Health and Horticulture Conference Session 3

Session 3: Designed horticultural activities for health & wellbeing

1135 Gavin Atkins (Mind)Horticultural Activities Improving Health & Wellbeing – Mental Health Overview

1145 Kathryn Rossiter (Thrive)Social & Therapeutic Horticulture

1155 Dr Margi Lennartsson (Garden Organic)Growing Health

1205 Questions for Session 3

Horticultural Activities Improving Health and

Wellbeing – Mental HealthGavin Atkins, MindHead of Community Programmes and

Grants

An intervention that improves mental and physical health and wellbeing by supporting people to be active outdoors; doing gardening, food growing or environmental work

Mind, Ecominds: Feel Better Inside, Feel Better Outside

Opportunity?• A million prescriptions for anti-

depressants issued per week and waiting times in psychological talking therapies

• 50 per cent of people wait over three months for talking therapy

Opportunities

Health professionals are interested!• Poll of GPs found that just over 50%

considered ecotherapy suitable for treating anxiety and depression

• 46% interested in prevention and early intervention for people at risk of developing a mental health problem

• 36% would refer to ecotherapy if it was available in their area

Mind, 2013

Challenges

Wellbeing Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) Short version of the Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS) Personal Well-being Index (PWI) Personal Wellbeing Index China version (PWI-C)

Generic health or efficacy SF-36v2 Adapted SF12 Short Form 36 Health Survey (SF-36) General Self Efficacy Scale(GSE) IPAQ-S (physical health – activity)

Depression Beck Depression Inventory (BDI) Attentional Function Index (AFI) The Brooding Scale- subscale of revised Ruminative Response Scale Perceived Restorativeness Scale Zung Depression Inventory (ZDI) Depression, Anxiety and Stress Scale (DASS21)

Anxiety The State-Trait Anxiety Inventory–State Subscale (STAI-SS) Beck anxiety inventory (BAI), Hospital and Anxiety Scale HAD) Speilberger state anxiety inventory (STAI-SS)

Stress Salivary cortisol levels Perceived Stress Scale (PSS) mental stress scale (MSS), physical stress scale (PSS)

Self- esteem or mood Profile of Mood States (POMS) – state Positive and Negative Affect Schedule (PANAS) Dutch version Rosenberg Self Esteem Scale (RSES) – state and trait

Dementia - various Mini Mental State Examination (MMSE), Bradford Well-Being Profile, Large Allen Cognitive Level Screen (LACLS) Pool Activity Level (PAL) Agitation assessed with Chinese version of the Cohen-Mansfield Agitation Inventory (C-

CMAI) modified version- Apparent Affect Rating Scale (AARS) Menorah Park Engagement Scale (MPES) Barthel Index (BI) Interview for Deterioration in Daily living in Dementia (IDDD)

Other or specialist mental health Emotional State Scale (ESS) questionnaire adapted from the Osgood Semantic

Differential Scale Two items from Connor Davidson resilience scale Mental Health Inventory Impact of Events Scale (IES-R)

Meaning or Quality of life The Life Regard Index –revised (LRI-R) The Quality of life - Life Experiences Checklist (LEC) Quality of life – WHOQuoL Satisfaction with life – (GGZ)

Recovery Six standardised questions from the Elements of a Recovery Facilitating System

(ERFS) measure Recovery Star

Other Work Behavioural Assessment (WBA) Work Environment Impact Scale (WEIS) Work and Social Adjustment Scale (WSAS Volitional Questionnaire (VQ) Personal Outcomes Record Vineland Adaptive Behaviour Scale

Social Questions on social inclusion Social provisions scale The Therapeutic Factors Inventory Cohesiveness Scale (TFI-CS) adapted version of Buckner’s (1988) Community Cohesion Scale

QualitativeInterviews focus groups Qualitative Benefit Analysis (QBA)

observationsdiaries, scrapbooksphotos

Evidence

Social and Therapeutic Horticulture

- including Food growing

(as a treatment Intervention)

AnimalAssisted Therapy

Care Farming

Environmental Conservation

(as a treatment intervention);

Ecotherapy

Green Care

Green Exercise

(as a treatment intervention)

Others:• Wilderness

therapy;

• Nature therapy;

• Nature arts and crafts;

• Ecopsycho-therapy;

Range of different contexts, activities, health benefits, service users, motivations and needs.

Source: Adapted from Hine et al., 2008; Bragg et al., 2013 and Bragg 2014

Evidence

Inte

racti

ng w

ith n

atur

eEx

perie

ncin

g na

ture

Everyday life –

General population

Health promotion –Nature-based activities

General population

Green Care –Nature-based therapy or treatment intervention

People with a defined need

Restorative landscapes and gardens

Green exercise(e.g. walking, running cycling

in nature etc.)

Social and Therapeutic Horticulture (STH)

Community food growing (as a treatment intervention)

Horticultural Therapy (HT)

Environmental conservation (as a treatment intervention)

Ecotherapy

Animal Assisted Therapy (AAT)

Care Farming

Human Animal InteractionsAnimal-based recreation (e.g. dog walking, horse riding etc.)

View from window (at home or work)

Gardening/Horticulture (at home or work )

Farming

Forestry, environmental conservation

(at work or at home)

Source: Adapted from Haubenhofer, Bragg et al., 2010; Sempik and Bragg, 2013; Bragg 2014

Green exercise initiatives(e.g. Walking for Health)


Community food growingCommunity gardening

Community farming; city farms;one-off care farm visits

Environmental conservation groups

Animal Assisted Activities (AAA)

Green exercise (as a treatment intervention)

Nature therapy; Wilderness therapy

• There is no complete picture or definitive data for the scale of green care services in the UK overall

• Data collected is often organisation specific and not in a common format

• Using data from 2003, we can estimate at that point 1000 projects were supporting 8,400 people with mental health problems per week

• There are approximately 230 Care Farms in the UK provided services to 7,820 people per week. 75% of care farms report providing services to people with mental health problems

Next steps

1. There is a need for green care umbrella organisations to collaborate and raise awareness of the need for common messages and evidence

2. The term ‘Green Care’ should be used, with the possible addition of the strapline ‘nature-based interventions for individuals with a defined need’

3. A clear distinction must be made between interventions designed as treatment and public health programmes for the whole population

4. The green care partnership organisations should work with their members to facilitate access to, and development of, larger scale health and social care contracts

Social & Therapeutic Horticulture: Using Gardening to Improve Health and

Transform Lives

Kathryn RossiterChief Executive Officer

Thrive www.thrive.org.uk

[email protected]


Using gardening to bring about positive changes in the lives of people living with disabilities or ill health, or who are isolated, disadvantaged or vulnerable.

Benefits of Gardening

• Better physical health• Improved mental health• Opportunity to connect

with people• Being outdoors, in touch

with nature • Opportunity to learn

new things

STH in the UK

• The main groups accessing STH in the UK are people with:– Mental ill health– Learning disabilities– Children and young people – Older people with specific support

needs• Specific practice-based texts e.g.

– Ex-service men and women – Children with SEND

STH: Conceptual framework• Biophilia hypothesis• Psycho-evolutionary theory• Attention Restoration

Theory

Person

Natural environment

Therapist

Social environment

Out

com

esSTH guided model of practice

Green Care Coalition

Social and Therapeutic Horticulture

- including Food growing

(as a treatment Intervention)

AnimalAssisted Therapy

Care Farming

Environmental Conservation

(as a treatment intervention);

Ecotherapy

Green Care

Green Exercise

(as a treatment intervention)

Others:• Wilderness

therapy;

• Nature therapy;

• Nature arts and crafts;

• Ecopsycho-therapy;

Range of different contexts, activities, health benefits, service users, motivations and needs.

Source: Adapted from Hine et al., 2008; Bragg et al., 2013 and Bragg 2014

Therapist/ Outcomes

Social Environment

Activity

Natural Environment

Everyday life/Health promotion

Green Care

Gardens and Health Kings Fund report (published May 2016)

• Overwhelming strength of evidence of association between green space and physical/mental health– Studies in Netherlands, Japan and Canada show a 10% increase

in exposure to green space translates to health equivalent of being 5 years younger

– Access to open spaces correlates to higher levels of physical activity

– The proportion of green space in an environment correlates to self-rated health and mental health

– Living in areas of green space is associated with less income-related health inequality

– High salivary cortisol levels related to levels of lower green space and vice versa in deprived Scottish neighbourhoods

Evidence base – from STH• Sempik et al (2005) Health Well-being and Social Inclusion

– The ‘social’ is a both a key outcome and a mechanism enabling disabled or vulnerable people to access the benefits of nature

• Clatworthy et al’s (2013) review of the research– Gardening based interventions have multiple benefits for people with

mental ill health• Reduced depression and anxiety (BDI depression scores)• Enhanced emotional well-being• Improved social functioning• Physical health • Opportunities for vocational development

• Thrive’s INSIGHT research– Improved behavioural scores in social interaction, communication,

motivation and task-engagement especially for mental health and learning disability groupsat 6, 9 & 12 months

Gardening as Green Activity

• Wood et al (2015) in Journal of Public Health– Just 30 minutes of gardening a week can improve self

esteem and mood, and lower BMI– Gardening can play a ‘key role in promoting mental well-

being and could be used as a preventive health measure’ • Strength, stamina, balance, fine and gross motor skills• James Shippen at Coventry University

– Transplanting seedlings – 1.8W/kg– Hand weeding – 2.6W/kg– Raking – 3.1W/kg (walking 3.8W/kg)– Digging – 4.2 W/kg (jogging 8.1W/kg)

Growing recognition from within the medical profession

Dr Matilda Van Den Bosch“Nature-assisted therapy [is] a relevant resource for public health.”

(from an article published in the Scandinavian Journal of Public Health)

Sir Richard Thompson “I have for some time thought doctors should prescribe a course of gardening for people who come to them with depression or stroke”

(Chair of Royal College of Physicians, 2010-14)

Dr James Cavanagh GP “I have at least three patients whose families have come to me and said (community growing) made an enormous difference to their relative – they’re happier and more confident.”

Dr William Bird GP “There are considerable savings to be made if we really managed to get horticulture therapy up to the standard of other health interventions. The savings made could see money being channelled in other directions such as cancer drugs.”

Turning evidence into more delivery

• Challenges:– The variety of Green Care provision– Standardising practice

• Training and qualifications– Quality assurance

• Cultivating Quality (PQASSO approved)– Outcome measurement

• Which Tool to Use? (Growing Health)• INSIGHT (Thrive)

– Problem of causality and the lack of RCT

Turning evidence into more delivery• Opportunity

– Developing knowledge base – Clinical Commissioning– Social prescribing/community

referrals– Cultural, economic and social forces

are transforming healthcare in the UK

• The value of nature-based approaches is impossible to ignore

www.growinghealth.info

Margi Lennartsson Garden Organic

Health & Horticulture Conference 2016RHS Hampton Court Palace Flower Show, 4 July


• Initiative run by Garden Organic and Sustain, funded by The Tudor Trust

• Provides a network of support for health professionals, commissioners, academics and food growing projects

• Identify barriers & solutions• Finding ways to make it happen

Vision - community food growing to be a natural part of the health service and routinely used to deliver health improvement


Why isn’t food growing commissioned?NHS & Public Health• Lack of awareness of the benefits of food growing and

how to use it in practice • Unsettled times and new structures• Need evidence of outcomes and impact

Food Growing Groups• Don’t have the contacts or awareness of routes to

commissioning• Not always set up to make commissioning easy – define

the service, work in partnership and provide evidence of outcomes and impact


Benefits for health and wellbeing – the evidence


• Wellbeing centre using its garden and nature reserve to promote physical and mental health and wellbeing. • Commissioned by Lewisham CCG to provide therapeutic gardening, arts & crafts and cooking sessions for co-workers.• Weekly sessions for adult mental health groups focusing on recovery and rehabilitation, and for people with early stages of dementia on improving quality of life and haltering symptoms from getting worse.• Received 403 referrals in 2015/16, from local GPs and key workers• Average unit cost per session is £10/hour/co-worker. • Typical placement lasts 12 months

Case study:


Case study:

• Peer-to-peer learning and support networks• Recruit, train and support volunteers - Master Gardeners and Food Buddies• Volunteers support people to grow food• Commissioned by Public Health • For general public and specific target groups• Improves health, social wellbeing and happiness• Supports adoption of healthy and pro- environmental behaviours• Social Return on Investment Ratio - £1 : £10.70


Case study:

• Network of community gardens; over 70 spaces• People of all ages and abilities involved in supervised horticultural activities• Specialists gardens with green care services for people with additional needs, with mental health issues, vulnerable or disadvantaged groups• Commissioned by Public Health and CCG • Improvements in wellbeing, life satisfaction, diet and physical activity levels


Finding ways to make it happen - Supporting community growing groups

• Share and learn Working with the health service Routes to commissioning Building partnerships Measuring outcomes

• On-line tool kit


• Raise awareness of the opportunities for using horticulture for health improvement

• Continue to build and disseminate the evidence base• Develop options for referrals at the local level – connecting partners Growing Health Network and Champions Green Care Coalition National Outdoor for All Working Group Health & Horticulture Forum

Finding ways to make it happen - Supporting health professionals and commissioners


Thank you

[email protected]

Twitter - @growing_health

Session 3: Designed horticultural activities for health & wellbeing

1135 Gavin Atkins (Mind)Horticultural Activities Improving Health & Wellbeing – Mental Health Overview

1145 Kathryn Rossiter (Thrive)Social & Therapeutic Horticulture

1155 Dr Margi Lennartsson (Garden Organic)Growing Health

1205 Questions for Session 3

Health and Horticulture Conference Session 3

Science

Transcript of Health and Horticulture Conference Session 3