Feeling good inside, outside
Being outside is good for the soul, the skin, lungs and other bits and pieces of our bodies. Whether it’s sedately sitting in a wheelchair listening to music or having an impromptu game of frisbee, the outdoor areas of the ward provide some of patients’ most enjoyable experiences.
Outdoor exercise is accessible, fun, motivating, sociable and you get to see sky and nature and hear birds singing. As the Open Gym describes it:
If you hate the gym but want to get fit, try an outdoor workout. …We are passionate about the benefits of outdoor exercise. Slalom-racing through the trees is much more fun than slogging away on a sweaty old treadmill. So find your plimsolls, bring your friends and get down to the park!
Green gyms have a mental health cousin – eco-therapy. Some hospitals even have eco-therapists to support patients gaining the maximum benefit from outdoor activities.
A large number of studies, all using sound methodology, have produced strong evidence of the positive effect of nature on recovery from stress and attention fatigue. Exposure to nature has proved to have a positive effect on mood, for example, as well as on concentration, self-discipline and physiological stress. The studies were conducted both in the laboratory and under field conditions. The beneficial effects occur even after brief exposure to a view of nature.
The brilliant organisation Sensory Trust has loads of imaginative, fun, practical ideas for accessible outdoor activities.
For more about views of nature, please see Idea #18 Landscape pictures.
- Lots of cycling to local places and “if someone gets a puncture, it becomes a walking group for the return journey!”
- There are a range of garden games including quoits, petanque and badminton.
- Presently OT is developing links with local allotment groups to develop this activity.
- Green therapies have been established and I part of the rehab and recovery programme.
- Links have been made with BTCV and patients have accessed groups.
- Staffs facilitate activities in garden area (cricket, rounders, badminton, swing ball).
- Occupational Therapist runs weekly swimming groups.
- Patients help with feeding and care of the cats. Including lots of cuddles and watching their antics.
- Patients suffering from depression and anxiety are on a gentle exploration of local woodlands and parks. This helps them explore nature, overcome their anxieties, make new friends and reduce social isolation.
- Bowling green! Lovely gardens, attached to wards and in the grounds. Reclaiming football pitch areas for sports’ use. Used to have a 6 hole golf course on the site! Are considering setting up putting green.
- Gentle exercise is used to stimulate endorphin production.
- Teaching patients to have fun with traditional exploration of nature, i.e the garden, at a local pond or a local woodland.
- Practical and theoretical learning in organic gardening, allotment management and bee keeping.
- Monitoring bird activity – photographic ‘Bird Diary’.
- Complimenting the units are several secure outdoor exercise/recreation areas leading from the individual units, these enable all of the patients to easily and safely access fresh air.
- Growing fruit and vegetables on our allotments.
- Developing the community orchard, including ponds and wildlife areas.
- Developing wildlife friendly gardens.
- Nature, wildlife and bird watching walks.
- Friendly off road bike rides.
- There is a large rural garden area within the remit of the hospital, which is set aside for a variety of activities such as, practical skills training, which include small animal husbandry, gardening, individual projects, and woodwork; all within a risk assessed environment.
- Using photography to capture environmental and wildlife images.
- Creating environmental art and sculpture.
- A woodpecker. (It would be very wrong for this to be included in any national standards. Star Wards’ stuff is, of course, all totally optional, adaptable, ignorable….)
- Drumming workshops in woodland settings.
- Weekly walking groups are arranged by the Occupational Therapy department whether this be in the local community or further afield.
- In celebration of World Mental Health day a National Mental Health Cricket Tournament took place at a cricket club.
- On my first leave I didn’t leave the hospital grounds because it felt too scary so my family made a picnic and we sat in the garden and ate it.
- I loved sitting in the garden and getting to know other people on the ward.
- It was a hot sunny day and one of the staff bought a tub of ice cream. You can’t beat sitting in the sun eating a ice cream cone.
- I made the most of the sunshine absorbing those lovely rays in the ward garden. Go on give it a go!
- I went for a twenty minute walk everyday day at a nice steady pace and took time to get in touch with nature.
- I became very interested in the birds that came to feed at the bird table in the ward garden. I decided to make sure there was enough food for them every day. It opened my eyes to how beautiful birds are.
- When it was sunny we invariably were outside doing things. I even had my individual therapy outside in the summer!
- We used to go on twilight walks when the weather was nice. It kept our minds busy in that time post dinner that many of us struggled with.
- Access to fresh air is invaluable. It clears the mind and allows you to recharge.
- Even those of us on high levels of supervision were able to participate in activities outside. They used to carefully calculate staffing levels accordingly. It was much appreciated!
- We used to go for these amazing group walks and the staff were very careful to keep each individual’s needs in mind. They also used it as an opportunity to catch up with each of us.
Jamie has found running to be invaluable in the fight against anxiety.
“I was diagnosed with anxiety during a difficult chapter in my life. I was drinking heavily and the booze softened the anxiety but when I allowed myself to soberly reflect on my life, I was full of fear and experienced panic attacks. Due to my drinking I was not eligible for any help and I convinced myself that I didn’t need any.
Four years after my original diagnosis and the loss of my father I attempted suicide and, while sitting in the Accident & Emergency waiting room, staring down at a bandaged arm, I finally realised myself. I was assigned a psychiatrist and together we established that I had never really faced anything.
I started running short distances which at first were to distract me but I began to feel good when I added another half mile to my runs. It had been a long time since I had felt good without the intake of alcohol. The anxiety was fading, and the more I pushed myself the more I felt the depression lose its grip on me. Those short runs at the beginning of my recovery were to become the foundations of who I am now.
The hardest part is taking those first few steps, be it putting on a pair of running shoes or signing up to a sports club, but once you have done that you will never look back. I am now running three times a week, have signed up to run the High Wycombe marathon to raise money for the Mental Health Foundation, and it is only ten months since I sat in that waiting room staring down at my bandaged arm feeling completely helpless.
I see no better way of doing this than with the easily accessible method that rewards you with endorphins, improves your overall health and teaches you that you do have control over your mind: exercise. Use today as a time to achieve something that challenges you, I have learnt that it is the only rite of passage in to a brighter tomorrow.”
Outdoor gyms are becoming very popular, whether it’s a group of neighbours meeting up with a trainer for a work-out in the park, or the enticing and fun gym machines sprouting up in parks around the country. Little would make us happier than visiting a hospital and discovering a scene similar to this (probably without the scarves).
Some promotional information on outdoor gyms:
Camden Council funky video on outdoor gyms:
The ConferenceBike is a revolutionary way to bring people together. The circular ConferenceBike is pedalled by 7 riders sitting in a circle. One person steers while the other 6 pedal (or not) as the bike moves effortlessly along. ConferenceBikes are being used to transport employees on the Google campus in California; and as ice-breakers on university campuses in New York. So cool.
Health Benefits of Gardens in Hospitals
Findings from several studies have converged in indicating that simply viewing certain types of nature and garden scenes significantly ameliorates stress within only five minutes or less. Further, a limited amount of research has found that viewing nature for longer periods not only helps to calm patients, but can also foster improvement in clinical outcomes — such as reducing pain medication intake and shortening hospital stays.STRESS REDUCING EFFECTS OF VIEWING PLANTS AND NATURESeveral studies of nonpatient groups (such as university students) as well as patients have consistently shown that simply looking at environments dominated by greenery, flowers, or water — as compared to built scenes lacking nature (rooms, buildings, towns) — is significantly more effective in promoting recovery or restoration from stress. (See Ulrich, 1999, for a survey of studies.)A limited amount of research suggests that viewing settings with plants or other nature for a few minutes can promote measurable restoration even in hospital patients who are acutely stressed.There is considerable evidence that restorative effects of nature scenes are manifested within only three to five minutes as a combination of psychological/emotional and physiological changes.
Concerning the first, psychological/emotional, many views of vegetation or garden-like features elevate levels of positive feelings (pleasantness, calm), and reduce negatively toned emotions such as fear, anger, and sadness. Certain nature scenes effectively sustain interest and attention, and accordingly can serve as pleasant distractions that may diminish stressful thoughts. Regarding physiological manifestations of stress recovery, laboratory and clinical investigations have found that viewing nature settings can produce significant restoration within less than five minutes as indicated by positive changes, for instance, in blood pressure, heart activity, muscle tension, and brain electrical activity (Ulrich, 1981; Ulrich et al., 1991).
For longer version of article see Idea #19 Gardening
Health benefits of exercising outdoors
A systematic review by the Peninsula College of Medicine and Dentistry found exciting benefits to mental and physical well-being from taking exercise in the natural environment compared to exercising indoors including:
- greater feelings of revitalisation, increased energy and positive engagement
- decreases in tension, confusion, anger and depression
- greater enjoyment and satisfaction with outdoor activity and stated that they were more likely to repeat the activity at a later date.
The senior author of the study, Professor Michael Depledge, Chair of Environment and Human Health at the ECEHH, added: “Some 75 per cent of the European population now live in urban environments, so that increasing efforts need to be made to re-connect people with nature via programmes such as the Green Gym and Blue Gym. Our research, which brings together data from a wide variety of sources, adds significant weight to the case for spending more time in the natural environment as members of the public and their clinicians fight to counteract the negative outcomes of modern living, such as obesity and depression. We look forward to conducting the further research and trials required to establish the evidence-base for introduction of outdoor activity into general lifestyle to complement therapeutic intervention.”
Mental health patients offered fishing therapy
Two hospitals in Scotland are offering their patients a chance to go fishing in the hope that it will be therapeutic. The sport, which is known to have a calming effect on people, is being undertaken by patients being treated in Greater Glasgow and Clyde. Some staff members from two mental health hospitals, Leverndale and Dykebar, already enjoy the benefits of fishing as a hobby. The idea to use it as a form of therapy was devised by nursing assistant John Kelly, from Leverndale, and David Potter and Mark Aitchison, nursing assistants from Dykebar.
By taking the patients to a relaxed environment, they hoped it would have a calming effect as well as tackle the stigma that some of them face.
Mr Kelly said: “We all find angling extremely therapeutic and thought that some of our patients would really benefit from it. We work with patients who have enduring mental health problems and long-term life limiting conditions and we wanted to do something for them that would improve their quality of life and provide a change to their everyday routine. We had brilliant feedback from our managers, who were quick to help us establish a plan – the results have surpassed all our hopes.” Staff take the patients to the fishery, the New Haylie Loch in Largs, in small groups once a week.
A– Apple collecting / picking, allotment
B – Badminton, Brisk walks, boules, baseball mitt and softish ball (for movie fans), beach, hut, big band days, barbeque days, bug palaces
C– Cycling, cricket, croquet, cottage garden
E– Ecotherapy, environmental awareness, exercise
F– Football, fresh air, fête, fruit picking, fishing, flower growing and picking, forest walks, forest garden, fruiting trees,
G– Gardening, golf with OT!!, gnome painting, green house
I– Igloo building (in the snow)
J– Jam making (with picked fruit)
L– Lemonade making / drinking on hot days
M– Miniature golf, model village
N– Nature walks
O– Outdoor therapy groups, outdoor gym, organic fruit and vegetables
P– Parachute games, pot plants, picnics, preserve nature, pond
Q– Quick jog around hospital grounds
S– Swimming outdoors, swingball, spacehoppers, sponsored walks, secret garden, seaside, sand, sport days, shaded borders
T– Table tennis
V– Visits to botanic gardens and parks
W– Water colour painting, walking groups, walks in woods and fields, wild-life, wild birds
Y– (model) yacht racing
Z– Zoo themed days
Lemos and Crane’s Acorn Awards are: “Using nature to improve and enhance the lives of vulnerable and socially excluded people.” The shortlisted projects are completely fabulous, and even just the titles give a really good feel for the richness of experience these provide for their service users, including prisoners.
- Abbeyfield Society, Cunningham House – The Great Outdoors
- Abbey Physic Community Garden
- About Turn CIC – About Turn Angling Academy
- Brent Lodge Park Art Collective
- Community Support Initiatives – Building Cohesive Families Using Nature
- Cwmbwrla Day Services – Organic Gardening and Beekeeping Project
- Dementia Adventure – Wandering in the Woods
- Derbyshire Mind – Enjoy Derby; Walking for Wellbeing
- East Kent Mencap – Bird Diaries
- Framework Housing Association – Gateway to Nature
- Future Roots – The Countrymen’s Club
- HMP Guys Marsh – Biodiversity Corridor
- Home Group – Mirehouse Community Garden
- Kairos Community Trust – Kairos Beekeeping
- King’s Reach – Trax
- Life Cycle UK – Two’s Company
- Newport City Homes – The Lliswerry Pond Project
- Octopus Community Network – Wild Places
- Poplar HARCA – Re(sidents)Cycling
- Plas Dwbl: Ruskin Mill Trust
- St Mungo’s (Bath) – The Big Grow
- The Hyde Group – The Enchanted Woodland
- Threshold – Gone Fishing
- Write to Freedom – Wilderness and Writing Weekend
What are the project’s objectives?
To provide inclusive environments that give a sense of identity and belonging and areas that would allow self-expression, evoke fun and laughter and would be used all year round. We wanted an environment where residents, families co-exist in a collaborative and autonomous community as well as play a part in the wider community. Our objective was also a project where personalisation is evident and the environment is tailored to the individual characters and preferences. And a project that encourages increased activity, mobility and discovery.
What are the project’s activities?
The activities are many and varied. Our very own seaside complete with beach hut, promenade, sand, sea and boat, transport the residents in time and memory to times they remember as well as give new experiences. So many activities can be themed round its use; picnic days, big band days, barbeque days, sport days. The list is endless whatever the season. A sunny day just lazing around reliving the memories. A balmy evening where the bands strike up or the sounds of waves and seagulls emit from hidden speakers. A windy day on the beach when some wrap up and wander along the shore or the promenade and then enjoy a warm drink or soup in the chalet.
We have a ‘Walk of Hollywood’ that brings a sense of peacefulness as they walk round the piano seeing the great artists of their day. In another area, a beautiful copper tree that is a water feature with water coming out of every leaf where residents can stop a while and absorb the soothing effect of nature.
The project encourages working with nature by growing things like grapes and then picking them so all can share or feed to the pet pigs as a treat! Growing flowers and picking them so they can be used in their flower arrangements that proudly decorate the home.
We back on to a forest so have much wild-life and residents preserve nature by feeding the wild birds and the peacocks, peahens and chicks. The flowers they pick on their forest walks, whether freely or in a wheelchair are then used for their activities. Some residents help with the feeding and care of the cat and two kittens whilst others are happy to just cuddle them or watch their antics.
Because of the positive effect the animals and wildlife had on everyone, it was decided we would look at different animals and, when put to the residents, they voted for….pigs! So we became home to two
mini-pigs recently who the residents have named, ‘Bonnie and Clyde’ The residents helped prepare the area and house and are always very eager to go out and see these tame and friendly animals several times a day and feed them.
Next to Bonnie and Clyde’s area is a windmill complete inside with nesting boxes and perches and recently we incubated eggs so we now have four young chicks. They have been very much handled and are very domesticated and are about to move into their deluxe coop and run. In time the residents will be able to collect the eggs. Residents and volunteers helped with all this from the planning to completion, from choosing names to anything that would enhance and improve their lives and give them a sense of belonging.
What has been the impact / achievement of the project?
These inclusive environments attracted, not just the residents but also, their families as well as the local community. No longer were we that place ‘at the end of the road’, but a place that people could visit and find a vibrant community. And of course the residents could enjoy the visitors, too. The children who visit from the local schools and the grandchildren who are excited about visiting. Families who now visit more often because conversations became easier as there are things to be involved in and talk about. We have seen a huge increase in well-being and increase in mobility and use of the outside space and a sense of belonging and purpose. Cunningham house has a residential unit and a dementia unit and this project has strengthened relationships so the person is seen first and not the frailty and the resident is seen first not the dementia as all these areas promote free expression. For our residents living with dementia, it has helped to greatly reduce challenging behaviour as it offers a diversion and something with meaning and no-one has the need for any psychotropic medication which can only enhance their quality of life.
For our frail elderly, the varied areas and stimulation and their engagement in them distracts them from their physical limitations.
What are your plans for developing the project further?
Because the animals have had such a positive effect on the whole community, we plan to develop this area more. Goats and ducks appear the favourites at the moment so there is much discussion going on about the next arrival. Activities around the seaside are endless and we will add anything that will give positive outcomes or develop it to incorporate new ideas.
We want to increase the variety of areas as there are lots of inlets of garden areas that can be enjoyed separately so there will be a surprise around every corner and something that will support and increase the personhood of everyone living here and make everyday matter.
How would you spend the winner’s prize of £1,000?
To further develop areas that are person centred and that will enhance and improve the lives of the residents living with us. We would like to develop an allotment with raised beds and a raised greenhouse and an outside workshop where residents can make or repair items. And have a little shop that residents can walk out to or be wheeled to if needed. But of course they would get the vote which the money would be spent on.
Outdoor exercise equipment, including fun kit which is as much about recreation as physical fitness, especially pieces which are used collaboratively.
Resources & REFERENCES
Sensory Trust – for ideas and help with enabling everyone to really enjoy the great outdoors.
The influence of nature on social, psychological and physical well-being. Advisory report by the Health Council of the Netherlands for the Minister of Agriculture, Nature and Food Quality (NL). (2004)
Health Benefits of Gardens in Hospitals. Roger S. Ulrich. Plants for People conference 2002
Mental health patients offered fishing therapy
Using nature to improve and enhance the lives of vulnerable and socially excluded people
Systematic review by a team at the Peninsula College of Medicine and Dentistry of the benefits to mental and physical well-being from taking exercise in the natural environment. Environmental Science and Technology. February 4th 2011.
Camden Council funky video on outdoor gyms:
Outdoor workouts in London parks