The power of nature is something I’m really passionate about. Thinking more about green exercise again recently and being reminded of the wonders of ‘forest bathing’ has reignited a thought I had several years ago: we have amazing National Parks which have the potential to be used and valued as a health and wellness resource. Whilst the scope of their potential value is huge, today I thought I’d explore how exposure to nature and ecosystems is beneficial to mental health and wellbeing.
Mental illnesses are a major health issue. The World Bank estimates that in 2020 depression alone will be the second most common cause of disability in the Western World1. The financial impact of mental health problems to the English economy is estimated at £105 billion per year2.
You probably know what I mean about feeling good when being in nature – walking barefoot along the sand, being surrounded by tall trees, hearing bird song….but is that feeling supported with scientific evidence that being in the countryside really does improve your mental wellbeing? Well you’re about to find out the answer is yes! I’ll show you some of the evidence as well as mention some programmes that are already harnessing the power of nature to help treat mental health issues.
The concept that exposure to natural environments is beneficial to psychological well-being is demonstrated by the ‘Mappiness’ initiative. The wellbeing of the UK was explored utilising a sampling method using smart-phone based satellite located, wide-scale data associating mood states and one’s surrounding environment3. The findings of this study were that overall, participants were most happy outdoors. Happiness was increased with vigorous outdoor activities such as running, walking and hiking, yet also with less intense forms of enjoying nature e.g. bird watching and gardening. Of significance was the strong association between happiness and the habitat within which a person was outdoors, urban habitats producing lower happiness levels compared to natural habitats such as moorlands, heaths, woodlands and coasts.
As I mentioned in my previous post, green exercise is physical activity in the presence of natural environments4. Green exercise delivers both the mental health benefits of physical activity and benefits of exposure to nature in a synergistic manner4.
The evidence supporting the efficacy of green exercise as a therapeutic intervention for mental health diagnoses is expanding. Walking in green space has a greater positive effect on self-esteem and mood than walking indoors5. Green exercise also significantly reduces anxiety states, with the effect being correlated with how ‘green’ the environment is6.
There is evidence that exposure to nature not only enhances the attention of those with ADHD 7, but in healthy university students as well 8. Targeting the emotional needs of the young population is prudent as half of all cases of mental health problems are diagnosed by 14 years of age and three-quarters by the mid-twenties9. By harnessing the therapeutic potential of green exercise, outdoor physical activity has the potential to offer treatments to improve the quality of life of children with mental health needs.
Not only does exercise provide the opportunity to support mental health issues in the young, it also has potential as a therapeutic intervention for dementia. It has been demonstrated that sleep10,11, continence10 and mobility12 are all improved when dementia patients undertake green exercise.
The association between increased health and wellbeing and exposure to nature and natural ecosystems reflects the concept of ‘Ecotherapy’. Ecotherapy is ‘an intervention that improves mental and physical health and wellbeing by supporting people to be active outdoors’13. Ecotherapy can be structured so that interventions can be targeted to suit specific needs of the participants. Furthermore, Ecotherapy can attract hard to reach groups; for example 56% of the Mind project ‘Ecomind’s’ participants were men, whilst recent statistics from the NHS Improving Access to Psychological Therapies Programme demonstrate that men account for only 36% of NHS psychological therapy patients14. Facilitated green exercise is therefore one form of Ecotherapy. It has been suggested that green exercise could be offered as an alternative or adjunct to traditional antidepressant drugs in the treatment of depression15. Furthermore, since approximately 21% of general practitioners prescribe exercise in the management of depression16, the enhanced efficacy of exercising in nature presents green exercise as a potential development in the support available for this common disabling disease.
There are several other forms of Ecotherapy which are ideally suited to the National Parks. Care farming is the utilisation of agricultural landscapes and farming practices to promote physical and mental health and social well-being17. Studies into the efficacy of care farms within the UK have shown significant benefits in self-esteem and mood18. An example of a successful care farming project is Tom’s farm in Dartmoor National Park. This enterprise uses the working farm environment to engage vulnerable young adults in order to gain confidence and social skills. This is an example of a self-sustaining organisation; several participants had the strength to become Young Leaders once completing the programme and now support others participating in the project19. Care Farming can also have an educational, as well as therapeutic, role.
High Mead farm in Wimborne, for example, provides a supported work environment and animal assisted therapy for those with learning and physical disabilities20. They actively engage their participants with the ethical issues of sustainable farming. By providing the skill set required to enter work, care farming can expand the horizons of those supported in such a way. Such case studies provide a structural framework upon which similar projects based within National Parks could be built.
Not only is Ecotherapy effective, it is cost efficient. Analysis of the Ecominds project run by the charity Mind suggests that for five of the typical participants total savings were £35 413 in one year, an average of £7 082 each21, this included reductions in costs to the NHS, benefits reductions and increased tax contributions. As unemployment is strongly associated with poor mental wellbeing, this access to employment sustains participants on a road of recovery. Ecotherapy also has the potential to reduce demand upon conventional health and social care services. For example, by using natural environments as a health resource the number of traditional pharmacological prescriptions could be reduced, potentially decreasing the £270.2 million cost to the NHS of the 50 million dispensed antidepressants in England in 201122.
I’m just back from holiday and had the joy of reading ‘Shinrin-Yoku: The art and science of Forest Bathing’ by Dr Qing Li23 whilst on holiday. Forest bathing is the concept of immersing yourself in the wonder of a forest atmosphere and connecting with nature using all your senses. Whilst the most traditional form of forest bathing is forest waking, yoga, eating, t’ai chi, meditation, art classes and aromatherapy within the forest environment are all forms of forest bathing23. It has such potential to relieve stress, lower blood pressure, improve concentration and aid depression, amongst many other health benefits23.
We have numerous beautiful forests within the UK, including the New Forest where I live which was included in Dr Qing Li’s 40 Beautiful Forests across the World23. Just think of the potential these forests being established as forest-bathing sites has. Some established sites in Japan have on-site medical staff and trained forest therapists. Developing such resources in forests of the UK is a dream of mine. With ever increasing urbanisation, the importance of connecting with nature has never been so great.
By using natural environments, we can enhance the mental health of our population whilst potentially reducing the financial burden on our health and social services. The National Parks of England provide the perfect opportunity in which to deliver such goals.
- Bank, W. World Development Report 1993. (The World Bank, 1993). doi:10.1596/0-1952-0890-0
- Centre for Mental Health. The economic and social costs of mental health problems in 2009 / 10. 1–4 (2009).
- Mourato, S. & MacKerron, G. Cultural services and subjective wellbeing. 2010
- Pretty, J., Peacock, J., Sellens, M. & Griffin, M. The mental and physical health outcomes of green exercise. Int. J. Environ. Health Res. 15, 319–37 (2005).
- Mind. Ecotherapy – the green agenda for mental health Key findings Green exercise at local Mind groups. (2007).
- Mackay, G. J. & Neill, J. T. The effect of “green exercise” on state anxiety and the role of exercise duration, intensity, and greenness: A quasi-experimental study. Psychol. Sport Exerc. 11, 238–245 (2010).
- Hoza, B. et al. A randomized trial examining the effects of aerobic physical activity on attention-deficit/hyperactivity disorder symptoms in young children. J. Abnorm. Child Psychol. 43, 655–67 (2015).
- Lin, Y.-H., Tsai, C.-C., Sullivan, W. C., Chang, P.-J. & Chang, C.-Y. Does awareness effect the restorative function and perception of street trees? Front. Psychol. 5, 906 (2014).
- No Health Without Public Mental Health the case for action. R. Coll. Psychiatr. London (2010).
- Brooker, D. J., Woolley, R. J. & Lee, D. Enriching opportunities for people living with dementia in nursing homes: an evaluation of a multi-level activity-based model of care. Aging Ment. Health 11, 361–70 (2007).
- Connell, B. R., Sanford, J. A. & Lewis, D. Therapeutic Effects of an Outdoor Activity Program on Nursing Home Residents with Dementia. J. Hous. Elderly 21, 194–209 (2007).
- De Bruin, S. R. et al. Day care at green care farms: a novel way to stimulate dietary intake of community-dwelling older people with dementia? J. Nutr. Health Aging 14, 352–7 (2010).
- Mind. Feel better outside, feel better inside: Ecotherapy for mental wellbeing, resilience and recovery.
- Centre, H. and S. C. I. Improving Access to Psychological Therapies Dataset Final Quarter 4. (2013).
- Samson, C. & Pretty, J. Environmental and health benefits of hunting lifestyles and diets for the Innu of Labrador. Food Policy 31, 528–553 (2006).
- Mental Health Foundation. Moving on up. (2009).
- Hassink, J. COMBINING AGRICULTURAL PRODUCTION AND CARE FOR PERSONS WITH DISABILITIES: A NEW ROLE OF AGRICULTURE AND FARM ANIMALS. (2003).
- Rachel hine, J. P. and J. P. Care farming in the UK: Evidence and Opportunities.
- Ecominds Directory of projects 2009-2013. (2013).
- http://www.highmeadfarm.org.uk/#!whatwedo/c10d6. Available at: http://www.highmeadfarm.org.uk/#!whatwedo/c10d6. (Accessed: 21st May 2015)
- Vardakoulias, Olivier, nef consulting limited. The Economic Benefits of Ecominds: A case study approach.
- Centre, T. H. and S. C. I. Prescriptions Dispensed in the Community, Statistics for England 2001-2011. (2012).
- Li, Q. Shinrin-yoku : the art and science of forest bathing. (Penguin Life, 2018).