Why set up a Green Walk
Green walks for mental health patients are nothing new. The value of time spent in natural spaces has long been recognised and championed particularly by occupational therapists. However, growing pressures on services have meant that wards are increasingly pushed to provide a minimum of care.
In their simplicity, walks in green space represent the effort to begin introducing more holistic ways of caring. Moreover, as we recognise the importance of green space in supporting wellbeing, it is apparent that those of us admitted to hospital should be afforded this as a basic right. Finally, in supporting the establishment of a new green walk, we allow ourselves to reflect on the sort of treatment we would want for ourselves, as much as those for whom we care.
‘Scientific evidence strongly supports the common-sense notion that good access to green and natural space supports health in multiple, synergistic ways. The Green Walking Guide highlights that access to the natural world is a vital element in our wellbeing, perhaps particularly when we are at our most vulnerable’ - Professor Catharine Ward Thompson, University of Edinburgh
- Green Walking Groups
- Patient and Carer Perspectives
- Benefits to Physical and Mental Health
- A Model of Sustainable Healthcare
Walking groups are an established intervention in inpatient mental health settings – but they are currently under-used. Walking outdoors should be viewed as part of routine care, here is why:
Firstly, hospitals have a responsibility to provide a therapeutic environment which promotes mental healing and recovery. This is even more important where people are detained against their will under the Mental Health Act. Patients appreciate walks and staff have reported that the whole ward can feel calmer after a group has returned from a walk.
Secondly, time spent in green spaces and physical activity can contribute directly to people’s mental wellbeing and recovery. For some, it provides a connection to a time before they became unwell; for others, this may be their first experience of connecting with nature, which may become a relationship that sustains them through their recovery.
Thirdly, green walking can contribute to improving physical health in people living with severe mental illness, whose life expectancy is currently 10-20 years shorter than the rest of the population. At some of the Green Beacon sites, walkers with previously poor mobility have been seen to grow in confidence and balance as well as fitness.
Finally, as an intervention that consumes few resources and yet supports both recovery from a current crisis and resilience to future crises, green walking is a shining example of sustainable healthcare.
‘We owe it to those whom we care for to adapt to the challenges placed on us to provide the highest standard of mental health care. Elegant in its simplicity, Green Walking is an important initiative which urges us to consider how we can safely provide the sort of care we would wish for ourselves.’ - Dr. Geraldine Strathdee, Co-founder, Zero Suicide Alliance & Non-executive Director, South London and Maudsley NHS Foundation Trust
Studies of people’s experiences of inpatient mental health services have identified the importance of high-quality relationships with staff, reducing violence and the need for restraint, and providing meaningful activity as part of holistic care. Green walking can contribute positively to all of these.
Walking together in nature offers a space for relationships with staff to develop. Both patients and staff at the Green Beacon sites found that walks were a good time to talk, with less of the healthcare professional-patient divide. In several cases, it was while on a walk that patients opened up for the first time.
Green walking, through strengthened relationships with staff, together with the calming effects of physical activity and time spent in natural spaces, can help people to feel supported, relieve anxiety and reduce the need for restraint.
In addition, whether simply walking, engaging in conversation, observing wildlife or sketching the view, green walking can be a meaningful activity, which connects people to their life before the crisis and, possibly, to an imagined future.
There are now many reviews and summaries that provide overviews of research on specific aspects of the relationship between physical and mental health:
- The robust evidence base showing that exercise in the natural environment has many therapeutic benefits, for both mental and physical health, is summarised in the Natural England briefing : Links between natural environment and mental health evidence briefing (July 2016).
- A review of nature-based interventions for mental health care (Feb 2016), also by Natural England, shows that taking part in nature-based activities helps people who are suffering from mental ill-health and can contribute to a reduction in levels of anxiety, stress and depression.
- A lot of the medical literature on the relationship between nature and wellbeing looks at psychological health in particular. Dan Bloomfield’s evidence report for NHS Forest, A Dose of Nature: Addressing chronic health conditions by using the environment (2014), is a useful resource.
‘Leisure has the potential to fulfil so many needs, particularly in acute mental health settings where boredom gives space and energy to introspection and isolation. Learning how to justify and use leisure to benefit those we support is the most important skill that healthcare providers can develop. This guide goes a long way towards doing that for Green Walking.’ - Dr. Tania Wiseman, Occupational Therapy Course Lead, University of Brighton
The current global ecological crisis threatens to irreversibly alter the conditions under which human civilisation has evolved. Within the decade, the whole world – including healthcare – must change to become sustainable. We now need to reshape health services to provide the best health outcomes for patients and populations from the wisest use of environmental, social and financial resources:
In mental healthcare, sustainable value may be achieved through:
- Prioritising prevention, thereby reducing the need for health care in the future.
- Empowering individuals and communities, improving mental health resilience through self-management and independent living, social networks and employment.
- Delivering the right intervention, at the right time, to the right person.
- Considering the carbon impacts of interventions and models of care to enable design of carbon efficient services.
In the right circumstances, Green Walking embodies all of these principles: contributing to prevention of future ill health, offering a means of self-management, improving resilience and enhancing the inpatient pathway, all at a minimal environmental cost.
Green Walking and the ‘triple bottom line’
Green Walking scores well across the ‘triple bottom line’ of environmental, social and financial resource use:
- Environmental: Green walking makes use of an abundant, low carbon, natural resource with potent therapeutic value: green spaces. By spending time in and noticing what is around us, we can actually benefit the environment by developing our connection with nature, learning to cherish and protect it.
- Social: Green walking strengthens social connections and restores social capital - including among staff, who not only benefit directly from the activity itself, but also take satisfaction from developing meaningful connections with patients and witnessing their steps to recovery.
- Financial: Finally, green walking is inexpensive, relying primarily on the time of existing salaried staff, with few additional costs. Meanwhile, it contributes to patients’ recovery and, potentially, their resilience to future (expensive) mental health crises.