Green walking and national recommendations
Green Walking embodies and helps to take forward a number of national recommendations in mental health:
2011 NICE Clinical Guideline [CG136], Service User Experience in adult mental health
In acute mental health care, the guidelines call for a broad range of social, group and physical activities as essential elements of the service provided.
2011 DEFRA Natural Environment White Paper, The Natural Choice: securing, the value of nature
This report highlights that “nature is sometimes taken for granted and undervalued” and sets out the need to strengthen the connection between people and nature, to build “prospering communities and personal wellbeing.”
2014 NHS England Strategy Report, Sustainable, Resilient, Healthy People & Places
This report outlines a vision for developing a health and care system that is financially, socially and environmentally sustainable.
2014 NHS England, The NHS Five Year Forward View
This planning document cites concern with the ‘factory model of care and repair, with limited engagement with the wider community’ that is sometimes in evidence in the NHS, and strives for a ‘radical upgrade in prevention and public health.’
2016 Commission on Acute Adult Psychiatric Care, Old Problems, New Solutions
The Commission advocates for ‘a philosophy of care which is holistic, person-centered, facilitates recovery and which is underpinned by humanity, dignity and respect.’
2016 NHS England, The Five Year Forward View for Mental Health
The strategy calls on Commissioners to ‘emphasise early intervention, choice and personalisation and recovery’ and to consider physical health needs in tandem with mental health.
2018 Independent Review of the Mental Health Act, Modernising the Mental Health Act – summary version
The review recommended the introduction of ‘four new principles’ to inform the Mental Health Act in future, which are: ‘choice and autonomy, least restriction, therapeutic benefit and the person as an individual.’ The following recommendations are also particularly relevant:
- No. 82 notes that the CQC should develop new criteria for monitoring the social environment of wards.
- No. 84 highlights the need for improvement to inpatient wards.
- No. 154 states that NHS England should consider implications of the evidence linking staff morale and patient experience.
2018 RCOT, Getting my life back: occupational therapy promoting mental health and wellbeing
Recommendations include improving the physical health of people with serious mental health problems by incorporating and promoting healthy occupations.
2019 RCPsych, Standards for Inpatient Mental Health Services 3rd Ed.
These core standards for inpatient mental health services are revised by the Royal College of Psychiatrists’ College Centre for Quality Improvement (CCQ). The following standards are helpful to reference:
- No. 6.1.6 states that every patient has a seven-day personalised therapeutic/recreational timetable of activities to promote social inclusion, which the team encourages them to engage with.
- No. 6.1.11 insists that patients have access to safe outdoor space every day.
- No. 21.1 notes that the ward/unit actively supports staff health and well-being.
- Guidance: For example, providing access to support services, providing access to physical activity programmes, monitoring staff sickness and burnout, assessing and improving morale, monitoring turnover, reviewing feedback from exit reports and taking action where needed.
2019 RCPsych, Standards for Acute Inpatient Services for Working Age Adults (AIMS-WA) 7th Ed.
Fulfilling the following standards will help your ward to reach accreditation through the AIMS scheme:
- No. 46 identifies the importance for patients to have access to weekly activities which focus on accessing green spaces.
- Guidance: The manner in which the green space is engaged can include a range of activities from a basic group walk but also include interests which can be supported by staff and reflect interests of patients such as photography, drawing, mindfulness etc.
- No. 74 states that patients have access to safe outdoor space every day.
- No. 150 observes that staff recognise the benefit of using natural settings or green spaces to enhance the therapeutic potential of the ward environment and make patients aware of those benefits.
2019 NHS England, The NHS Long Term Plan
The planning document offers the observation in point 3.102 under the Inpatient Care section that ‘for people admitted to an acute mental health unit, a therapeutic environment provides the best opportunity for recovery. Purposeful, patient-orientated and recovery-focused care is the goal from the outset.’
This evidence is powerful, but it is equally important to see how it is working in practice. Learning from Green Beacon sites focuses on the experiences of places that have successfully introduced Green Walks. This is also evidence, but of a different kind, taking us from theory into practice.