The increasing incidence of mental health problems are daily reported in the news. The distressing effects span every age group, from children under stress at school, to mental health stigma in the workplace, to older people suffering loneliness and isolation as the places they used to go to for human contact are disappearing.
Natural England’s recent review of nature-based interventions for mental health care could not have come at a more appropriate time. Statistics have shown a staggering 1 in 4 people experience problems with their mental health each year, three quarters of whom will receive no medical help. On the back of an independent Mental Health Taskforce Report, which gave further shocking figures regarding mental health, the Government commits (with an arguably belated response), to a “mental health revolution,” to reconcile funding and considerations with the reality of the situation.
According to Natural England, 93 percent of GPs have prescribed antidepressants against NICE guidelines due to a ‘lack of alternatives’. ‘Green Care’ or nature based interventions are, however, a highly effective alternative for preventing the onset mental health issues. MIND has also published its green agenda for mental health, which draws on solid evidence in support of accessible, cost effective and natural additions to existing treatment options, to show that Green Care can assist with full scale recovery, as well as a prevention measure. The provision of multiple Green Care options for patients with diagnosed mental health issues have resulted in a more extensive, holistic and sustained rehabilitation than typical treatments based on antidepressant and Cognitive Behavioural Therapy (CBT) alone.
The Landmark Practice’s conceptual illustrative masterplan and green roof section for a Residential Care Home planting scheme. The design’s primary aim is to provide a safe urban oasis for residents.
What is preventing implementation and wider use?
The need for a holistic approach to health was highlighted ten years ago by the Disability Rights Commission Equal Treatment: Closing the Gap 2006, which looked at the wider determinants of mental and physical illnesses, and revealed general complacency in the way in which mental health problems and other health issues are addressed for vulnerable groups. People most at risk of mental health issues are those also exposed to an overall equalities gap. A decade later, the Mental Health Taskforce Report again highlights quality of housing, debt and poverty, employment and education, along with lack of access to green space, as major determinants of mental health issues.
Natural England’s review explains that many Green Care providers work with participants who are both ‘ill’ and ‘well’ simultaneously. Considering that those most affected by an overall equalities gap are already marginalised, this simultaneous involvement is a big part of the rehabilitation process. Owing to the natural and social connections it fosters, sensory stimulation, physical activity and the escape from modern life, Green Care is a cost effective catalyst for good mental health which is more likely to be sustained.
There is some good news on this front. The majority of Clinical Commissioning Groups (CCGs) and GPs are interested in learning more about Green Care options, and GPs can now prescribe ‘Green Gym’ sessions as a treatment option for mental health as well as to improve physical activity levels and tackle obesity. Even so, referrals from CCGs or GPs to Green Care options are currently in the minority, and more needs to be done to promote Green Care as a clinically valid treatment option for patient’s recovery.
There is ample evidence that economic stability and growth in cities, along with social security, are directly linked with the amount of green space available. Urban green space is, however, under threat from development pressure and massively reduced council maintenance budgets. On top of this, interpretation of policy regarding green space provision for new residential areas varies dramatically from authority to authority. This cumulative loss of shared and accessible green and wild places, often imperceivable, is detrimental to both physical and mental health, as well as the health of neighbourhoods and communities.
All studies referenced here give a positive insight to the importance of encouraging healthy, active and sociable lives as a means of tackling the growing crisis of obesity, poor health, loneliness and isolation. Placing the revival and maintenance of quality public places with ready access to nature at the heart urban planning seems a logical and obvious step to help tackle the substantial personal, economic and social costs of health care.
Landmark regularly comments on the multitude of ways in which accessible green spaces can support health and wellbeing, as well as providing economic, social and environmental benefits to communities and individuals (Branching Out – The Future for Street Trees, Putting a Price on Ecosystem Services). Today, a lack of joined up thinking represents one of the most crippling hidden costs of austerity politics. It is possible to create healthy places that are also economically, socially and environmentally successful, but it needs all of us, at all levels of government, development and community sectors, to raise our sights above the politics of austerity.
 Green Care’ or ‘nature based interventions’ are umbrella terms for a variety of methods and activities used to produce health, social or educational benefits in green spaces, for a variety of people, particularly those in vulnerable situations.