Greencare - using Permaculture ideas for mental health

Where next?

Why are we here?

The Growing Better Lives "GREENCARE" Project:

Permaculture for Mental Health

Permaculture ideas:

• Have a strange feeling of familiarity
• Makes coherent sense of a lot of what we have been doing for years
• Almost identical value base
• Complexity and emergent processes
• Human scale and 'person-centred'
• Relational and systems based
• Beyond instrumental rationality / linear thinking etc

Rex Haigh, Consultant Psychiatrist in Medical Psychotherapy, Berkshire NHS

Honorary Professor of Therapeutic Environments and Relational Health, Nottingham University

Fiona Lomas, Expert by Experience and Greencare Coordinator

David Hare, Horticultural and Animal Assisted Intervention Therapist

Vanessa Jones, Research Lead

...permaculture is better for our planet than chemicals are; permaculture is better for our brains and minds and spirits than chemicals are...

Special thanks to...

Kevin Mascarenhas: who ran a 2 day introductory permaculture workshop in our therapy yurt (March and April 2014) called

"Sustainability for mental health projects: Developing a greencare mental health service using an integrated systems approach"

Royal College of Psychiatrists

National Sustainability Award 2014

Sustainability requirements:

our equivalent of Permaculture ethics

Triple Bottom Line

- Social (people)

- Ecological (planet)

- Economic (profit)

Social sustainability

What IS greencare?

What is greencare's theoretical and evidence base?

A serious treatment in its own right - not just an add-on

- Biophilia Hypothesis

- originally Fromm (a Frankfurt School post-Freudian): "the connection that human beings subconsciously seek with the rest of life"

- in evolutionary psychology as The Biophilia Hypothesis by Kellert & Wilson (1993)

- 'Nature Deficit Disorder': Richard Louv (2005) Last Child in the Woods

- Is the core of what we do in PD (helping people with unsustainable lives)

- Based on the group analytic concepts

- emotionally safe space and belongingness there

- the network of relationships does (most of) the work

- Adaptogenic = better mental equilibrium rather than 'cure'

- Healthier relationships with:

- our planet, our countries & cultures, each other, our patients, ourselves

- At the core of ENABLING ENVIRONMENTS

- Therapeutic and social horticulture

- Animal assisted interventions

- Care farming

- Ecotherapy

- Wilderness therapy

- Rural crafts

- Forest and woodland skills & schools

- Green gyms

AND POSSIBLY

- Weather immersion

- Geological projects

- Ocean wildlife ...etc etc

any contact or interaction with the natural world

incorporated into the therapy programme

- THERAPEUTIC COMMUNITIES

- everything is part of the therapy

- For people with very chaotic lives - across agencies

- High risk - long-term care coordination etc

- Definitive therapy - NOT an adjunct to TAU

- Pre-therapy / TC / post-therapy

- Impossible to NOT do therapy in this setting

- EU Conceptual Framework

- Sempik J, Hine R, Wilcox D (2010) Greencare: a conceptual framework. A report on the Working Group on the Health Benefits. EU COST Action 866. EU COST Office, Brussels

"It’s not therapy-focused time, but time spent with the people you’re in therapy with, working together on cooperative projects. It helps to break down barriers that are sometimes formed in therapy. It is a calming and peaceful space"

"I used to think that this greencare was a heap of shit, but I went home and realised I felt a lot better"

"This is the best

therapeutic

experience

of the week"

Ecological sustainability

Even more wild:

That Slough becomes a transition town and we are part of it1!

Why does mental health need greencare?

When one tugs at a single thing in nature, one finds it attached to the rest of the world.”

John Muir

“I have found that there is always some beauty left - in nature, sunshine, freedom in yourself.

These can all help you.”

The 'golden thread'

of

RELATIONAL

PRACTICE

Anne Frank

“With innovation and technology we seem to have forgotten to cherish the true beauty the world has to offer”

A C Van Cherub

Linking across disciplines:

“Greencare is a holistic and economically viable alternative to treatment with medication and hospitalisation.

Sustainability is about connecting people to each other and to nature, helping people to see that there is a life worth living, and on a planet that is worth living on.”

• Philosophy
• Aesthetics
• Utopias and temporalities
• Value-based care
• Spirituality
• Evolutionary biology
• Social sciences
• Critical theory
• Anthropology
• Low impact architecture
• Political theory

• Psychiatry
• Psychotherapy
• Psychology
• Group analysis
• Organisational dynamics
• Occupational therapy
• Public health
• Health promotion
• Outcome studies
• Neuroimaging
• Interpersonal neurobiology

Starting to get some evidence together:

2. Quality

Network

And the latest scheme - with our local NHS managers, the council and third sector organisations:

Growing the whole system to meet 'austerity challenges'

... rather like Permaculture's "The problem is the solution"

Starting to see the whole town as 'The Therapeutic Community'

Hope College

Ideas from Transition Totnes, plus Sustainability, plus Permaculture - what a powerful mix!

First - our own sustainability:

(1) Funding from:

• Social prescribing by GPs
• Individual MH budgets
• Public health prevention
• Not one-off grants

(2) New areas for us to work in:

• CAMHS transitions programme
• Animal Sanctuary therapy centre
• Equine
• Veterans
• Addictions and dual diagnosis
• Homeless - PIEs
• With probation - PIPEs
• The golden thread - EEs

3. Vision

...some quotes from our participants

...and some preliminary qualitative research

Wild:

That we will take over

PD mental health services

from NHS providers

and run them better!

Spreading the idea: 'Yurtification'

- Cumbria

- Retreat

- Nottingham

- Khiron

- others?

1. Rigorous research

Our asprations

for the future of

our local project:

small, medium and wild

Clinical features:

• Containment and boundaries
• Structure - check-in & check-out
• Group principles
• Range of activities
• Evaluation - Recovery Star

- Also fundamental: we work in an environment centre

- Organic allotment / composting / PV roof panels

- Minimal energy use in our yurt

- Public transport & shared lifts; Skype etc

- Off-grid and low impact (cob) buildings: next stage!

Medium:

That we will get a

sustainable system

to provide some MH

services for the NHS

Needed:

A friend in a high place...

Highgrove?

Small:

That we will

get funded

to survive

beyond 2015

- Disaffection with increasing technical and regulatory aspects of clinical practice - losing sight of the person

- Sense that we have lost touch with each other and the natural world in 'industrialised' health care, especially relevant in mental health

- Antidote to institutionalisation

- Less based in individual acquistive life style (with health as a commodity), and more in interdependence and valuing relationships

- Congruent with - but different to - 'recovery approach'

- Can incorporate religious or non-religious spirituality

So...

Where do we run this programme?

What do we

do together?

Structure:

- check-in and check-out

- choice of activities

- subgroup minimum = 3

- all group-led

- and most importantly...

Relationships

- emotional instability with oneself and others

- extreme sensitivity to rejection / abandonment

- knowing and holding risk, eg suicidality and self-harm

- quality of relationship in greencare:

- experience of relationship with nature

Containment and

boundaries

Economic sustainability

- Time & space

- Therapeutic framework of socialising and eating together

- Peer-group agreed ground rules

What do people think of Greencare?

• Anecdotal evidence

• Focus Group Discussions

Do they want us?

They say they do,

but...

But the irony of our own sustainability

Struggling with the elements, 2010-14

Where does greencare happen?

- All done in groups (treat several people at once)

- Much self-help (and often better at it)

- The groups make the environment themselves

- And usable, edible or saleable goods are produced

- The project attracts volunteers (eg assistant psychologists and associate psychotherapists)

The Launch Party 2011

Activities & special events

Wild weather winter 2011-12

Fair shares?

- our therapeutic community methodology includes 'democratisation' aka 'flattened hierarchy'

But for the last word,

we must give apologies to the late

Sir John Betjeman

But, just after that, we had

to leave the council garden centre - and were homeless for a few months.

Then it was winter again...

- Health promotion

- Elderly and long-term care

- Drug and alcohol projects

- Prisons and offender management

- Schools and special needs education

- Mainstream mental health

- Specialist mental health

- Therapeutic communities

- Other therapeutic environments

A very cold winter 2010

Rebuilding no. 5

Then came the cold & rain

So - much of it has been going on for years

But it's getting taken more seriously now...

An urban greencare project in central London

As a treatment in its own right - not just as an adjunct to medication - but as a first line for treatment for severe 'mental illness'

Gentle care farming for frail elderly people in Staffordshire

A training programme for Young Offenders

in Worcestershire

Particularly powerful when used in conjunction with modern TC ideas

A therapeutic farm village for people with severe learning disability, and staff, in Yorkshire

Examples form round the world...

Forest skills for excluded-from-school teenagers in Oxfordshire

A residential therapeutic community

for severe mental illness in Bangalore

Care farming for long-stay service users in Taiwan - to be developed along TC lines

A residential therapeutic community for addictions in Melbourne

Thank you!

www.growingbetterlives.org

“ I think going over there and interact in a different environment can make us bond better, when we bond there better then we can get on…”

“Sometimes if you have a difficult morning the only thing you want to do is go home… you go there you think about something else , you do something else, it can ease attention…”

“I suppose you could liken it to an athlete, so when they’ve done their work-out they then do their stretches to come down and this is a bit like that”

“There’s many a time I’ve walked out of the hospital and I still feel agitated but when I come here feel different”