Greenspace and mental wellbeing: the evidence

1. Greenspace and mental wellbeing: the evidence Amy Stewart Branching Out Seminar 15th September 2010 Pollock House, Glasgow

2. Introduction • Access to greenspace has been shown to encourage higher levels of physical activity which is beneficial to population health in many ways • Physical activity also has mental health benefits and physical activity in greenspaces may actually be more beneficial than activity in less natural settings • Greenspace also has restorative value through more passive usage or views • Greenspaces can help individuals to experience increased levels of social interaction and integration

3. Contents • The state of the nation • What is mental health? • How can greenspace help? • Chopwell Woods project • Restoration and stress reduction • Public perception in Scotland • Restoration and cognitive functioning • Mental health and greenspace • Ecotherapy and civic environmentalism • Social interaction, greenspace and mental health • Limitations in evidence

4. The State of the Nation • 1 in 6 adults have mental health problems at any one time • For half these people the problem will last more than a year • Around 1 in 4 people will suffer from some form of mental illness at some point in their lives • By 2020, depression will be the second largest single cause of ill health • In urban areas incidences of depression, psychiatric morbidity, alcohol and drug dependence are higher • According to the Sustainable Development Commission, mental health in England costs the country £76 billion per year (£12 billion on health and social care, and £64 billion in terms of the wider economy) • Edwards et al. (2009) estimate that the cost to society of mental illness in Scotland to be over £2000 million in 2007/08 prices

5. What is Mental Health? • The Department of Health assert that mental health is: ‘more than the absence or management of mental health problems; it is the foundation for well-being and effective functioning for individuals and their communities’ • The Scottish Government’s Towards a Mentally Flourishing Scotland: Policy and Action Plan 2009-2011 notes that: ‘Our approach is based on a social model of health which recognises that our mental state is shaped by our social, economic, physical, and cultural environment, including people's personal strengths and vulnerabilities, their lifestyles and health-related behaviours, and economic, social and environmental factors’.

6. How can Greenspace Help? Complexity of health and well-being Natural and built environment part of wider determinants of health (Barton and Grant 2006)

7. How can Greenspace Help? • Around 93% of General Practioner’s admit that they have prescribed antidepressants against their better judgement due to a lack of alternative treatments • There is strong evidence which suggests that green spaces have a beneficial impact on mental well-being and cognitive function through both physical access and usage, as well as through access to views. • In particular greenspaces have been shown to provide a restorative environment which helps alleviate stress and mental fatigue. • While the potential benefits of green space for physical health may be significant, ‘it is the restorative effects of greenspace and contacts with nature where evidence is most compelling’ (Croucher, K. et al. The links between greenspaces and health: a critical literature review. Greenspace Scotland, Stirling)

8. Chopwell Wood Health Project Chopwell is a 360 hectare mixed woodland on the border between Gateshead and Derwentside in North East England • GP referral scheme (Gateshead) - tai chi, cycling, walking, conservation work • School visits as part of Healthy School Standard (Derwentside)

9. Pre and Post Project Evaluation Methods: Questionnaires to school pupils and staff pre and post woodland sessions, focus groups with teachers and with GP referrals, on site survey of woodland users Results: • 229 children and a number of staff made 4 visits each to wood • Significant increase in percentage of children regarding the wood as a ‘healthy place’ post project from 74% to 87% • 33 referrals to Chopwell, 91% completed the 13 week programme and majority continued to participate after project completion • A further 128 got involved in activities encouraged by project leader • 60% thought that visiting had an impact on health through undertaking physical activity and 40% thought that visiting had an impact on both their mental and physical health. • 99% of visitors in survey felt that visiting Chopwell Wood has a positive impact on their health and well-being

10. Restoration and stress reduction • Passive or less strenuously active contact with greenspaces can also be psychologically and physiologically restorative • An experiment where 112 participants were randomly assigned to a gentle walk in either an urban or a natural setting provided evidence of the positive impact of natural settings on improved attention functioning, emotional gains and lowered blood pressure (Hartig et al. 2003. Tracking restoration in natural and urban field settings. Journal of Environmental Psuchology 23: 109-123)

11. Restoration and stress reduction • An American study found that people living in urban public housing close to vegetation, were significantly more effective in managing major life issues and better equipped to cope with stress. (Kuo, F. E. 2001. Coping with poverty: Impacts of environment and attention in the inner city. Environment and Behaviour 33: 5-34) • A study focusing on patients recovering from surgery in a hospital found that those with a view of nature healed faster than those without such a view. (Ulrich, R. S. 1984. View through a window may influence recovery from surgery. Science 224: 420-421) • An experimental study which involved participants watching a stress inducing video followed by either a video of natural settings or urban settings found that those who viewed the natural settings had a significantly better recovery from stress. (Ulrich et al. 1991. Stress recovery during exposure to natural and urban environments. Journal of Environmental Psychology 11: 201-230)

12. Restoration and stress reduction • People have a well-developed awareness of the stress reducing benefits of nature. • A large postal survey in Sweden found that when asked what they would recommend to a friend who was feeling stressed and worried, taking a walk in the forest was ranked highest by most respondents. • This study also found that statistically significant relationships were found between the use of urban greenspaces and self-reported experiences of stress. (Grahn, P. and Stigsdotter, U. A. 2003. :Landscape planning and stress. Urban Forestry and Urban Greening 2 (1): 1-18)

13. Scottish Public Perception • The 2009 Scottish Public Opinion of Forestry survey involved interviews with 1,040 adults.

14. Forestry for People Study What? : Project carried out for Forestry Commission Scotland 2006- 2008 to quantify and describe the social and economic benefits of Scottish forestry to the people of Scotland How? Survey of 1,015 representative sample of Scottish population Mental health related findings: • An approximate estimate for the annual value of the physical and mental health benefits of Scottish woodlands is calculated to be between £10 million and £111 million at 2007/08 prices • 82% agree that woodlands are places to reduce stress and anxiety

15. Restoration, Cognitive Functioning and Mental Health • Two studies looking at children aged 7-12 found that greenspace can have a beneficial impact on concentration and on the ability to focus attention. (Taylor et al. 2001. Coping with ADD: The surprising connection to green play setting. Environment and Behaviour 33 (1): 54-77; Wells, N. M. 2000. At home with nature: Effects of ‘greenness’ on children’s cognitive functioning. Environment and Behaviour 32: 775-795) Intensity of restorative experience was greatest for those with the worst mental health Roe, J et al. 2009. Forest School. Evidence for the restorative health benefits in young people

16. Greenspace and mental health • A large-scale study of around 17,000 inhabitants looked at self-reported health data and land use data and found that living in a greener area was positively related to self-reported mental health (de Vries et al. 2003. Natural Environments – healthy environments? An exploratory analysis of the relationship between greenspace and health. Environment and Planning A 35 (10): 1717-1731) • A postal survey in Greenwich confirmed an association between the physical environment and mental well-being. (Guite et al. 2006. The impact of the physical and urban environment on mental well-being. Public Health 120 (12): 1117-1126

17. Ecotherapy • Ecotherapy is the name often given to the green agenda for mental health whereby people are engaged in greenspace-based activities as part of their treatment programme. • One study found that for 90 per cent of people involved in a green exercise programme the combination of nature and exercise was the most important factor in determining how they felt. (MIND, 2007. Ecotherapy: The Green Agenda for Mental Health. Mind week report, May 2007. http://www.mind.org.uk/mindweek • Another study looking at the effects of horticulture projects on 137 people with severe mental health problems found that they had multiple positive beneficial effects. (Sempik et al. 2005. In touch with the earth. Mental Health Today 23: 6)

18. Civic environmentalism • Townsend (2006) evaluated the impacts of participation in civic environmentalism for people suffering from depression and concluded that there are significant benefits, but not just for mental health. • Factors that can make it difficult for people with depression to get involved in such activities: • Shyness • Fear of stereotyping (greenie) • Relative openness and accessibility of groups • Lack of recognition of health benefits • Lack of awareness of groups and how to get involved • Busy lifestyles • Practical issues such as lack of transport and childcare • Greater access might be facilitated through diversity training among support group leaders, greater promotion of health benefits of forest activities among support groups and medical practioners, and provision of practical support

19. Social interaction, mental health and greenspace • Initiatives in groups also provide benefits in terms of social interaction between participants which can further enhance mental well-being and help reduce feelings of social exclusion • A study using ‘adventure therapy’ with nine people with severe mental health problems found that participants changed dramatically when introduced to nature (Surridge et al. 2004. cited in Davies and Deavillle. 2008. Natural Heritage: A Pathway to Health – CCW Policy Research Report 07/20. Countryside Council for Wales.

20. Limitations to the evidence • Causal relationships between the components of urban greenspaces and health are not easy to establish. • Majority of studies self-reported data using questionnaires • However, while in the minority, other studies that use objective measurements do exist and their findings confirm the self-reported data.

21. Thank you for listening! Please visit our website to find out more about our work www.forestresearch.gov.uk/peopleandtrees