Green-care-using-nature-for-health-Sempik's.pp.doc.ppt

Green Care: using nature for health

Carlisle 17 December 2010

Some history…..

St Dymphna

Patron Saint of those who suffer from mental illnesses and nervous system disorders, epileptics, mental health professionals, incest victims, and runaways.

Feast Day 15th May

Geel, Belgium: the first example of using land-based activities as care in the community for people with mental health problems and learning difficulties(from the 13th Century to the present day)

“We find that the patients derive more benefit from employment in the garden than anywhere else, and this is natural, because they have the advantage of fresh air as well as occupation'‘ (Nottingham Borough Asylum, 1881, page 11, quoted by Parr, 2007, p. 542)

“The healthy mental action which we try to evoke in a somewhat artificial manner, by furnishing the walls of the rooms in which the patients live, with artistic decoration, is naturally supplied by the farm. “

Report of the Commissioners of the Scotch Board of Lunacy (1881 )

History…the UK asylum farms

The 1950s and 1960s

After creation of NHS in 1948 hospital boards were asked to consider “whether farming activities could be limited”…because…

The 1950s and 1960s

After creation of NHS in 1948, UK hospital boards were asked to consider “whether farming activities could be limited” because…

190 hospital farms 16,187 Hectares of farm (40,000 acres) 1,537 Hectares of market gardens (3,800 acres) 7,000 cows, 25,000 pigs, 5,000 sheep, 63,000

hens….

(James Dance, MP for Bromsgrove speaking in Parliament in 1959)

“I think that the value of farms is undoubtedly apparent to the layman. It is obviously a good thing that people who suffer from mental sickness should have the peace and comparative quietness of working on the land, and the hard manual work involved is also beneficial…”

(James Dance, MP for Bromsgrove speaking in Parliament in 1959)

“I have said that that is the layman’s point of view, but I am supported by the doctors…I have visited that hospital. I have seen the people in it and have spoken to the doctors. Not only do they say a farm is of great value, but they also stress that it is essential for the cure of certain of their patients”

The 1950s and 1960s

Discovery of new drugs for treatment of mental ill health e.g. chlorpromazine (1954)

Closure of hospital farms in the UK But continued use of farms in Europe Development of occupational therapy (OT)

and use of horticulture in OT

The 1970s and 1980s

Use of nature in a wide variety of ways to promote health

Therapeutic horticulture, American Horticultural Therapy Association

founded in 1973 Thrive founded as the Society for Horticultural

Therapy in the UK in 1978 Many other national organisations

Other interventions - animal assisted therapy, wilderness therapy etc

2000…

Consolidation of ideas regarding different approaches using nature

Rise of ‘care farming’ Creation of the concept of ‘Green Care’ Creation of practitioner and research

networks (Community of Practice, COST 866 ‘Green Care in Agriculture’)

Experiences within nature ‘casual’ experience of landscape

– city greening


– city greening ‘passive’ use of landscape as

therapy



therapy physical activity within nature –

‘green exercise’



therapy physical activity within nature –

‘green exercise’ activity that ‘uses components of

nature’ e.g. care farming, therapeutic horticulture

A spectrum of approaches Care farming Therapeutic Horticulture Animal assisted therapy Horticultural therapy Ecotherapy Wilderness therapy Nature therapy Occupational therapy using plants Sheltered employment in agriculture Green exercise Nature conservation Employment in a natural environment Urban greening Living in a green environment

A journey through green care!

Mapping the influence of nature – nature as care and therapy

looking at nature being active in nature shaping nature interacting with animals

nature therapy, wilderness therapy

animal-assisted activities

care

farm

ing

social&therapeutic horticulture

horticultural therapy

healing gardens/ environments/

landscapesgreen exercise

animal-assisted therapy

animal-assisted interventions

healthpromotion

therapy

work rehabilitation/ sheltered green employment

+

green exercise(as treatment)

ecotherapy

usual work/ working place in natural environment

++

experiencing natural environment interacting with natural elements

Level of Productivity Ownership & Democracy Economics/turnover Degree of Mechanisation Animals (pets or production?)

From garden to farm…

Green Care Provides

Activities and approaches for people with a wide range of difficulties: Mental health problems Learning difficulties Social problems Physical disabilities Drug and alcohol problems Disaffected youth

Green Care Provides

Engagement and connectedness with nature

Nurture of animals and plants Structure and routine Productivity - but without the

pressure of employment Opportunities for training and

possible employment

Green Care Provides

Physical activity Social inclusion through…

Production Consumption Social interaction Political engagement

Extensive social support

Green Care Provides

No formal psychotherapy (generally) Arts and crafts (sometimes) Democratic involvement (sometimes) Engagement with the ‘Green

Agenda’? (sometimes) A spiritual dimension?

Effectiveness of Green Care

What is ‘effectiveness’? Individual goals Improvement of general…

Well-being… Self-esteem… Coping ability… Self-efficacy

Developing a theory and framework

Applying frameworks to themes

Social inclusion production, consumption, social interaction,

political engagement Employment

‘latent’ benefits of employment, social contact, purpose, structure, status, identity

Psychological theories Attention restoration theory & recovery from stress

Combining different explanatory frameworks…

Social Inclusion:

productionconsumptionsocial interactionpolitical engagement

Employment:

meaningful goalsidentitystatus, competenceroutinesocial interaction

Social Inclusion:


Employment:

meaningful goalsidentitystatus, competence routinesocial interaction

Social Inclusion:


Employment:


Environment:

SocialPhysical

Social Inclusion:


Employment:


Environment:

SocialPhysical

Natural environment:

Attention restorationRecovery from stressAesthetic and spiritual fulfilment

Social Inclusion:


Employment:


Environment:

SocialPhysical



MOHO:

Volition (personal causation, values, interests)Habituation (habits, roles)Performance Capacity (objective, subjective)

Social Inclusion:


Employment:


Environment:

SocialPhysical



MOHO:


Social Inclusion:


Employment:


Environment:

SocialPhysical



MOHO:


Social Inclusion:


Employment:


Environment:

SocialPhysical



MOHO:


Environmental psychology, views of nature and attention restoratione.g. Roger Ulrich and Stephen and Rachel Kaplan

Exercise and physical healthmany studies show link of physical health with physical activity

Exercise and mental health e.g. Dunn et al (2005)

Evidence from other fields

Aerobic exercise at a dose consistent with public health recommendations is an effective treatment for MDD of mild to moderate severity. A lower dose is comparable to placebo effect.

American Journal of Preventive Medicine, 2005;28(1):1–8)


Physical activity and Alzheimer’s Disease

At least three major studies suggest that increased physical activity or exercise are associated with reduced incidence or delayed onset of Alzheimer’s Disease.


Ann Intern Med. 2006;144:73-81.

1,740 older people followed up for 6 years

At least 15 minutes of exercise taken 3 times per week reduced risk of dementia


Physical activity and dementia

Implications for policy and practice Recognition of therapeutic horticulture as a

form of health and social care – i.e. policy ‘Greening’ medical, psychiatric & social care Guidelines for referrals Addressing under-representation Addressing finance Professional status for practitioners Further research – more interest

Development of research in Green Care

Links with other research fields European initiative in ‘Green Care’ (COST

866) includes STH, ‘Care Farming’, ‘Animal-assisted Therapy’ and others

Therapeutic Communities – similar difficulties with research approaches; similarities between ‘interventions

More researchers interested in the field of STH e.g. university researchers, psychiatrists, OTs

Challenges

There is little ‘hard’ (i.e. experimental, quantitative) evidence of effectiveness

Policy makers and ‘mainstream’ health professionals can be sceptical of qualitative data alone

Debate as to whether experimental methodology e.g. RCT can and should be applied to therapeutic horticulture and other nature-based approaches

Opportunities

Natural links and overlaps with other therapeutic approaches and networks, for example, Therapeutic Communities, Care Farming and Green Care movement

Common themes in research ‘Respectable’ area for academic research Professionalisation of Therapeutic Horticulture

English Tree by Anne Williams

Conclusion: green care is a mosaic of processes and effects…

…that addresses a mosaic of needs…

Joe Sempik

Centre for Child and Family Research

Loughborough University

Leicestershire LE11 3TU

+44 1509 223671

[email protected]

Green-care-using-nature-for-health-Sempik's.pp.doc.ppt

Health & Medicine

influence of nature

s use of nature

nature green exercise

components of nature

natureshaping nature

green employment

green environment

therapy physical activity