The Farm as Medicine

An Ancient Practice with a Modern Evidence Base

Horticultural therapy, the use of gardening and plant-based activities as a therapeutic intervention, has roots stretching back to ancient Mesopotamia and Persia, where enclosed garden spaces were deliberately designed for rest and restoration. In the United States, the practice was formally documented by Dr. Benjamin Rush, a signer of the Declaration of Independence and the man often called the Father of American Psychiatry, who observed in the early 19th century that working in gardens had measurable positive effects on patients with mental illness.[1] The field was professionalized after World War II, when horticultural programs played a significant role in rehabilitating hospitalized veterans, and the American Horticultural Therapy Association was established in 1973 as the first national organization dedicated to the field.

What was once observed and intuited is now rigorously measured. The convergence of environmental psychology, neuroscience, and clinical research over the past four decades has produced a substantial body of evidence confirming what gardeners have always known: that contact with growing things is not incidental to human health. It is foundational to it.

Two theoretical frameworks underpin much of this research. Attention Restoration Theory, developed by Stephen and Rachel Kaplan, holds that the directed, effortful attention demanded by modern life depletes cognitive resources, and that natural environments restore them through “soft fascination,” the kind of effortless, pleasurable engagement that a garden or a view of trees provides without taxing the very systems it is restoring.[2] Stress Recovery Theory, developed by Roger Ulrich, proposes that nature contact produces rapid emotional and physiological recovery from stress,  lower blood pressure, reduced cortisol, decreased sympathetic nervous system arousal,  through automatic responses that predate the cognitive mind.[3] Together, these frameworks explain why a garden works the way it does, and why its effects are not placebo.

What the Research Shows

The clinical evidence for horticultural therapy is now substantial enough to support meta-analysis. A 2024 systematic review published in Frontiers in Psychiatry analyzing multiple randomized controlled trials found large and significant effects on depression reduction and moderate to large effects on anxiety reduction[4] from social and therapeutic horticulture programs. A multi-site trial of 192 participants across 30 therapeutic gardening sessions found effect sizes of 0.583 for depression, 0.728 for anxiety, 0.903 for stress, and 0.695 for loneliness, results that compare favorably with pharmacological and psychotherapeutic interventions for the same conditions.

The physiological evidence is equally compelling. A landmark randomized study found that cortisol levels decreased significantly more in people who gardened than in those who read,[5] and that positive mood was fully restored after gardening where it further declined during reading. The Royal Horticultural Society’s 2021 analysis of national survey data found that people who garden daily have wellbeing scores 6.6% higher and stress levels 4.2% lower[6] than those who do not garden at all, a dose-response relationship between time in the garden and measurable health outcomes.

These are not small effects. They represent the kind of improvements that, in a pharmaceutical context, would trigger widespread adoption. In a garden context, they represent an intervention that costs relatively little, requires no prescription, produces no side effects, and, in institutional settings, can also grow food that feeds the people receiving treatment.

“Gardening promotes neuroendocrine and affective restoration from stress more effectively than reading, and the effects are measurable in cortisol, blood pressure, and self-reported mood within a single session.” – Journal of Health Psychology, 2011

When the Farm Is the Hospital

The connection between gardens and healing has been demonstrated most precisely in healthcare settings. In 1984, environmental psychologist Roger Ulrich published a study in Science that became one of the most cited papers in healthcare design history. Examining surgical patients in a Pennsylvania hospital, he found that those whose windows faced a natural scene recovered an average of one day faster, required significantly fewer potent pain medications, and received fewer negative evaluative comments in nursing notes[7] than matched patients whose windows faced a brick wall. The only variable was the view. His work has since influenced billions of dollars in hospital construction worldwide and established the healing garden as a clinical infrastructure investment, not a decorative one.

Today, a growing number of healthcare institutions have moved beyond the view to the farm itself, creating on-site growing programs that combine therapeutic benefit with actual food production for the patients they serve.

Eskenazi Health –  Indianapolis, Indiana

The Sky Farm at Eskenazi Health is a 5,000-square-foot rooftop farm producing over 2,000 pounds of food annually[8] for patient meals and educational programming. It was designed with therapeutic access as a primary consideration, raised beds sit at 30 inches to accommodate wheelchair-bound patients participating in physical and occupational therapy. “Fresh Veggie Fridays” cooking classes teach patients how to prepare and use what the farm grows, connecting the act of growing with the act of eating in a way that extends the therapeutic benefit beyond the garden gate.

Boston Medical Center – Boston, Massachusetts

Boston Medical Center’s on-site farm and Preventive Food Pantry represent one of the most integrated food-as-medicine models in American healthcare. The farm produces 3 tons, 6,000 pounds, of produce annually,[9] contributing to approximately 1,800 patient meals per day. The Preventive Food Pantry, integrated directly into clinical care, connects food-insecure patients with fresh produce through physician referral, addressing the upstream nutritional factors that drive chronic disease readmission. Research on similar food pharmacy programs has documented reductions in hospital readmission rates as improved post-discharge diets reduce emergency department returns.

Other hospitals are following similar paths. Saint Joseph Mercy Hospital grows approximately 9,000 pounds of produce per season. UCSF Medical Center at Mission Bay features 160,000 square feet of green space including rooftop gardens, and its Food Farmacy program doubled food distribution to 80,000 pounds annually[10] during the pandemic as food insecurity among patients surged. Lankenau Medical Center has produced more than 13,000 pounds from its Deaver Wellness Farm since 2016.

The institutional farm in a healthcare setting is doing double work: it is growing food that reduces the cost and burden of patient care, and it is providing the documented psychological and physiological benefits of contact with living plants to patients, families, and clinical staff who are often operating under chronic stress. These are not competing functions. They reinforce each other.

Gardens as Safe Ground: Shelters and Transitional Housing

Among the most compelling applications of therapeutic farming is in settings where people are rebuilding lives after acute trauma such as women’s shelters, transitional housing programs, domestic violence recovery centers, and homeless service organizations. The garden, in these contexts, is not primarily a food production system. It is a therapeutic environment in which the act of tending something living, and watching it grow, can mirror and support internal processes of recovery that are difficult to access through talk therapy alone.

The research on horticultural therapy with domestic violence survivors is specific and encouraging. A review published by the National Resource Center on Domestic Violence found that therapeutic horticulture in shelter settings reduces stress, depression, and negative affect while promoting relaxation, social inclusion, and self-confidence[11] among residents and their children. Garden activities, planting seeds, weeding, watering, harvesting, are accessible regardless of verbal communication ability or prior trauma history, which makes them particularly valuable in populations where direct discussion of traumatic experience may be retraumatizing rather than healing.

Two peer-reviewed studies specifically found statistically significant reductions in PTSD symptoms among women who participated in gardening interventions.[12] A broader review found that marginalized populations who participated in community farm programs with voluntary engagement and shared decision-making,  where participants had genuine agency over the space, reported increased feelings of dignity, independence, and belonging.[13] The garden becomes a place where it is safe to be a beginner, where effort is rewarded visibly, and where the relationship between care given and growth received is reliable in a way that human relationships, in these contexts, often have not been.

GreenHouse17 –  Kentucky

GreenHouse17, a domestic violence organization in Kentucky, operates a farm program where shelter residents receive compensation for their participation, blending the therapeutic benefits of the garden with vocational training and an employment pathway. Residents gain skills in food production, land management, and small farm economics alongside the healing that the physical act of farming provides. The model recognizes that recovery is not only emotional but economic, and that a farm can address both.

“The garden is a place where it is safe to be a beginner. Where effort is rewarded visibly. Where the relationship between care and growth is reliable in a way that, for many of the people we serve, human relationships have not been.”

Where Faith and Farming Meet

One of the most widespread and least recognized networks of institutional food growing in the United States operates through faith communities. A 2021 analysis drawing on Pew Research Center data found that 48% of U.S. congregations either operate their own food distribution program or actively support food banks and pantries.[14] Many of these programs have evolved to include on-site growing, church gardens, synagogue plots, mosque community farms, that connect the theological dimensions of land stewardship with the practical work of feeding neighbors.

Faith community gardens operate with a particular social logic: no paperwork, no qualifications, no means testing. Food is grown and distributed as an act of community care, available to anyone who shows up. That accessibility, which formal food assistance systems often struggle to achieve, makes faith-based growing programs uniquely effective at reaching people who fall through the gaps of institutional support.

The examples are as varied as the communities behind them. Crossroads Community Baptist Church in Whitley City, Kentucky, distributes free groceries to approximately 400 families and feeds 250 children daily[15] during summer months. Upper Sand Mountain Parish in northeastern Alabama operates a food pantry, a community garden, a cannery, and healthy eating education programs. Plymouth Congregational Church in Minneapolis runs both a community garden and a farmers market, connecting congregational food production to neighborhood food access. Interfaith Communities in Eugene, Oregon, links residents directly with local farmers through CSA-style distribution.

The theological roots of this work are deep across traditions, the stewardship of land, the obligation to feed those who are hungry, the sacred quality of growing things, but the practical outcomes are secular and measurable: more fresh food in communities that need it, distributed through trusted local institutions, grown by people whose motivation is something larger than profit.

Roots and Renewal: Senior Living and Retirement Communities

Among the most quietly powerful applications of therapeutic farming is one that often goes unrecognized in the broader conversation about healing gardens: the senior living community. Older adults face a convergence of challenges that gardening is particularly well-positioned to address, social isolation, cognitive decline, loss of purposeful activity, and reduced physical mobility. A growing body of research confirms that regular gardening activity measurably addresses each of these dimensions, providing a non-pharmacological intervention for depression rates that are significantly underdiagnosed in aging populations.

The clinical evidence for horticultural therapy with older adults is compelling, documenting improvements in cognitive function, hand strength, sleep quality, and self-reported life satisfaction. The mechanism is not mysterious: gardening provides “soft fascination” that restores cognitive resources while offering a reason to go outside and a task that rewards patience. For a resident in an assisted living facility who has spent decades cultivating the earth at home, access to a plot of soil is not a wellness amenity. It is a continuation of identity, a way to remain a producer in an environment where one is often a recipient.

The development of community gardens at Seaside, a senior living community in South Florida, represents one of the most resonant projects in the Neighborhood Farms USA network. This is the institutional farm at its most human scale: a carefully tended space where residents contribute their hands, their knowledge, and their time. In this environment, longtime gardeners become informal teachers and first-time growers discover new skills, creating a community-centered space where effort is rewarded visibly and residents matter in a tangible, flourishing way.

Starting Where You Are: Tools and Resources

The infrastructure for institutional and therapeutic farming has been built for decades. The American Horticultural Therapy Association[18] is the primary professional home for practitioners, offering credentials at multiple levels, from the Horticultural Therapist-Registered (HTR) designation requiring intensive clinical training to the Therapeutic Horticulture Practitioner credential for those integrating garden programming into broader care contexts. A new board-certified credential (HT-BC) launches in October 2026, signaling the field’s continued professionalization.

The Therapeutic Landscapes Network,[19] founded by landscape architect and researcher Naomi Sachs, serves as a comprehensive knowledge base for healing garden design, with patient-population-specific guidelines covering burn units, psychiatric wards, Alzheimer’s care, hospice, and pediatric settings. Its foundational text, Therapeutic Landscapes: An Evidence-Based Approach to Designing Healing Gardens and Restorative Outdoor Spaces is the standard reference for healthcare institutions building or retrofitting therapeutic outdoor spaces. An important finding from this literature: not all gardens are equally effective. Poorly designed gardens can actually increase stress in clinical populations. Design specificity matters as much as the presence of green.

For institutions starting from scratch, a hospital system considering a rooftop farm, a shelter director looking to add a garden program, a faith community ready to expand from food pantry to food garden, the Horticultural Therapy Institute offers certificate programs that build the skills to run therapeutic programming, not just the infrastructure to grow plants. The distinction matters: a therapeutic farm is a clinical environment. Its outcomes depend on intentional facilitation, not just soil and seeds.

The Neighborhood Farms USA Connection

The Institutional and Therapeutic Farm is one of the core farm types within the Neighborhood Farms USA network and one of the most resonant with our mission. When a hospital grows food for its patients, it is doing what a neighborhood farm does at its best: closing the distance between where food is grown and where its nutritional and healing power is needed. When a shelter creates a garden space for women rebuilding their lives, it is demonstrating that the act of growing is an act of care, for the land and for the person doing the growing. When a faith community tends a garden and distributes its harvest to neighbors who are hungry, it is practicing the oldest form of food access work there is. And when a senior living community gives its residents a plot of soil and the space to tend it, it is returning to them something that formal care environments so often take away: agency, purpose, and the simple dignity of growing something that feeds another person.

These are not peripheral applications of the neighborhood farm model. They are among its most powerful expressions. The gardens at Seaside, one of the earliest projects in the NFUSA network, have shown us what this looks like in practice. Residents with decades of gardening knowledge sharing it in a communal space. First-time growers discovering something new late in life. A garden that becomes one of the rare places in a senior living environment where people are contributors, not just recipients. That model is replicable, and it is part of what our Community Gardens program is designed to help communities build.

The NFUSA Get Involved Guide includes institutional and therapeutic farm programs among its resources, places where volunteers can contribute, where community members can participate in therapeutic gardening programs, and where organizations exploring this model can find partners and examples. The infrastructure of healing farms already exists in neighborhoods across the country. Finding it, joining it, and supporting it is where we start.

The Growing Impact Fund supports institutional farm buildouts at exactly this scale — the raised beds accessible to wheelchairs, the soil amendments that turn a rooftop into a productive growing space, the composting infrastructure that makes a shelter garden sustainable season over season, the signage and programming materials that turn a garden into a therapeutic environment rather than simply a plot of land. Because the gap between a concrete courtyard and a healing garden is often smaller than it appears,  and the outcomes on the other side of that gap are among the most meaningful our network produces.