too. A 2020 study published in the Malaysia Architectural Journal documented vegetable growing at Hospital Bahagia Ulu Kinta. It also noted ponds where fish farming formed part of patients’ daily activities.

Another hospital with vast estate

Over in Johor, the search for a new hospital site took a doctor and his wife into the hills. In 1936, Sultan Ibrahim asked the state’s principal medical officer, Dr George Herbert Garlick, to find a more suitable site for an existing psychiatric hospital.

Garlick and his wife came across a stretch of wooded land about 16km from Johor Baru. Work began that same year and Hospital Permai opened in October 1937.

How much land came with it? According to the hospital’s own records, the grounds covered 635 acres. But when the hospital was opened, only 110 acres were used. That’s roughly one-sixth, a detail that’s easy to miss if you go by the size of the estate alone.

Other uses for the land

These mental health hospitals attempt to fully utilise their large piece of land in multiple ways such as footpaths to make navigating the grassy hillscape easier and more relaxing.

In a study of outdoor psychology sessions at an adult mental health rehabilitation unit, a patient described finding it easier to talk while walking alongside their therapist on the path. There was less pressure to make eye contact and that made the conversation feel less overwhelming.

But still, the layout of the land is crucial right down to the amenities. The study emphasised on privacy despite being outdoors.

When a patient needs to sit down, crucial moments are spent just trying to find a comfortable seat. This matters when it comes to someone as fragile as a mental health patient.

Moreover, the vast expanse of space lets patients draw up how they want to spend their day on their own.

At a mental health facility in Norway, researchers asked patients to photograph their surroundings as a form of therapy. A patient spoke about how much it meant to simply see a bird in the courtyard garden during the patient’s period of isolation.

So, a courtyard visible from the ward could look like a pleasant bit of landscaping to them.

Ensuring privacy

What difference could a hedge make to someone spending a few weeks in a psychiatric hospital?

At a hospital in Paderborn, Germany, a path lined with maple trees crossed the lawn and led to a circle of benches. Behind the seats grew a hedge.

When researchers asked patients what they liked about the grounds, five of the 16 people interviewed on that lawn mentioned how the hedge gave them a sense of shelter or privacy. They could still see across the garden while having a little cover at their backs.

The benches were part of a 2024 study at two German psychiatric hospitals. Researchers took stock of what the grounds contained, then spoke to patients who were actually outside using them.

In Germany’s Paderborn City, one patient described photographing the birch trees in the sunlight. Over in an area set aside for exercise, two patients interviewed had little to say about the sports equipment but both enjoyed listening to birdsong. One liked sitting on a bench facing the building and talking with other patients.

For anyone planning hospital grounds, that detail deserves a second look.

On a blueprint, exercise equipment might catch the eye first, yet a patient sitting outdoors may value a quiet bench within earshot of birdsong far more. On the same lawn, someone seeking company and someone wanting a peaceful half hour will choose entirely different spots to sit.

Back in Tanjung Rambutan, the chillies and brinjals make it easy to picture what 20 acres can produce.

Some uses of hospital land are quieter. A patient who has spent the morning indoors might be quite happy to find a bench, see a hedge at their back and decide how to spend the next half hour in peace on the lawn.