new green agenda for mental health. With a mass of new and growing evidence, Mind calls for ecotherapy to be recognised as a clinically-valid frontline treatment for mental health problems. As 93 per cent of GPs have prescribed drugs due to a lack of alternatives (2) and access to Cognitive Behavioural Therapy takes up to four years in some areas of the UK (3), it is vital that ecotherapy is considered by GPs alongside these as a treatment option.
Ecotherapy involves getting outdoors and getting active in a green environment as a way of boosting mental wellbeing. Whether it's taking regular walks in the park, flying a kite or participating in a gardening therapy project, green exercise is proven to have huge benefits for mental health. The prescription of care farms as a treatment for mental distress has been highly successful on the continent but the UK is lagging far behind Europe - there are only 43 care farms in the UK, none of which are directed at mental health, compared to 600 in the Netherlands and 400 in Norway.
Ecotherapy versus retail therapy
Mind's new report Ecotherapy: the green agenda for mental health presents the findings of the first ever study looking at how green exercise specifically affects people with mental health problems. A walk in a country park was compared with a walk in an indoor shopping centre (4). The results are startling:
* 71 per cent reported decreased levels of depression after the green walk
* 22 per cent felt their depression increased after walking through an indoor shopping centre and only 45 per cent experienced a decrease in depression
* 71 per cent said they felt less tense after the green walk
* 50 per cent said their feelings of tension had increased after the shopping centre walk
* 90 per cent had increased self-esteem after the country walk
* 44 per cent said their self-esteem decreased after window shopping in the shopping centre.
Green activities boost mental health
Mind's second research study (5) showed the views of people who regularly partake in green activities run by Mind's network of local Mind associations:
* 90 per cent said it was the combination of nature and exercise that had the greatest effect on them
* 94 per cent said that green activities had benefited their mental health, lifting depression.
Britain is trailing far behind other European countries in introducing care farms as a treatment for mental distress. Patients suffering from mental distress in the Netherlands, Italy, Germany, Austria, Belgium and Slovenia are prescribed agriculture work where they acquire new skills and gain increased confidence while farmers get paid for providing a health service and benefit from additional labour power.
Holland has 600 care farms that are a fully integrated part of the health service but in the UK care farming is still a relatively new concept. The National Care Farming Initiative estimates that there are 43 care farms in the UK but none aimed at mental health, the majority self-funded and there is no national framework. The expansion of UK care farms could aid thousands of people with mental health problems. It could also help rural regeneration and break down the stigma and isolation surrounding mental health problems in rural communities.
Antidepressant prescriptions soar
Antidepressant prescriptions are at an all-time high with over 31 million prescriptions written in 2006, up 6 per cent on the number of prescriptions written by GPs last year.
Within this figure, there has been a 10 per cent hike in primary care prescribing of SSRIs (Serotonin Specific Reuptake Inhibitors) which include drugs such as Prozac, from 14,746,100 in 2005 to 16,227,100 in 2006 (6). Unlike drugs, ecotherapy is low-cost, has no negative side effects and is available on most people's doorsteps.
Green space at prisons and hospitals
There is often little or no access to green space in many prisons, despite evidence that even a view of trees can improve prisoners' health and behaviour. A study of prisoners in Michigan found that those who had cells overlooking farmland and trees had 24 per cent fewer sick visits than those in cells facing the prison yard (7).
Similarly, a 10-year comparative study of post-operative patients in Pennsylvania showed that hospital stays for patients with tree views was significantly shorter, they required fewer painkillers, used less medication, and nursing staff reported fewer negative evaluation comments in the medical records.
In a recent Mind survey, 33 per cent of psychiatric inpatients said they did not have access to an adequate garden or green exercise. In one worrying case, the inpatient said that trips to the garden were often withheld as a punishment (8).
Mind is calling for access to green space and exercise to be a core issue for the Healthcare Commission, Commission for Social Care Inspection and the Prisons Inspectorate.
Today, Mind's Chief Executive Paul Farmer said: "Mind sees ecotherapy as an important part of the future for mental health. It's a credible, clinically-valid treatment option and needs to be prescribed by GPs, especially when for many people access to treatments other than antidepressants is extremely limited. We're not saying that ecotherapy can replace drugs but that the debate needs to be broadened."
"Hundreds of people have benefited from the green projects run by our local Mind associations but if prescribing ecotherapy was part of mainstream practice it could potentially help the millions of people across the country who are affected by mental distress."
Mind's recommendations include:
* Ecotherapy should be recognised as a clinically-valid treatment for mental distress.
* GPs should consider prescribing green exercise as a treatment option for every patient experiencing mental distress.
* People on care plans should be supported in accessing green space.
* Referral to care farms should be incorporated into health and social care referral systems.
* Allocation of health and social care budgets should be informed by cost-benefit analysis of ecotherapies.
* All health, social care and criminal justice institutions should be required to offer access to green space.
* Architects and town and country planners should design with mental wellbeing in mind.
* The benefits of green exercise should be promoted by public health campaigns.