Ecotherapy

Mind has been running green schemes for almost 20 years.  One example is in Solihull, in the West Midlands where Mind took over a piece of derelict land 12 years ago.  Now it's an organic garden, surrounded by a conservation area and a five-a-side football pitch - all created by Mind workers and people suffering from mental distress.  GPs in the area regularly refer people who are mentally unwell to the Mind project.  Meanwhile the surrounding community has moved from slight wariness to enthusiastic support.
 
Recently Mind commissioned some research from the University of Essex to quantify the effects of these 'green' approaches to mental illness.  
 
FIH: Tell us about a particular project that's worked.

MR: Thurrock Mind's gardening project has now been running for 16 years. It provides horticultural training and work experience for people who have mental health problems. Ron and his team provide support and encouragement for participants, helping them to grow in confidence and self-esteem. The project gives people the opportunity to get a City and Guilds qualification in horticulture, so it can be a stepping stone back into education or employment.
 
Tony Barrell is one of the of the projects success stories - he's 35. When his community mental health team referred him to the garden project about 4 years ago he was agoraphobic and had been having problems with mental distress for years. He tells us that with the chance to work in a safe environment, without stigma, his confidence began to grow.
  
FIH: Has anyone tried to pin down scientifically why it works so well?

MR: Yes indeed. There are studies by experts at the University of Essex showing that the combination of exercise and engagement with nature adds up to more than the benefits of either activity alone.  We commissioned some research from Essex ourselves, which identified three key benefits of our 'ecotherapy' approach in particular.  They told us that it improves psychological wellbeing by improving mood and self-esteem, and lessens anger, confusion, depression and tension.  Secondly, it's helpful to get the physical exercise, and lastly it helps people reconnect socially. 
 
Fascinatingly, if you get people to exercise whilst viewing pleasant pictures of greenery, it improves self-esteem and reduces blood pressure more than just exercise by itself, or exercising whilst looking at less pleasant environments.  
 
FIH: Do you think city dwellers are more prone to depression?

MR: All sorts of factors might feed into depression, but it's true that city dwellers will usually have less access to green spaces, will take less outdoor exercise and will be exposed to higher levels of stress. This can affect mental health. We also now know more about the benefits of green space. There's a Dutch study from 1995 which found that people living near a green space had fewer health complaints and better physical and mental health than people in a totally urban environment.
 
Anyway, the principles behind ecotherapy aren't new. A century ago, mental health institutions were often built in pleasant gardens and natural landscapes. But in the past few decades this has all been forgotten, and those considerations have dropped out of the planning of urban space.
 

FIH: There's a lot about making people feel better in the short term, getting things into proportion. Have you done any research to see if an ecotherapy approach might be curative in the long term?

MR: Evidence does not suggest that the benefits of green exercise reduce with time. But we are intending to build research and evaluation into our service development, as ecotherapy expands further. We're planning to gather data that helps build a better evidence base.

FIH: You give some pretty shocking stats about doctors prescribing antidepressants - why do you think they have so few options?

MR: Research shows that 93% of GPs have prescribed antidepressants against NICE guidelines.  Doctors often feel forced to give their patients antidepressants even though they might prefer another option simply because no alternative exists. Few GPs will consider a local conservation or rambling group as a treatment option for people with depression often because there are no local schemes to which patients can be referred, or no links to those that exist. 

Although NICE recommends talking therapies as  the frontline treatment for certain mental health conditions  far too often people simply cannot access them. It's not uncommon for patients to wait 2 years for evidence-based treatment such as cognitive behavioural therapy (CBT). We're currently running a joint charity campaign We Need To Talk that emphasises the need to give people greater access to talking therapies too.

FIH: If GPs are reading this now and thinking 'great - ecotherapy is  just what my patients need' - what can they do?

MR: We set up our ecotherapy campaign to answer that very question. We want to raise its profile as an emerging and clinically valid treatment, and so we're working to provide a framework for ecotherapy within UK mental health policy.  The great thing about it is it's free, natural and has no unpleasant side effects.

In the short term we're encouraging GPs to find out about grass roots rambling and conservation groups in their area and establish close links with them. All over the country Mind's volunteer groups have been setting up ecotherapy projects, so GPs may find that there are already services in their area that they don't know about.

FIH: What are the next steps for this idea - what would you like to have happened in five or ten years?

MR: Our vision is that ecotherapy will be a mainstream treatment option for people who are visiting their GPs with mental distress, and we'd like information about local ecotherapy projects to be available at GP practices. Ideally, the need for green spaces and an environment that promotes mental wellbeing would be central to the town planning process, just as the need to tackle crime is currently incorporated into design.
 
 
 
Case study 
 
'In September 1997 I was forced to give up employment and all other social networks as I was suffering from an anxiety disorder coupled with depression.  Over the following two or three years I was prescribed various antidepressant drugs by different consultant psychiatrists, none of which helped with my increasing mental health problems.  Eventually in 2003, it was suggested I attend Thurrock Mind's garden project.  While the mere thought of it was frightening, I decided to give it a try... for the first time in years I felt that I was treated as an equal citizen.'
 
Tony Barrell, aged 35
 
In 2005, he took a six-week volunteering course, and now works with the advocacy and befriending service.