We’ve all felt the calming effects of spending time in nature, whether it’s a stroll through a park or a quiet moment in a garden. But not all natural environments induce the same mental health benefits. Some landscape features, when combined, are more effective than others at promoting well-being, and the Contemplative Landscape Model (CLM) helps us understand why.
What is CLM?
The Contemplative Landscape Model (CLM) was developed in 2016 by Agnieszka Olszewska-Guizzo to guide the design of urban green spaces, especially in cities where space is limited. By combining neuroscience research with landscape design, CLM identifies the specific features in a natural setting that are most likely to enhance mental health, even through passive exposure. The model offers a framework for urban planners, landscape architects, and decision-makers to create spaces that are both aesthetically pleasing and beneficial for well-being.
CLM focuses on seven key components: Landscape Layers, Landform, Biodiversity, Colour and Light, Compatibility, Archetypal Elements, and Character of Peace and Silence. By considering these components, CLM provides a systematic way to evaluate and optimize green spaces for their mental health benefits.
Investing in contemplative landscapes can lead to significant economic benefits. For one, providing access to highly contemplative spaces can reduce mental health struggles in citizens, easing the burden on healthcare systems and improving quality of life. Nature-based solutions are already cost-effective in improving urban livability, and including contemplative landscapes alongside these efforts prolong the benefits beyond what green spaces alone promise to offer for mental health and well-being promotion.
Evaluating a local park in Canterbury, UK.
Real-world Examples: Singapore and Sweden
Singapore and Sweden have both integrated CLM into their NbS health promotion projects with great success.
In Singapore, CLM played a key role in the creation of Therapeutic Gardens and other mental health-promoting urban spaces as part of the city’s “City in Nature” vision. These spaces are designed to foster respite and contemplation amidst the fast-paced environment of the city-state.
In Sweden, CLM has been incorporated into the country’s Nature-based Rehabilitation program. This initiative helps people suffering from stress-related exhaustion syndrome recover in high-quality rural environments, as part of Sweden’s public healthcare scheme.
A series of neuroscience experiments conducted to validate the CLM.
How CLM Evaluations Work
When we evaluate a landscape using the CLM, the first step is mapping out the perimeter we’ll be assessing and selecting key viewpoints. These viewpoints are chosen carefully, based on where people are most likely to experience the space—whether they’re entering or exiting the space, walking along a path, sitting on a bench, or pausing to enjoy the scenery. At each viewpoint, we can also look at the landscape from up to four different directions (north, east, south, and west) to get a complete understanding of that viewpoints’ features.
Once we have picked our viewpoints, it is time to begin scoring. At each viewpoint, we take time to observe the space and break it down according to the seven core components of CLM: Landscape Layers, Landform, Biodiversity, Color and Light, Compatibility, Archetypal Elements, and the Character of Peace and Silence. We consider how each of these components contributes to the overall experience of the space and how they might change under different weather conditions or times of day.
For instance, we know that sunny weather can bring out vibrant colors and create dynamic shadows, while seasonal shifts might affect the appearance of trees and plants. In cases where the weather isn’t ideal, like the rainy day we encountered in Canterbury, we rely on our experience to imagine how the landscape would look under more favourable conditions.
Once we’ve gathered our observations, we score each component and calculate an average to determine the overall CLM score. A score above 4.33 means the landscape has a strong contemplative quality and high potential to promote mental health and well-being.
Final Thoughts
The Contemplative Landscape Model offers an evidence-based practical way to design and evaluate green spaces that support mental health. By evaluating elements like landforms, biodiversity, character of peace and silence, and compatibility, cities and can create environments that foster well-being and resilience. As seen in Singapore and Sweden, integrating CLM into Nature-based Solutions projects, can improve public health and enhance communal quality of life.
As more public authorities recognise the importance of contemplative landscapes, we can look forward to cities that are not only greener but also healthier for everyone.
Our cities are often designed with function in mind. We build parks for exercise, wider sidewalks for pedestrians, and bike lanes for commuters. While we have made progress towards building healthier bodies, we have overlooked the equally important mental well-being.
Urban design has a powerful influence on the quality of its citizens’ life, especially mental health. It shapes the spaces where we live, work, and interact with others. From the soothing presence of green spaces to the efficiency of street layouts, the built environment affects our daily mood and overall well-being. Well-designed urban areas can foster a sense of community and belonging, providing places for people to connect, be active, and recharge. However, poorly planned environments can contribute to feelings of stress, anxiety, and isolation. By understanding the relationship between urban design and mental health, we can create cities that not only meet our physical health needs but also nourish our mental health.
How Urban Space Can Deteriorate Mental Health
Several factors in urban environments can negatively impact mental health, such as:
Disconnection from Nature
Urban environments often disconnect residents from nature, which is deeply rooted in our evolutionary history. Humans have evolved in natural environments, and the lack of green spaces and natural ecosystems in cities can lead to residents developing what is referred to as “nature deficit disorder.”[i] Urban residents lack access to nature’s psychological benefits, such as reduced stress, improved mood, and enhanced cognitive function [ii], [iii]. Research on anxiety disorders (such as post-traumatic stress disorder, distress, anger, and paranoia) and the risk for developing schizophrenia showed higher rates in urban versus rural areas [iv]. In fact, epidemiological studies concluded that the more time spent in an urban environment as a child, the higher the risk for developing schizophrenia as an adult [v].
Noise Pollution
Constant exposure to noise pollution from traffic, construction, and industrial activities can seriously impact mental health. Humans are not adapted to endure continuous loud noises, which can lead to chronic stress, sleep disturbances, depression, and increased anxiety [vi].
Air Pollution
Air pollution not only contributes to respiratory and cardiovascular diseases but also affects mental health [vii]. Long-term exposure to polluted air has been linked to cognitive function decline and an increase risk of developing mental health disorders such as depression, anxiety, and even dementia.[viii] The World Health Organization (WHO) estimates that air pollution is responsible for approximately 7 million premature deaths per year, and a considerable percentage of these are in connection to mental health effects [ix].
Traffic
Heavy traffic and long commutes in bigger cities lead to mental exhaustion, stress and decreased life satisfaction [x]. The daily grind of tackling the morning and post-work rush hour adds to mental strain, leading to irritability and anxiety. A study from the American Journal of Preventive Medicine found that longer commutes are associated with higher levels of stress and lower levels of life satisfaction [xi]. Not to mention that traffic also increases exposure to noise and air pollution, adding to the detrimental effects on mental health [xii]. Living close to traffic can also disturb sleep patterns and cause further irritability and potentially aggression, which then fuels mood and anxiety disorders [xiii].
Overcrowding
High population density, often associated with large-scale, closely packed buildings, can lead to feelings of claustrophobia, stress, and social isolation. Overcrowding reduces personal space and increases competition for resources. This can lead to social tensions and a higher chance of (violent) conflict [xiv]. Furthermore, urban environments with high population densities can overload residents with stimuli, leading to sensory overload, higher stress levels and an impaired cognitive function [xv]. These factors can harm mental well-being, especially since humans are not evolutionary adapted to such densely populated living environments [xvi].
Overload of Stimuli and Information
Modern cities are packed with static and dynamic elements, which are abstract in design, all connected by a complex web of infrastructure. The variety of forms, colours, and textures, in a dense environment, can overwhelm the brain. Tasks that are simple in theory such as navigating the city become mentally exhausting as the brain struggles to process the overload of information being thrown its way. Over time, the constant over-stimulation can lead to mental fatigue, which in turn may increase the risk of developing mood and anxiety disorders [xvii].
Abstract Forms
Cities are made up of forms based on Euclidean geometry, including straight lines, circles, triangles etc. But these forms are rarely found in nature. Rather, nature is filled with amorphic and asymmetrical forms. Research has shown that high exposure to abstract forms, like those in plentiful supply in modern cities, can feed feeling of unease and detachment, leading to increased stress and reduced mental well-being. On the other hand, exposure to natural elements does not have the same effect and can even reverse the strain caused by the urban structures [xviii].
Shortened Visual Outreach
A key characteristics of city environments is the large-scale, high density of buildings and other built structures, packed into limited land plots. This places even more psychological strain on citizens as it creates the impression of a smaller personal space [xix].
How Urban Spaces Can Boost Our Mental Health
Well-designed urban spaces can have a transformative impact on our mental, physical, and social well-being. Research suggests that environmental factors in our surroundings can either exacerbate or protect us from the development of diseases, depending on our genetic makeup. The good news is that by creating optimal urban environments, we can not only enhance overall well-being but also potentially reduce the impact of genetic predisposition to certain health conditions. Our efforts should not stop at the doors of prevention (of mental health deterioration), but we should be striding towards taking action to improve mental health. So, what aspects should we consider when designing our urban environments?
Green Spaces and Nature
Providing free access to parks and other green areas is essential for not only improving but also maintaining mental health. Spending time in nature helps reduce stress, anxiety, and depressive symptoms while boosting mood and concentration. Green spaces also promote physical activity, relaxation, and social interaction [xx]. Incorporating more green spaces such as community gardens curated with contemplative elements into city planning, we can counterbalance the negative effects of urban environments [xxi].
Healthcare Accessibility
Easy access to both mental and physical healthcare services is important for early intervention and continuous support. By reducing barriers to care, such as long travel times and exposure to elements that may negatively affect our health, we can improve overall well-being [xxii].
Community Centres: Community centres offer social support networks, recreational activities, and educational programs that strengthen social cohesion and reduce feelings of isolation. These centres also provide safe spaces for individuals to engage in hobbies and group activities, fostering a sense of belonging and community [xxiii].
Inclusive and Accessible Design
Designing flexible urban spaces that accommodate all ages and abilities ensures that everyone can enjoy public spaces. Inclusive design promotes social involvement and equity, which are crucial for community mental health [xxiv].
Implications for Urban Design and Directions
To take full advantage of smart urban design, we must prioritize the health of residents. Planners and policymakers have a key role in promoting mental well-being through thoughtful design. Therefore, consider the following recommendations:
Integrate Nature-Based Solutions (NbS): Incorporating green spaces, urban forests, and community gardens into city planning can enhance mental health and help prevent (and treat) mental health conditions. Nature-based solutions reduce environmental stressors, encourages social interaction, and creates mentally supportive urban spaces.
Implement Contemplative Landscapes: Design features that promote mindfulness and relaxation, such as depths in views, biodiversity in plant and animal species, harmonious, warm colours, shade and seating areas, water elements, can significantly reduce stress and improve mental health [xxv].
Promote Social Interaction: Design public spaces that encourage social interaction and community engagement, such as "walkable neighbourhoods," community hubs, and recreational areas.
Ensure Accessibility and Inclusivity: Urban spaces should be accessible to all, including people with disabilities, the elderly, and children. Inclusive design fosters a sense of community and ensures that all residents can benefit from public spaces. Inclusiveness should also be reflected in the design process, with active participation from users during development.
Use Technology and Data-Driven Approaches in Design: Incorporate advanced tools like mobile Electroencephalography (mEEG) and machine learning to assess and predict the impact of urban design on mental health. This will confirm the changes that are to be implemented are indeed creating calming spaces that boost mental health and quality of life.
By prioritizing mental health in urban design, cities can become healthier, more resilient, and inclusive. When green spaces, accessible facilities, and safe, active areas are integrated from the start of the urban planning process—rather than as an afterthought—urban planner can create environments that ultimately improve the quality of life for all residents.
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[ii] Olszewska-Guizzo, A. (2018). Contemplative Landscapes: Toward Healthier Built Environments. Environment and Social Psychology. 3. 10.18063/esp.v3.i2.742.
[iii] Olszewska-Guizzo, A., Fogel, A., Benjumea, D., Tahsin, N. (2022). Sustainable Solutions in Urban Health: Transdisciplinary Directions in Urban Planning for Global Public Health. In: Leal Filho, W., Vidal, D.G., Dinis, M.A.P., Dias, R.C. (eds) Sustainable Policies and Practices in Energy, Environment and Health Research. World Sustainability Series. Springer, Cham. https://doi.org/10.1007/978-3-030-86304-3_14.
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[xx] Kumar, P., Brander, L., Kumar, M., & Cuijpers, P. (2023). Planetary Health and Mental Health Nexus: Benefit of Environmental Management. Annals of global health, 89(1), 49. https://doi.org/10.5334/aogh.4079.
[xxi] Kabisch, N. Basu, S., Van den Bosch, M., Bratman, G., Masztalerz, O. (2023). Nature-based solutions and mental health. 10.4337/9781800376762.00019.
[xxii] Coombs, N. C., Meriwether, W. E., Caringi, J., & Newcomer, S. R. (2021). Barriers to healthcare access among U.S. adults with mental health challenges: A population-based study. SSM - population health, 15, 100847. https://doi.org/10.1016/j.ssmph.2021.100847
[xxiii] Alexander Haslam, S., et al. (2023). Connecting to Community: A Social Identity Approach to Neighborhood Mental Health. Personality and Social Psychology Review. doi.org/10.1177/10888683231216136.
[xxiv] Alexander Haslam, S., et al. (2023). Connecting to Community: A Social Identity Approach to Neighborhood Mental Health. Personality and Social Psychology Review. doi.org/10.1177/10888683231216136.
“The future of humanity is undoubtedly urban,” warns the UN-Habitat in their World Cities Report (2022), urging public health policies to address the growing health risks associated with urban expansion. Urban environments — characterized by traffic, pollution, noise, and overcrowding — not only create fertile ground for physical health issues but also place a significant burden on the mental health of their citizens (Olszewska-Guizzo et al., 2023). Neuropsychiatric diseases now account for 19.5% of all disability-adjusted life years (DALYs), while depression is responsible for 6.2% of DALYs (World Health Organization, n.d.). These mental health challenges deteriorate citizens’ quality of life and generate serious economic losses for the state.
Figure 1: Population living in urbanized areas in 1990, 2014, and 2050 by continent and worldwide, UN, 2018 (https://www.esa.un.org/
unpd/wup)
Governments are increasingly recognizing the urgent need for interdisciplinary, evidence-based solutions to address this mental health crisis (Gruebner et al., 2017). A growing body of research highlights the restorative effects that contact with nature has on human health (Olszewska-Guizzo, Sia, & Escoffier, 2023). These effects include reducing stress and fatigue, triggering positive emotions, and improving cognitive functions such as concentration, memory, and creative performance (WHO, 2021).
Nature-based Solutions (NBS) are emerging as effective and cost-efficient strategies for addressing the growing mental health challenges in urban environments. The IUCN defines NBSs as actions to protect, sustainably manage, and restore natural or human-modified ecosystems, offering benefits for both environmental preservation and human well-being. Adopting NBSs to confront human health challenges arising from unhealthy environments aligns with the One Health approach (WHO) — which recognizes the interdependence of animal, ecosystem, and human health — and the UN 2030 Agenda for Sustainable Development. NBSs have been well-documented to support people’s emotional, mental, and physical health by adopting a holistic approach to prevention, promotion, rehabilitation, and therapy.
Figure 2: "Envisaging the Future of Cities," World Cities Report 2022 (https://unhabitat.org/sites/default/files/2022/06/wcr_2022.pdf)
Not Just Green
Often there is limited space available in cities for green areas, so it is important to optimize the design and use of the available green spaces (Olszewska-Guizzo, Sia, Fogel, et al., 2022). Urban planners, landscape architects, and conservation experts need to understand which types and characteristics of urban green spaces (UGS) most effectively benefit citizens’ mental health. This challenge inspired the development of the Contemplative Landscape Model (CLM) in 2016. The CLM measures how different landscape scenes can positively influence mental health through passive exposure. It focuses on landscape components that, when combined, trigger low-frequency brain activity associated with decreased cognitive strain, increased relaxation, and positive affect, as well as positive effects on mood and anxiety disorders(Olszewska-Guizzo, Sia, Escoffier, 2023).
The CLM evaluates landscape scenes based on seven key-components, each of which is rated using a 1–6-point scale. The final CLM score, the average of the seven key-components, provides a comprehensive assessment of a landscape's potential to offer beneficial mental health outcomes. The CLM is increasingly being used by practitioners to bridge the gap between landscape design and evidence-based impacts on mental health. It is also helping policy-makers make informed decisions on how to effectively curate UGSs to improve the mental health of their communities.
Figure 3: Seven key-components of Contemplative Landscape Model (CLM).
The main advantages of using the CLM include:
Accessibility and Ease of Use: The tool can be easily learned following formal training and applied by urban design practitioners, landscape architects, and those with a keen eye for landscapes.
Accuracy: The final CLM score is an average from the seven key landscape components in a single view or at multiple sites across the area, which helps to eliminate human error.
Cost-effectiveness: The CLM requires minimal equipment. Evaluations can be conducted in a single site visit using tablets or just pen and paper.
Efficiency: CLM also works with digital representations of landscapes (photos or videos) to save time, making it ideal for practitioners needing to assess multiple sites.
Versatility: The CLM can be applied to a wide range of sites, including urban, suburban and rural spaces, making it a useful tool for diverse environments, and scales.
Dual-purpose: The CLM can be used as an evaluation/ audit tool for green spaces, but also as a set of design guidelines to develop new creative mentally-healthy environments.
Figure 4: CLM evaluations can be conducted using tablets.
Global Examples: Singapore
The CLM has received increasing attention among professionals and researchers worldwide and is slowly finding its place in nature-based health promotion policies. The first country to adopt the CLM in its urban greening initiatives was Singapore. The National Parks Board (NParks) recognized the value of the evidence-based approach early, as part of their City in Nature initiative, which aims to ensure that the available green spaces are designed optimally to maximize the well-being of citizens across a diverse demographic, from the elderly and hospital patients to children with special needs.
The research conducted in Singapore, in collaboration with NParks and the National University of Singapore, found that therapeutic gardens with contemplative features contribute positively to a person's mental health and overall well-being. They also concluded that there were positive neuro-psychophysiological benefits from passive exposure to a therapeutic garden for the mental health of individuals with clinically concerning depressive disorders (Olszewska-Guizzo et al., 2022; Olszewska-Guizzo, Sia, Fogel, Escoffier, & Dan, 2022).
Figure 5: Neuroscience research studies conducted in Singapore between 2018 and 2021
Singapore established the network of 13 therapeutic gardens scattered across the city-state, with plans for an additional 7 to be completed by 2030. Each garden is designed according to the contemplative landscape guidelines to encourage visitors to enjoy everyday contact with the salutogenic nature of the premises.
NParks’ efforts go beyond transforming parks and are slowly moving into the wider urban environment. There is a growing number of public officers and professionals trained in use of CLM for landscape assessment and design (an example of a recent workshop). Their continued research into Nature-based Solutions integrating CLM aligns with Singapore’s healthcare transformation plan, Healthier SG, to promote preventive health strategies for the whole population. Singapore’s efforts are setting a powerful and inspiring example of how states can benefit from embracing Nature-based Solutions to create healthier communities while prioritizing evidence-based design of their available green spaces.
Global Examples: Sweden
Sweden is the second country to incorporate the Contemplative Landscape Model (CLM) into its national health policy as part of its Nature-based Rehabilitation (NBR) program. Alos known as the Skåne-model, or Naturunderstödd Rehabilitering (NUR), it launched in 2013, and is the first of its kind in the Nordic region. NUR is currently active in the southern region of Skåne County, with plans to expand throughout the rest of the country.
The program is founded on extensive research from the Alnarp Rehabilitation Garden, run by the Swedish University of Agricultural Sciences (SLU) (Grahn & Pálsdóttir, 2021). It emphasizes the role of nature in aiding patients to recover from stress-related mental illnesses, specifically exhaustion syndrome, mild to moderate depression, and anxiety (Grahn, Pálsdóttir, Ottosson, & Jonsdottir, 2017). The program takes eight weeks and is run at selected rural properties across Skåne Region (Wissler & Pálsdóttir, 2024).
Figure 6. One of the NBR providers' rural property.
The NBR program supports the rural development goals by employing trained coordinators to deliver the nature-based interventions and services of the program on their premises. These interventions are designed with the following core objectives in mind:
1) Rehabilitation Focus: Aims to support the standard of care to improve physical, mental, and social health through nature-supported activities.
2) Nature-Infused “Awake Rest:” Focuses on relaxation and recovery in a peaceful, undemanding natural environment that promotes mental rejuvenation.
3) Integration of Meaningful Activities: Encourages daily tasks in natural settings, offering participants purposeful engagements that align with the day-to-day operations of the NBR provider.
NBR requires from providers to maintain the quality standards set by the program. These include both the day activities to be offered to the patients and the quality and design of the property's natural environment. The CLM has been introduced to the program as a tool of evaluation for the property's landscape and to provide a systematic approach to develop quality standards comparable between the properties.
Figure 7: CLM on-site evaluations of NBR providers.
In the summer of 2024, six of the eight current NBR providers’ properties in the Skåne region were evaluated by independent experts using the Contemplative Landscape Model (CLM). This was the first time the CLM was conducted on rural properties. Previously, the CLM was used almost exclusively on urban environments. For this evaluation, an average of 12 to 23 landscape views per rural property was scored based on site maps, and the average score was computed for each location. This evaluation was carried out in preparation for the fourth procurement phase of the NUR program. The satisfactory performance of the CLM in this new context demonstrates its versatility and reliability, further supporting Sweden's ongoing commitment to integrating Nature-Based Solutions into public health policy. Sweden is the first country in Europe to adopt the Contemplative Landscape Model (CLM) as part of its national health policy. The adoption reflects their commitment to innovative approaches, including evidence-based initiatives such as the Alnarp Rehabilitation Garden and therapeutic gardens for dementia patients(Pálsdóttir, Wissler, & Thorpert, 2024; Pálsdóttir, O'Brien, Poulsen, & Dolling, 2021), and highlights the country's leadership in promoting preventive health strategies through nature. Sweden's efforts are setting a model example for other European nations to follow in creating healthier, more resilient communities.
Improving citizens’ access to mental health programs and developing holistic strategies to address mental illness remains a key concern worldwide. Without transformative action, mental health problems will “contribute to human suffering, premature mortality, and social breakdown, and will slow down economic recovery.” Improving the mental health of communities is essential not only for enhancing the quality of life of individuals but also for the continued economic and social development of states.
Recognizing the health-promoting value of landscapes, by integration of the Contemplative Landscape Model (CLM) by countries like Singapore and Sweden highlights its potential as a vital tool in integrating Nature-Based Solutions into national public health policies. It is, therefore, crucial to continue educating governments and decision-makers across the globe on the impact of evidence-based landscape design on public health. Through continued collaboration, research, and innovation, the CLM can become a foundational tool for preventive health strategies, helping to promote healthier, happier, and more resilient communities across the globe.
Reference List
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Grahn, P., Pálsdóttir, A.-M., Ottosson, J., & Jonsdottir, I. (2017). Longer nature-based rehabilitation may contribute to a faster return to work in patients with reactions to severe stress and/or depression. International Journal of Environmental Research and Public Health, 14(11), 1310. https://doi.org/10.3390/ijerph14111310
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Olszewska-Guizzo, A., Sia, A., & Escoffier, N. (2023). Revised contemplative landscape model (CLM): A reliable and valid evaluation tool for mental health-promoting urban green spaces. Urban Forestry & Urban Greening, 86, 128016. https://doi.org/10.1016/j.ufug.2023.128016
Pálsdóttir, A.-M., O'Brien, L., Poulsen, D., & Dolling, A. (2021). Exploring migrants’ sense of belonging through participation in an urban agricultural vocational training program in Sweden. Journal of Therapeutic Horticulture, 31(1), 11.
Pálsdóttir, A. M., Wissler, S. K., & Thorpert, P. (2024). An innovative approach in research and development of clinical nature-based rehabilitation in health care and vocational training: The living laboratory, Alnarp rehabilitation garden. Landscape Architecture, 31(5), 116-123. https://doi.org/10.3724/j.fjyl.202404020196
Wissler, S. K., & Pálsdóttir, A. M. (2024). A quality assurance framework for outdoor environments, facilities, and program standards in nature-based rehabilitation. Landscape Architecture, 31(5), 91-102. https://doi.org/10.3724/j.fjyl.202312140567
World Health Organization. (2021). Mental health promotion and mental disorders prevention: Framework for a comprehensive mental health strategy in Europe. WHO Regional Office for Europe. https://www.who.int/europe/publications/i/item/9789289055666
“The important thing to understand is that a hospice is not a place where people die, but rather a place where they live – their final stage of life.”
Palliative care is a specialized form of healthcare that focuses on quality-of-life care for those with chronic, life-limiting conditions. This care most often includes counseling sessions, symptom management, movement practices, creative therapies such as music or art, as well as spiritual or emotional guidance. The facilities are designed to act as “healing spaces,” blending aesthetics with practical aspects of comfort and safety for patients, staff, and visitors.
From the micro details of color palettes and the homeliness of kitchens to the angle, size, and position of windows allowing natural light and views of the outdoors, every indoor element of these places is thoughtfully considered. However, while there is extensive literature on the restorative effects of nature on patients, less attention has been given to the quality of the natural landscape as a critical factor in the therapeutic equation.
In the following interview, we explore the importance of landscape architecture in creating therapeutic (contemplative) spaces within hospices. Our guest, Anna Artemeva, is a Master of Landscape Architecture (MLA) from the Swedish University of Agricultural Sciences (SLU), specializing in sustainable urbanization. Originally from Russia, Anna now finds inspiration in the blend of the natural and the urban in her new home of Stockholm, Sweden.
Interview with Anna Artemeva, a landscape architect based in Sweden.
AB: To get started, could you share a brief introduction about yourself and your first steps into the world of landscape architecture, particularly with a focus on therapeutic landscapes?
AA: My name is Anna Artemeva. I’m originally from Russia, but I’ve now lived in Stockholm for about 7 years. In Russia, I studied interior design and landscape architecture. However, I primarily worked as an interior designer on public and private projects. When I moved to Sweden, I decided to shift my career focus towards landscape architecture. I was fascinated by how landscape architects create such beautiful environments here. I pursued a Master’s program in Landscape Architecture for Sustainable Urbanization at the Swedish University of Agricultural Sciences.
AB: Can you describe a specific experience in nature that sparked your interest in landscape architecture?
AA: My life in Russia gave me two different experiences that I believe really shaped my interest in landscape architecture. I grew up in Chelyabinsk. So, I was surrounded by the stunning natural beauty of the Ural Mountains and the crystal-clear, incredibly beautiful lakes. However, at the same time, Chelyabinsk itself is a city with severe environmental issues, especially air pollution. It’s a big city with poor urban infrastructure.
So, there is this contrast between the natural and the urban environment. The experience of growing up with both of these worlds really pushed me to want to learn more about cities and how to build nice environment. I could feel how it affects you if you live in such a harsh city environment.
I think what initially drew me to using design to improve people’s well-being especially through nature is my experience living in Sweden and Stockholm. Stockholm is such a good example of this – a city where there’s a union between nature and the city. So, I’m really interested in understanding these processes. How it can happen, how it affects people, and how we can create these types of environments.
AB: Your thesis focused on the application of the Contemplative Landscape Model (CLM) developed by our founder, Agnieszka Olszewska-Guizzo, at Mellanorrlands Hospice. Why were you inspired to explore the use of landscapes for therapy in hospice care?
AA: I was drawn to hospice care because it offered a unique context and specific needs. Here, creating therapeutic landscapes wasn’t simply desirable, but of necessity. It’s not about creating fancy landscapes. They need landscapes that genuinely support their patients.
I felt connected to the philosophy of hospice care. Especially the fact that they are built to allow their guests live their life as fully as possible. I wanted to support this and this is where therapeutic landscapes came in.
Mellanorrlands Hospice during the springtime, side view. Photo Credit: Anna Artemeva.
AB: What initially drew you to study Mellanorrlands Hospice as a subject for exploring CLM?
AA: What initially drew me to Mellanorrlands Hospice and not another hospice as a subject for exploring CLM? It’s quite simple. It was the only hospice I could establish a connection with. I conducted a lot of research into the hospices here in Sweden. There are great examples in southern Sweden, but they were too far away.
Mellanorrlands Hospice was not only geographically accessible, but they were very willing to cooperate and give me the opportunity to work with a specific spot on their premises. I’m incredibly grateful for their willingness to participate. There was a moment when I thought, “Oh my God, I will probably write my thesis without a subject.” So, I’m really very thankful that they answered and were so open and kind.
AB: Could you tell me a little more about Mellanorrlands Hospice itself? How would you describe its environment (rural, urban, etc.)? Does the surrounding landscape play a role in the overall therapeutic experience, and if so, how? Who are the typical patients that receive care at the hospice? Can you profile them?
AA: Mellanorrlands hospice is located in Sundsvall, a Swedish town north of Stockholm. The hospice itself is located on the shore of Lake Sidsjön on the border between the city and a nature reserve. It is positioned in the urban area, next to a residential area with a school, a hospital, a sports club, and hotel. However, the hospice and nursing home are deliberately set apart, separated by a road and a forest. This separation helps to orient it towards the beautiful, hilly landscape of the nature reserve, offering stunning views down to the lake.
The surrounding landscape plays a large part in the therapeutic experience of patients. The hospice is designed so that all patient rooms face the natural landscape. These rooms not only offer beautiful views, but each has its own access to a common terrace with an open view of the valley. On the hospice website there is a testimonial from one of the patient’s daughter. She notes how her father cherished the view from the window, watching the ice melt and spring arrive from his bed. He watched these views daily in the last spring of his life.
“Dad’s room was fantastic, as I realized over time,” she writes. “It had a wonderful view of the lakeside. From his bed, he could watch the ice send off and spring come in for the last time.”
The important thing to understand is that a hospice is not a place where people die, but rather a place where they live out their final stage of life. The most frequent diagnosis of hospice patients at Sundsvall is cancer. In 2021, only 8% of patients were diagnosed with non-cancer. The average age of patients is 73. In 2021, the youngest patient was 41 and the oldest was 92. What we learn is, hospice patients are very diverse in age and spend anywhere from a few weeks, to months, to a whole year in care. The condition and mobility of the patients can also vary quite a lot. They can be quite independent, as well as those who need specialized cage and struggle to move without using a wheelchair or there are those who lie on a bed the whole day.
Despite the varied backgrounds and conditions, what these individuals share in common is that, with the proper medical care and anesthesia, they can and want to live their lives to the fullest.
Mellanorrlands Hospice during the springtime, front view. Photo Credit: Anna Artemeva.
AB: Can you walk me through the process of using the Contemplative Landscape Model (CLM) to design a space for hospice patients? Maybe use an example from Mellanorrlands Hospice?
AA: Let’s do it. The first step using CLM is to understand the view which specific view to focus on. In my case at Mellanorrlands Hospice, it was very easy to find this spot because there was a central area that was most usable for both patients and staff. This is where they often relax, chat, and just spend time with loved ones. So, it was definitely this point where I could work with the landscape and a very specific view.
The next step was to evaluate the existing view using the Contemplative Landscape Model guide. It’s a step-by-step guide where you answer the questions and receive a score for each element. In my case, the landscape scored well in some elements like typical and archetypal elements, a good visible and recognizable character, peace and silence, and a natural and harmonious color palette.
However, some important elements like layers of landscape, biodiversity, and land forms weren’t well represented in the landscape. This resulted in an overall average contemplative score. This meant this particular landscape couldn’t provide a good stress reduction atmosphere.
So, the last step was to develop a design proposal that addressed these weak elements and increased the overall contemplation score. Here, it was important to think about specific design solutions that were necessary for the group of users. For instance, many patients in the hospice use wheelchairs or have limited mobility. That was why my design proposal focused on creating the landscape by using trees instead of other plants. Plants placed on a lower level wouldn’t be very accessible for these people. This highlighted another interesting aspect of the CLM framework.
AB: What surprised you the most about the challenges of designing a therapeutic landscape?
AA: You know, the biggest surprise came during a discussion about my thesis. I wanted to find an approach with a strong scientific basis, ideally something that has a medicine base. My goal was to really prove that this approach could lead to design a stress-reducing environment.
Some landscape architecture professors were very skeptical that it’s possible at all to scientifically prove that an environment can be stress reducing. This led me to believe that many professors may not be very familiar with neurobiology and cognitive science. It seemed to be they were unaware that today’s research can now design experiments that clearly demonstrate how this landscape can have an effect on stress reduction.
So, this skepticism was the most surprising moment for me. Before I found the Contemplative Landscape Model, there were very few articles and papers that provided enough that can be used in cases where you need to create a very specific environment for stress reduction.
AB: In your thesis, you proposed further research to refine CLM for wider applications. Can you elaborate on some specific areas you’d like to see explored to strengthen the model?
AA: Absolutely. I’d be very interested in knowing more about the dynamics that happen in the process. So in the research papers, the practitioners creates experiments where they used a mechanism that let them see this process played out in the brain. But what I’m trying to say is that a person just comes and observes a landscape, and we don’t know what’s going on.
What if someone observes this landscape not just that day, but for weeks, months and years? Because our brains can adapt pretty well to all environments, and I believe there could be some changes that happen if a person observes a landscape over longer periods of time. So I’d like to see how that looks.
Another thing that’s very important for me as a landscape architect is to investigate if the framework that exists right now with this guide system is good enough for landscape architects to implement this method. I found that there’s a very subjective process that happens when you answer the questions.
What if I someone with a different background than myself, maybe someone who lives here and has fallen in love with this landscape, how would they answer the questions? And I observed that some questions I could have answered differently. So, it would be great to see this instrument in a more objective framework.
Mellanorrlands Hospice during the wintertime. Photo Credit: Anna Artemeva.
AB: Building on your research, what advice can you offer to landscape architects who want to design therapeutic spaces in other healthcare settings or even public areas?
AA: That’s quite a tricky question. Build on my experience, I’d say that I need more context. For instance, the specific location and the user group. But I can definitely recommend looking into the Contemplative Landscape Model. It has a really good set of questions and detailed descriptions for each element that can influence a landscape’s impact. This framework can inspire landscape architects and encourage them to develop their own questions specific to the project. They can then create better therapeutic environments, I believe.
AB: Your research highlights the connection between nature and well-being in hospice care. Can you translate this concept into actionable steps for our audience who might be interested in creating a more therapeutic outdoor space in their own homes or gardens?
AA: I’m not sure if my my experience can be directly applied in this way. Especially when we’re talking about private gardens, because one of the important elements in a stress-reducing landscape is biodiversity, and biodiversity is often combined with natural colors. But in private gardens, I believe people often prefer a more colorful environment.
So again, maybe it’s a good idea to read Neuroscientists for Design in Green Space and learn from the experiences there, and make your own experiment. Understand what kind of therapeutic garden you’d like to create, and just just to do it! Experiment! With this approach, remember that a landscape is always a process. It’s not just about the results. So, enjoy the process!
AB: During your research, how did your personal views or feelings about nature and healing evolve?
AA: I have always enjoyed being outside. I spend a lot of my free time closer to nature. Now, I realize even more that being in nature can be a tool for stress management. If I am in a stressful situation, I look for open spaces with inspiring views. I understand now how important it is to spend even more time in a calming landscape.
AB: Can you share a story about how your interactions with patients or staff at Mellanorrlands Hospice influenced your approach to the project?
AA: Absolutely. One specific interaction with a patient really stands out in my mind. During a visit, the hospice staff asked me to talk with a woman because she and her husband spoke primarily Russian and little Swedish. We had a great conversation about a lot of different things. The woman had difficulty holding her head up because she had recently had surgery. So, she was mostly resting her head on the headrest.
As we talked, I asked her where in the landscape her gaze fell most naturally. Surprisingly, she pointed to a completely different spot than the one I had identified initially. This small change in the angle of the head position really affected her relationship with the landscape and her perspective. This experience pushed me to think deeper about other unique needs and limitations people face in this period of their life.
AB: Can you elaborate on the specific “gazing point” the woman identified?
AA: In general, I was talking about the difference between a healthy person’s perception of the landscape and a person with physical limitations. In the initial design process, I analyzed the therapeutic garden through the lens of a healthy person. That is, I looked at elements for contemplating and reflecting that naturally attracted my attention, what was missing, how my gaze wandered through the landscape, where it stopped.
However, when talking to this patient who had difficulty keeping her head upright and so spent most of her time resting her head on the headrest with her head slightly tilted, I realized that her process of contemplation – how her gaze wandered across the landscape and where it lingered and stopped – was different from mine.
I haven’t had the opportunity to further fully research and develop this specific question in more detail. It was an important moment of realization. In my work, I’ve always kept in mind that the landscape should interact both with people with no mobility limitations and with people with mobility limitations. I also tried to take into account factors such as a patient’s depressive state and their experiencing an existential crisis.
From this point of view, it was encouraging to see how a contemplative landscape showed positive effects on people with depression. But internally, the question remained: what other physical changes, brought on by illness, could have a significant impact on the perception of the landscape that I hadn’t taken into account.
AB: What were some of your most significant personal challenges during this research, and how did you overcome them?
Personally, it was very challenging to write my thesis. It was my first major research paper, and I struggled to find enough people to have discussions related to my topic. Unfortunately, I didn’t find many opportunities to discuss my topic. But I use all the opportunities I get to discuss my topic with anyone open to it.
Snowy landscapes at Mellanorrlands Hospice. Photo Credit: Anna Artemeva.
AB: I am curious to hear about the reception of your research topic and final design. How did the patients, staff members, and even your teachers and fellow students react to your work on therapeutic landscapes at Mellanorrlands Hospice?
AA: There was a lot of interest amongst fellow students in the method itself. For most of them, it was entirely new, and they wanted to learn more about its use and the evidence supporting it.
The topic of the hospice center was also interesting to the teachers. Because the topic is not common, people don’t often get to work with it in depth. They hear about it, discuss it, and can really immerse themselves in the topic. It seems to me there is a common misconception: “Hospice is a place where people die”, which gives rise to certain associations.
Just a year ago, there was a situation where people opposed building a hospice in their neighborhood. I think if people realized that a hospice is a place where people live, they might be less likely to protest.
So, we had a lot of discussions with the teachers about the philosophy and specifics of palliative care, and the unique relationship between hospices and landscape design.
AB: Being at the beginning of your journey into landscape architecture, what reflections can you share about how you see the future of landscape architecture evolving, particularly in the context of therapeutic and contemplative spaces?
AA: I would definitely like to see more collaboration between landscape architecture and other fields, especially neurobiology and cognitive science. And I believe that landscape architecture can gain a lot of useful tools from these collaborations, and maybe rethink existing tools and approaches in a more efficient way.
AB: What advice would you give to communities or institutions looking to integrate therapeutic landscapes into their environments?
AA: First of all, it’s definitely important to do research and understand the needs. This means conducting thorough research to understand the specific needs and preferences of the community or institution. Consider factors such as the cultural backgrounds and even the health issues of the community.
Find the right experts to collaborate with is also very important. Landscape architects, environmental psychologists, or even other relevant experts in this field can really help build a built environment in a more efficient way.
AB: What are your next steps or future projects in this field? Are there particular aspects or techniques you wish to explore further?
AA: For me, right now, it’s very important to use my theoretical knowledge in a practical way. I’m looking forward and very excited to gain practical experience in the field.
AB: If you could create a therapeutic landscape in any location in the world, where would it be and what unique features would it have?
AA: I took this question very seriously actually. I just want to see a therapeutic landscape everywhere where it’s really needed.
AB: Which fictional character do you think would most benefit from spending time in a therapeutic landscape? Why?
AA: I shared this question with my sister and I really liked her answer. She said to change the final scene in the movie, Fight Club, where the main characters are standing and holding hands with exploding buildings in the background. So, we suggest to change this background to a therapeutic landscape. Really, I feel that it this is what we, across the world, are really seeking right now and it’s changing this whole story in such a positive way. This is our suggestion that would completely rewrite Fight Club.
AB: If you had to describe your ideal therapeutic garden using only three words, what would they be?
AA: Appropriate, attractive and therapeutic. Because if a random person came to this landscape I created and said, Oh my God, it’s so therapeutic,” then I know I’ve achieved my goal.
Experience the power of "Neuroscience for Designing Green Spaces: Contemplative Landscapes" - a revolutionary book by Dr. Agnieszka Olszewska-Guizzo. This comprehensive guide was released on May 30, 2023. It revolutionizes landscape design through an innovative approach rooted in neuroscience.
Unveiling Contemplative Landscape Design
Delve into the concept of Contemplative Landscape Design, meticulously crafted over a decade of research. Driven by neuroscience principles, this book serves as a go-to resource for landscape architects and architects seeking to effortlessly integrate mental health and well-being into their practice.
This is the first time where I put together the knowldege acumulated thoughout the years. This book contains all the nuances about design for mental health and well-being. So that landscape architects and architects can easily access and use for their practice. Before I published only peer-reviewed articles focused mostly on the mental health implications and the performed neuroscience experinents. But I am a landscape architect first, so I come back to my original field with and I hope it will be a useful tool for anyone interested in designing or benefitting from contact with natural landscapes! - says the author.
Accessing the Book
Discover "Neuroscience for Designing Green Spaces: Contemplative Landscapes" available in paperback, hardcover, and e-book formats. You can easily purchase your copy through the Taylor & Francis website or Amazon, ensuring convenient access to this groundbreaking publication.
ABSTRACT
Urban parks and gardens are where people go to reconnect with nature and destress. But do they all provide the same benefits or are some better than others? What specific attributes set some green spaces apart? Can we objectively measure their impact on mental health and well-being? If so, how do we use this evidence to guide the design of mentally healthy cities?
The Contemplative Landscape Model unveils the path to answer these questions. Rooted in landscape architecture and neuroscience, this innovative concept is described for the first time in an extended format, offering a deep dive into contemplative design and the science behind it. In the face of the global mental health crisis, and increasing disconnection from nature, design strategies for creating healthier urban environments are what our cities so sorely need.
This book delves into the neuroscience behind contemplative landscapes, their key spatial characteristics, and practical applications of the Contemplative Landscape Model through case studies from around the world. Landscape architects, urban planners, students, land managers, and anyone interested in unlocking the healing power of landscapes will find inspiration here.
"Neuroscience for Designing Green Spaces: Contemplative Landscapes" - a revolutionary book
In our most recent contribution to the Volume Two of the book series Urban Health and Wellbeing Systems Approaches, published by Springer and Zhejian University, we discuss the preliminary findings of our research project currently conducted in low-income communities in Medellin Colombia for our program Planting Seeds of Empowerment: Mental Health and Wellbeing of the Communities.
The book is intended for citizens and political decision-makers interested in systems perspectives of urban health and well-being seeking for inspiration to find solutions for the increasing complexity of cities and the environmental, social, and health impacts of urbanization.
In our paper entitled: Coping with Extreme Circumstances Through Community-Led Local Nature Interventions: A Science-based Policy Analysis, we discuss
the importance of the Local Nature Interventions Projects (LNIP) that are created by low-income communities as coping strategies to extreme events to help them sustain
health and well-being.
We present examples of the LNIP taking place during the Covid-19 pandemic and we argue that the LNIP are part of a secondary green network that could be acknowledged as part of the main city’s urban green infrastructure. Therefore, the internal capacities of the communities to create sustainable projects in the natural and built environment across time should be acknowledged and supported in future urban green projects. With these preliminary findings, we seek to draw attention towards LNIP initiatives as they could become alternatives to sustain community empowerment, environmental awareness, and health and well-being across settlements located in extreme urban environments.
Contents:
COVID-19, Cities and Health: A View from New York (Jo Ivey Boufford and Anthony Shih)
Current and Future Human Exposure to High Atmospheric Temperatures in the Algarve, Portugal: Impacts and Policy Recommendations(André Oliveira, Filipe Duarte Santos, and Luís Dias)
Neuroscience-Based Urban Design for Mentally Healthy Cities(Agnieszka Olszewska-Guizzo)
The Role of Money for a Healthy Economy(Felix Fuders)
Developing Health-Promoting Schools: An Initiative in Government Schools of Indore City, India(Alsa Bakhtawar)
Mobility and COVID-19: Time for a Mobility Paradigm Shift (Carolyn Daher, Sarah Koch, Manel Ferri, Guillem Vich, Maria Foraster, Glòria Carrasco, Sasha Khomenko, Sergio Baraibar, Laura Hidalgo, and Mark Nieuwenhuijsen)
COVID-19 Shows Us the Need to Plan Urban Green Spaces More Systemically for Urban Health and Wellbeing(Jieling Liu)
How Lack or Insufficient Provision of Water and Sanitation Impacts Women’s Health Working in the Informal Sector: Experiences from West and Central Africa(H. Blaise Nguendo Yongsi)
Planning Models for Small Towns in Tanzania(Dawah Lulu Magembe-Mushi and Ally Namangaya)
Coping with Extreme Circumstances Through Community-Led Local Nature Interventions: A Science-Based Policy Analysis(Diana Benjumea and Agnieszka Olszewska-Guizzo)
Disconnection from Nature 
Noise Pollution
Air Pollution
Traffic
Overcrowding
Overload of Stimuli and Information
Abstract Forms
Shortened Visual Outreach
Green Spaces and Nature
Healthcare Accessibility
Community Centres: Community centres offer social support networks, recreational activities, and educational programs that strengthen social cohesion and reduce feelings of isolation. These centres also provide safe spaces for individuals to engage in hobbies and group activities, fostering a sense of belonging and community 
Inclusive and Accessible Design
