This section focuses on conducting a detailed and comprehensive review of existing literature based on the role of woodland-based recovery programmes in improving people’s mental health. The fundamental focus of this chapter is on exploring a number of arguments from other scholars on the implications of woodland activity in recovering people undergoing mental Illness.
Primarily, the author provides a critical discussion on woodland-based recovery programmes. Moreover, the problems relevant to mental health and their causes are critically explored. Other than that, this chapter highlights the benefits of woodland-based recovery programmes for people recovering from mental Illness.
Furthermore, the relevant literature based on the role played by woodland activity groups in easing the recovery process for people undergoing mental-health treatment is reviewed. To narrow the discussion, the meaning-making amongst the participants for woodland-based recovery programme is explored in this literature.
The contribution of horticulture-based therapies for the victims of mental health concerns is thoroughly discussed. In addition, an occupational perspective on mental health recovery in a woodland-based setting is provided, along with the significance or value of occupational therapy in addressing mental health problems. At last, the author provides a summary of key findings in the reviewed literature.
Conceptualising the Woodland-based Recovery Programme
In the research of Christie, Cole, and Miller (2020), the author alluded that woodland-based recovery programmes are commonly attended by people undergoing drug addiction treatment. In other words, these programmes help people with drug addiction connect with nature for rehabilitation (Ward et al., 2019). On the other hand, Goodenough, and Waite (2020a) reported that woodland-based recovery programmes are established to help people relieve stress and depression in their lives.
While acknowledging the previous statement, Goodenough and Waite (2020b) cited that a woodland-based recovery programme aids people in recovering from various kinds of mental illnesses. It was mentioned that woodlands rehab is more than just a way to heal from addiction; it is primarily a place to develop healthy connections in groups and on an individual basis. It helps many individuals gain productive skills that they never had or had neglected due to their addiction (Mmako, Courtney-Pratt, and Marsh, 2020). As per the views of Husk et al. (2016), the woodland-based recovery programme offers a peaceful and serene environment to the service users,
which helps them learn new skills for living a healthy life, free from all worries. To comprehend, the prior source added that woodland-based recovery programmes perform fundamental functions of building optimistic perceptions about life among the users and their value as individuals to live that life in the best possible manner.
Exploring the Mental Health Problems and their Causes
Mental disorder is a broad term that refers to a category of disorders that may impair a person’s thoughts, beliefs, mood, or actions. People with mental disorders experience complexities to manage their job, families, and other pressures (Iwata et al. 2016). While the connection between mental disorder and stress is uncertain, it is proven that stress can exacerbate a mental illness incident. Medication, therapy, or both can help certain people treat their mental condition (Cook, 2020).
The common causes of mental health problems were childhood trauma, abuse or neglect, grief, social isolation, long-term stress, loneliness, poverty or debt, chronic health condition and more (Christie and Cole, 2017; Coventry et al. 2019; Cole and Christie, 2016). Among many mental health problems, few of the most common ones are depression, bipolar affective disorder and anxiety disorders, which are explained below:
Depression is a psychological condition marked by a deterioration in mood, lack of motivation and pleasure, and decreased energy. It is not just a case of sadness. Depression comes in various forms and signs (Husk et al. 2016).
Depression manifests itself with various degrees of intensity and signs. Suicidal thoughts or behaviours are more likely found in people with depressive symptoms (Iwata et al. 2016). A disturbing or traumatic life occurrence, such as a death in the family, separation, sickness, unemployment, and work or financial worries, may trigger depression in some people (Cook, 2020).
Anxiety disorders are a category of mental illnesses marked by intense symptoms of panic and anxiousness. Anxiety is apprehension about what will happen in the future, whereas fear is a response to what is happening now (Iwata et al. 2016).
Physical effects such as elevated heart rate and disorientation can result from these emotions (Christie and Cole, 2017). Examples of an anxiety disorder include physical phobias, claustrophobia, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD) and more.
Bipolar affective disorder
Bipolar affective disorder (BPAD) is a form of personality disorder characterised by phases of mania and sadness. Psychotic signs may or may not be present in the person. While the precise cause is unclear, a genetic predisposition has been shown. Stressors in the environment will also set off instances of this psychiatric disorder (Coventry et al. 2019).
However, Cole and Christie, (2016) stated that BPAD is a mental condition characterised by extreme mood swings. Mood swings can come from manic depression, which can last for weeks. Patients who are depressed often feel sad, guilty, have no appetite, have insufficient sleep, and cannot enjoy themselves (Iwata et al. 2016).
The Benefits of Woodland-based Recovery Programme for people recovering from Mental Illness
It has been claimed by Goodenough and Waite (2020b) that woodlands provide a peaceful and relaxing atmosphere in which a person can exercise to relax their tension. Physical conditions like high blood pressure and overweight, as well as emotional symptoms like fatigue and depression, are relieved from walking through the woods.
An increasing body of research suggests that woodland-based rehabilitation activities provide a range of social advantages in addition to the more apparent social and environmental ones. Mental and physical fitness and cultural and social gains are among them (Mmako, Courtney-Pratt, and Marsh, 2020). Working to preserve woodlands, as well as cycling and walking, are also examples of woodland-based activities.
There is a “Green Gym” initiative run by the British Trust for Conservation Volunteers exclusively for exercise. However, various other initiatives can help with physical activity while still exploring the woods (Ward et al. 2019). In the context of mental illness recovery, Christie, Cole, and Miller (2020) suggested that woodlands-based recovery programmes are also considered to help people improve their psychological health and well-being. The prior source expanded that horticulture therapy and Tai Chi are two of the most prominent activities performed at woodland-based recovery programmes that aid people in improving their mental health.
The Role of Woodland Activity Group in Recovering People with Mental Ill-health
According to Cole and Christie, (2016), the very different benefits of trees and forests for human wellbeing and fitness are becoming more widely recognised. From carbon capture and flood control and air and water pollution reduction, there are many health benefits as well. From the investigation of Goodenough, and Waite (2020a) it was explored that woodland activity group primarily connects and influences them to open up and express their pain to help them recover from certain mental Illness.
To narrow the prior opinion, Cook (2020) comprehended that woodland activity suggests exercise and aerobic techniques that facilitate people in improving their mental health. On the other hand, it was revealed that social interaction has been one of the productive approaches employed by woodland activity group to improve the recovery of people undergoing mental Illness (Husk et al. 2016).
In contrast, it has been justified by Coventry et al., (2019) that exploring the beauty of woodland atmosphere relieves the stress and depression among the people undergoing the mental Illness and woodland activity group does not play any specific role in it.
In the investigation of Husk et al. (2016), the author asserted that woodland activity groups primarily promotes green exercise among the people, which diverts the attention of people suffering from mental Illness from their condition while enhancing their recovery. Considering the opposing opinion from Iwata et al. (2016),
which indicated that woodland activity group share their experiences of mental health or addiction recovery with new participants that encourages them to partake in green exercise and other types of activities performed at woodland-based recovery programmes. However, Cook (2020) argued that the woodland activity group simply improves visitors’ well-being. They simply initiate activities such as biking, dog walking, picnic and more, which directly or indirectly develops positive mood among the people while reducing their stress and depression.
The Meaning-Making amongst Participants for Attending Woodland-Based Recovery Programme
It has been described by Christie and Cole (2017) that participants of woodland-based recovery programme tend to find new and optimistic perspectives by partaking in various activities like green exercise, horticulture therapy and more. The source as mentioned earlier elaborated the meaning-making process depends on the effect woodland-based recovery programmes have on participants’ mental health. From the investigation of Coventry et al. (2019),
it was explored that participants could explore their inner self and desires from woodland-based recovery programmes, which were blocked due to post-traumatic stress. Furthermore, a self-determination to improve their well-being was developed through woodland-based recovery programmes. It has been explored that the meaning-making of preserving the environment and nature was also identified in a few of the studies based woodland-based recovery initiatives (Cole and Christie, 2016).
However, Christie, Cole, and Miller (2020) claimed that meaning making of enhancing the quality of life was found among certain participants attending woodland-based recovery sessions.
Horticulture or Green Care as a Source of Mental Health Recovery
Green Care is a broad term that refers to various clinical approaches, including farm animal-assisted treatment, horticultural rehab, and specific farm-based treatments (Ward et al. 2019). In the research of Goodenough, and Waite (2020a), the author justified that horticulture has played a significant role in improving people’s mental health recovery.
As per the research results above, participants showed a substantial increase in mood and significantly higher levels of interest and creativity when they got involved in planting activity. Affirming the prior argument, Mmako, Courtney-Pratt, and Marsh (2020) cited that gardening has been shown to relieve stress, enhance mood, and minimise symptoms of stress and depression.
In a similar context, the report of Husk et al. (2016) highlighted that based on the data gathered, it was discovered that just looking out a window at greenery would make people relax and alleviate levels of stress. Other research has shown that gardening is a good physical practice for mental health.
The research participants in Iwata et al. (2016) study noted that horticulture activities provide inner satisfaction to the people, which help them go through their mental Illness. In other words, it was unveiled that horticulture activities offer therapeutic benefits to people with mental health concerns, which directly improves their well-being and build positive outlook on healthy lifestyle (Goodenough and Waite, 2020b).
The findings from one of the studies identified that horticulture’s medicinal importance emerged from a complicated interrelationship of personal aspects such as gender-based desires, human values, and societal needs (Cook, 2020). Agreeing to the prior results, Christie and Cole (2017) indicated that horticulture therapy has been one of the emerging technology that uses planting and cultivation to enhance the cognitive and physiological health of individuals dealing with mental illnesses. It combines the dynamic scientific advantages of being in nature (Coventry et al. 2019).
Horticulture therapy, in addition to the more conventional methods of medicine and psychotherapy, may help people develop consciousness and social relationships (Cole and Christie, 2016).
Occupational Perspective on Mental Health Recovery in a Woodland Based Setting
The theory of healing and wellbeing is aligned with a consumer-focused and consumer-inclined action ideology (Christie, Cole, and Miller, 2020). With the use of fieldwork arrangement between the mental wellness facility and an occupational therapy development programme, occupational therapy has been given wide recognition in addressing mental health concerns for various people (Ward et al. 2019).
In the research of Goodenough and Waite (2020b) one of the occupational therapists reported that woodland-based setting helps an individual connect with the natural world and surrounding atmosphere that provides evidence of liveliness, enabling them to develop a purpose for their mental health recovery.
From another perspective, it was mentioned that healthcare professionals must move from a clinical to a recovery-oriented approach to comply with universal mental health policies (Mmako, Courtney-Pratt, and Marsh, 2020). However, there is a substantial lag between strategy and implementation. Occupational therapists have been described as being well-positioned to be recovery-oriented, but there is weak data into how they do so (Husk et al. 2016).
Prominence and Value of Occupational Therapy Approach in Addressing Mental Health Problems
Since occupational therapy philosophy and recovery-oriented concepts are sufficiently related, occupational practitioners have been consistently recognised as the best people to help people transition to recovery-oriented practise (Goodenough, and Waite, 2020a). Both client-centred occupational therapy and recovery-centred practise emphasise independence, preference, strong clinical relationships, and integration (Iwata et al. 2016).
To comprehend on the value of occupational therapy in resolving the issues of mental health among the service users, the study of Cook (2020) is cited, which reflected that occupational therapy has its foundations in mental health, when the practice was established at the same time as the early twentieth-century mental wellness revolution. Acknowledging the prior statement, Christie and Cole (2017) alluded that there has been a transition in the concept of care delivery as programmes for people with mental disorder have moved from the institution to the local communities. Previously,
the scientific method was followed; currently, the emphasis is on incorporating the rehabilitation model. This model emphasises that regeneration is a long-term journey with full engagement in-group events as the primary objective (Coventry et al. 2019).
There has been a long debate on whether occupational therapy delivered positive health-related outcomes, especially for the patients undergoing mental health treatment. However, sufficient evidence has verified that occupational therapy integrated the rehabilitation model,
which enables service users to take a long-term journey in horticulture therapies or woodland-based recovery programmes to recover their mental Illness (Cole and Christie, 2016). The study of (Cook, 2020) supported the prior argument by highlighted that occupational rehabilitation approaches have been shown to increase experiences for people with chronic mental Illness who live in the local community. Learning, job, skills acquisition, fitness and wellbeing, and behavioural restoration and adjustment are examples of such therapies (Iwata et al. 2016). In addition,
it was revealed that occupational therapy could help people of all ages who have been diagnosed with a psychiatric disorder. Friends and relatives would also thrive from these programmes by learning how to cope with the burden of providing care and managing their everyday obligations so that they can continue to live happy and fulfilling lives (Husk et al. 2016).
As mentioned earlier, the key focus of this literature was on exploring the role of woodland-based recovery programmes and occupational therapy in addressing mental illness issues among people. The author has utilised the psychodynamic theory and humanistic psychology to appraise the theoretical underpinning of this investigation.
In the wider context, psychodynamic psychology is a branch of neuroscience that focuses on the systemic investigation of the psychological influences that underpin human actions, thoughts, and feelings and how they can be related to early experiences (Berzoff, Flanagan and Hertz, 2021). To comprehend,
Pitman and Knauss (2020) reported that psychodynamic theory describes personality characteristics of implicit neurological mechanisms such as desires and impulses that an individual is unaware of, and asserts that early experiences are critical in defining personality development. The clinical understanding of behavioural and emotional phenomena is known as psychological therapies. It is based on object interaction, ego psychology, and self-neuroscience and is embedded in conventional psychoanalytic theory (Zerbe, 2015).
Humanistic psychology is a philosophical perspective that emerged in the mid-twentieth century as a response to the shortcomings of Sigmund Freud’s psychoanalysis and B. F. Skinner’s behaviourism (Pincus, Kiefer and Beyer, 2018). In addition, it was explained by DeRobertis (2016) that the humanistic perspective stresses an individual’s importance, the meaning of human ideals, and the inventive, creative disposition of humans.
The method is constructive and emphasises humanity’s admirable potential to transcend adversity, suffering, and depression (Wong, 2017). From another perspective, it was identified that humanistic psychology emphasises ideas like freedom, personal self, and self-actualisation, as well as a holistic view of the personality. Humanistic psychology, rather than focusing on disorder, aims to help individuals reach their full capacity and achieve optimal well-being (Duff, Rubenstein and Prilleltensky, 2016).
Humanistic psychology was developed to support developmental philosophies such as Maslow’s needs hierarchy, under which a person strives for self-actualisation. Furthermore, it relates to Erikson’s later phase of older years, ego dignity versus depression, and several psychological techniques that seek to examine and value individuals’ perceptions as individuals and the definitions they assign to certain events.
Potential Gap Dealt through this Research.
As identified earlier, this study sought to explore the role of the woodland activity group in enhancing the recovery of people undergoing mental Illness. From the identified literature, it was discovered that most healthcare practitioners either prescribe medicines or encourage therapractic approaches.
There was weak literature on the effectiveness of woodland-based recovery programme in treating mental Illness among people. Therefore, this investigation has been centred towards analysing the role of woodland-based initiatives such as green care or horticulture in helping people recover from mental illnesses.
In this chapter, the author conducted the thorough review of existing literature based on mental health problems, woodland recovery approaches as well as role of occupational therapy in enhancing health-related implications for people suffering from mental illnesses. Furthermore, this section provided extensive benefits of participating in woodland-based recovery programmes, especially for people with mental health issues.
Other than that, the literature on horticulture therapy and green care has been discussed, which significantly contributed in mental health recovery of several individuals. After conducting the comprehensive review of existing literature, it was uncovered that most people with mental Illness are prescribed to partake in horticulture therapy and woodland-based recovery programmes as these have notable implications for improving mental health of people.
The findings indicated that individuals with mental illnesses tend to find a purpose for rehabilitation through social interaction and interaction with the natural environment. However, occupational perspective suggested that horticulture therapies enable individuals to surround themselves with positive elements such as garden and planation, which gives them optimistic vibes, contributing to developing positive viewpoints towards life and their well-being.
Berzoff, J., Flanagan, L.M. and Hertz, P. eds., 2021. Inside and outside: Psychodynamic clinical theory and psychopathology in contemporary multicultural contexts. Rowman & Littlefield.
Christie, M., Cole, F. and Miller, P.K., 2020. A piloted Think Aloud method within an investigation of the impacts of a therapeutic green exercise project for people recovering from mental ill-health: Reflections on ethnographic utility. Journal of Therapeutic Horticulture, 30(1), pp.36-55.
Christie, M.A. and Cole, F., 2017. The Impact of Green Exercise on Volunteers’ Mental Health and Wellbeing–Findings from a Community Project in a Woodland Setting. Journal of Therapeutic Horticulture, 27(1), pp.16-33.
Cole, F. and Christie, M., 2016. Occupational engagement in a woodland: belonging and wellbeing for mental health.
Cook, M., 2020. Using urban woodlands and forests as places for improving the mental well-being of people with dementia. Leisure Studies, 39(1), pp.41-55.
Coventry, P.A., Neale, C., Dyke, A., Pateman, R. and Cinderby, S., 2019. The mental health benefits of purposeful activities in public green spaces in urban and semi-urban neighbourhoods: A mixed-methods pilot and proof of concept study. International journal of environmental research and public health, 16(15), p.2712.
DeRobertis, E.M., 2016. On framing the future of humanistic psychology. The Humanistic Psychologist, 44(1), p.18.
Duff, J., Rubenstein, C. and Prilleltensky, I., 2016. Wellness and fairness: Two core values for humanistic psychology. The Humanistic Psychologist, 44(2), p.127.
Goodenough, A. and Waite, S., 2020a. Natural Sources of Psychological Wellbeing. In Wellbeing from Woodland (pp. 133-159). Palgrave Macmillan, Cham.
Goodenough, A. and Waite, S., 2020b. Woodland Wellbeing. In Wellbeing from Woodland (pp. 9-39). Palgrave Macmillan, Cham.
Husk, K., Lovell, R., Cooper, C., Stahl‐Timmins, W. and Garside, R., 2016. Participation in environmental enhancement and conservation activities for health and well‐being in adults: a review of quantitative and qualitative evidence. Cochrane Database of Systematic Reviews, (5).
Iwata, Y., Dhubháin, Á.N., Brophy, J., Roddy, D., Burke, C. and Murphy, B., 2016. Benefits of group walking in forests for people with significant mental ill-health. Ecopsychology, 8(1), pp.16-26.
Mmako, N.J., Courtney-Pratt, H. and Marsh, P., 2020. Green spaces, dementia and a meaningful life in the community: a mixed studies review. Health & Place, 63, p.102344.
Pincus, D., Kiefer, A.W. and Beyer, J.I., 2018. Nonlinear dynamical systems and humanistic psychology. Journal of Humanistic Psychology, 58(3), pp.343-366.
Pitman, S.R. and Knauss, D.P., 2020. Contemporary Psychodynamic Approaches to Treating Anxiety: Theory, Research, and Practice. Anxiety Disorders, pp.451-464.
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Appendix: CASP Appraisal Tool
Flowchart of Inclusion/Exclusion Criteria and Databases Searched for Literature Review
|(Christie, Cole, and Miller, 2020)||‘A piloted Think Aloud method within an investigation of the impacts of a therapeutic green exercise project for people recovering from mental ill-health: Reflections on ethnographic utility’||Provided extensive arguments on the role of woodland therapy in improving recovery process for people mental ill-health||Many arguments seemed supportive towards therapeutic green exercise, without any drawbacks on it.|
|(Ward et al. 2019)||‘Enhancing Health Through Access to Nature: How Effective are Interventions in Woodlands in Deprived Urban Communities? A Quasi-experimental Study in Scotland, UK’||Discussed strong arguments on the role of nature and woodland programmes in improving the health of deprived urban communities in the UK||Limited evidences were provided based on the contribution of woodland programmes in recovery of mental health of deprived urban communities|
|(Goodenough, and Waite, 2020a)||‘Natural Sources of Psychological Wellbeing’||Comprehensive discussion on sociocultural and natural environment was provided, which helped the author in comprehending the role of nature in improving the overall psychological wellbeing of an individual.||Limited empirical evidences were discussed that can justify the claims made by the authors.|
|(Goodenough and Waite, 2020b)||‘Woodland Wellbeing’||This research looked at the increasing body of research that shows a connection between our exposure to plants, woodland, and forests and our wellbeing and happiness.||The study lacked in providing sufficient gaps in existing literature that could verify the impact of woodland on human health.|
|(Mmako, Courtney-Pratt, and Marsh, 2020)||‘Green spaces, dementia and a meaningful life in the community: A mixed studies review’||The effects of green space interaction on the views of people living with dementia in the city were investigated in this mixed research analysis.||The study lacked in supporting the claim that to empower people coping with dementia, future studies should explore flexible methodological approaches.|
|(Husk et al. 2016)||‘Participation in environmental enhancement and conservation activities for health and well‐being in adults: a review of quantitative and qualitative evidence’||The study used the mixed design to determine the effects of environmental restoration and conservation practises on adults’ health and well-being.||The characteristics of participants were misreported; eight researches did not include gender or age, but none included socioeconomic status.|
|(Iwata et al. 2016)||‘Benefits of group walking in forests for people with significant mental ill-health’||Centred on a pilot programme in Ireland, this research looked at the impact of group walking in woods for people with serious mental Illness, such as depression, bipolar disorder, and anxiety disorders.||The study provided limited literature review on the topic, which created a gap in proving the results generated in the findings of this study.|
|(Cook, 2020)||‘Using urban woodlands and forests as places for improving the mental well-being of people with dementia’||Using phenomenology, participative action studies, and case study methods, this study explores the nature and usage of residential woodlands and trees, as well as how they can lead to the better mental well-being of people with dementia||There were no significant limitations found in this research|
|(Christie and Cole, 2017)||‘The Impact of Green Exercise on Volunteers’ Mental Health and Wellbeing–Findings from a Community Project in a Woodland Setting.’||The medicinal value of nature on mental health and wellness is backed up by a growing body of research. The increase in diagnosed mental Illness around the world has significant ramifications for the efficient use of healthcare resources as well as economic repercussions.||The study was limited in terms of providing statistical or quantitative evidence to appraise the validity and reliability of the results.|
|(Coventry et al. 2019)||‘The mental health benefits of purposeful activities in public green spaces in urban and semi-urban neighbourhoods: A mixed-methods pilot and proof of concept study’||Access to and engagement to community green space can be important for mental health development and protection. However, it is unclear if various practises in community green space are correlated with specific health and mental wellbeing outcomes.||The generalisation of results from the thematic analysis was weak, which contributed in drawing the vague conclusion|
|(Cole and Christie, 2016)||‘Occupational engagement in a woodland: belonging and wellbeing for mental health.’||While extensive research backs up the importance of horticulture, green exercise, and the impact of nature on wellness, some individuals in mental health rehabilitation do not see organised and standardised programmes as available.||This research, on the other hand, was conducted in an unofficial rural area that offered conservation and horticultural practices, which affected the truthfulness of results presented.|
Table of Key Words and Search Terms
|(Mental Health Issues OR Mental Illness OR Mental Disorders)|
|(Woodland-based Recovery Programmes OR Woodland Activity OR Woodland Rehabilitation)|
|(Mental Health Recovery OR Mental Rehabilitation OR Psychological Healing)|