environments that promote mental health and wellbeing

Environments that Promote

Mental Health & Wellbeing

Assoc. Prof. Mardie Townsend

School of Health & Social

Development

Mental health:

> “a state of complete physical, mental,

spiritual and social wellbeing in which

each person is able to realise one‟s

abilities, can cope with the normal

stresses of life, and make a unique

contribution to one‟s community” (The Melbourne

Charter, 2008)

Trends in mental health:

> 11% = current mental issue

2004/5, up from 6% in 1995 (ABS,

2006)

> Mental illness = 13% of total

disease burden and 30% of non-

fatal burden (AIHW 2006)

> In 2007, 45% of Australians

aged 16-85 had experienced

anxiety, mood and/or substance

abuse disorders (ABS 2009a)

Prevalence of mental and behavioural

problems 2004-5 (ABS, 2006)

Determinants of mental health:

“multiple and interacting social,

environmental, psychological and

biological factors” (The Melbourne Charter, 2008)

“protective and risk factors can be

biological, emotional, cognitive, cultural,

behavioural, interpersonal and

environmental” (The Melbourne Charter, 2008)

Flow-on effects of mental ill-health:

> Mental health problems are associated with

increased exposure to health risk factors →

increased risk of poor physical health.

> “Poor mental health, loss of wellbeing, and

illness have economic and social consequences

for societies, communities, families and

individuals” (The Melbourne Charter 2008)

Environment and wellbeing:Wellbeing depends on:

> the natural environment

> the human made

environment

> social arrangements

(families, social networks,

associations, institutions,

economies)

> human consciousness(Australian Bureau of Statistics, 2001 p.

6)

Wellbeing includes:

> satisfactory human relationships,

> meaningful occupation,

> opportunities for:

- contact with nature,

- creative expression, &

- making a positive contribution to human society (Furnass, 1996)

Environmental degradation & health:

> Humans are dependent physiologically on

nature (Boyden, 1992)

> WHO claims that > 25% of world‟s disease

burden is attributable to environmental factors(World Health Organisation, 2005)

> But this is just referring to the health effects of

environmental „degradation‟

Environmental deprivation:

> Humans are dependent psychologically on

nature – i.e. humans require contact with nature (Wilson, 1984; Kellert & Wilson, 1993)

> Explained by „biophilia hypothesis‟ (Wilson 1984)

> Supported by anecdotal evidence – popularity of

pets, flowers

> Supported by empirical evidence – no. of visits

to gardens; spending on gardens.

“Everybody needs beauty

as well as bread, places to

play in and pray in, where

Nature may heal and cheer

and give strength to body

and soul alike.”

John Muir (1838-1914)Founder of the Sierra Club

Environmental deprivation alleviated by:

Viewing nature

Being in nature

Contact with plants

Contact with animals

Evidence of environmental influence on

mental health & wellbeing:

> Lower stress levels among those who visited green areas more frequently (Nielsen & Hansen 2007)

> A Dutch study linking proximity to green space with morbidity data for >345,000 patients found strong relationship for anxiety disorder & depression (Maas et al. 2009)

> An Australian study found that people who perceive their neighbourhoods as green were 1.6 times more likely to experience better mental health (Sugiyama et al. 2008)

Attention restoration theory:

> Natural environments are „restorative‟:

> Shift individuals‟ thinking from effortful to effortless

> 4 aspects:

> Being away

> Fascination

> Extent

> Compatibility(Kaplan & Kaplan 1989; Kaplan 2001)

Therapeutic use of environments:

> Long history of therapeutic use of landscapes to

promote mental health

> Early Egyptian doctors advised disturbed

patients to walk in gardens (Nebbe 2006)

> Early 19th C. European hospitals involved

patients in „care farming‟ (Nebbe 2006)

> In 1870s, natural landscapes & activities in a

greenhouse were used to treat mental illnesses

in Pennsylvania (Louv 2008)

Therapeutic use of environments (ctd.):

> In Norway, forest-based activities have been

used have been used with people on long-term

leave for stress (Nordh et al. 2009)

> A combination of physical activity, social

connection and the natural environment has

been used to manage depression, esp. in young

people (Pryor 2009)

> Horticultural therapy in a range of settings has

been shown to have significant benefits for

physical, psychological & social wellbeing (Gigliotti &

Jarrott 2005)

Therapeutic gardening:

> Increasingly, gardening is

being used

therapeutically

> In a range of contexts,

incl.:

> Acute care

> Rehabilitation

> Disability services

> Aged care

> Prisons

„Feel blue, touch green‟ (FBTG):

> In collaboration with Parks Victoria, Barwon

Health, Alcoa & Surf Coast Shire (with funding

brokered by People & Parks Foundation)

> Nature-based intervention of people suffering

anxiety & depression

> Attempting to build a sustainable connection with

environment

> Evaluation of health & wellbeing benefits

„Feel Blue, Touch Green‟ (FBTG) ctd.:

> Pilot study - 10 participants with mental health problems:

> Based on „single-case design‟ (participants = own controls)

> 10+ hours of a range of nature-based activities over 6-12 weeks

> Activities (incl. weeding, planting, plant propagation, plant identification, wildlife watching) supported by Angair volunteers

> Evaluation using a range of scales plus in-depth interviews

(Townsend & Ebden, 2006)

Findings from FBTG:> SF36, ADL, K-10 & MRC

scales → no conclusive

evidence of ↑ in health

> May be due to short duration

(6-12 weeks)

but

> Emotional State Scale (ESS) indicated ↑ positive emotional

change in all participants

Findings from FBTG (ctd.):> Participants:

> Experienced improvement in

emotional, mental & physical

health

> Developed

> Skills

> Pro-environmental attitudes &

actions

> Connections with others

> Connections with their

ecological context

Findings from FBTG (ctd.):

> In-depth interviews identified benefits for:

> Developing skills, taking risks & confronting challenges

> Mental health, confidence & self-worth

> Stress & anxiety management

> Managing depression & depressed mood

> Improving physical health

> Building social connections/social capital

> Building natural capital

Developing skills, taking risks and

confronting challenges:

“I developed new skills and acquired knowledge

in [plant] propagation and in [identifying] noxious

weeds”

“I have been able to participate even when I‟m

not well”

Improving mental health, confidence and

self-worth:

“by taking part in „Feel Blue, Touch Green‟ I have

experienced happiness that I otherwise would

have missed out on.”

“I developed confidence in [this] supportive

environment …They [project partners] offered

gentle encouragement and were supportive”

Positive cognitive changes - stress and

anxiety management:

“you don‟t get criticised in the bush. Self criticism,

negative criticism does not occur in the outdoors”

“it takes the tension and focus away from

myself…[and I] forget reality…”

“In the bush there are not a lot of intrusive noises

… the natural sounds are pleasant while …

mechanical sounds are irritating”

Managing depression and depressed

mood:

“Being involved in Feel Blue, Touch Green helps

[me] manage depression”

“[I] demonstrated that I could do it today [weeding]

even though I had doubts that I can do it”

Improving physical health:

“The physical exertion leads to feeling calm”

“I feel the whole body is one, using all my muscles

(when bush walking)”

Building social connections:

> “This [FBTG] is good for people who may not

have the courage to get involved … People

were accepting and this broke down the

stigma.”

> “It‟s been good to be with each other.”

The take home message:

> A significant relationship between mental health

& greenness

> Neighbourhood greenness associated more with

mental health than physical health

> Mental ill-health is on the rise

> Need to promote good mental health by

ensuring access to green spaces, gardens &

pets

“Thousands of tired, nerve-shaken over-civilized

people are beginning to find out that going to the

mountains is going home; that wildness is necessity;

that mountain parks and reservations are useful not

only as fountains of timber and irrigating rivers, but as

fountains of life.”John Muir (1875)