URN:NBN:fi:tsv-oa128634
DOI: 10.11143/fennia.128634
Urban landscapes as therapeutic landscapes: the transforming 
conceptions of care environments
SIIRI PYYKKÖNEN AND PÄIVI KYMÄLÄINEN
Pyykkönen, S & Kymäläinen, A. (2024) Urban landscapes as therapeutic 
landscapes: the transforming conceptions of care environments. Fennia 
202(1) XX-XX. https://doi.org/10.11143/fennia.128634
Psychiatric hospitals are increasingly being built in urban 
landscapes, in contrast to many of the old hospitals which were 
located in peripheral areas close to nature. This indicates a change 
in the conception of therapeutic landscapes: rural natural landscapes have 
been replaced by a more relational and fluid understanding and practices 
where therapeutic environments are created in relation to society, 
communities, networks and everyday urban life. We examine how the 
conception of therapeutic landscapes was constituted in the planning 
process of the urban psychiatric hospital in Turku, Finland, by analyzing 
the arguments and discourses on therapeutic elements in the planning 
materials. The findings reveal how the shift from inpatient care towards 
outpatient care has redirected attention away from hospitals. Instead of 
relying on healing by natural elements in remote locations, everyday 
environments, artificial landscapes and multifunctional spaces are now 
expected to create therapeutic atmospheres.
Keywords: therapeutic landscapes, urban landscapes, psychiatric hospital, 
care environment 
Siiri Pyykkönen (https://orcid.org/0000-0002-5228-3589), Department of Geography 
and Geology, University of Turku, Finland. E-mail: siiri.pyykkonen@utu.fi 
Päivi Kymäläinen (https://orcid.org/0000-0001-7911-2838), Unit of Social Research, 
Tampere University, Finland. E-mail: paivi.kymalainen@tuni.fi
© 2024 by the author. This open access article is licensed under 
a Creative Commons Attribution 4.0 International License.
Introduction
The conception of therapeutic landscapes has changed drastically in the planning and design of 
psychiatric hospitals in Finland. When Niuvanniemi, the oldest psychiatric hospital still in operation in 
Finland, was planned in the 1880s, the selection of the hospital site was not only based on the 
possibility of land purchase, but also on the building site’s location which was peaceful and had an 
impressive natural beauty (Malmivuori 1985). Similar kinds of reasons can be found behind the 
locations of other old urban psychiatric hospitals at spacious sites near to the sea, or areas close to 
lakes, parks and forests. In the 18th and 19th, centuries, the natural environment was understood to 
draw patients out of indolence as they could walk in attractive grounds in nature (Guha 2019). For 
instance, the Lapinlahti Hospital in Helsinki was located next to the sea and a park and was well-
2 FENNIA 202(1) (2024)Research paper
known as a sanctuary where patients could heal in tranquility and natural beauty. Lapinlahti was seen 
as a location with natural beauty and had a lot of space for walking routes (Rappe & Malin 2010). 
Today, the selection of the location is based on other types of criteria, as our research data from the 
Kupittaa Psychiatric Hospital shows.
These differences convey the transformation in hospital planning and denote the ways of thinking 
on therapeutic landscapes. Urban environments are becoming increasingly fundamental to the 
planning of therapeutic landscapes, as there is an ongoing trend to locate psychiatric hospitals in 
central places, within the proximity of somatic healthcare. A central location is considered to 
improve the possibilities for individual care compared to the old ‘forest hospitals’ with scattered 
locations. The current trend is connected with the shift from inpatient care towards outpatient care 
in mental healthcare services (e.g. Ala-Nikkola et al. 2016; Wahlbeck et al. 2018; Ahonen 2019). While 
previous research on therapeutic landscapes has included a great deal of research on the restorative 
elements of the natural environment and on nature’s role in stress relief and health (Ulrich et al. 
1991; Taheri & Shabani 2016; Duzenli et al. 2017; Dushkova & Ignatieva 2020), there still remains a 
lack of comprehension regarding current trends and the role of urban environments in the design 
of therapeutic landscapes; including how these changing designs reflect the conceptions of more-
than-therapeutic landscapes (Emmerson 2019) or therapeutic networks (Edwards 2022) that have 
been introduced in recent research literature.
As we will argue in this article, the urbanization of mental healthcare fosters the relational 
understanding of therapeutic landscapes. Therapeutic experiences are not expected to only take 
place within the hospital, but they extend to the outside and occur in relationships, networks and 
imaginations. The changing hospital designs reflect the concepts of more-than-therapeutic 
landscapes that emphasize friendship and homemaking (Emmerson 2019), networks of people, 
places and events (Conradson 2005; Doughty 2018; Edwards 2022), and the increasing use of 
digitally produced artificial landscapes (Thompson 2021). The current hospital design not only 
diversifies the conceptions of healing places and practices, but it represents a means of constructing 
cost-effective buildings and commodifying psychiatric care.
To analyze how the current concept of therapeutic landscapes is changing and increasingly 
evolving within urban settings, we examine the planning process of the new Kupittaa Psychiatric 
Hospital in the City of Turku in Finland. In Finland, over ten new psychiatric hospitals are undergoing 
a planning process or being constructed or have recently been taken into use. The forthcoming 
Kupittaa Psychiatric Hospital has a central location next to a larger hospital area, the university 
campus, a business hub, and a train station. In the planners’ vision, the hospital will become a part 
of everyday urban life and serve as meaningful public space that diminishes the stigma linked to 
psychiatric hospitals and their patients (VSSHP 2019). While writing this paper in 2023, Kupittaa 
Hospital is still under construction and its realization has undergone several changes due to a 
reduction in both the budget and the permitted size of the building.
The first part of the article discusses the previous research on and transformations regarding the 
concept of therapeutic landscapes. The second section sheds light on the planning process of the 
Kupittaa Psychiatric Hospital, elaborating the ways in which a therapeutic landscape is constituted in 
urban planning and architectural design. The third part argues that the Kupittaa case represents a 
relational understanding of therapeutic landscapes which is based less on actual places and 
landscapes, and more on intangible aspects, such as networks and technological solutions. The 
fourth section ties together the theoretical part and the findings and argues for the need to expand 
and critically evaluate the new interpretations and realizations of therapeutic landscapes.
Therapeutic landscapes
The concept ‘therapeutic landscape’ has been widely examined following Gesler’s (1992) essay 
where he presents the idea of therapeutic landscape as a metaphor to understand the meaning of 
space and place in a healing process. The views have been varied and they have received critique 
(Kearns & Milligan 2020), illustrating how the conceptions of therapeutic landscapes are dynamic 
and dependent on the dominant views regarding the construction of illnesses and their causes 
FENNIA 201(2) (2024) 3Siiri Pyykkönen & Päivi Kymäläinen
(Wood et al. 2015). The use of the concept of therapeutic landscapes has emphasized the needs of 
vulnerable people, and how more places are needed for healing (Williams 2017).
Therapeutic landscapes do not replace therapy and other medical services (Belcáková et al. 2018), 
nevertheless they are understood as necessary for well-being and recovery. The early research on 
therapeutic landscapes focused on extraordinary landscapes such as traditional therapeutic places, 
spiritual sites or natural parks. Hospital buildings were considered a part of the healing process, and 
they endeavored to provide peacefulness, fresh air and light (Marques et al. 2021). Working and 
spending time in sanatoriums, pavilion-style hospitals and healing gardens were regarded as being 
able to produce well-being, stress reduction, and relief from trauma (Dushkova & Ignatieva 2020). 
They offered a “temporary movement away from an everyday, domestic location” (Conradson 2005, 
341) as the healing process in a respite care center freed a patient from the responsibilities and 
problems of everyday life (Edwards 2022) and provided a possibility to “think and feel differently 
about themselves and their wider life situation” (Conradson 2005, 345).
The old asylums were not considered therapeutic landscapes per se, but rather as representations 
of the ideal of a sanctuary located in a new environment (Moon et al. 2006). Some of the literature 
notes how these hospitals created rootedness or a sense of attachment that advanced the therapeutic 
effects of landscape (Gesler 1992). Although some people reacted positively to the rural setting, some 
others felt isolation or separation, and found the landscape dull and unsettling (Conradson 2005). An 
isolated hospital presented the perception that patients needed to be moved out of sight and out of 
mind (Parr et al. 2003) so that “society can continue relatively undisturbed” (Gesler 1992, 738). This 
increased the stigmatization of psychiatric patients (Wood et al. 2013). Furthermore, some studies 
have argued that a too pleasant and homely psychiatric hospital could prolong patients’ stay and 
hinder their return to normal life – if they started to prefer the hospital to a home that they associated 
with illness (Curtis et al. 2009).
Material and physical landscapes only have a certain amount of importance in the patients’ 
experiences of therapeutic landscapes. Equally important are community-based activities, social 
relations and the connections between people, places and events (Conradson 2005; Doughty 2018; 
Edwards 2022). Emmerson (2019) writes about the need for a more-than-therapeutic approach that 
would acknowledge how, for instance, homemaking activities, friendship, or even rivalries can provide 
new insights into the investigation of places for healing. In the experiences gained in a therapeutic 
landscape, of equal importance are experiences of stigmatization, trauma, feelings of loss, nostalgic 
feelings, or sensual and imaginative engagement with the landscape (Wood et al. 2015).
Our understanding of landscape is not merely based on physical and material realities, but we 
consider landscape a way of seeing as it is constructed through visual symbols and representations 
with individuals’ memories and perceptions (Cosgrove 1984; Wylie 2007). Conradson (2005, 340–341) 
suggests that the idea of the “relational conception of self” could help understand the significance of 
landscape in a personal healing process as an individual reflects on their life situations through the 
landscape. Along with personal preferences, cultural and social factors shape the concept of 
therapeutic landscapes (Gillespie 2002), as they impact which types of social or power relations are 
‘read’ from the landscape (Mitchell 2003).
The conceptualization of therapeutic landscapes has transformed from a place-based thinking 
(where healing happens in certain sites and institutions) to both non-physical (symbolic, social, 
cultural) dimensions (Taheri et al. 2021) and a process-based understanding where therapeutic 
landscapes are regarded as relational constructs (Conradson 2005; Smyth 2005; Foley 2015; Gorman 
2017; Edwards 2022). The concept of a therapeutic landscape has, thus, moved towards being 
between the categories of nature and culture (Gesler 1992), stressful and restorative, or urban and 
natural (Besson 2020), reflecting the problematic nature of such dichotomies in the first place. 
Regardless of being urban or rural, a view from a window (Ulrich 1984), natural light, garden spaces 
(Curtis et al. 2007), or landmarks (Karmanov & Hamel 2008) are appreciated in psychiatric hospital 
designs. As a counterargument to the assumption of the healing power of the rural (Conradson 
2005), Karmanov and Hamel (2008, 122) argue that a “well-designed and attractive urban environment 
may have a stress-reducing and mood-enhancing power equal to that of an attractive natural 
environment”. Furthermore, Ulrich (1984, 421) notes that “to a chronically under stimulated patient, 
4 FENNIA 202(1) (2024)Research paper
a built view such as a lively city street might be more stimulating and hence more therapeutic than 
many natural views.”
In addition to the micro-level therapeutic setting of a hospital or a home, the healing process can 
occur at a macro-level, within the scale of a city and related to its services, actions, or people’s sense 
of place in the city (Smyth 2005). Easily accessible everyday spaces can be therapeutic (Pitt 2014; 
Dushkova & Ignatieva 2020; Edwards 2022) – as well as everyday sites such as yoga studios (Hoeyz 
2007), parks, gardens (Finlay et al. 2015) or libraries (Brewster 2014). Therapeutic effects can be 
obtained by moving between indoor and outdoor spaces, between urban and rural environments 
(Mossabir et al. 2021), or between ‘real’ and artificial spaces. However, when care increasingly becomes 
dislocated, deinstitutionalized and commodified, the patients become more dependent on the 
availability of multiple services, which can create ‘landscapes of despair’ if facing difficulties in receiving 
care or services (Dear & Wolch 1987; Moot et al. 2006; DeVerteuil & Evans 2009).
The new psychiatric hospital in Kupittaa
We examined the constitution of therapeutic landscapes by investigating the planning documents 
of the new Kupittaa Psychiatric Hospital in Turku. The documents are useful in determining how the 
planners depicted the therapeutic landscapes during the first stages of the hospital planning. The 
hospital project was carried out by the Intermunicipal Hospital District of Southwest Finland (VSSHP), 
and our primary research material consists of the Needs Assessment (TYKS 2019), the Project Plan 
(TYKS 2020) and the Operation Plan (TYKS Psykiatria 2020). In addition to the official planning 
documents, the data includes official statements by the VSSHP that discuss the urban location of the 
hospital and its therapeutic or restorative influence. This data was chosen as it indicates the shift in 
understanding therapeutic landscapes and provides important knowledge on the planner’s reasoning. 
The data is limited in the sense that the documents have been created to validate the need for the 
new hospital. However, at the same time, the data reveals those aspects that are considered to 
advance the formation of good and therapeutic hospital environments.
The data was analyzed with critical discourse analysis to reveal the arguments and ways of speaking 
included in the planning process. The main purpose of the analysis was to understand and critically 
examine how the concept of a therapeutic landscape was discussed during the envisioning and 
promotion of the new hospital. The analysis was carried out, firstly, by reading the documents to 
obtain an overall understanding of the case, and secondly, by focusing on the arguments and 
comments on the elements that were considered to make the building therapeutic and suitable for 
psychiatric care. The found discourses were guided by the theoretical debate although the focus was 
on finding the arguments of the planners. The plans regarding specific treatments were not included 
in the analysis as they are beyond the scope of this article.
In our analysis, we follow Gesler’s (1992) thoughts on how mental healthcare is shaped by ideologies 
that lead to a metaphoric language that is influenced by the moral-aesthetic norms of dominant 
groups. For instance, maintaining the formerly dominant discourse of restorative nature and stress-
inducing urban landscapes may uphold the ideology that mentally ill patients ought to be separated 
from society in isolated locations. Thus, the purpose of the analysis is to investigate how the discourses 
on therapeutic landscapes have transformed or diversified along with the new trends of outpatient 
care and centralized urban hospitals.
Therapeutic landscapes in an urban psychiatric hospital
Therapeutic landscape in outpatient care
The documents describe how the previous locations of psychiatric care in Southwest Finland 
were mainly built circa a hundred years ago and were distributed throughout the district (TYKS 
2020). The psychiatric wards had rural locations and they provided recovery in natural environments 
(TYKS Psykiatria 2020). Halikko hospital, for instance, formed a self-sufficient community where 
agriculture was practiced (ibid.).
FENNIA 201(2) (2024) 5Siiri Pyykkönen & Päivi Kymäläinen
The old hospitals are not optimal today as there is a need to respond to the increased demand for 
psychiatric care, and to the increasing outpatient, non-institutional care (TYKS 2020). In the plans of 
the new Kupittaa Hospital, therapeutic landscapes are constructed through a combination of the 
features and functions of the building, and the possibilities that an urban environment can provide for 
the creation of therapeutic and restorative spaces (including the nearby possibilities for exercising or 
experiencing nature). The documents imply that the significance of the hospital is diminishing, as 
psychiatric care is becoming increasingly based on outpatient care and remote services:
During the past forty years, the emphasis on outpatient care has strongly diminished the need for 
institutionalized care. […] The need for hospital care is strongly decreasing, which means that, in 
the future, there needs to be inpatient care at one location only.1 (TYKS Psykiatria 2020, 3)2
As a result of outpatient care, round-the-clock care will be reduced (TYKS 2020), and therapeutic 
landscapes will not be limited to the location of the hospital (TYKS Psykiatria 2020). This reflects a 
new, wider understanding of therapeutic landscapes that does not just consist of the surrounding 
views, but rather refers to a more comprehensive experience that is not restricted to a certain 
location (Bell et al. 2018).
Patients are no longer expected to recover in isolation, but through the connections between 
hospital care and society (TYKS Psykiatria 2020). Psychiatric outpatient care is a part of everyday life 
rather than a separate function in a distant location (Parr et al. 2003). The emphasis on outpatient 
care can be seen as a mean to avoid constructing expensive hospitals. When care takes place at 
home, the hospital becomes a place to drop by or to stay for short periods of time. This implies that 
the spatial planning of therapeutic landscapes has become a somewhat secondary issue.
Location and stigmatization
The therapeutic landscape of Kupittaa Hospital is linked with its central location, which is considered 
to make the hospital open and accessible. The documents indicate that the patients in psychiatric care 
require public transport services, which makes having good traffic connections important (TYKS 
Psykiatria 2020). The location, which is within walking distance of the city center and close to the 
public transport network, was seen to improve equality as well as to advance the availability and 
timeliness of the services (TYKS 2020). However, since the waiting time for outpatient psychiatric care 
can be several months (YLE 2021a; Linnaranta 2022), the concept of a hospital where a patient can 
drop by easily, seems to be far from reality.
The location in the center of a busy urban structure is considered the best way to integrate 
psychiatric care into society and to modernize psychiatric care services. The location would connect 
the hospital to “a wide range of public functions” such as healthcare services, education, businesses 
and housing (TYKS Psykiatria 2020, 44). The incorporation of psychiatric care into the hospital’s 
emergency services and different wards is considered important for therapeutic efficiency as it 
diminishes a patient’s need to travel between various health service units (TYKS 2019; TYKS Psykiatria 
2020). This transformation follows the guidelines which have led to the centralization of hospitals in 
several hospital districts of Finland (TYKS 2020). The possibilities of obtaining more physical exercise 
could diversify the functions of psychiatric care, and various businesses and services could be utilized 
in exposure therapy (ibid.). It is seen as important that “the psychiatric hospital is not hidden but is a 
part of society” (TYKS 2020, 31) and could be developed alongside the society’s social infrastructure. 
The care workers could, for example, easily visit places where people normally spend their time, such 
as homes, schools, day care centers or places of work (TYKS Psykiatria 2020). This follows the argument 
of Moon and others (2006, 145) on how in a modern asylum, care is provided in “a combination of 
state planning and medical progress”.
Stigmatization would be reduced by locating some other functions in the entrance hall of the hospital 
so that it would be used by other members of society. The ground floor would be allocated for 
education, associations and businesses to lower the threshold necessary to enter the hospital (TYKS 
2020). Providing psychiatric care among other functions was expected to increase the publics’ 
awareness of mental health services, decrease the stigmatization of the patients, fight against society’s 
6 FENNIA 202(1) (2024)Research paper
prejudice towards mental health problems, and create encounters (TYKS Psykiatria 2020). The hospital’s 
desire is to implement care together with both the patients and their relatives, whose organizations 
would be located on the ground floor. To diminish stigma, these spaces “need to be convertible and 
open” (TYKS 2020, 17), and there should be “living room spaces” not visible to everyone but easy to find 
(TYKS Psykiatria 2020, 77). Stigmatization would be prevented by promoting encounters and by distributing 
correct information about how common mental disorders are (TYKS 2020; TYKS Psykiatria 2020).
Spatial infrastructure, natural elements and outdoors
The hospital spaces have been planned to enhance functionality, safety, health and pleasantness 
(TYKS Psykiatria 2020). Spaces would be multi-functional and connect to different parts of the hospital 
(ibid.). To ensure safety, there would be visual contact between different spaces (ibid.). These spatial 
solutions have been planned to be subtle so that they seem natural and imperceptible without making 
the hospital seem like a prison (TYKS 2020; TYKS Psykiatria 2020). It is hoped that spatial solutions will 
help to control patients without the need to use force or coercive methods (TYKS 2020), which is 
regarded as one of the signs of the quality of psychiatric wards (TYKS Psykiatria 2020).
The transformation of the conception of therapeutic landscapes emerges when the plans note 
how inadequate the previous wards were for modern psychiatric care. The wards are described as 
being reminiscent of the prison areas of traditional police departments where noises and shouts 
could be heard from the rooms and corridors (TYKS Psykiatria 2020). Due to the current emphasis on 
outpatient care, hospitals are becoming more like office buildings rather than residential places for 
restoration (TYKS 2019). Another way of pursuing improvement in contrast to the old hospitals is to 
design clear inner spaces so that the patients can easily find their way from one place to another 
(TYKS 2020; TYKS Psykiatria 2020). The new waiting rooms are separated from other spaces to ensure 
privacy and to reduce the anxiety of patients when arriving at the reception. Moreover, privacy will 
be increased by providing single patient bedrooms which will enhance relations with relatives and 
other visitors (TYKS Psykiatria 2020).
Although the connection with nature is regarded as important (TYKS 2020), the plans do not present it 
as a priority. Therapeutic landscapes do not consist of the natural elements of the hospital surroundings 
but are rather comprehensive therapeutic experiences that are created in collaboration with society 
and the urban environment. It is, thus, essential to examine therapeutic landscapes as a diverse 
ensemble of various materialities and atmospheres that create a therapeutic network (Smyth 2005).
The plans highlight access to outdoor spaces (TYKS 2020) and suggest maximizing natural light, 
outdoor spaces, a connection to nature, and indoor plants (TYKS Psykiatria 2020). Since it is not safe 
for all patients to go outside, it is acknowledged that the building needs to have balconies with high 
ceilings and large windows with wide views that can take thoughts away from the hospital (TYKS 
2020). The plans include a rooftop terrace and inner courtyards to ensure safe outdoor activities 
(ibid.). Inner yards are peaceful alternatives for the busy urban life, and they are presented as a 
requirement for good institutional psychiatric care (TYKS Psykiatria 2020). Furthermore, they are seen 
to create therapeutic landscapes that reduce stress and violent situations (ibid.). These plans follow 
the original ideas of therapeutic landscapes, noting how patients need to have access to balconies or 
courtyards for outdoor exercise, and to have natural elements in outdoor spaces (TYKS 2019; TYKS 
2020; TYKS Psykiatria 2020). Small, spatially limited outdoor spaces – such as balconies – can become 
central aspects in a recovery process although Curtis and others (2007) have noted that if the outdoor 
spaces are too small, they are insufficient for restoration.
Digital therapeutic landscape
Recent literature on therapeutic landscapes discusses the use of technology in therapeutic settings. 
Digital health technologies have created new spaces of health and have formed new therapeutic 
landscapes in the interplay between health, the physical, and the representational (Thompson 2021). 
Some scholars have regarded these kinds of imaginary encounters with landscapes as beneficial for 
well-being and health (e.g. Rose 2012).
FENNIA 201(2) (2024) 7Siiri Pyykkönen & Päivi Kymäläinen
The project plans for Kupittaa psychiatric hospital repeatedly present the possibility of using 
technological solutions in the creation of therapeutic landscapes, such as smart walls, relaxing but 
neutral soundscapes, virtual reality monitors, or changing lighting and colorscapes of the rooms (e.g. 
TYKS 2020; TYKS Psykiatria 2020). Technology is regarded as an important asset, which can “open 
new approaches to advancing mental health regardless of the age group”, and thanks to which “the 
patient does not need to adapt to the needs of the care, but the care adapts to the patient’s needs” 
(TYKS 2020, 18). It is mentioned that taking all the senses into consideration can help to ensure both 
calming spaces and stimulating experiences (TYKS Psykiatria 2020). Technological systems can help 
to create personal environments by simulating “almost any environment safely and resource 
effectively” (TYKS Psykiatria 2020, 81–82). Moreover, digital solutions could be utilized in general 
communication and in cases of emergency (TYKS Psykiatria 2020).
The use of technology appears to challenge the prior understanding of therapeutic landscapes. 
Digital technologies can both produce and disrupt therapeutic landscapes (Thompson 2021), and 
they can blur the line between public and private spheres since the technologies are designed by 
private companies. Digital health technologies can create successful healthcare encounters, but they 
might also fail if connections are disrupted or data safety causes concerns.
Transforming therapeutic landscapes
Our analysis of the planning process of Kupittaa Psychiatric Hospital confirms Edwards’s (2022) 
notion that therapeutic landscapes are not simply physical landscapes that can be viewed, but 
rather relational constructs that become constituted through various processes. The case of 
Kupittaa Hospital shows how the constitution of therapeutic landscapes has changed compared to 
earlier hospital design that relied on healing gardens, restorative and calming physical landscapes, 
and isolation from overstimulating mundane life. Compared to these ideals, three significant 
changes have occurred. Firstly, the benefits of urban locations have been acknowledged, such as 
the accessibility of centrally located hospitals. The location makes it easier to develop psychiatric 
care as a part of the social infrastructure of the city, and in collaboration with society, relatives and 
patient associations. A central location and multifunctional spaces are expected to decrease the 
stigma related to psychiatric patients and mental health disorders, as care can be obtained by 
‘dropping in’ to a familiar building in an everyday urban environment instead of being isolated in the 
peripheries (Wood et al. 2013).
Secondly, the increase in outpatient care has influenced the hospital design and how much effort 
is put into therapeutic landscapes. The emphasis on outpatient care diminishes the significance 
of the hospital building as care mostly takes place outside of the hospital. Hospitals are no longer 
built with the purpose of creating long-term psychiatric recovery and care but are rather designed 
as places that enhance therapeutic networks in patients’ everyday lives (see Edwards 2022). 
Subsequently, therapeutic elements are expected to be found in everyday landscapes rather than 
being provided by the hospital and its surroundings. The focus is on therapeutic networks that are 
formed by multiple human and non-human actors and are expected to shape and enhance the 
recovery and well-being of the patients.
Thirdly, the absence of healing gardens in the new hospital building and their replacement with 
artificial ones indicates the changes that have taken place in the constructing and understanding of 
therapeutic landscapes. The urban landscapes next to the hospital are not considered therapeutic, 
which is understandable given that the building site is small and at a crossroads between many 
busy streets. Nor have architectural solutions been utilized to create replacements for healing 
environments inside the building. Perhaps more than being linked with better care, artificial 
therapeutic landscapes seem to be connected with the restricted funding and the effort to adjust to 
the trend that emphasizes outpatient care.
Kupittaa hospital will be a public hospital, but the plans affirm the findings of Moon and others 
(2006) regarding how modern asylums can commodify care. The psychiatric hospital is conceived not 
only as a place for treatment, but as one of many services provided in the innovation hub of Kupittaa. 
Centralized psychiatric services, increasing outpatient care, cost-effective architectural solutions and 
8 FENNIA 202(1) (2024)Research paper
the lack of therapeutic landscapes are aspects of the current transformation that are justified with 
positive effects – such as, a decrease in stigmatization, the accessibility of care, and the adaptability of 
therapeutic landscapes according to the patient’s preferences.
There is, however, a gap between the justifications and how the plans are realized. During the time 
this research was conducted, the plans and the budget for the hospital were reduced, and the latest 
update estimates that there will not be enough room for all the patients in the hospital. The plans to 
allocate the ground floor to semi-public everyday spaces with the functions being available for 
everybody have been removed. This made the arguments for the openness and everydayness of the 
new hospital questionable. Another argument that is now doubtful is the proposition that people 
could just stop by and use the services easily as a part of their mundane everyday lives. Since the lines 
to mental healthcare are long and services are not available for many, the new hospital design cannot 
advance the everydayness of mental health services as claimed. Furthermore, artificial therapeutic 
landscapes as well as the emphasis on outpatient care are cost-effective choices whose effects on the 
patients are still unknown.
In the new Kupittaa psychiatric hospital, therapeutic landscapes will not be limited to the hospital 
area, nor will they offer an escape from the patient’s mundane life (Conradson 2005). Healing will not 
occur through therapeutic taskscapes (Smith 2021), healing gardens (Stigsdotter & Grahn 2003), green 
and blue spaces (Finlay et al. 2015), out-of-sight asylums in natural landscapes (Parr et al. 2003), or 
urban greeneries (Dushkova & Ignatieva 2020). The therapeutic landscape will rather work as a 
metaphor for a wide network of different therapeutic attributes that aim to create a restorative 
atmosphere from various elements. Therapeutic landscapes will be built in a relationship with society 
and the social infrastructure of the city, and with the help of the hospital design, small outdoor and 
nature contacts, and technological solutions. When therapeutic landscapes are pursued in this way, 
as a complexity of various aspects of the hospital building and society, the effects on the healing 
process remains to be seen when the realities of the project are attained.
Notes
1 The quotes from the data are translated by authors.
2 Although being out of the scope of this article, it is noteworthy that the lack of inpatient care has 
increasingly been criticized as outpatient care has not been sufficient for many (e.g. YLE 2021b; 
YLE 2022).
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