Imagine getting a prescription from your GP for a walk in the woods, a spot of gardening or even a surf lesson. It’s not as improbable as it sounds.
With the prescription of antidepressants at record levels globally and a huge demand for cognitive behavioural therapy (CBT) and other psychological therapies, health and social care services are turning to nature-based interventions as part of a new solution for mental health.
Known as green care or ecotherapy, nature-based interventions have been shown to increase general mental wellbeing, reduce depression, anxiety and stress-related symptoms, and improve dementia-related symptoms, among other benefits.
While nature-based interventions in mental health are still new to Ireland, ecotherapy projects are widespread throughout the US, Canada and the UK. The most common forms of green care are social and therapeutic horticulture (STH), environmental conservation interventions and care farming (see panel for more information).
Other forms include animal-assisted therapy, arts and crafts in nature, and green gyms.
Mind, the UK mental health charity, funded 130 ecotherapy projects across England with £7.5 million (€9.4 million) in lottery monies through its Ecominds programme between 2009 and 2013. More than 12,000 people used these projects to look after their mental health by gardening, farming, growing, exercise, art and crafts, or environmental conservation works, supported by trained professionals.
The Green Gym movement in the UK combines exercise to improve health and fitness, while taking action to improve the environment.
A national evaluation of 52 Green Gym projects in the UK suggests that ecotherapy is an accessible, cost-effective complement to existing treatment options for mild to moderate mental health problems.
Ireland has been slower to embrace the green care concept, but awareness is starting to grow here. St John of God Hospital in Dublin introduced a green gym about six years ago, and St Patrick’s University Hospital opened a therapeutic garden and pet area on its campus last year.
An evaluation of the Green Prescription exercise referral programme piloted by the HSE West in Co Donegal found that it not only reduced obesity in participants, but impacted positively on physical and mental health.
The Woodlands for Health project in Co Wicklow was set up in 2012. It has offered 12 weekly walks in nature to people using Wicklow mental-health services. It is led by guides from Coillte and participants are accompanied by a community mental-health nurse, Ita Kelly. The three-hour walks include a talk on the environment, environmental art and relaxation. At the end of the programme, participants share a meal to celebrate their achievements.
Last year the project was evaluated by the HSE and University College Dublin, which found that participants improved their mood by 75 per cent and sleep by 66 per cent; in addition, their thoughts of suicide declined by 82 per cent.
David Staunton, founder of Walk Inniú, Counselling Psychotherapy Outdoors, lives on a busy street in inner city Dublin and while he enjoys city life, he strongly identifies with the greener, quieter and more natural setting of his native west of Ireland.
“I have been living in Dublin most of my life now, and three or four years ago I went through my own personal process. I felt something was missing, I wasn’t getting enough green space and needed to reconnect with nature. I looked at how I could combine my work and love of the outdoors, and that is what led to me setting up Walk Inniú two years ago.”
While Staunton provides a form of ecotherapy, he points out that it is “not just a walk in the park or woods”, but a full counselling psychotherapy session outdoors. He uses a number of parks in Dublin city, including the Phoenix Park, and he lets the client choose where they want to work.
“I like the idea of having a portal, like a tree which the client picks, where we start the therapy. Nature does its own thing in the background, like a co-therapist, and mindfulness is very much part of the therapy, but it’s always up to the client what they want to talk about. Some people like to walk through the park, others like to sit on a bench.
“We come back to our portal at the end of the session and check back in to the wild, busy world.”
Staunton is holding an Ecotherapy Open Day on Sunday, September 11th in the Phoenix Park to promote the concept.
Shirley Gleeson, a senior mental health social worker, is another fervent advocate of the benefits of ecotherapy. Last year, she came together with Diarmuid McAree, former chief forestry inspector with the Irish Forest Service, and research psychologist Donal O’Keeffe to set up Nature, Health and Wellbeing Ireland which delivers evidence-based ecotherapy interventions around the country.
This month they are launching their Green Prescription intervention for people aged 18 and over who are experiencing stress or mental health difficulties.
“The programme involves eight two-hour walks over eight weeks in locations around south Dublin and Wicklow. It will include nature connection, mindfulness, physical activity, expressive arts and social connection,” Gleeson explains.
The team at Nature, Health and Wellbeing also provides gentle guided forest therapy walks in parks, gardens and forests around the country, and ecotherapy walks in places such as Glendalough, the Botanic Gardens and Powerscourt Gardens.
As passionate as Staunton and Gleeson are about green space, marine biologist Lucy Hunt is all about blue space. She has combined her deep love of marine biology and environmental protection, with her interest in health and wellbeing.
“The curative power of water is impossible to deny. From the Victorian era, water has been used to heal and people were sent to the coast to breathe in the sea air for convalescence after illness. I see a real synergy between the sea and our mental and physical wellness.
“In Brittany and California, GPs are prescribing surfing to treat symptoms of depression. In the US, thousands of war veterans are benefitting from programmes like Heroes on Water, using swimming, kayaking, fishing and surfing to help get over post-traumatic stress disorder. How much better to prescribe a walk, swim or surf lesson than to just focus on prescribing drugs.”
When it’s pointed out to Hunt that the Irish coastal weather is hardly conducive to water-based activities, she retorts: “There’s no such thing as bad weather, just bad clothes. Put on a wet suit.”
Through her Sea Synergy Marine Awareness Centre in the seaside village of Waterville on the Ring of Kerry, Hunt is helping to raise awareness about our marine environment, and to connect children and adults with the sea in a fun and light-hearted way.
She does this through activities that include Kids Seashore Explore Workshops, beach yoga and nature connection and craft workshops, in addition to the wellness workshops she runs in conjunction with Carey Yoga and Nutrition.
Walk Inniú: walkinniu.ie; email@example.com Nature Health and Wellbeing: naturehealthandwellbeing.ie; firstname.lastname@example.org
Wicklow Woodlands for Health is managed by Charlie Burke, one of Coillte’s recreation officers: email@example.com
DLR Nature for Health organises outdoor walks for groups in the Dún Laoghaire-Rathdown area of Dublin. naturehealthandwellbeing.ie.
Sea Synergy Marine Awareness: the next adult wellness Optimum You workshop is on July 23rd; seasynergy.ie; firstname.lastname@example.org