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 ones abilities, can cope with the normal stresses of life, and make a unique contribution to ones 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 nonfatal 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 worlds 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

Contact with plants

Being in nature

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 Im 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 dont 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.
> Its 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)