About the Green Walking Initiative

The Green Walking initiative began in 2018 with the mission to provide respite and healing to people receiving inpatient psychiatric care through walking together in nature. It has been funded by a grant from the Network for Social Change and delivered by the Centre for Sustainable Healthcare in partnership with the Royal College of Psychiatrists, and endorsed by the Royal College of Occupational Therapists.

The initiative builds on a significant existing body of evidence that establishes the health benefits of greenspace and of walking and recognises that many healthcare professionals are already hugely supportive of this type of activity and have been championing it for decades.

Telephone interviews with staff in eight Trusts asked about the practicalities of setting up and maintaining walks, barriers encountered and any benefits (or drawbacks) that they had noted. These interviews were also used to create the first Green Walking Case Studies.

To gain a better understanding of the experience of being admitted to inpatient mental health wards, as well as the attitudes and potential barriers to taking part in walks, a focus group discussion was held with patients and carers at the Royal College of Psychiatrists.

The next step was to recruit a group of committed Green Beacon sites who agreed to start new walking groups together in Spring 2019, while gathering insights on the process from participants and staff. Ten adult inpatient wards on eight NHS sites took part, resulting in 83 new walks (out of a possible 100) over three months, and a wealth of first-hand knowledge to help with the writing of this Guide.

The learning from the Green Walking initiative is that introducing walking groups is entirely doable and brings benefits that are both simple (people feel better for having been on a walk) and complex (relationships can shift, the ward can feel calmer).

The initiative will continue to promote and support walking in green spaces in the care of people with severe mental illness, to aid their recovery and rehabilitation. If your organisation would like to partner with us on this journey, we would love to hear from you. Please get in touch!

Message from Dr Geraldine Strathdee

The COVID-19 pandemic has thrown into sharp relief the experience of sustained periods indoors and, in turn, highlighted the value of time spent in natural spaces. Moreover, it has made it clear that access to such spaces is not equitably distributed.

There is now a robust body of evidence which supports the physical and mental health benefits of being in green space. There is increased support for the importance of physical exercise and integrated mind-body care from national policy and regulatory bodies such as the Care Quality Commission, NHS England and NHS Improvement, and Public Health England.

There is a strong case for good examples of green walking being included in co-produced care plans, and consideration in good practice reviews by the national bodies, as they move to greater integration of mind and body care. It is also important to include Green Walking aims as part of the accreditation process developed by multi-disciplinary teams and agencies at the RCPsych College Centre for Quality Improvement (CCQI).

The walks clearly support the health of those for whom we are caring. The initiative can also help us to begin improving the deeply problematic application of the Mental Health Act (MHA), contributing to the ambition many of us have to improve rights-based, least-restrictive care in practice. 

With the goal of creating a more ethical MHA, integrating green walking is a fantastic first step. I would like to see it play a role in measuring how well a ward is able to provide care under the MHA. Green walks can support this effort by helping to inform the Section 17 leave policies which so often continue to have a focus on the forms, rather than the ethical and rehabilitation guiding principles set out in the Code of Practice. The Green Beacon pilot sites are impressive front runners in finding solutions to the practical implementation challenges.

The question is not if green walking should be adopted, but rather how we can work together to best support its integration as a standard of care in a manner that is both humane and safe?

Dr. Geraldine Strathdee C.B.E. O.B.E. Hon. FRCPsych
Co-founder, Zero Suicide Alliance & Non-executive Director, South London and Maudsley NHS Foundation Trust