All Party Parliamentary Group on Mental Health

Meeting on Ecotherapy

Tuesday 4th March

The Chair, Lynne Jones MP, welcomed the Members of the All-Party Group on Mental Health to the meeting on ecotherapy. She said that as a keen gardener and cyclist this is an area of particular interest to her.

She introduced the speakers:

Dr Marcus Roberts – Head of Policy at Mind.

Dr Roberts began by giving an outline of the policy context behind ecotherapy. He said that in a society where 1 in 4 people will suffer from mental health problems in a lifetime and 1 in 6 people suffer from anxiety or depressive illness at any one time, ecotherapy acts as an augmentation to existing therapies to deal with these problems.

This is particularly relevant given the fact that doctors are finding that they have to prescribe more drug treatments than they would like to.

He stressed the importance of choice in mental health services. It is not about certain treatments being better or worse than other alternatives, but about getting a wide programme of available treatments, of which ecotherapy has a role. This idea of choice ties in very much with Lord Darzi's review process, he said.

Dr Roberts described Ecotherapy as a therapeutic interaction with nature, which involved the following: 

• The importance of your own 'nature' such as the view from one's own window.
• Getting out and doing things in nature, for example, going for a walk.
• Interacting directly with nature through activities like gardening.

Dr Roberts then said that there is an emerging incomplete evidence base that shows that ecotherapy is an effective therapy. All side effects are benevolent, it improved physical health and helped to break down the barriers of stigma and discrimination.

Ecotherapy should be a mainstream in front-line health services and there should be a reconfiguration in the way that we think about primary care. This means that commissioners need to be aware of the cost-benefit analysis of the therapy. This will also involve getting ecotherapy mainstreamed in architecture and town-planning.

Concluding, Dr Roberts said that it is important for ecotherapy to be explored, as a cheap, accessible, natural addition to existing treatment options.

Rachel Hine. Centre for Environment and Society, University of Essex

Ms Hine spoke to the group about the research around green exercise and mental health

She discussed the evidence base for ecotherapy, the recent ecotherapy research, and the challenges for the green agenda.

She said that there is much anecdotal and qualitative evidence for the benefits of physical activity in the natural environment. Looking at the many different types of exercise amongst the ages, the results were conclusive: it improves your mental health.

Most of the evidence is in green exercise, but there is a need for hard evidence to really deal with the commissioners and, more generally, the sceptics.

She went on to say that actual green exercise was about people who had already decided to take part, but actually to take the idea further, they wanted to show that these therapies could be helpful for people who are depressed.

This led to the work that the Centre for Environment and Society carried out with Mind on their campaign Ecotherapy: The Green Agenda for Mental Health.

The survey compared exercise indoors with exercise outdoors, using standardasisd healthcare indicators and the results showed that 90% of people who took part in Mind green exercise activities said that the combination of nature and exercise is the most important in determining how they feel.

She concluded by saying that the evidence base is growing but there is a need for more evidence to engage healthcare professionals to see ecotherapy and other therapies as tools to use as part of a package. This is not an either/or situation, but a useful tool for healthcare professionals to use in treating people with mental health problems.

Ambra Burl, and David Scoffield, Kensington and Chelsea Mind

Ms Burl spoke to the group about what ecotherapy/green exercise means in practice.

She discussed her doctoral research project and her interest in ecotherapy and related work with horticultural and nature therapies.

She said that she wanted ecotherapy to be redefined as a part of mainstream health policy by creating a curriculum which develops the therapeutic work. There is also a much broader element of developing inter-connections and ensuring that people can engage with the areas they live in.

Mentioning the work that has taken place through Kensington and Chelsea Mind (discussed in more detail by David Scoffield) she said that the results had been imaginative and creative.

David Scoffield gave some more detail about the ecotherapy project, which is one of many that Mind run. He said that the site is part of a large community garden. The garden sits on land which was previously a brownfield site, owned by the Royal Borough of Kensington and Chelsea, and leased to a local community association. The training course can accommodate up to 15 people at a time, normally referred by the local community mental health teams. Trainees work towards a City and Guilds qualification in horticulture.

He said that people go in for this not necessary to have therapy, but to keep active. Then as people do this they benefit by being there, which adds layer upon layer to the therapeutic benefit.

This is why the project is about being supported to be active in the local community. People who take part in the project are not patients, but members of their local community.

Dr Ross Cameron, Deputy Director, Centre for Horticulture and Landscape, University of Reading

Dr Cameron discussed the importance of access to quality green space with a presentation that used a lot of photographs to emphasise his arguments.

He argued that a green environment has many positive benefits on mental well-being, pointing out that even the colour green could be seen to be beneficial. He then showed a slide of a prison and went on to say that data has shown that having an environment with more trees and open space has helped to reduce mental stress and lower crime.

Dr Cameron drew on the statement from Natural England than no-one should be more than 300 metres from green space and said that going green is a win-win situation: not only can it improve mental health, but it is useful in an environmental point of view. It is worrying therefore that Local Authorities are currently selling green spaces.

The quality of green spaces is important, he said, and it must be socially encouraging, taking in to account personal taste. There are huge benefits available if we can get it right.

Questions from the floor

The first person to speak from the floor told a story about her son who suffered from mental health problems and wanted to get involved with local ecotherapy projects but that the staff there were not helpful and welcoming.

Marcus Roberts agreed that sometimes it can be intimidating to get involved, but it is about ensuring that staff members are supportive. This is why the Kensington and Chelsea Mind project is so important because it is based around supporting people to get involved.

There was a discussion on the need for secure units to be in areas which are surrounded by green space. In particular, there are young and fit people who need to be able to exercise.

Lord Carlile pointed out that the Howard League report on children in custody showed that there were institutions which did not offer energetic children a green space. He wondered whether there was engagement between the Youth Justice Board and Ministers.

Marcus Roberts raised the fact that in old custodial environments there used to be prison farms and said that ideas like these tend to be the first to go. He stressed that in hospitals and secure environments access to green space was very important.

Lynne Jones then discussed the importance of ecotherapy being mainstreamed for health. In areas, such as work, it is seen as important, she said.

Marcus Roberts said that there were two barriers. Firstly, ecotherapy needs an evidence base or people like GPs will not recommend it. Secondly, there need to be ways to incentivise commissioners to commission ecotherapy services.

Adrian Delemore discussed his organisation’s London network who would be very interested in these schemes. He asked whether Mind had been in touch with the Greater London Ecology Unit? He said that the scientific evidence needs to be developed, as it is clear that the impetus is there

Jonathan Naess spoke about how frustrating it was for people on acute wards without green space. He questioned whether it should actually be called ecotherapy? If one is trying to encourage service users perhaps it should not be too focused on the medical nature, he wondered. Perhaps it should be called what it is, such as exercise? However, he said that it was important to make sure that robust evidence was available.

Marcus Roberts said that if it is to be taken seriously a label is necessary, particularly if it is to fit in to any of Lord Darzi’s thinking.

At the end of the meeting Simon Walters, from the Ramblers Association, said that it was important for people, even those who live in highly migrated areas, to take regular activity like walking. He said that people needed to walk more, even if just for 30 minutes.

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