How to set up a walk
Green walks are not about the distance or number of steps taken, but about the simple process of moving together in natural spaces, whether these be local city parks, small woodlands, the seaside or the countryside. Success is founded upon a cooperative and inclusive approach.
The costs associated with the walks are mainly staff time. There may be small additional costs for transport or equipment, such as a camera or art supplies.
It is not complicated – in fact, the power of green walks is their simplicity – but there are some things to think about, which we will address in this section.
- Establish a new walking group
- Prepare for a walk
- Integrate into care
- Register your walk/share with others
“The Green Walking project has benefited lots of patients and had a positive impact on the service. People are talking about getting service users involved in the group and we have always had service users attending the walks.”
Clinical walk leader, York (Tees, Esk and Wear)
Common pressures, including staff shortages and waiting lists for beds, make it a challenge to maintain holistic care on acute psychiatric wards. So, you might not feel completely supported in starting a new walking group. However, this can be helped by representing the green walk as a necessary and valuable part of care. Importantly, it should be discussed at various levels of the Trust and across professions. Make sure people know you’re starting it and that it matters!
The absolutely critical first step to starting a new walking group is a discussion of the proposal involving the entire multidisciplinary team, including nursing and medical colleagues. It must be made clear that this is everyone’s walk. Once the decision has been made collectively, the ward should seek to inform the higher levels of Trust management such as the lead Allied Health Professional and Medical Director (you can find an example letter for this here). Responsibility for organising the walk should be with a particular member of staff but should be felt to be shared by the entire ward. Encouraging staff to join in the walk has a lasting and transformational impact on the group.
Having said all of the above, if you are unable to gain the widespread support of colleagues at first, it is still worth going ahead and getting your walk started. Experience from Green Beacon sites shows that over time and with sustained communication, the group can become accepted and valued as a central part of the ward routine.
Wards can also support one another by presenting the walks at Trust functions to promote the start of other walking groups.
Although no intervention can replace adequate overall resources, the minimal demands of a weekly walking group provide a platform to begin the effort of creating a more holistically mindful ward that strives to embody the expectations of patients and the standards recognised by the Accreditation for Inpatient Mental Health Services (AIMS) and the Care Quality Commission (CQC).
To get others on board with the group, it is worth thinking about these things before you approach someone:
The key points you want to communicate
- why you want to set up the walk
- how you will do this
- where it has been done before
- who already supports this
Also bear in mind
- who you are talking to
- what they are interested in/worried about
- how you can address those interests or concerns
Remember: Engage the emotions. Tell a story, if you have one, about a patient who would really benefit from green walking and how staff would also enjoy it. Let your passion and enthusiasm shine through. Evidence shows that presenting in this way is one of the most powerful ways of influencing others.
If you are nervous, consider practising ‘speaking out’ your key points and stories with enthusiasm, either to yourself in front of a mirror or to a trusted colleague and asking for feedback.
If you meet apprehension or resistance at any step remember to consider the big question: “This has already been successfully implemented in several places. What does it reflect about our offer of care if we do not have the resources or will to offer a walking group?”
Generally, each walk should have a minimum of two staff present. This is to help liaise with the ward in the unlikely event that an emergency, such as injury, were to happen. These groups can be led by any type of healthcare professional, including doctors of all grades, occupational therapists, nurses and activity coordinators. There is also the possibility of involving volunteers or staff from third sector organisations.
Staff may like to have additional training to enhance walks, for example in walk leadership, forest therapy, photography, bird-watching and tree recognition. And of course, staff should be encouraged to incorporate their own interests and knowledge into walks.
Serious incidents are rare. The maintenance of a safe walking group begins with proper planning and communication. Responsible staff should be clear of the route and communicate this ahead of time both to prospective walkers and to staff members remaining on the ward.
The planning process involves a discussion between the clinical staff and the walking team during regular meetings to ensure that the needs of patients hoping to join the walk are considered, for example, the need for 1:1 care, mobility issues, or sensitivity to different environments. These discussions have the additional benefit of helping to establish wider acceptance of the walk within the ward as well as fostering dialogue between staff.
During the Covid-19 pandemic, measures to reduce the spread of the virus may require walks to be adapted. There may need to be fewer walkers per group to meet physical distancing requirements, for instance. An assessment will also be needed as to whether patients are able to comply with relevant guidance before accompanying them to public spaces; where this is in doubt, a walk within hospital grounds or other secluded areas may still be possible.
Ideally, time should be taken to discuss the walk in advance with those who have agreed to attend. This is an opportunity to discuss people’s experience, expectations and how the group will respond if some find it difficult.
Few resources are needed beyond regular staff time and some spare outdoor clothing (which can often be donated). It may be helpful to have a small fund to spend on refreshments or transport; some teams have also invested in equipment such as a digital camera or art supplies, but this is by no means essential.
Aim to make the group accessible to as broad a range of people as possible, facilitating attendance by understanding and meeting individual needs. This relies upon support and recognition of the value of Green Walking from the whole team. People who appear the most agitated on the ward may be those who stand to gain the most from a change to a calmer and less restrictive environment.
‘The walk today had a positive impact, facilitating two of the highest risk patients to get outdoors’ - Nurse at Green Beacon site, Cornwall
Allow plenty of time to arrange leave for patients, as it can be extremely discouraging for them if their participation is cancelled for administrative reasons. Keep communicating with colleagues so that they understand the role of walks in patient wellbeing and recovery. This will help them to factor it into decisions and, where leave is granted, to make sure that necessary paperwork is in place.
The more that a walking group is seen as part of the ward’s culture of care, the more comfortable people are to participate. This begins by presenting the walk as a central activity in any introduction to the ward.
Raising awareness of the walk - through posters, route maps and photos - is also helpful in creating a buzz. Casual conversations between the staff and those cared for can include gentle reminders about the walks which can be further discussed in weekly ward rounds.
Apprehension about joining a walk should not always be interpreted as disinterest. People who initially declined to join can find themselves interested the following week.
A considered discussion from an interested staff member can help someone join the group and have a positive experience of the outdoors they would otherwise not have anticipated. In such instances, bear in mind that people may have little previous relationship with natural spaces or may have had a negative one. Others will be worried about being unable to keep up or might have experiences of stigma. Green walks can become an opportunity to help someone discover the outdoors in a positive way. On occasion, a one- to-one walk may be the best way to help someone enjoy a natural space.
Walkers should be invited to shape the experience by discussing the destination or length of a walk, or a particular focus, such as photography or collecting flowers.
‘When we walked down to Tong Park Dam we saw the swans had laid eggs and everyone was so excited about this’ - Patient at Green Beacon site
Within a group there will be varying levels of comfort and experience which may guide the choice of walk.
Changing the destination from week to week can help keep people’s interest. At the same time, people find that becoming familiar with a route or space is special in its own way. A trip away, perhaps with arranged transport, can be even more exciting when planned for. People often find that walks can lead to enriching their relationship with a locality they have known for years.
Weather has a big impact on the nature of a walk. Increasingly extreme weather in the forms of rain and heat mean it is important to have the right clothing, food and water. Use common sense when deciding on whether to go on a walk, but bear in mind that a day out in ‘interesting weather’ that is organised and prepared for can be a rich and wonderful experience.
Just walking together while enjoying the surroundings is the essence of Green Walking. However, depending on the interests of the people involved, there are many ways to bring new elements into walks:
- Food and drink – either bring a picnic or choose a destination café (who doesn’t love a snack?!)
- Photography – and display photos to promote the group on the ward
- Wildlife study
- Forest crafts
- Exploring different areas – walk through parks in your local town, or make field trips to local places of interest.
- Patient leadership – invite current or former inpatients to help guide or decide the route
If you have sufficient staff time and access to transport you may wish to vary your walk by travelling to green spaces further afield. Some wards may have access to a car or even a minibus, but other groups have successfully used public transport and some patients prefer this as they feel more normal. Such longer trips could be done less frequently, such as once per month.
A few sets of wellies, coats and/or sun hats will make the activity accessible to a wider range of participants. Do not assume someone has the clothing needed. Lack of rain gear and clothing should never be a barrier. Carers may be able to bring in patients’ own coats and footwear. Seeking donations is an easy way to get some spares.
Be mindful of appearances: it is worth having a selection of different donated coats (in different sizes) to avoid looking like an obviously institutional outing. And avoid high-vis vests!
‘I have seen service-users open up more, relax and engage more with me simply by being out of the ward environment and in a “normal” setting. This allows for more deep and meaningful discussions and promotes an environment that is more social and relaxed. The whole experience normalises things for them, changes their level of engagement with you as a staff member and fosters greater trust and rapport’ - Clinical walk leader, South London and Maudsley
Walks will be most meaningful when integrated into a patient’s care plan, becoming a valuable part of their recovery. This should be done by including walks in shared care plans and discussing someone’s experience during clinical reviews. It is important that walks are supported by the entire ward to occur on time and regularly.
In the days before a walk, a range of staff (medical, nursing and allied) should explore with someone if it is the right time to join, leaving space for change depending on how they are feeling.
Many people reflect on how much they have enjoyed a walk, sometimes even for the first time. Arranging for someone to engage in walks close to their home through a local group or community team is an excellent way to maintain elements of care started on the ward once people leave. Some people have returned to join walks with their former inpatient walking group following discharge.
For those who are receiving care under the Mental Health Act, joining a walk can be an important step in their care as it involves moving with a group away from the hospital site. A walk enjoyed can then be used in considering the need for further detention. It is also imperative for those who are detained that appropriate leave is arranged in advance.
It is not acceptable for someone to miss a walk because of inefficiencies in arranging Section 17 leave. Such experiences degrade an individual’s sense of agency as well as undermine their rapport with the clinical team. They should be treated seriously, documented and reflected upon. A clear explanation should be given to whomever was affected by the mistake.
Responsibility of having leave arranged in a timely, organised fashion is not primarily within the hands of the walk coordinators. In fact, it is shared across the ward and represents a key reason why the walks and their integrity are co-created by the entire MDT.
Your walk will have great triumphs and may meet some difficult hurdles. Do share both the good and the bad with others. Those in your organisation, your communities and others trying similar walking groups further afield will all want to learn from your experiences.
Spread the news to other wards
- Contact your Quality Improvement department
- Register your walk here
- Join our clinical networks including Psych Susnet or Occupational Therapy Susnet
- Connect with the Green Walking Twitter page
- Consider presenting to a regional meeting