Ruh sağlığı kurumlarında iyileştirme bahçelerinin irdelenmesi ve peyzaj tasarım ilkelerinin belirlenmesi
Examination of healing gardens in mental health institutions and determination of healing garden design principles
Yazar: PELİN KEÇECİOĞLU
Danışman: DOÇ. DR. HAYRİYE EŞBAH TUNÇAY
İstanbul Teknik Üniversitesi / Fen Bilimleri Enstitüsü / Peyzaj Mimarlığı Ana Bilim Dalı
Derece: Yüksek Lisans, 2014
Konu: Peyzaj Mimarlığı = Landscape Architecture

Özet:
İyileştirme bahçeleri, insan merkezli yaklaşımla ele alınan, birey ve doğa arasındaki iletişimi ve bu iletişimle bireylerin iyi olma halini destekleyen, stresi azaltan, doğal elemanların hakim olduğu, sağlık kuruluşlarına yakın ya da bitişik olan, herkes için erişilebilir ve çoğu kullanıcıya hitap eden, bireylerin yaşam kalitesini yükselten bahçelerdir. Bu bahçeler literatürde genel olarak beş ana grupta ele alınmaktadır. Her grubun istek ve ihtiyaçları farklı olduğu için tasarım süresince kullanıcı grubun detaylıca ele alınması ve o alandaki iyileştirme bahçelerinin tarihsel gelişiminin tasarımcı tarafından bilinmesi gerekmektedir.
İyileştirme bahçelerinin, ilk örnekleri olarak bilinen eski Türklerin darüşşifaları ve daha sonra Ortaçağ'daki manastır bahçelerinden başlayan tarihi, günümüzde son teknoloji ile yapılan hastanelere ulaşmaktadır. Özellikle 1990'ların başından itibaren, sağlık kurumlarında bahçelerin iyileştirici etkisinin önemsendiği, Avrupa ve Amerika'daki iyileştirme bahçelerinin tarihinde görülmektedir. Türkiye'de ise iyileştirme bahçeleri yeni gelişen, önemsenen ve yayılan bir kavramdır ve bu konu hakkında yapılan bilimsel çalışmalar oldukça kısıtlıdır. Yapılan bu çalışma ile ülkemizdeki bu boşluğun bilimsel açıdan belirli ölçülerde doldurulmasında katkıda bulunulması hedeflenmiştir. 
Türkiye Hastalık Yükü Çalışması'na göre ulusal düzeyde hastalık yükü nedenlerinin dağılımında %19 oranında ikinci sırada psikiyatrik hastalık grubunun yer aldığı bilindiğinden, psikiyatrik hastalar için yapılacak olan iyileştirme bahçeleri konu olarak seçilmiştir. Tüm dünyada peyzaj mimarlığının çalışma alanlarından biri olan iyileştirme bahçelerinin ruh sağlığı kurumlarında tasarlanmasının psikolojik rahatsızlıkları bulunan bireyler üzerinde iyileştirici rolünün olduğu hipotezinden yola çıkılarak ruh sağlığı kurumlarında yapılacak iyileştirme bahçelerinin peyzaj tasarımı ilke ve kriterlerinin belirlenmesi amaçlanmış; bu amaçla, iyileştirme bahçelerinin alt sınıfı olan tedavi edici bahçeler üzerinde durularak, yalnızca psikolojik rahatsızlıkları olan hastalar, onların istek ve ihtiyaçları kapsamında çalışılmıştır.
Çalışmanın amacı ve kapsamı doğrultusunda belirlenen anahtar kelimeler ve daha sonrasında yapılan içerik analiziyle iyileştirme bahçelerinin, genel tarihi ve tasarım yaklaşımları ile birlikte Avrupa, Amerika ve Türkiye'deki ruh sağlığı kurumlarının tarihsel gelişimi irdelenmiş ve bu bilgiler doğrultusunda ruh sağlığı kurumlarında psikiyatrik hastalar için yapılacak terapi temelli iyileştirme bahçelerinin tasarım ilke ve kriterleri altı ana başlık altında toparlanarak detaylıca ortaya konulmuştur. Ülkemizdeki ruh sağlığı kurumlarında bulunan bahçelerin günümüzdeki durumu tartışılarak, psikiyatrik hastaların tüm istek ve ihtiyaçlarına estetik ve fonksiyonel olarak cevap veren, olumlu psikolojik ve dolayısıyla fizyolojik sağlık çıktıları sağlayan, yaşam konforu ve kalitesi yüksek mekan organizasyonuna sahip iyileştirme bahçelerine dönüştürülebilmesi ve yeni yapılacak olanlara ışık tutulabilmesi amacıyla öneriler getirilmiştir.

Abstract:
Healing gardens are generally defined as gardens that supports the communication between individual and plants, and the well-being of individuals. They are dominated by natural elements, located near or adjacent to healthcare institutions, which are accessible to everyone and which are appealing to most users. It is known from the literature that healing gardens are examined in 5 main categories as the children, the elderly, the poor, Alzheimer patients and psychiatric patients. Because of different wishes and needs, each group has to be considered specifically in detail and their historical development needs to be known.
Sun light, fresh air and green areas are the main features of individual's needs. These features have the capital importance for patients who are treated in healthcare facilities. The approaches made to meet this features in the character of the gardens from past to present are divided into three groups as traditionalist approach, botanical/ecological approaches and people-centered approach. In people-centered approach, it is proved by scientific studies that healing garden design that is made in the direction of user's request and needs is more successful. Healing gardens are a landscape design which is designed with people-centered approach.
Healing garden's history is started with the courtyard of ancient Turkish hospitals and then medieval monastery gardens, which are known as the first examples, nowadays reached to the hospitals that are made by latest technology. Hospital gardens began to gain importance especially in France and Italy during the Renaissance, and the hospital garden criterias began to put forward. The inner courtyard surrounded by hospital buildings came into use as the area that provides both active and passive recreation opportunity. Making a design in healing garden towards inwards involvement to outgoing involvement allows individuals to socialize. 
The importance of fresh air, sun light and natural elements showed an increase with support of Florence Nightingale. Body, mind and soul are all a whole is accepted as a fact, and the interest in alternative and complementary treatments increased. The effects of environmental factors that are important in the healing gardens on health outcomes are proven by the researches and they have been accepted in whole scientific world. 
Especially, since the beginning of 1990, the healing effects of gardens are considered important in health care facilities in the history of healing gardens in Europe and America. In literature research, it is observed that the healing and the healing garden concepts are discussed in detail, and written in many articles and thesis upon these concepts. Ulrich put forth the criterias to reduce stress, Kaplan and Kaplan theorize the criterias to reduce mental fatigue, and Marcus and Barnes put forward the criterias to provide well-being sensually. All of them are known as doyen of healing gardens and provided a base for future researches. They all share their theoretical and practical experiences in academic fields.
As for in Turkey, healing gardens is a new evolving, minding and sprawling concept and the scientific studies on this concept are fairly rare. In this study, it is aimed to fill this gap from a scientific point in our country with a certain extent. According to the Turkey Mental Health Profile Study, 18% of Turkey's population had given a mental illness at least once in their life, and additionally, according to the Turkey Burden of Disease Study, with the percentage of 19% psychiatric disease group is placed in second within the reasons of disease burden in national level. These rates emphasize that the needs of psychiatric patients should be reviewed. Identifying the needs of different user groups and developing a design approach according to these needs is important in healing gardens. Therefore, healing gardens for psychiatric patients was selected as the theme subject of the study.
Begining with the hypothesis that designing healing gardens in mental health institutions, which is one of the working field of landscape architecture, have a healing role on psychiatric patients; landscape design principles of healing gardens to be made in mental health institutions were aimed to be determined. For this purpose, this study dwelled on therapeutic garden which is a subclass of healing garden and studied only on psychiatric patients within the context of their wants and needs.
In the direction of aim and context, document review which is one of the data gathering method is done. In the first phase, the documents which are master thesis, doctoral thesis, articals, papers, books and book chapters were found from searching in different databases and search engines with the help of specified keywords. The keywords are healing gardens, healing landscapes, healing environment, therapy gardens, mental health, mental patients, psychiatric patients, hospital gardens, psychiatric hospital gardens. After the evaluation of written and visual sources, the irrelevant ones were eliminated. In the second phase, sources were categorized according to their themes. After that, the bibliography of the sources were searched to obtain more further studies in detail and also, relevant lecture notes, reports, contracts, more written sources vb. documents. In the last phase, visual datas and sample projects were examined for giving examples in literature review. With this phase, the data gathering part was completed.
The data assessment is carried out in three parts. In the first part, after the content of the datas are analysed, the differences, similarities and complementariness of them evaluated and themed. Then, they are outlined and explained in literature review. In the second part, in the direction of datas and theories, the history, the importance and the positive effects of healing gardens were explained; the design approaches hold in detail; and with evaluating the history of mental healthcare institutions, healing garden design principles in mental healthcare institutions were generated. All the criterias that are needed in a therapy based healing garden design derived for psychiatric patients from litereture review, and they were grouped under six main categories as organization of space, pathways and locomotion, planting design, outdoor equipments and security. Addition to this, the current state of healing gardens in Turkey discussed and proposals were made in the result of these discussions.
To be used as a base for scientific studies about studied subject, land evaluation form and questionnaire forms were prepared. These documents prepared for field work, but because of the failure to obtain a permit, they were included as received datas in the study. To reveal the outdoor therapy and treatment methods, to make the hospital outdoor areas affordable and to create a healing garden for psychiatric patients; questionnaire forms were prepared. All the questions were organized for examining almost all of the criterias. They had taken seriously to be easily understood by experimentals. In order to test the clarity of the survey questions, exploration survey (pre-survey) was applied. Some abstract concepts that are not included in the surveys examined in land evaluation form with complementary and supplimentary questions. 
The gardens in our country that are located in mental healthcare institutions were discussed within today's situation and proposals were given to light the way the for transforming them into healing gardens which are respondent to the psychiatric patients' all wishes and needs in aesthetical and functional way; are provider for positive psychological and physical health outcomes; are keeper of space organization that contains high life comfort and high life quality.
To sum up, in this study, it is explained how healing gardens in mental healthcare institutions were effective tools for reducing dense stress and other problems of psychiatric patients. In this regard, to satisfy the deficiency about it in our country, some improving processes should be taken seriously as giving priority to mental health, extending the mental health services in whole country, designing relevant healing gardens accessible. In addition to this, healing gardens should be designed by landscape architects for creating urban areas to meet the needs. They should be organized seriously not only in our country, but also in all af the world by using active and passive usages, aesthetical and functional landscape compositions, providing physical, cultural and social relationships, having a space organization that involves occupational therapy and high life quality, sustaining positive psychological health outcomes.