Environments that Promote Mental Health and Wellbeing

1. Environments that Promote
Mental Health & Wellbeing
Assoc. Prof. Mardie Townsend
School of Health & Social
Development

3. 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)

4. 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 Prevalence of mental and behavioural
aged 16-85 had experienced problems 2004-5 (ABS, 2006)
anxiety, mood and/or substance
abuse disorders (ABS 2009a)

5. 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)

6. 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)

7. Environment and wellbeing:
Wellbeing depends on: Wellbeing includes:
> the natural environment > satisfactory human
> the human made relationships,
environment > meaningful occupation,
> social arrangements > opportunities for:
(families, social networks, - contact with nature,
associations, institutions, - creative expression, &
economies) - making a positive
> human consciousness contribution to human
(Australian Bureau of Statistics, 2001 p. society (Furnass, 1996)
6)

8. 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‟

9. 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.

10. “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

11. Environmental deprivation alleviated by:
Viewing Contact with
nature plants
Contact
Being in with
nature animals

12. 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)

13. 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)

14. 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)

15. 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)

16. Therapeutic gardening:
> Increasingly, gardening is
being used
therapeutically
> In a range of contexts,
incl.:
> Acute care
> Rehabilitation
> Disability services
> Aged care
> Prisons

17. „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

18. „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)

19. 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

20. 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

21. 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

22. 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”

23. 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”

24. 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”

25. 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”

26. Improving physical health:
“The physical exertion leads to feeling calm”
“I feel the whole body is one, using all my muscles
(when bush walking)”

27. 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.”

28. 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

29. “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)