Mental Health Awareness Week 2021: nature-based interventions for brain injury and mental well-being.
Are we digging nature-based neurorehabilitation? In Mental Health Awareness Week, we get to the grassroots of ecotherapy and its blossoming outcomes for brain injury survivors.
What is it about getting up close and personal with nature that has helped so many of us cope with the constraints of the covid pandemic?
And if we had that knowledge, could we incorporate it into occupational therapy practice to enhance neurorehabilitation?
This week, as the UK’s Mental Health Foundation(MHF) focuses on nature as a remedy, we go rummaging in the research undergrowth for budding evidence of its impact on the brain.
It was as if we were re-discovering at our most fragile point our fundamental human need to connect with nature. 
MHF Chief Executive Mark Rowland
Seeds of change sprout from freshly cultivated beds of knowledge, and it’s to one of those beds we’re being asked to tend with particular care this week–mental health.
Since the outbreak of covid-19 and the ensuing lockdowns, university researchers looking at the pandemic’s impact on our mental health [1]have discovered:
- Walking outdoors is one of our top coping strategies.
- Green spaces are a mental health lifeline for almost half of us.
- Viewer numbers for wildlife webcam websites have spiralled.
So, while one of nature’s most insidious products – the covid-19 virus –has been devastating humankind, nature itself, it seems, has been providing a panacea.
Indeed, a £5.77m Government-funded research project is currently underway at seven sites across England, looking at ways of preventing and combatting mental health through ‘green’ social prescribing. [2]
Social prescribing is an option for healthcare professionals to refer patients to non-medical community support services. [3]
Activities such as walking, cycling, community outdoor projects and supported visits to green spaces are among the ‘green prescriptions’ being tested for effectiveness.
In the meantime, the Mental Health Foundation has planted nature at the heart of its 2021 Mental Health Awareness campaign this week, with a call to the public to pool their ecotherapy experiences.
“During long months of the pandemic, millions of us turned to nature,” said MHF Chief Executive Mark Rowlands.
“It was as if we were re-discovering at our most fragile point our fundamental human need to connect with nature.
“It is only in the last five generations that so many of us have lived and worked in a context that is largely separated from nature.
“And it is only since a 1960s study in the US, which found that patients who were treated in hospitals with a view of nature recovered faster, that science has started to unpack the extraordinary health benefits.”
The growing evidence, Mark added, will show that “even small contacts with nature can reduce feelings of social isolation and be effective in protecting our mental health, and preventing distress.”
Natural defence
So, if there’s burgeoning proof that nature nurtures us, is there also evidence, within the realms of neuro occupational therapy, of its impact on brain injury rehabilitation?
Digging deep for the answers, occupational therapy (OT) researchers in Denmark have been busy scanning data logs dating back to 1995.[4]
And there, despite an overall ‘paucity’ of evidence, they have unearthed seven studies with such promising outcomes; the team concludes that further research is merited.
The studies, involving 172 patients, most of whom were traumatic brain injury (TBI) or stroke survivors, looked at the impact of:
- Horticultural therapy, such as gardening.
- Forest therapy, based in wooded areas.
- Outdoor therapy.
And among the ‘significant’ findings recorded were:
- Improved motor and sensory-motor function.
- Increased brain activity, specifically visual and colour processing areas.
- Boosted motivation, proactivity, and engagement.
- Reduced anxiety in acquired brain injury (ABI) survivors.
- Enhanced quality of life.
Benefits relating to depression, mental fatigue and other well-being factors remained unclear on this occasion, hampered in part by design and methodology inconsistencies between the studies.
But muddy research waters around OT outcomes isn’t stopping the drive for ecotherapy to be recognised as an effective health care tool.
A report on nature-based interventions commissioned by Natural England reveals ‘strong evidenceof their efficacy [5] for people with:
- Two or more long-term health conditions.
- Complex, untreatable or poorly understood conditions.
- A history of mental health problems.
And the UK’s Natural Capital Initiative (NCI), an influencer in sustainable science decisions, believes the time is ripe for rolling out a new ‘NHS’ – Nature’s Health Service![6]
Citing the Natural England report, it points to green care’s ‘great potential’ and additional benefits such as:
- Cost savings.
- Better outcomes for health and social care service providers.
- More effective use of GP time.
“There is still a lot to be done before ‘green prescription’ enters the mainstream,” the NCI says, “but the report is encouraging and provides guidance to those who want to make this happen.”
And making it happen couldn’t come at a better time, believes MHF’s, Mark Rowlands.
“2021 is going to be a huge year for nature,” he said. “A new Environment Bill will go through the UK Parliament which will shape the natural world for generations to come.
“The UK will host the G7 nations where creating a greener future will be a key priority.
“And a historic international UN Climate Change Conference of the Parties (COP26) will be hosted in Glasgow in November.
There could not be a more important time to understand the links between nature and mental health.
The MHF is inviting people to #ConnectWithNature throughout this week and share their nature-linked mental health stories here: visit mentalhealth.org.uk/mhaw.
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