Green walking for mental health recovery

The Centre for Sustainable Healthcare’s Green Walking Project aims to move the mental health paradigm away from a more clinical, medication led approach, and towards a more sustainable and holistic model of care. The Green Walking Project aims to reconnect patients with nature and outside spaces both as a form of treatment and as a preventative measure.

CSH can empower clinicians, ward staff and patients themselves with the tools, knowledge and information they need to make green walking an integral part of all mental health services

How Green Walking started

In 2018 with funding from the Network for Social Change, CSH recruited teams across eight NHS Mental Health Trusts to run a pilot scheme of new Green Walking groups for inpatients.  The wealth of benefits and first-hand knowledge from these Green Beacon Sites informed the writing of Green Walking in Mental Health Recovery: A Guide. The guide was endorsed by the Royal College of Psychiatrists, Royal College of Occupational Therapists, Royal College of Nursing and the Maudsley Charity on launch in May 2020. 

Green Walking in mental health recovery: A guide is a resource to help professionals start new groups within their wards, the guide also summarises relevant evidence as well as representing perspectives from patients and a wide range of professionals.

Download the guide here

The Green Walking in Mental Health Recovery initiative continues to promote and support walking in green spaces in the care of people with severe mental illness, to aid their recovery and rehabilitation, through resourcing and supporting NHS trusts to implement Green Walking. The initiative seeks to identify and overcome barriers preventing greater access to the natural world and empower the health service to integrate engagement with green spaces into standard models of inpatient care and beyond into other mental health settings. 

Changes in psychiatric care

• Acute psychiatric wards can be dehumanising and noisy environments, with limited access to therapeutic and community activities. More diverse and therapeutic environments are required. 
• A shift towards sustainable and holistic models of care is required.  Mental health services need to improve in the face of reduced funding, and be less carbon intensive to meet net zero targets. 
• There is an increasing emphasis on physical health and activity in mental health services, but there can be limited opportunities to support this. 
• Excessive use of the Mental Health Act without considering alternative solutions can lead to excessive detention and lack of supported leave.
• There can be a lack of collaborative practice across inpatient wards between different professions. 
• For psychiatric inpatients, there can be limited opportunities to go out for fresh air.  Green space access can often be minimally considered, despite  it supporting mental health wellbeing and recovery. 
• People can experience difficulties with their transition between inpatient and community services upon discharge.

Green Walking groups can provide a solution

Green walking groups can address issues in each of the above problems areas. The groups provide respite and healing to people receiving inpatient psychiatric care through walking together in nature, building on a significant existing body of evidence that has established the health and wellbeing benefits of green spaces and of walking.

Green walking groups can lay the foundation for transformational healthcare policy. Implications of the climate crisis have made it increasingly clear that delivery of effective healthcare by the NHS is not possible without an urgent shift towards sustainable policy and preventative models of health. Walking groups are a known but under-utilised intervention in mental health care which call on the physical and mental health benefits of engagement with green space. Implementation of Green Walking can be delivered as part of the aims of net zero, sustainable healthcare and integrated care policies.

The benefits of Green Walking

• Green walking can bring benefits that are both simple (people feel better for having been on a walk) and complex (relationships can improve and the ward can feel calmer).
• It can promote recovery off the ward, helping to shift mental healthcare from detention and crisis solutions towards a sustainable, preventative model. 
• It can bring people together with their community.
• Green Walking is an inclusive activity which works to ensure equitable and just access to green space.
• It can help NHS Trusts implement their Green Plans
• It is an activity which could be accessible to people once they leave hospital

Green Walking in a group

• Can be led by ward staff or volunteers
• Are an activity for staff and service users to enjoy together
• Can promote non-restrictive practice
• Can support the right to access green space
• Can be an integral tool in recovery, care and discharge planning
• Can take place in local parks, woodland and walking trails, or in the hospital grounds
• Are easily incorporated into existing ward activity timetables
• Can complement walking groups with social prescribing elements
• Can include learning about the natural world and creative activities such as art or photography
• Promotes positive relationships and caring ward environments

About the Green Walking in Mental Health Recovery initiative for sustainable healthcare

The Centre for Sustainable Healthcare (CSH) started the Green Walking in Mental Health Recovery initiative in psychiatric hospital setting as inpatients are generally the client group with the least access to green spaces and who as a result benefit from Green Walking the most. CSH is working towards a shift in the mental health paradigm where Green Walking is seen as an integral component of mental health wellbeing and recovery across all mental health settings, from primary care through to acute inpatient services. 

Green Walking case studies

• Cornwall Partnership NHS Foundation Trust
• Derbyshire Healthcare NHS Foundation Trust
• Kent and Medway NHS and Social Care Partnership Trust
• Norfolk and Suffolk NHS Foundation Trust
• Tee, Esk and Wear Valleys NHS Foundation Trust
• Avon and Wiltshire Partnership NHS Trust
• Lancashire Care NHS Foundation Trust: Guild Lodge
• Lancashire Care NHS Foundation Trust: Orchard Unit
• Oxford Health NHS Foundation Trust
• NHS Greater Glasgow and Clyde
• South London and Maudsley NHS Foundation Trust
• South West Yorkshire Partnership NHS Foundation Trust

Sign up to your own Green Walking project

Individual guidance to setting up Green Walking

I’m ready to set up a Green Walking group on my ward. How do I get started?

We’re very glad to hear that you want to start a Green Walking group. The information that you need to facilitate this can be found within the Guide to Green Walking in Mental Health Recovery, which you can download for free here.

What funding might I need for Green Walking groups?

Green walking is a low-cost intervention which uses available time and human resources efficiently. Some groups have hospital volunteers co-facilitating to support staff numbers.  You may want to access funds for certain items, but these may also be available for free. For example, some wards have set up donation schemes for wet weather gear. 

How do I get support with Green Walking groups?

You can ask questions about Green Walking in CSH’s own Mental Health Sustainable Network and/or the Green Space for Health Networks.

Green Walking is working well in my setting- how can I scale it up?

Once the efficacy of your green walking group is apparent, other local wards may want to replicate this.  Green walking could grow into the group programme on all the wards of your hospital.  Speak to your line manager or service lead about the development of further green walking groups. 

Service guidance to setting up Green Walking

I’d like there to be Green Walking groups across my hospital or ICB/Trust/Health Board. How do I get started?

Liaise with the clinical teams on the wards to ascertain who is ready to start a Green Walking Group. The information needed to set this group up can be found within the Guide to Green Walking in Mental Health Recovery, which can be downloaded for free here.

Once the efficacy of the first green walking group is apparent, other wards often want to replicate this. Use the knowledge, learning and resources from the first group to facilitate integration of green walking into the group programme on all the wards of your hospital. 

What funding might I need for Green Walking groups

Green walking is a low-cost intervention which uses available time and human resources efficiently.  Some groups have hospital volunteers co-facilitating to support staff numbers.  You may want to access funds for certain items, but these may also be available for free.  For example, some wards have set up donation schemes for wet weather gear.

I have funding options and need help to implement Green Walking or to scale it up?

The Centre for Sustainable Healthcare can offer project management of the development and implementation of Green Walking across health services. If you would like to see Green Walking to be integrated across your Trust/Health Board/ICS, throughout inpatient services and across other mental health settings, then CSH can provide oversight of this initiative. For example:

• Supporting staff programme delivery, including via training based on CSH’s existing Green Walking Guide
• Development of routes, risk assessments around S17 leave and discharge plans, and sharing of group resources
• Oversee programme monitoring and evaluation by collecting, collating and reporting feedback against agreed criteria
• Project promotion and liaison with NHS communication teams
• Supporting the liaison with NHS volunteer services about possible volunteer involvement in Green Walking groups
• Supporting signposting of inpatients to community walking groups after discharge and/or supporting the development of these community groups if they don’t exist yet
• Producing and sharing Green Walking case studies
• Development of CSH Green Walking Toolkit, a folder of further resources containing templates (e.g. risk assessments and checklists), case studies of existing groups and FAQ
• Promotion of the Green Walking initiative to support the NHS’s net zero targets
• Guiding engagement with CSH online networks and external networks