Beyond Blue to Green

beyondblue: the national depression initiative Beyond Blue to Green: The benefits of contact with nature for mental health and well-being Mardie Townsend and Rona Weerasuriya Beyond Blue to Green: The benefits of contact with nature for mental health and well-being The benefits of contact with nature Beyond Blue to Green: Project conducted by For more information www.beyondblue.org.au or beyondblue info line 1300 22 4636 © Copyright Beyond Blue Limited 2010. All rights reserved. Associate Professor Mardie Townsend, PhD Associate Dean (International and Development) Faculty of Health, Medicine, Nursing and Behavioural Sciences Deakin University 221 Burwood Highway Burwood VIC Australia 3125 [email protected] Suggested citation: Townsend M and Weerasuriya R. (2010). Beyond Blue to Green: The benefits of contact with nature for mental health and well-being. Beyond Blue Limited: Melbourne, Australia. Edited by RaggAhmed www.raggahmed.com This review was funded by beyondblue: the national depression initiative. ISBN 978-0-9581971-6-8 Beyond Blue to Green: The benefits of contact with nature for mental health and well-being beyondblue: the national depression initiative i Contentst 1. Introduction 1 1.1 Definitions 3 1.2 Examining past and present trends in humans’ contact with nature 4 2. Methodology 7 2.1 Literature search strategy 7 2.2 Selection of articles for the review 8 2.3 Analysis 8 3. Prevailing theories linking well-being and contact with nature 9 3.1 The biophilia hypothesis 9 3.2 Attention restoration theory 11 3.3 Stress reduction theory 12 3.4 Environmental self-regulation hypothesis 13 3.5 The bio-ecological model 13 3.6 The relaxation response 14 3.7 Maslow’s hierarchy of needs 14 4. Health benefits associated with contact with nature 17 4.1 Introduction 17 4.2 Research linking nature contact with health and well-being 18 4.3 Mental health and well-being benefits from contact with nature 28 5. Therapeutic contact with nature and its mental health and well-being benefit 39 5.1 Therapeutic landscapes 39 5.2 Local parks and green spaces as settings for therapeutic nature contact 41 5.3 Forests and woodlands as settings for therapeutic nature contact 43 5.4 Gardens as a setting for therapeutic nature contact 45 5.5 Specific therapeutic approaches using nature contact 50 5.6 Contact with animals 62 6. Dimensions of mental health positively affected by nature contact 83 6.1 Relaxation, restoration and stress reduction 85 6.2 Attention deficit hyperactivity disorder (ADHD) and attention deficit disorder (ADD) 89 6.3 Acquired Brain Injury 90 6.4 Cognitive functioning: concentration and attention fatigue 91 6.5 Mood: depression, anxiety, aggression, anger and humour 92 6.6 Impact on physiological processes underpinning mental health 93 ii Beyond Blue to Green: The benefits of contact with nature for mental health and well-being 7. Other links between nature and mental health and well-being 95 7.1 Physical activity 95 7.2 Social connectedness and interactions 99 8. Climate change and mental health 103 8.1 Underlying impacts of climate change for mental health and well-being 104 8.2 Connections between contact with nature, environmentally sustainable stewardship and mental health 106 9. Urban environments: the relationship with mental health and well-being 111 Appendix A—List of books used during the literature search 114 Appendix B—Potential benefits from outdoor play and adventure 117 in natural settings Appendix C—Key assertions 118 Appendix D—Examples of goals and strategies to address 122 mental health concerns Appendix E—English terminology in the literature and in practice 127 Appendix F—Impacts and benefits of ‘offenders and nature’ schemes 128 References 130 iii Beyond Blue to Green: The benefits of contact with nature for mental health and well-being iv Photo: VicHealth 1. Introduction Thousands of tired, nerve-shaken, over civilised people are beginning to find out that going to the mountains is going home; that wildness is a necessity; that mountain parks and reservations are useful not only as fountains of timber and irrigating rivers, but as fountains of life. John Muir 1901 This quote, from the founder of the Sierra Club, the largest grassroots environmental organisation in the USA, highlights the fact that mental exhaustion, assumed to be a common outcome of everyday life in modern societies, is not new. Of much greater importance, however, is that he reminds us of the human need for contact with nature and of nature’s capacity to benefit not only our physical needs but our psychological well-being as well. This report, commissioned by beyondblue: the national depression initiative (beyondblue), provides a review of existing Australian and international literature on the links between mental health and well-being and contact with nature, especially through green spaces. The evidence included in the review has been drawn from a range of sources including relevant electronic databases, peer-reviewed journals and grey literature. In contrast to past reviews, which have been broader in scope, the major focus of Beyond Blue to Green is on the links between parks and other green open spaces and mental health, in particular depression 1 and anxiety. While the review mainly concentrates on the most recent literature, where it is relevant (for example, to demonstrate changes in attitudes and understandings), older literature from earlier reviews has been included. The conviction that contact with nature—for example through viewing landscapes that contain vegetation, water and other natural features—ameliorates stress and benefits humans in general, including patients in healthcare settings, is evident as far back as the earliest documented histories of China, Greece and Persia (Velarde et al. 2007, p. 49). The earliest hospitals in Europe were situated in monasteries which typically included cloistered gardens, providing “relief to the ill” (Velarde et al. 2007, p. 200). However, approaches to health have become increasingly technical since that time, leading to a decline in recognition of nature’s healing role (Velarde et al. 2007). Since the early 1980s, environmental psychologists have studied the health effects of contact with nature (Nielsen and Hansen 2007). At the same time, models that promote ecological health have informed the development of strategies such as “healthy cities”, “healthy schools” and “healthy workplaces” which recognise the importance of natural environments for human health and well-being (Burls 2007b). Nevertheless, until recently even within these strategies, the major focus has been on the health effects of environmental degradation, with little attention paid to environmental deprivation (Townsend and Ebden 2006). In the 1980s, the Ottawa Charter for Health Promotion (World Health Organization 1986) noted that “the fundamental conditions and resources for health are peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice and equity”. Over the past two decades, there has been a growing acknowledgement that humans depend on nature not simply for material requirements such as water, food and shelter but also for emotional, psychological and spiritual needs (Friedmann and Thomas 1995; Frumkin 2001; Katcher and Beck 2006; Wilson 2001). The recent past has seen researchers across a range of disciplines, including environmental health, public health policy, psychiatry, land use planning, horticulture, leisure, recreation and wilderness, contributing to the accumulation of evidence that supports the notion that contact with nature is beneficial for human health and well-being (Maller et al. 2006; Wells and Evans 2003). Based on this evidence, efforts have been made to improve quality of life in neighbourhoods and cities (Diener et al. 2006) through interventions such as increasing access to natural settings. While the major focus of this report is on green spaces and mental health, other nature-based approaches such as wilderness therapy, ecotherapy, ecopsychology, adventure therapy, horticulture therapy, animal-assisted therapy and garden therapy are also discussed in this review. A growing body of research evidence has supported these approaches for their ability to enhance health and well-being, skills and behaviours as well as reduce the risks of ill health (Pryor et al. 2006). Identifying environments as “living entities” (Parr 2007, p. 539) which are intimately involved with humans, the powerful agency of nature as an “actively shaping force” (Parr 2007, p. 539) is considered in this report in relation to a variety of populations. Beyond Blue to 2 Green aims to explore the evidence on the human–nature relationship and to understand Beyond Blue to Green: The benefits of contact with nature for mental health and well-being the ways in which nature helps to mitigate or even prevent mental health related issues and challenges faced by society today. 1.1 Definitions Nature is defined as “an organic environment where the majority of ecosystem processes are present (e.g. birth, death, reproduction, relationship between species)” (Maller et al. 2006, p. 46). Nature also refers to “any single element of the natural environment (such as plants, animals, soil, water or air), and includes domestic and companion animals as well as cultivated pot plants” (Maller et al. 2006, p. 46). Nature can also refer “collectively to the geological, evolutionary, biophysical and biochemical processes that have occurred throughout time to create the Earth as it is today” (Maller et al. 2006, p. 46). Nature has been subdivided into the following categories by the Health Council of the Netherlands and Dutch Advisory Council for Research on Spatial Planning Nature and the Environment ([HCNDACRSP] 2004, p. 25): • Urban nature: nature in urban settings (e.g. gardens, parks, leisure parks) • Agricultural nature: a primarily agricultural landscape with small, set-aside patches of nature • Natural forests: nature in woodland where management is geared towards more authentic vegetation • Wild nature: nature in an environment that develops spontaneously and can be maintained with minimal management (natural rivers, marshy woodlands, etc.).

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