Finally, the day has arrived that the beneficiary arrives on site and meets the Therapists in person.

Day 1 is an Induction Day, some focussed on the medical aspects and some on the practicalities of gardening. The medical aspects aim to record data to ensure the well-being of the beneficiaries and to provide further data about the efficacy of STH and specifically each garden’s efficacy.

Metrics regarding physical and mental health are recorded as a base line and will all be repeated at the end of the therapeutic period.

NB These may not be appropriate for all Gardens or Projects. This project was effectively attached to a group of GP Surgeries and therefore subject to standard NHS Data protection policices as well as clinical protocols. Your choice of metrics and assessments should depend on depends on the qualifications, skillsets and governance standards set within an individual garden or project.

Physical Health Metrics recorded:

• Weight
• Height
• Blood Pressure
• Resting heart rate

If appropriate equipment is available, the following measurements would be valuable metrics

• Waist circumference
• HbA1C finger prick blood test that shows average blood sugar (glucose) level over the past two to three months. It is an indicator of metabolic health.
• Cholesterol finger prick test.

For all these metrics it must be established what range is acceptable and what to do if data falls outside that range. Robust protocols need to be developed so that assessors can have absolute confidence in how to address results – especially abnormal ones.

Mental Health Metrics recorded:

There are a variety of scales that can be used to assess mental health. Not all will feel appropriate and it may be that gardens devise their own bespoke model. Equally valuable are qualitative assessments – open ended questions and answers are helpful in charting the Gardeners care and progress. They are also useful in anonymised reporting of the work that the garden is doing.

However it is done, to have a robust and reproducible method to monitor progress – and importantly to flag up any risk as it develops – so appropriate referrals can be made and support can be provided.

In the event of identified risk each organisation needs to have clear guidelines and protocols on what actions should be taken when a risk of suicide, self-harm or harm to others is identified, and who is responsible to take them.

Appropriate scales and assessments may include:

• The Generalised Anxiety Disorder Assessment (GAD-7) is a seven-item instrument that is used to measure or assess the severity of generalised anxiety disorder (GAD). Each item asks the individual to rate the severity of his or her symptoms over the past two weeks.
• PHQ-9 (Patient Health Questionnaire -9) provides objective information about the severity of depression.
• The Warwick-Edinburgh Mental Wellbeing (WEMWBS) scale has been developed to enable the monitoring of mental wellbeing in the general population and the evaluation of projects, programmes and policies which aim to improve mental wellbeing.

An ambition of Gardening4Health is to create a more standardised approach across STH providers to assessment and includes Mental Health Recovery metrics.

After the Therapeutic Period

At the end of the therapeutic period, whatever was agreed, the same physical and mental wellbeing metrics will be recorded by the therapists together with a review of how the beneficiary feels about the therapy and what benefits they derived.

The Therapists will also ask whether they would like to continue gardening in some form and offer options to make that possible. We have established links to various organisations local to us that offer:

• Further horticultural training leading to an NVQ.
• Options for working as a volunteer gardener.
• The possibility of joining a community run allotment.
• Taking on their own allotment.

We can help gardeners access them if needed.