Using HT for Mental Health in Puerto Rico
By Pedro Arocho Soto
Pedro J.Arocho Soto is a Doctoral Intern in Clinical Psychology at the Hospital (psychiatric) Metropolitano de la Montaña in Utuado, Puerto Rico. He is a member of the student community of Albizu University, Mayagüez center, and was educated in clinical psychology at Albizu University in Mayagüez, Puerto Rico; clinical neuropsychology at Miguel de Cervantes University in Barcelona, Spain; therapeutic horticulture at the Institute of Therapeutic Horticulture in Lima, Peru; and agroecology at the Josco Bravo Agroecology Project in Ponce, Puerto Rico. Pedro has been an active promoter of self-management and a leader in directing community interventions for his town of Utuado.
This blog shows how the integration of horticultural therapy can be effective in supporting the processes of adjustment, resilience, self-sustainability, and promotion of well-being in a community.
He is currently working on the writing of an intervention manual: “Horticultural therapy: an intervention manual for children diagnosed with ADHD based in mindfulness and cognitive stimulation.” He is also raising awareness of horticultural therapy in different towns throughout Puerto Rico.
Hurricane Maria’s Effects on the Island
In September 2017, Puerto Rico (PR) experienced the devastation of Hurricane Maria with an approximate cost in damages of $80 billion and with more than 4,000 deaths as a result of the hurricane (Vélez,2020). Three years later, on January 7, 2020, an already shocked population awoke to a 6.4 magnitude earthquake. Three months later, the COVID-19 pandemic arrived. The effect of the pandemic is visible especially in the 56 percent of our children living under conditions of poverty and hunger (Vélez-Serrano, 2020). This has created a movement of social awareness, promotion of food autonomy, and raising awareness about the importance of mental health for social-community development. The faculty and the student community (to which I belong) of Carlos Albizu University are actively involved in the psychological care of the country.
In my experience as a doctoral student, I have been able to appreciate how the integration of horticultural therapy (HT) in psychological adjustment processes has been an important behavioral activation (BA) tool during these crisis processes. Behavioral activation (BA) aims to create healthier patterns of behavior to improve mood and overall quality of life (Maero & Quintero, 2015). Scientific literature tells us that crisis is an acute state of stress, typified by the sudden break of psychic fixity and by the subject’s active response to a process of change (Gonzalez, 2001). The DSM-V states that supervening stressors can lead to emotional and behavioral changes with an impact at the individual or community level (APA,2013).
Use of Horticultural Therapy
Horticultural therapy (HT) consists of using plants and related activities to procure the wellbeing of the participants. It is an active process that occurs within an established treatment plan, offered by a qualified horticultural therapist to achieve specific and documented therapeutic goals. (Peña, 2013). Therefore, the process of BA using horticultural therapy, promotes behavioral and psychological de-centering as well as integrating adequate physical activity routines with horticulture-related skills. This connection occurs with nature and the promotion of food autonomy through vegetable growing.
In the face of events such as natural disasters and COVID-19, I observed the need to promote in my clients, a sense of subjective wellbeing and encourage resilience. In one of the interventions, one of the participants said: “this seed will grow, and it will be a bean, now I know that I can still achieve something by cultivating calm and harvesting patience.” In my experience, in these crisis interventions people question themselves, feel guilt and helplessness because of the negative appraisal of their feeling and thoughts of inability for self-realization. The integration of HT promoted a sense of accomplishment, positive moods and motivation through gardening activities related to the ability to grow a living thing, care for it and having the possibility of replicating it dozens of times for the benefit of their mental health, physical health, and nourishment. In addition, HT allowed clients to recognize that facing challenges involves going through a process of psychological adjustment.
Horticultural Therapy allowed clients to recognize that facing challenges involves going through a process of psychological adjustment
This process of psychological adjustment is indeed a process of change. In January 2020, together with relief brigades led mainly by Dr. Melissa Bezares (director of the Albizu Clinic in Mayagüez, Puerto Rico), and other faculty members and students, we demonstrated through the integration of HT, to those impacted by the earthquakes in the southern area of Puerto Rico, how this event can be an opportunity for change and the maintenance of a sense of wellbeing. Many people in times of crisis were not able to identify their primary needs and begin to work towards change. One of the participants mentioned during one of the activities: “we have to allow ourselves to water our lives with healthy water”, thus contemplating the real need for change, such as getting out of stagnation and moving into action. The integration of HT taught that just as in plants, there are moments when human beings have to cut and separate from variables that affect our health; in a plant it helps to get out of a small pot that prevents progress, and in human beings to get out of a condition that controls our wellbeing and prevents behavioral and psychological decentering.
Unlike Hurricane Maria and the earthquakes which took place early 2020, the COVID-19 pandemic involved social distancing, and it was the community itself that lifted much of the country; something we were also part of. Scientific literature mentions that social distancing generates a non-normative stress that can increase the probability of experiencing a mental health problem for the first time, or the recurrence of a pre-existing mental disorder (Caballero & Campos, 2020). Faced with this new reality, the psychological services provided by students in clinical training adopt the modality recognized as “tele-psychology”. Psychological services within this modality during the pandemic are mainly aimed at mitigating the psychological impact of COVID-19, the stress that can be caused by the process of adjustment to social distancing and providing continuity to the psychological services offered in this community clinic. One of the tasks I mainly executed was the creation of healthy routines. In these, participants were assisted in creating a garden work plan, the creation and maintenance of small family vegetable gardens and the inclusion of backyard walks contemplating nature in full awareness. Exposure to nature for 20-30 minutes has been found to reduce salivary cortisol levels by 21.3% (Hunter et al.,2019). To this end, HT integration was shown to be a useful tool, as it can promote the hope of contact with another living being despite estrangement.
My experience as a doctoral student integrating the use of plants to the therapeutic process and adjusting it to our current reality, allowed me to perform this practice via “tele-psychology”. I showed my participants how human beings, just like plants, can be impacted by viruses; Puerto Ricans at this moment, just like aphids, can become vectors. It was exemplified through HT how social distancing and hygienic practices can help us to avoid the spread of pests to other plants and humans. On the other hand, it has been mentioned that therapeutic gardens can help alleviate psychological distress caused by illness (Burton, 2014). In the absence of a structured garden, the backyard and home plants became a place to achieve therapeutic goals. With the help of parents and caregivers, attentional processes were stimulated through adapted gardening exercises, reminiscence of positive memories was stimulated through sensory integration, family integration, physical activity and the implementation of healthy routines including the production of their own food were encouraged.
The historical milestone we are living, the economic and social repercussions, and our socio-demographic reality has provoked a sense of social-community action at many levels. The integration of work with plants is a useful tool for intervention processes in situations of social crisis and psychological adjustments of individual and collective impact. The need to create healing gardens of community impact and therapeutic gardens of impact in psychological practice remains as a viable, accessible, and non-threatening issue to be considered in the future. In addition, the need for the creation of scientific documentation to validate or discard the effectiveness of this integration into psychotherapeutic processes is exposed. Human beings, like plants, are vulnerable to events beyond their control and these events are opportunities to execute adaptive processes and seek survival. In this process we treat children as the seed of the village, something that you take care of and take responsibility for its permanence in generations.
Finally, if we germinate these seeds under conditions of stress and constant crisis, if they survive, they will carry with them battle marks that may compromise their progress and survival. In Puerto Rico, the constant moments of crisis that we have experienced have undoubtedly left battle marks that will remain latent in our memory.
We invite you to cultivate love, hope, and commitment in children because they are the seed of the people and in time we will harvest empathy, solidarity, and respect for all human beings equally.
Spanish Version
The Spanish version of this blog is available for viewing here.
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