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  • Oliver Sacks eloquently describes the history in his Foreword to Eugene Roosens and Lieve Van de Walle’s anthropological illustration of Geel’s current state: In the seventh century, the daughter of an Irish king fled to Geel to avoid the incestuous embrace of her father, and he, in a murderous rage, had her beheaded. Well before the thirteen century, she was worshipped as the patron saint of the mad, and her shrine soon attracted mentally ill people from all over Europe. Seven hundred years ago, the families of this little Flemish town opened their homes and their hearts to the mentally ill – and they have been doing so ever since. (Roosens and van de Walle, 2007, p 9.)
  • Interesting in two ways: an example of community based approach and also as a nature based approach. The history is this: The earliest recognisable ‘care programmes’ that used what may be called ‘Green Care principles’ were at Geel in Flanders in the 13th century. Here, ‘mentally distressed pilgrims’ came to worship at the holy shrine of St Dympna and stayed in a ‘therapeutic village’ where they were sympathetically cared for by the residents (and pilgrims were regularly weighed to demonstrate progress!). Bloor (1988) has described this as the first example of a ‘Therapeutic Community’. This was a rural agricultural setting, and the main work activity for everybody was to work on the land. A range of structures and procedures were in place for taking care of these individuals in the context of local families and wider village life. The tradition of caring in this way still continues at the original town of Geel, 60km north-east of Brussels in modern-day Belgium (see Roosens, 1979, 2008).
  • We start with recent history – rather than going back to Biblical times We need to know more from the different countries about history – for example in the UK we have hospital farms and also Camphill communities which are involved in nature based approaches (taking much of the philosophy of Rudolf Sneider – Anthrosophical approach). The Camphill movement was setup by an Austrian, Dr Karl Konig in 1939. So we really need to include that.
  • What is interesting that there is no written history of how the hospital farms declined; the policies and laws that ended these activities. We know that in the 1950s the newly formed National Health Service made an audit of the land held by the farms and 190 hospitals were farming 40,000 acres (16,187 Hectares) of farm; 3,800 (1,537 Hectares) of market garden; 4,000 (1,618 Hectares) of Woodland – 7000 cows, 25000 pigs, 5000 sheep 63,000 hens. There were also pedigree herds Ministers felt that hospitals shouldn’t be farming and ordered that they close thearms unless they were an essential part of the hospital, but the history of closure is not well documented and some farms were still working up to the early 1970s.
  • So what happened? The creation of the National Health Service (NHS) in 1948 is important for our understanding of the demise of hospital farms in the UK. The Government was able to take an overview of its hospitals, including those for the mentally ill, and their various activities. Regional hospital boards “were asked to consider whether the farming activities at hospitals in their area could be limited and surplus land disposed of” (Report of the Ministry of Health, 1954). However, the report notes that “little progress was made in this direction” and so an audit had been conducted. This showed that 190 hospitals were working 39,859 acres of farm, 3,884 of market garden and there were a further 4,083 acres of woodland. The stock comprised of dairy herds of 7,173 cows and heifers with an additional 6,468 young stock and other cattle on 129 farms. There were also around 25000 pigs, 5000 sheep and 63,000 hens. This confirms hospitals to have been sites of a substantial farming effort; and one that the Government wished to reduce. The view of the Government was that the Minister of Health did not have the authority to allow the NHS to farm unless it was absolutely necessary for the well-being of the patients. Farming was seen as a commercial activity which was becoming increasingly mechanised and therefore provided fewer opportunities for ‘therapeutic’ work for patients: “ It was found that modern methods of farming with increasing mechanisation no longer provided suitable outdoor occupational therapy for any but a very small number of male patients, most of whom had little or nothing to do with the care of livestock…The Committee considered that market gardening and poultry keeping provide in present day circumstances a more suitable form of outdoor occupational therapy for patients than full-scale farming…” (Report of the Ministry of Health, 1954, p. 31).
  • So what happened? The creation of the National Health Service (NHS) in 1948 is important for our understanding of the demise of hospital farms in the UK. The Government was able to take an overview of its hospitals, including those for the mentally ill, and their various activities. Regional hospital boards “were asked to consider whether the farming activities at hospitals in their area could be limited and surplus land disposed of” (Report of the Ministry of Health, 1954). However, the report notes that “little progress was made in this direction” and so an audit had been conducted. This showed that 190 hospitals were working 39,859 acres of farm, 3,884 of market garden and there were a further 4,083 acres of woodland. The stock comprised of dairy herds of 7,173 cows and heifers with an additional 6,468 young stock and other cattle on 129 farms. There were also around 25000 pigs, 5000 sheep and 63,000 hens. This confirms hospitals to have been sites of a substantial farming effort; and one that the Government wished to reduce. The view of the Government was that the Minister of Health did not have the authority to allow the NHS to farm unless it was absolutely necessary for the well-being of the patients. Farming was seen as a commercial activity which was becoming increasingly mechanised and therefore provided fewer opportunities for ‘therapeutic’ work for patients: “ It was found that modern methods of farming with increasing mechanisation no longer provided suitable outdoor occupational therapy for any but a very small number of male patients, most of whom had little or nothing to do with the care of livestock…The Committee considered that market gardening and poultry keeping provide in present day circumstances a more suitable form of outdoor occupational therapy for patients than full-scale farming…” (Report of the Ministry of Health, 1954, p. 31).
  • So what happened? The creation of the National Health Service (NHS) in 1948 is important for our understanding of the demise of hospital farms in the UK. The Government was able to take an overview of its hospitals, including those for the mentally ill, and their various activities. Regional hospital boards “were asked to consider whether the farming activities at hospitals in their area could be limited and surplus land disposed of” (Report of the Ministry of Health, 1954). However, the report notes that “little progress was made in this direction” and so an audit had been conducted. This showed that 190 hospitals were working 39,859 acres of farm, 3,884 of market garden and there were a further 4,083 acres of woodland. The stock comprised of dairy herds of 7,173 cows and heifers with an additional 6,468 young stock and other cattle on 129 farms. There were also around 25000 pigs, 5000 sheep and 63,000 hens. This confirms hospitals to have been sites of a substantial farming effort; and one that the Government wished to reduce. The view of the Government was that the Minister of Health did not have the authority to allow the NHS to farm unless it was absolutely necessary for the well-being of the patients. Farming was seen as a commercial activity which was becoming increasingly mechanised and therefore provided fewer opportunities for ‘therapeutic’ work for patients: “ It was found that modern methods of farming with increasing mechanisation no longer provided suitable outdoor occupational therapy for any but a very small number of male patients, most of whom had little or nothing to do with the care of livestock…The Committee considered that market gardening and poultry keeping provide in present day circumstances a more suitable form of outdoor occupational therapy for patients than full-scale farming…” (Report of the Ministry of Health, 1954, p. 31).
  • So what happened? The creation of the National Health Service (NHS) in 1948 is important for our understanding of the demise of hospital farms in the UK. The Government was able to take an overview of its hospitals, including those for the mentally ill, and their various activities. Regional hospital boards “were asked to consider whether the farming activities at hospitals in their area could be limited and surplus land disposed of” (Report of the Ministry of Health, 1954). However, the report notes that “little progress was made in this direction” and so an audit had been conducted. This showed that 190 hospitals were working 39,859 acres of farm, 3,884 of market garden and there were a further 4,083 acres of woodland. The stock comprised of dairy herds of 7,173 cows and heifers with an additional 6,468 young stock and other cattle on 129 farms. There were also around 25000 pigs, 5000 sheep and 63,000 hens. This confirms hospitals to have been sites of a substantial farming effort; and one that the Government wished to reduce. The view of the Government was that the Minister of Health did not have the authority to allow the NHS to farm unless it was absolutely necessary for the well-being of the patients. Farming was seen as a commercial activity which was becoming increasingly mechanised and therefore provided fewer opportunities for ‘therapeutic’ work for patients: “ It was found that modern methods of farming with increasing mechanisation no longer provided suitable outdoor occupational therapy for any but a very small number of male patients, most of whom had little or nothing to do with the care of livestock…The Committee considered that market gardening and poultry keeping provide in present day circumstances a more suitable form of outdoor occupational therapy for patients than full-scale farming…” (Report of the Ministry of Health, 1954, p. 31).
  • Within ‘Green Care’ there are many approaches, It is a spectrum that moves from activities that are ‘interventions’ designed to be ‘therapeutic’ to those that may be beneficial but are incidental experiences of nature – not interventions We can look at it in this way..
  • Dangers of using employment as an outcome – not all clients are ready or able to participate in proper paid employment. Some have become ill as a result of their jobs
  • Gaining informed consent from vulnearble people may be difficult – is it patronising to get consent from a carer or physician? Data should not be stored indefinitely – it should be destroyed after it has no useful value, and in any event there is usually a prescribed time limit for its storage (in research establishments) How data presented is important and can affect the conclusions of a study

Green-care-using-nature-for-health-Sempik's.pp.doc.ppt Green-care-using-nature-for-health-Sempik's.pp.doc.ppt Presentation Transcript

  • Green Care: using nature for health Carlisle 17 December 2010
  • Some history…..
  • St Dymphna Patron Saint of those who suffer from mental illnesses and nervous system disorders, epileptics, mental health professionals, incest victims, and runaways. Feast Day 15 th May View slide
  • Geel, Belgium: the first example of using land-based activities as care in the community for people with mental health problems and learning difficulties (from the 13 th Century to the present day) View slide
  • “ We find that the patients derive more benefit from employment in the garden than anywhere else, and this is natural, because they have the advantage of fresh air as well as occupation'‘ (Nottingham Borough Asylum, 1881, page 11, quoted by Parr, 2007, p. 542)
    • “ The healthy mental action which we try to evoke in a somewhat artificial manner, by furnishing the walls of the rooms in which the patients live, with artistic decoration, is naturally supplied by the farm. “
    Report of the Commissioners of the Scotch Board of Lunacy (1881 ) History…the UK asylum farms
  • The 1950s and 1960s
    • After creation of NHS in 1948 hospital boards were asked to consider “ whether farming activities could be limited ”…because…
  • The 1950s and 1960s
    • After creation of NHS in 1948, UK hospital boards were asked to consider “ whether farming activities could be limited ” because…
      • 190 hospital farms
      • 16,187 Hectares of farm (40,000 acres)
      • 1,537 Hectares of market gardens (3,800 acres)
      • 7,000 cows, 25,000 pigs, 5,000 sheep, 63,000 hens….
    • “ I think that the value of farms is undoubtedly apparent to the layman. It is obviously a good thing that people who suffer from mental sickness should have the peace and comparative quietness of working on the land, and the hard manual work involved is also beneficial…”
    (James Dance, MP for Bromsgrove speaking in Parliament in 1959)
    • “ I have said that that is the layman’s point of view, but I am supported by the doctors…I have visited that hospital. I have seen the people in it and have spoken to the doctors. Not only do they say a farm is of great value, but they also stress that it is essential for the cure of certain of their patients”
    (James Dance, MP for Bromsgrove speaking in Parliament in 1959)
  • The 1950s and 1960s
    • Discovery of new drugs for treatment of mental ill health e.g. chlorpromazine (1954)
    • Closure of hospital farms in the UK
    • But continued use of farms in Europe
    • Development of occupational therapy (OT) and use of horticulture in OT
  • The 1970s and 1980s
    • Use of nature in a wide variety of ways to promote health
    • Therapeutic horticulture,
      • American Horticultural Therapy Association founded in 1973
      • Thrive founded as the Society for Horticultural Therapy in the UK in 1978
      • Many other national organisations
    • Other interventions - animal assisted therapy, wilderness therapy etc
  • 2000…
    • Consolidation of ideas regarding different approaches using nature
    • Rise of ‘ care farming ’
    • Creation of the concept of ‘ Green Care ’
    • Creation of practitioner and research networks (Community of Practice, COST 866 ‘Green Care in Agriculture’)
  • Experiences within nature
    • ‘ casual’ experience of landscape – city greening
  • Experiences within nature
    • ‘ casual’ experience of landscape – city greening
    • ‘ passive’ use of landscape as therapy
  • Experiences within nature
    • ‘ casual’ experience of landscape – city greening
    • ‘ passive’ use of landscape as therapy
    • physical activity within nature – ‘green exercise’
  • Experiences within nature
    • ‘ casual’ experience of landscape – city greening
    • ‘ passive’ use of landscape as therapy
    • physical activity within nature – ‘green exercise’
    • activity that ‘uses components of nature’ e.g. care farming, therapeutic horticulture
  • A spectrum of approaches
    • Care farming
    • Therapeutic Horticulture
    • Animal assisted therapy
    • Horticultural therapy
    • Ecotherapy
    • Wilderness therapy
    • Nature therapy
    • Occupational therapy using plants
    • Sheltered employment in agriculture
    • Green exercise
    • Nature conservation
    • Employment in a natural environment
    • Urban greening
    • Living in a green environment
  • A journey through green care!
  • Mapping the influence of nature – nature as care and therapy nature therapy, wilderness therapy animal- assisted activities social&therapeutic horticulture horticultural therapy healing gardens/ environments/ landscapes green exercise animal-assisted therapy animal-assisted interventions health promotion therapy work rehabilitation/ sheltered green employment + green exercise (as treatment) ecotherapy usual work/ working place in natural environment + + looking at nature being active in nature shaping nature interacting with animals care farming experiencing natural environment interacting with natural elements
    • Level of Productivity
    • Ownership & Democracy
    • Economics/turnover
    • Degree of Mechanisation
    • Animals (pets or production?)
    From garden to farm…
  • Green Care Provides
    • Activities and approaches for people with a wide range of difficulties:
      • Mental health problems
      • Learning difficulties
      • Social problems
      • Physical disabilities
      • Drug and alcohol problems
      • Disaffected youth
  • Green Care Provides
    • Engagement and connectedness with nature
    • Nurture of animals and plants
    • Structure and routine
    • Productivity - but without the pressure of employment
    • Opportunities for training and possible employment
  • Green Care Provides
    • Physical activity
    • Social inclusion through…
      • Production
      • Consumption
      • Social interaction
      • Political engagement
    • Extensive social support
  • Green Care Provides
    • No formal psychotherapy (generally)
    • Arts and crafts (sometimes)
    • Democratic involvement (sometimes)
    • Engagement with the ‘Green Agenda’? (sometimes)
    • A spiritual dimension?
  • Effectiveness of Green Care
      • What is ‘effectiveness’?
        • Individual goals
        • Improvement of general…
          • Well-being…
          • Self-esteem…
          • Coping ability…
          • Self-efficacy
  • Developing a theory and framework
  • Applying frameworks to themes
    • Social inclusion
      • production, consumption, social interaction, political engagement
    • Employment
      • ‘ latent’ benefits of employment, social contact, purpose, structure, status, identity
    • Psychological theories
      • Attention restoration theory & recovery from stress
  • Combining different explanatory frameworks…
  • Social Inclusion: production consumption social interaction political engagement Employment: meaningful goals identity status, competence routine social interaction
  • Social Inclusion: production consumption social interaction political engagement Employment: meaningful goals identity status, competence routine social interaction
  • Social Inclusion: production consumption social interaction political engagement Employment: meaningful goals identity status, competence routine social interaction Environment: Social Physical
  • Social Inclusion: production consumption social interaction political engagement Employment: meaningful goals identity status, competence routine social interaction Environment: Social Physical Natural environment: Attention restoration Recovery from stress Aesthetic and spiritual fulfilment
  • Social Inclusion: production consumption social interaction political engagement Employment: meaningful goals identity status, competence routine social interaction Environment: Social Physical Natural environment: Attention restoration Recovery from stress Aesthetic and spiritual fulfilment MOHO: Volition (personal causation, values, interests) Habituation (habits, roles) Performance Capacity (objective, subjective)
  • Social Inclusion: production consumption social interaction political engagement Employment: meaningful goals identity status, competence routine social interaction Environment: Social Physical Natural environment: Attention restoration Recovery from stress Aesthetic and spiritual fulfilment MOHO: Volition (personal causation, values, interests) Habituation (habits, roles) Performance Capacity (objective, subjective)
  • Social Inclusion: production consumption social interaction political engagement Employment: meaningful goals identity status, competence routine social interaction Environment: Social Physical Natural environment: Attention restoration Recovery from stress Aesthetic and spiritual fulfilment MOHO: Volition (personal causation, values, interests) Habituation (habits, roles) Performance Capacity (objective, subjective)
  • Social Inclusion: production consumption social interaction political engagement Employment: meaningful goals identity status, competence routine social interaction Environment: Social Physical Natural environment: Attention restoration Recovery from stress Aesthetic and spiritual fulfilment MOHO: Volition (personal causation, values, interests) Habituation (habits, roles) Performance Capacity (objective, subjective)
    • Environmental psychology, views of nature and attention restoration e.g. Roger Ulrich and Stephen and Rachel Kaplan
    • Exercise and physical health many studies show link of physical health with physical activity
    • Exercise and mental health e.g. Dunn et al (2005)
    Evidence from other fields
  • Aerobic exercise at a dose consistent with public health recommendations is an effective treatment for MDD of mild to moderate severity. A lower dose is comparable to placebo effect. American Journal of Preventive Medicine, 2005;28(1):1–8) Evidence from other fields
    • Physical activity and Alzheimer’s Disease At least three major studies suggest that increased physical activity or exercise are associated with reduced incidence or delayed onset of Alzheimer’s Disease.
    Evidence from other fields
  • Ann Intern Med. 2006;144:73-81. 1,740 older people followed up for 6 years At least 15 minutes of exercise taken 3 times per week reduced risk of dementia Evidence from other fields
  • Physical activity and dementia
  • Implications for policy and practice
    • Recognition of therapeutic horticulture as a form of health and social care – i.e. policy
    • ‘ Greening’ medical, psychiatric & social care
    • Guidelines for referrals
    • Addressing under-representation
    • Addressing finance
    • Professional status for practitioners
    • Further research – more interest
  • Development of research in Green Care
    • Links with other research fields
      • European initiative in ‘Green Care’ (COST 866) includes STH, ‘Care Farming’, ‘Animal-assisted Therapy’ and others
      • Therapeutic Communities – similar difficulties with research approaches; similarities between ‘interventions
    • More researchers interested in the field of STH e.g. university researchers, psychiatrists, OTs
  • Challenges
      • There is little ‘hard’ (i.e. experimental, quantitative) evidence of effectiveness
      • Policy makers and ‘mainstream’ health professionals can be sceptical of qualitative data alone
      • Debate as to whether experimental methodology e.g. RCT can and should be applied to therapeutic horticulture and other nature-based approaches
  • Opportunities
      • Natural links and overlaps with other therapeutic approaches and networks, for example, Therapeutic Communities, Care Farming and Green Care movement
      • Common themes in research
      • ‘ Respectable’ area for academic research
      • Professionalisation of Therapeutic Horticulture
  • English Tree by Anne Williams Conclusion: green care is a mosaic of processes and effects… … that addresses a mosaic of needs…
    • Joe Sempik
    • Centre for Child and Family Research
    • Loughborough University
    • Leicestershire LE11 3TU
    • +44 1509 223671
      • [email_address]