Mental health, wellbeing and the natural environment: case studies of four areas in England
Sally Brammall, Amanda Norrlander, Kandy Sisya and Louisa Thomson Renaisi May 2020 Mental health, wellbeing and the natural environment: case studies of four areas in England
Table of contents
1. Introduction ...... 1
2. Birmingham case study ...... 5
3. Hastings case study ...... 24
4. Middlesbrough case study ...... 47
5. Pendle case study ...... 67
6. List of documents ...... 87
7. Organisations and projects that took part in the research ...... 2
Acknowledgements
Renaisi is a social enterprise that supports people and places to thrive. We work with charities, funders, and government to help them deliver greater impact. This report was authored by Sally Brammall, Amanda Norrlander, Kandy Sisya and Louisa Thomson from Renaisi’s Consultancy Team.
The research team would like to thank everyone involved with the research – particularly the staff and participants in the projects we engaged with in Birmingham, Hastings, Middlesbrough and Pendle - who helped to support the research activities, giving their time generously to share their experiences.
The project was a collaborative effort and we are grateful to Simon Maxwell, Hester Clarke and Kate Hall- Wright from the Department for Environment, Food and Rural Affairs, Harmony Ridgley from Public Health England, Sarah Preston and Hazel Ainsworth from Natural England for their insight and guidance in terms of shaping the study.
Renaisi, May 2020
This report and the accompanying report ‘Increasing access and usage of the natural environment to support mental health and wellbeing’ are published by Defra (Defra Project Code BE0154) and are available from the Department’s Science and Research Projects Database at http://randd.defra.gov.uk.
While the research was commissioned and funded by Defra, the views expressed reflect the research findings and the authors’ interpretation and do not necessarily reflect Defra policy.
Mental health, wellbeing and the natural environment: case studies of four areas in England
Glossary and key terms
Ageing Better A programme from the National Lottery Community Fund to support activity which prevents isolation for people aged 50 and over.
AONB Area of Outstanding National Beauty
BAME Black, Asian and Minority Ethnic
Big Local A Lottery funded resident-led initiative where 150 neighbourhoods receive £1m of funding over ten years to deliver change in their communities.
CCG Clinical Commissioning Group
CIC Community Interest Company
CLT Community Land Trust
Defra Department for the Environment, Food and Rural Affairs
DfE Department for Education
FOPG Friends of Park Group
IMD Indices of Multiple Deprivation
LDP Sport England Local Delivery Pilot – 12 areas receiving £100m to work on new, systems wide approaches to encourage people to be more active
LSOA Lower Layer Super Output Area – a geographic area used in census reporting to improve reporting at a very local level
MHCLG Ministry of Housing, Communities and Local Government
NHSE NHS England
ONS Office of National Statistics
PHE Public Health England
TCV The Conservation Volunteers
VCS The voluntary and community sector
Mental health, wellbeing and the natural environment: case studies of four areas in England
1. Introduction
This document supplements the main research report ‘Increasing access and usage of the natural environment to support mental health and wellbeing’ and contains the in-depth findings from the four case study areas. It covers: • The main characteristics of each area - their population and health challenges.
• The features of the natural environment.
• Local provision within the scope of the research - activities that can help prevent poor mental health and wellbeing and are for those more at risk (rather than with a diagnosed condition).
• An assessment of what the local system of organisations, partnerships, networks and strategies looks like in each location.
The write up of the four case studies provides further context for understanding the opportunities and constraints in local systems summarised in the main report.
This supplementary report is intended to be of particular use for a range of stakeholders in other local areas who are interested in exploring how to support more at risk groups to access and use the natural environment for the mental health and wellbeing benefits.
1.1. Case study overview
Table 1 below shows the differences between the four case study areas by population size, density, area and land use.1 The categorisations are as follows:
• Built on: roads, buildings, airports, quarries
• Green urban: parks, gardens, golf courses, sports pitches
• Natural: moors, heathlands, natural grassland
• Farmland: Fields, orchards
1 The land use data is from the Coordination of Information on the Environment codes from the database produced by the Urban Studies and Planning Department at the University of Sheffield. 1 Mental health, wellbeing and the natural environment: case studies of four areas in England
Population Population Built Green Case study Area Farmland Natural size density on urban
268km 4,262/km 68% 21% 7% 3% Birmingham 1,141,400 squared squared 21.2km 4,426/km 15% Hastings 92,855 56% 22% 7% squared squared 53.9km 2,609/km Middlesbrough 140,398 54% 20% 27% 0% squared squared 169 km 539.6/km Pendle 91,405 8% 3% 61% 27% squared squared
Table 1: Case study population and land use comparison
Table 2 presents key demographic, socio-economic and health data from each case study area. This was drawn from the Indices of Multiple Deprivation 2015, PHE health profiles, and ONS figures and the 2011 census data on employment, ethnicity and age and was used during the longlisting process of priority areas.2
Ethnicity Un- IMD Life Life Median White Total 2015 employment expectancy expectancy age British BAME (male) (female)
Birmingham 39.6% 53.1% 41.9% 7.3% 77.6 82 32.80
Hastings 30.2% 89.3% 6.1% 4.8% 76.6 81.9 42.30
Middlesbrough 48.8% 86.1% 12% 7.4% 75.7 79.9 36.60
Pendle 28.1% 77.2% 20.4% 4.4% 78.1 81.3 39.50
Table 2: Case study demographic, socio-economic and health comparison
Considerations when reading this report When reading the case study findings it is important to recognise that the information is based on the interpretations of those who engaged with the research interviews and fieldwork visits. We have indicated in each case study the types of organisations we spoke to, but the main report includes a detailed breakdown of the fieldwork, including how the mapping of opportunities related to an overall framework that encapsulates the diverse nature of this work. The boxes with project examples in this report are all projects that the fieldwork team either visited, interviewed or identified through mapping as part of the research.
2 See the Appendix of the main report for a fuller explanation of the research methodology. 2 Mental health, wellbeing and the natural environment: case studies of four areas in England
The local mapping was intended to give a flavour of what is provided in each area rather than being a comprehensive catalogue of everything that exists. There will inevitably be some omissions – as outlined in the main report, this is not a ‘unified sector’. This means we have not quantified the amount of activity in each case study area but tried, where possible, to give a sense of how widespread some opportunities were.
The methodological approach and its limitations are covered in detail in the Appendix to the main report.
3 Mental health, wellbeing and the natural environment: case studies of four areas in England
Birmingham
4 Mental health, wellbeing and the natural environment: case studies of four areas in England
2. Birmingham case study
2.1. Birmingham context
The area
Birmingham is the UK’s second largest city. It is a multicultural city that celebrates its ethnic diversity.
“It’s a lovely city and the thing I like the most is that it is a mixed community.” (Volunteer, Community charity)
Birmingham’s industrial heritage has shaped the city landscape. An extensive canal system, formerly a major transport route in and out of Birmingham, is regarded as one of the city’s defining assets. Several interviewees referred to Birmingham’s reputation as ‘the Venice of the UK’.
Urban redevelopment has modernised aspects of Birmingham’s city centre. In the last decade, the centrally located Birmingham New Street station has had a design overhaul and a grand project was undertaken to relocate the Library of Birmingham to the west of the city. Some central sections of the canals, such as Gas Street basin, have transformed into social destinations with a vibrant nightlife.
Outside of the city centre, Birmingham is made up of neighbourhoods which each have their own community life and identity.
Population challenges and at-risk groups
Birmingham has a significantly young population, with 46% of its citizens aged under 30 and attracting a large student base via the city’s five universities.3 However, levels of unemployment are high and the area has suffered economically due to the decline of the city’s manufacturing industry.4 40% of Birmingham’s population live in the 10% most deprived areas of England. Birmingham faces various challenges that are linked to high levels of deprivation such as crime, antisocial behaviour and substance abuse.
“Inequality is a big factor, and inequality in Birmingham is quite often related to place. Access to employment is a big issue.” (Strategic staff, regional charity)
Small distances in geography add up to big differences in health outcomes in Birmingham - travelling the length of just six train stops can lead to a life expectancy variation of 10 years for men and 8 years for women.5 Birmingham was described as having a ‘pervasive car culture’ in the interviews and air pollution contributes towards some of the city’s health challenges.
3 Birmingham City Council (2018) Birmingham City Council Plan 2018-2022, p.2. 4 Greater Birmingham Chambers of Commerce (2018) Birmingham Economic Review 2018 (no page numbers). 5 Birmingham City Council (2019) Birmingham Health Profile 2019, p.5. 5 Mental health, wellbeing and the natural environment: case studies of four areas in England
Across the West Midlands, physical activity rates are lower than national averages. In Birmingham, 62.4% of adults aged 19+ are physically active for the recommended 150+ minutes per week, compared to national average 66%.6 Health issues that can be addressed with lifestyle changes, such as Diabetes Type 2 and obesity, also have a high level of prevalence in Birmingham. Mental health needs represent a considerable challenge in the city, affecting all ages. Birmingham contains a large number of areas where there is a very high risk of loneliness amongst older adults, according to Age UK’s Loneliness Index.7 There were frequent references in stakeholder interviews to mental health as a ‘hidden’ and sometimes stigmatised problem within Birmingham’s different communities.
“We know that it’s a big hidden problem in BAME communities, in women, in young people, as well as some boaters.” (Strategic staff, national environmental charity)
Funding and programmes
Some of the larger funding programmes in place are designed to focus on the wards and neighbourhoods in Birmingham which experience higher levels of deprivation.
One of Sport England’s Local Delivery Pilots, funded by the National Lottery. This involves working in partnership with the Birmingham Active Communities charity The Active Wellbeing Society to tackle physical inactivity in Pilot Birmingham and Solihull. The award is worth £9.72m and takes a collaborative approach to working with local groups and residents.
Birmingham Voluntary Service Council are leading the network of Ageing Better in partnerships in Birmingham. As part of this programme, citizens can Birmingham apply for small grants of up to £2000 to develop ideas and run projects locally.
Birchfield, Firs and Bromford and Welsh House Farm are three Big Big Local areas in Local neighbourhoods in Birmingham. This is a Lottery funded resident Birmingham led initiative involving £10m of investment over 10 years. Regeneration and development linked to The city is currently working to the Birmingham Development Plan expected population 2031, which sets out the planned development of different areas within growth and the 2022 the city. The Perry Barr locality is the site for much of the regeneration Commonwealth work linked to the Commonwealth Games. Games
Table 3: Funding and programmes in Birmingham
6 Birmingham City Council (2019) Public Health Green Paper 2019, p.18. 7 Birmingham City Council (2019) Birmingham Health Profile 2019, p.16. 6 Mental health, wellbeing and the natural environment: case studies of four areas in England
2.2. The natural environment in Birmingham
Overview
Birmingham has more parks than any equivalent sized European city, and these stem from Victorian-era moves to support the health of workers in the city and combat the ill effects of a factory environment.
Birmingham has 591 parks including 15 parks listed with Green Flag status and several larger country parks located just outside the city boundary. The 2,400 acre Sutton Park is a designated National Nature Reserve and Scheduled Ancient Monument; and there are seven other Local Nature Reserves. There are also green corridors adjoining natural areas such as Edgbaston reservoir, which cut through the city and are havens for local wildlife. Birmingham has considerable blue space in its canals, which extend across 35 miles within the city and have stretches which have both a rural and urban ‘feel’.
The Canal and River Trust look after Birmingham’s canals and waterways, which includes maintenance of the tow paths. Through the parks service, the City Council manages over 3,500 hectares of public space in Birmingham. It is estimated that the parks and green spaces are worth £520 to each resident annually.8 The Council also lead the maintenance of ‘Birmingham’s Forest’ - over one million trees which are scattered across the city. Voluntary efforts from the Birmingham Trees for Life charity are helping to further develop Birmingham’s urban canopy.
“If you climb up to the top of the library in central Birmingham and look out, particularly to the west, what you see is a forest - a forest with some buildings in it.” (Strategic staff, national environmental charity)
An appreciation of Birmingham’s numerous parks, green spaces and urban wildlife was a common theme in the interviews. However, some interviewees also suggested that these natural environment features were not generally reflected in people’s images of Birmingham overall.
“Birmingham is an incredibly green city and sometimes it’s hard to see that. The image of Birmingham is very grey, industrialised. It grew up in the Industrial revolution and it’s not seen as a beautiful city.” (Delivery staff, regional environmental charity)
There was also a perception among some local stakeholders that neighbourhoods in the south of Birmingham benefited from easier access to the natural environment. The reasons given for this were the number of parks located there and the existence of better transport connections for travelling to the larger country parks.
“The city centre is geographically skewed very much into the south, so that the north if you look at it on a map is quite big and expansive. The south is quite small in comparison and has more green spaces in it.” (Delivery staff, environmental charity)
8 Hölzinger & Grayson (2019) Birmingham Health Economic Assessment& Natural Capital Accounts. 7 Mental health, wellbeing and the natural environment: case studies of four areas in England
Local barriers in Birmingham’s natural environment
Although over half of Birmingham’s population live within walking distance of their canal, various issues were mentioned in relation to accessing the city’s canal system. Where this was raised, interviewees spoke about individuals that might live next door to the canal but were either unaware of its presence or did not consider it a place that they would go. Alongside this, negative associations with the canals persist, which were traced back to historic associations of the city’s waterways with poverty and crime.
“When I was a little girl there were canals right at the bottom of the garden and they were slum areas that really didn’t get used.” (Delivery staff, environment charity)
The perception of risk appeared to be reinforced by a lack of lighting along the canals (outside of the city centre) and inadequate signage which made navigation of the waterways difficult.
“In King’s Heath and places like that, there are lots of entrance points along the canal, but they are not really signposted. You can’t say ‘join this canal here’ to give you a map of where it might take you, and the exit entrance and exit points.” (Delivery staff, regional charity)
Litter, poorly maintained areas, and fears of antisocial behaviour or crime were consistently cited as the main deterrents to using the parks and canals in Birmingham.
Cost was also highlighted as a barrier to entry for visiting Birmingham’s larger parks. The expenses mentioned included the public transport to travel there, payment for car parking and for families especially, the cost of participating in on-site social activities (such as crazy golf or pedal boat hire).
“It might be free to go in, but you’ve got to pay the car parking.” (Delivery staff, local environmental charity).
2.3. Local provision in Birmingham
Overview of what is available
Mapping focussed on groups providing some form of engagement activities with the natural environment that either directly or indirectly promote wellbeing. These opportunities were limited to those active within the ward boundaries of Birmingham City Council. This identified:
• 48 opportunities that fall within the scope of the research. Several of the mapped organisations are involved in city-wide initiatives (such as The Active Wellbeing Society’s Active Communities and Active Parks projects) that in turn represent the facilitation of numerous activities and local partnerships.
• Over half of the mapped opportunities were provided by organisations solely operating in Birmingham. Eight organisations delivered work and activities across the West Midlands and seven were national charities or organisations with either a local or regional branch.
8 Mental health, wellbeing and the natural environment: case studies of four areas in England
• The Birmingham Open Spaces Forum lists 130 organisations that are active in relation to open space and 55 are Friends Of Park Groups (FOPGs).
The majority of opportunities identified were open to all, with approximately eight described as being for people with a defined need.
The spread of project activities alongside their target audience gave an indication of the health priorities in the area:
• Projects which help people to develop healthy eating habits, through learning about food growing and how food is produced. One example from the desk based mapping is Stirchley’s Fruit and Nut Village, run in partnership with wellbeing CIC Spring to Life. This project works with Stirchley residents to develop orchards, and edible landscapes suitable for natural foraging.
• Projects which support a holistic recovery process for individuals that have experienced homelessness or issues with substance use, such as Welcome Change CIC’s community garden.
• A significant focus on sports and physical activity in projects that are usually open to all and designed to be accessible for beginners. Many of these are developed through the Active Parks programme.
• Projects which connect and bring together BAME women and speakers for whom English is not their first language. Informal walking groups were mentioned, as well as the community garden looked after by the DOSTI Women’s Group, developed by Go Woman! Alliance CIC.
• Supporting families and children in deprived areas. Although projects aimed at engaging children/young people with the outdoors was not part of the mapping, many of the organisations delivering activities for adults, such as The Wildlife Trust, also hold family- oriented activities or have a schools offer.
Who is providing what in Birmingham?
There was agreement from interviewees that a range of activities aligning with the scope of this research were available in Birmingham. However, challenges in assessing the overall level of provision were frequently expressed. This was due to the size of the city and its population, as well as a sense that promotion of relevant activities were not always ‘framed’ by their engagement with the natural environment. Furthermore, there was an awareness that many groups and activities were co-ordinated in an informal context.
“Sometimes they [small community or voluntary sector groups] don't even have visibility online, they often don't have a referral structure. Sometimes they are running informally, they tend to go below the radar apart from for the
9 Mental health, wellbeing and the natural environment: case studies of four areas in England
people who participate in them - which across the city is significant. But it's very challenging to capture.” (Strategic staff, regional charity)
“The headline is not citizens and green space, often citizens and physical activity.” (Strategic staff, health sector)
The provision in Birmingham is characterised by the following main groupings:
Organisations that are linked to an open space
The mapping activity identified opportunities linked to a particular green space and the fieldwork focussed on those that had been mentioned in stakeholder interviews with a visit to a park with a FOPG, interviews with FOPG volunteers, and an observation of a physical activity class run weekly. However, we know from the BOSF directory that there are many more across the city.
The type of open space varied but was typically a park, nature reserve or community garden. The organisations linked to these sites range in size and levels of provision but are predominantly volunteer-run. The activities on offer relate directly to the characteristics of the open space, and include gardening, community food growing and nature crafts.
Those involved in these spaces mentioned that FOPG activity varies significantly between areas in Birmingham. Some groups concentrate on volunteering opportunities related to general area upkeep, or ‘bins, benches and fences’, while others form partnerships and run activities that promote physical and mental wellbeing. Volunteers and participants tend to be locally based although generally the activities are open to all.
Figure 1: Examples of projects linked to open spaces in Birmingham
10 Mental health, wellbeing and the natural environment: case studies of four areas in England
Larger VCS organisations linked to multiple sites or a larger space Through the mapping activity, 18 opportunities were found which were provided by larger VCS organisations. Through the fieldwork, we visited two organisations and interviewed 10 stakeholders (a mixture of delivery staff and volunteers) that fell into this category.
There is wider awareness of these organisations’ work due to their longstanding nature, specialism in a particular field and in some cases, a national profile. Participants may travel further to participate. Alongside regular programmes and projects run on third-party sites, they run drop-in activities and one-off events which are open to all. Specific funding is sought to do targeted work with a group that has specific needs.
Figure 2: Examples of larger VCS organisations in Birmingham
Social or community organisations The mapping identified 12 opportunities provided or facilitated through a group of organisations that were not primarily founded to promote access to the natural environment but are characterised by their strong relationships to the communities that they serve. During the fieldwork, we interviewed eight individuals linked to five organisations that fall into this category and observed one activity during a field visit.
Through partnerships or development of an existing space, these organisations coordinate activities in the natural environment that are designed to achieve physical, mental health and wellbeing benefits for their participants. They tend to already have access to an area of land, or partner with another organisation to run activities. Their activity may be focused to specific Birmingham neighbourhoods or with a community that has specific needs.
“We recently started the outdoor activities… they have transformed. They have taken such a pride to it, when we utilised what they had grown, and they were able to say they used it.” (Delivery staff, local charity)
11 Mental health, wellbeing and the natural environment: case studies of four areas in England
Figure 3: Examples of community organisations in Birmingham
Local projects based on a national model In addition to the categories mentioned above, the mapping of the opportunities available also showed four opportunities which represent a local project based on a national model. Our fieldwork included two project visits, observation of their activities and 13 interviews (a mixture of staff, activity volunteers and participants).
The Conservation Volunteers (TCV) in the Midlands run Green Gym sessions at a range of sites across Birmingham. Green Gym sessions generally involve conservation and upkeep activities in the outdoors. Collaborative TCV projects with Birmingham’s Queen Elizabeth Hospital Community Orchard and Gardens include a special focus on community food growing through the ‘Health for Life’ programme. A social prescribing initiative also links hospital patients and staff to sensory experiences in the Gardens.
Park Run, the 5km running initiative taking place on Saturday mornings, have a strong presence in Birmingham with 5 Park Runs (as listed on the Park Run website) established in the larger country parks on the outskirts of the city.
Large programmes In addition, there are two significant programmes taking place in Birmingham focussed on green and blue spaces in the city:
• Future Parks programme. Birmingham City Council was selected to take part in this National Trust and The National Lottery Heritage Fund initiative, which is designed to help councils find sustainable ways to manage parks and open spaces city-wide. The ‘Naturally Birmingham Project plan’ focuses on four neighbourhoods: Ward End; Brandwood; Perry Common; Ladywood.
12 Mental health, wellbeing and the natural environment: case studies of four areas in England
• Natural Rivers and Green Corridors. This project is improving the areas alongside the River Rea and the River Tame. It is part funded by the European Regional Development Fund and is a partnership between Birmingham City Council, Birmingham & Black Country Wildlife Trust and the Environment Agency.
Groups/events with a campaign or awareness raising focus
Given its size, it was not possible to map all the campaigning or awareness raising activities across the city than encompass different ways of engaging with the natural environment. Initiatives include a cycling festival with closed roads to help promote active travel and various events organised by Sustainability West Midlands, which exists to champion sustainability across the public, voluntary and private sectors.
How activities are promoted in Birmingham
There are various directories available online:
• The Active Wellbeing Society list upcoming physical activity activities on their website and give information about accessibility and contact points.
• ParkLives (the Coca Cola backed initiative that is part of the Active Parks programme) have a directory of activities taking place.
• Birmingham Open Spaces Forum (BOSF) have a directory of all their member organisations with links to their social media and websites.
Promotion of environmental activities, such as community gardening, appears to be via the open spaces’ bespoke websites or Facebook pages, as well as noticeboard flyers and word of mouth communication.
Birmingham City Council’s website carries a small number of suggested walking routes, one-off park events and ongoing conservation volunteering opportunities. The majority of these listings corresponded to activities taking place in the larger country parks. There is also a list of allotments and allotment application details.
“There are out-of-date walks that are listed on the Council’s website.” (Participant, walking group)
13 Mental health, wellbeing and the natural environment: case studies of four areas in England
Figure 4: Example of listing from the Birmingham Open Spaces Forum website
How projects are funded in Birmingham
Through the interviews and mapping, the following were identified as key sources of funding for activities in Birmingham.
For smaller VCS and community organisations:
• Awards For All • Postcode Lottery • Barrow Cadbury Foundation – which is based in the West Midlands and has a philanthropic interest in Birmingham • Heineken (The Orchard Project) • Heart of England community foundation • National Lottery Heritage Fund
Different funding streams were accessed for providing physical exercise activities in the parks and open spaces:
• Park Lives (Coca Cola’s corporate social responsibility programme) • Sport England
Larger VCS organisations in Birmingham received funding via a wider range of sources:
• Corporate sponsorship – TCV via Queen Elizabeth Hospital community garden and orchard, The Wildlife Trust, Martineau Gardens, Canal and River Trust • Walsall Public Health (The Wildlife Trust) • Membership (The Wildlife Trust) • Charitable trusts and foundations (Martineau Gardens)
14 Mental health, wellbeing and the natural environment: case studies of four areas in England
Future plans in the area
Our mapping and fieldwork also showed that at a strategic and delivery level, there was widespread recognition of the importance of engagement with the natural environment for mental health and wellbeing. Several smaller grassroots organisations and larger VCS organisations were piloting innovative projects with explicit mental health and wellbeing dimensions to them and aspired to further develop and measure the impact of existing pilots.
“We're starting a pilot project this year where we're running five week blocks of courses. These are outdoor activities but they are not necessarily horticultural. People who are self-identified or identified by one of our link organisations, which we're developing at the moment, can join these groups and we'll measure impact before and after.” (Strategic staff interview, local environmental charity)
2.4. The local system in Birmingham
Overview
Birmingham City Council is a unitary authority. It is part of the West Midlands Combined Authority alongside 11 other local authorities. The Public Health team sits within Birmingham City Council and the Health and Wellbeing Board is also at city council level. Birmingham and Solihull CCG covers Birmingham. Live Healthy Live Well is the Birmingham and Solihull Sustainability and Transformation Partnership.
Many of the local plans and strategies highlight the wealth of green space in Birmingham. These plans are being driven by Birmingham’s ambitions to be a leading green and sustainable city. At a strategic level, there are various actors and partnerships seeking to position Birmingham’s natural environment more closely with the health outcomes of its citizens.
Key messages which acknowledge and support access of the natural environment for improved mental health and wellbeing are less visible in local documents and mentions of green space are loosely woven into various plans to support better health outcomes in broad terms, such as the promotion of active transport routes or combatting air pollution. The Birmingham Health and Wellbeing Board Strategy also refers to Birmingham wide priorities to increase the use of public spaces for physical activity although it does not highlight the role of the natural environment in particular.9 However, these have become more prominent in more recent policy documents – such as the Public Health Green Paper and the Birmingham Health Economic Assessment.
“In light of our findings, green infrastructure of which Council-managed parks and green spaces should be seen as critical infrastructure rather than just a ‘good to have’.”10
9 Birmingham Health and Wellbeing Board (2017) Health and Wellbeing Board Strategy – committee paper July 2017. 10 Hölzinger & Grayson (2019) Birmingham Health Economic Assessment& Natural Capital Accounts, p.3. 15 Mental health, wellbeing and the natural environment: case studies of four areas in England
Although there is strong recognition within local strategies of the natural environment as a local asset which can be used to support health and wellbeing, a lack of overall strategic coordination was identified.
“You've got the physically active city forum and you will have the activity under the mental health trust, activity delivered by Mind and Rethink. Then you would have specific conservation and nature based voluntary sector activity. But there isn't a central strategic driver in the city around nature.” (Strategic staff, regional charity)
The local system is characterised by:
• At a strategic level, an engaged and proactive sustainability team within the Local Authority. There is a strong push from the Council to make Birmingham a leading green city, supporting its membership of the International Biophilic Cities network.11 Birmingham is also the first place in the UK to undertake a natural capital assessment (using the National Ecosystem Approach) of its Council-managed green space.
• An active, although not evenly spread voluntary sector, in which organisations both large and small are increasingly taking a role in developing cross-sector partnerships and delivering activities designed to support people’s health and wellbeing.
• A small number of key organisations that help to connect others and facilitate partnership activity in Birmingham.
• A strong regional health drive to address levels of physical inactivity. To date, some of the bigger funded health initiatives taking place in Birmingham’s natural environment, such as Active Parks and the Be Active Birmingham scheme, are geared towards promotion of physical activity as opposed to increasing interaction with the natural environment. However, there are signs that the health sector is forging a stronger role in facilitating access of the natural environment for improved mental health and wellbeing outcomes.
• The emergence of new committees and groups that are intended to meet locally identified gaps.
Partnerships and networks in Birmingham
Key players
The Active Wellbeing Society (TAWS): TAWS is a community benefit society which was formerly part of Birmingham City Council. Through its extensive network of partnerships across the city and a flexible, collaborative approach, TAWS was recognised in the stakeholder interviews as a key enabler of outdoors physical activity for at-risk groups in Birmingham.
TAWS run the Active Parks initiative (in partnership with Birmingham City Council and Birmingham Open Spaces Forum) which promotes physical activity and wellbeing in
11 Biophilic Cities champion the positive impacts of nature on urban health and economy. 16 Mental health, wellbeing and the natural environment: case studies of four areas in England
Birmingham’s parks and open spaces. Their delivery partners in these programmes range in purpose and size – from local FOPGs to small targeted charities. The activities are free and a card system is in operation to track and monitor participation. The role that TAWS takes in each partnership varies according to the needs of the people involved.
“A third-party org could be a community centre that wants to engage with their participants and get them out doing physical activities. They might not have the skills to deliver a cycling or running session like we do but they might have good engagement with the local community.” (Strategic staff, local charity)
TAWS is also involved with a Birmingham social prescribing project, employing a link worker to work with GP services and connect patients to community-based activity which can support mental and physical health.
Birmingham and Black Country Wildlife Trust (BBC Wildlife Trust): The regional branch of national charity The Wildlife Trust has a strong presence in Birmingham with two flagship nature centres centrally located, EcoPark and The Centre of The Earth as well as four other nature reserves. The majority of BBC Wildlife Trust’s work is on third-party sites in Birmingham, and engagement is often done via partnerships to transform spaces in collaboration with people that are going to use them.
The most recent strategy of the Wildlife Trust gives prominence to nature’s health and wellbeing benefits and sets a target to connect everyone to nature.
“To succeed we must raise the profile of nature and wildlife, communicate with diverse communities and accept the challenge of engaging with people who feel less connected to nature. We must listen to people to find out how they value the natural environment, and find ways to involve everyone in their local wild spaces.” (BBC Wildlife Trust Strategy 2017-2022)
Alongside other engagement programmes, BBC Wildlife Trust have developed a bespoke health and wellbeing in nature programme, which is based on the 5 Ways to Wellbeing guidance and evaluated using the Warwick and Edinburgh Mental Wellbeing (WEMWB) scale. Participants spend half a day a week for eight weeks on activities such as mindfulness and volunteering. BBC Wildlife Trust currently deliver these courses in partnership with targeted organisations supporting a client group but plan to scale further.
BBC Wildlife Trust is connected to the natural environment policy and strategic-level conversations in Birmingham, taking part in the Greener Birmingham and Natural Capital networks (see below) as well as hosting the Birmingham and the Black Country Local Nature Partnership for the region.
“We also influence the planning framework. We work with responsible planning applications, giving a wildlife point of view and trying to influence decision makers to generate policy that is best for people and wildlife.” (Strategic staff, regional charity)
Birmingham Open Spaces Forum (BOSF) functions as a membership network of community gardens and open spaces in Birmingham. Members are people active in Birmingham’s open
17 Mental health, wellbeing and the natural environment: case studies of four areas in England
spaces as well as interested members of the public. As outlined earlier, their online directory and map lists details of all the open spaces in their membership. BOSF are a key connecting point for many smaller environmental organisations and hold an annual conference for members to get together, share news and updates.
“Birmingham Open Spaces Forum – anyone doing anything with green spaces, charities like ourselves, will all be a part of this network.” (Delivery staff, national environmental charity)
Birmingham City Council park rangers work closely with BOSF and ongoing collaboration is mentioned in their service improvement targets for 2019.12
Other partnerships and groupings
In addition to the key players outlined above, the following groups and partnerships were also mentioned by interviewees or found during mapping of provision. • Greener Birmingham – a coalition of Birmingham environmental organisations working together to promote a ‘green Birmingham’ and protect the city’s green spaces. Funding from Awards For All enabled the coalition to host and run a survey campaign called the ‘Big Green Conversation’ in 2019, later developed into a People’s Manifesto. They are currently working on their partnership approach going forward.
• Natural Capital roundtable – integrating the work on the economic assets of Birmingham’s outdoor spaces with wider Birmingham and West Midlands combined authority representatives.
• Mentally Healthy City Forum - one of four new subgroups of the Birmingham Health and Wellbeing Board to support focused partnership delivery in selected thematic areas where there are not currently strategies or plans.
• Social prescribing - the Health Exchange and Our Health Partnership run a Social Prescribing programme in Birmingham funded by the Department of Health. Birmingham and Solihull CCG also have information about social prescribing on their website. This references ‘leisure activities, getting outdoors and exercising’ and ‘gardening/animal care’ as possible things people can be referred to. Listed partners/mechanisms include the Neighbourhood Network Schemes and Three Conversations social work approach. However, it was not immediately apparent how these linked to references to social prescribing involvement in the interviews.
Environmental charities and partnerships at county level
Further afield, across the West Midlands, there is an ongoing health sector drive to tackle obesity and raise physical activity levels, through strategies such as ‘West Midlands On The Move’.
12 Birmingham City Council (2019) Birmingham Parks Service Annual Report 2018/2019, p.6. 18 Mental health, wellbeing and the natural environment: case studies of four areas in England
Mental health and wellbeing has been identified by the West Midlands Combined Authority as a key issue for the region, and an area where WMCA could deliver public sector reform.13 The WMCA Mental Health Commission ‘Thrive West Midlands Action Plan’ was mentioned by several interviewees in relation to the wider policy context for mental health in the region.
“The WMCA Thrive at Work are trying to push this agenda. We have been part of their pilots and programmes, I think there is an opportunity to improve workplace wellbeing.” (Strategic staff, national environmental charity)
Birmingham and the Black Country is one of 12 Nature Improvement Areas that were designated in 2012 and is the sole wholly urban NIA. The Wildlife Trust host information about the work of the Nature Improvement Area and are involved in implementing its current strategy – they received continuation funding from Esmée Fairbairn Foundation after the initial period of funding from Defra ended. The focus of this work is on enhancing wildlife and diversity through a landscape-scale approach and as such there is not a specific focus on health and wellbeing.14 The NIA was not referenced by interviewees during the course of our fieldwork.
Strengths and enablers in the local system
Representatives from FOPGs and grassroots environmental community groups talked about the value of networks such as the Birmingham Open Spaces Forum to connect and learn about what others were doing.
These interviewees stressed the value of the Birmingham City Council park rangers to their work.
“We do a lot of work with the park rangers and they are sort of priceless really.” (Delivery staff, local charity)
In addition, there were positive reflections on the routes to taking ownership or responsibility for land in Birmingham. Those that had been involved with applications to look after or manage an area of land said the process of gaining access to outdoor space had improved.
“For many years the issue was about land and now basically it is fairly straight forward to get land.” (Delivery staff, local environmental charity)
“Friends groups can apply for funding to improve green spaces. Once they’ve got a constitution and insurance etc, they can apply for funding. Can work really well.” (Delivery staff, regional environmental charity)
Challenges in the local system in Birmingham
The majority of interviewees identified recent changes to local authority services, in particular cuts to Birmingham City Council’s parks services, as a significant challenge in the system. The
13 Lamb, N. Appleton, S. Norman, S. Tennantm M. (Eds.) (20170, Thrive West Midlands, An Action Plan to drive better mental health and wellbeing in the West Midlands, p.18. 14 The Wildlife Trust for Birmingham & Black Country (2017) Summary of the Birmingham and Black Country Nature Improvement Area Ecological Strategy 2017-2022.
19 Mental health, wellbeing and the natural environment: case studies of four areas in England
impact of these changes can be summarised as: fewer park rangers to lead, deliver or help to coordinate outdoor activities; less capacity in the system to tackle littering and antisocial behaviour. Interviewees felt that Birmingham’s open spaces, particularly parks and canal tow paths, had suffered from a lack of enforcement on issues such as fly tipping and littering.
“If we had better support, in terms of solving hygiene and dumping issues, it would solve a lot of problems.” (Delivery staff, national environmental charity)
Small community or environmentally-focused groups highlighted the outcomes-specific and short-term range of funding opportunities available.
“Funders aren’t really that bothered about just purely community gardening projects so if you have an angle of wellbeing or something else then they are more likely to be funded.” (Delivery staff, local charity)
Small-scale Birmingham projects were described as operating in a climate where ‘things come and go’. Sustainability in this context was contingent not only on volunteers but also on the long- term dedication and aptitude of core staff members to turn their hands to a range of different tasks.
Delivery organisations of different sizes expressed frustration with attempts to engage and work with local health services.
“We want to work with local surgeries but it’s very hard to communicate with them as they say things along the lines of ‘if we have any more leaflets then we will be overrun with leaflets’.” (Delivery staff, small community group)
Local plans and strategies
The table below summarises a) actions relating to access and the quality of the natural environment b) the link between the natural environment and health and wellbeing benefits in a variety of local policy documents and strategies. This is not exhaustive but illustrates where the connection is made between investing in green spaces and ensuring they are accessible, and the link to health agendas.
Natural environment Health and wellbeing/natural Strategy references environment
Council wide
Sustainable Community • Outcome ‘Stay safe in a Not referenced. Strategy “Birmingham clean, green city’ is 2026” (2008) Birmingham predominantly focused on City Council actions to tackle crime and antisocial behaviour.
• ‘Green spaces’, along with Not referenced. Birmingham City Council clean air and safe streets Plan 2018-2022 are mentioned in one of the chief strategic outcomes:
20 Mental health, wellbeing and the natural environment: case studies of four areas in England
Natural environment Health and wellbeing/natural Strategy references environment
‘Birmingham is a great city
to live in’. Green and open spaces
Green Living Spaces Plan • Presents a ‘Natural Capital’ • Principle 3 is ‘A Healthy (2013) Birmingham City approach to thinking City’. Suggests adoption of Council through the value of Natural Health Improvement Birmingham’s green Zones, integration of health spaces. delivery and green spaces, extend the Be Active offer • Seven ‘green living’ and situate Public Health as principles are laid out. key partners in planning.
Birmingham Tree Policy • One of the • Recognition of the important (2018) Birmingham City recommendations is that all role of trees in contributing to Council major planning applications mental wellbeing and should include physical activity. consideration of options to Recommends that the public improve the natural should be provided with (via environment, for example, the Council website) more greening space in dense information about the value urban areas. of Birmingham’s tree stock and the benefits it provides
in relation to the health and wellbeing agenda.
• Sets out the various Parks • Supporting healthy lifestyles Birmingham Parks Service Service (part of and behaviours is listed as Annual Review 2018/9 Birmingham City Council’s one of the Parks’ Neighbourhoods Performance Outcomes. Directorate) workstreams Performance targets link to which support access to ongoing delivery of Active Birmingham’s parks. Parks sessions and maintenance of ranger led • Includes a mention that community events. Some Birmingham Parks led the activity is led by the Parks move for Birmingham to Service, while parts of their become a Biophilic Cities role are in support of network member. voluntary orgs and partnerships.
Birmingham Health • Continuing the Natural • Alongside physical health, Economic Assessment & Capital approach this report includes a mental Natural Capital Accounts mentioned above, this health economic assessment (2019) Birmingham City report calculates the of the benefits provided by Council economic value of the Council managed green
21 Mental health, wellbeing and the natural environment: case studies of four areas in England
Natural environment Health and wellbeing/natural Strategy references environment
natural environment space. It starts from the
spaces managed by position that there are many Birmingham City Council. health benefits (that may be quantified in terms of health service savings) linked to accessing green space in the city, such as parks.
Birmingham Walking & Not referenced • Recognises the value of Cycling Strategy active travel for improved consultation draft (2019) health outcomes. Refers to Birmingham City Council benefits for both mental and physical health. Health
Mental health in the West Not referenced. • Mentions social prescribing Midlands Combined to initiatives including Green Authority (2017) Gyms to support and develop capacity of primary care.
Birmingham Public Health • One of the priorities • Use of ‘green space’ Green Paper (2019) supports the input of local included as part of the Birmingham City Council agencies to influence proposed action plan to changes in the built achieve 3 strategic priorities environment for health. for the area: tackling child ‘Access to a network of obesity; social isolation; high quality open spaces developing community and opportunities for sport assets. and physical activity is • The paper recommends an important for the health asset-based approach and and well-being of development of a social communities.’ (p.25). prescribing offer to include ‘strengthening links to green space’ (p.22).
West Midlands Combined • Highlights the importance • References increasing Authority (2017) Physical of safe, secure, connected opportunities for outdoor Activity Strategic and accessible exercise in informal and Framework environments and ‘making formal outdoor spaces – the outdoors more inviting’ including ensuring these are connected with a focus on increasing activity levels and improving wellbeing
Table 4: Local strategies in Birmingham
22 Mental health, wellbeing and the natural environment: case studies of four areas in England
Hastings
23 Mental health, wellbeing and the natural environment: case studies of four areas in England
3. Hastings case study
3.1. Hastings context
The area
Hastings is a town on the south coast surrounded by rural areas. The seafront is regarded as a key component of the town’s identity with unspoilt beaches and a small fishing industry. Hastings is viewed as having a rich cultural life, and many stakeholders emphasised the community spirit that exists in the town with frequent festivals and events throughout the year. Regeneration programmes have led to a new link road, employment spaces, renewal along the seafront (including the new Hastings Contemporary gallery) and a new college.
However, in common with other coastal areas, Hastings faces a number of challenges - “Perceptions of our town are often very varied, sometimes contradictory and reflect the contrasting lifestyles and backgrounds of the local people.”15 Poor road and rail links have historically isolated Hastings from opportunities in London, and the town has not kept pace with economic growth elsewhere in the region.
“The university has moved out of town. There’s been a lot of issues with the pier. Big ticket items haven’t had the best outcomes.” (Delivery staff, regional charity)
Population challenges and at-risk groups
Deprivation in Hastings is a significant challenge – almost one in three residents live in areas that are amongst the 10% most deprived nationally. 25% of children and 22% of those aged 65 and over live in poverty.16 Unemployment is high, and average annual earnings are low for the South East with many in low wage service sector or manual jobs. In addition, Hastings has suffered from issues around insecure poor quality housing particularly in the private rented sector. In the stakeholder interviews, references to ‘pockets of deprivation’ across the town were common, particularly in the north east of the town and St Leonards.
“Hastings can be a difficult place. Communities are quite centred. There are some areas like Hollington where there is little change.” (Volunteer, small community group)
Health outcomes for Hastings residents are generally poor compared to the rest of England. Local statistics estimate that 65% of the Hastings population is obese, with many adults being inactive.17 Recent figures also indicate a high prevalence of depression; high admissions for self- harm; and high GP reported prevalence of adults in contact with specialist mental health services or receiving assertive outreach.18
15 Hastings Borough Council (2009) Hastings and St Leonards Sustainable Community Strategy, p.36. 16 East Sussex County Council (2019) Picture East Sussex: Annual report of the Director of Public Health 2018/19. 17 Active Hastings Partnership (2016) Hastings Sport and Physical Activity Strategy 2016-2020. 18 East Sussex County Council (2017) Hastings and Rother needs and assets profile 2017. 24 Mental health, wellbeing and the natural environment: case studies of four areas in England
Social isolation is an issue in Hastings – with 30% of the population estimated to feel lonely.19
“I think isolation is massive. Lots of people in Hastings haven’t got families, and are on their own.” (Volunteer, small community group)
The reasons for this are varied. Hastings has an older age profile with a high percentage of pensioners living alone. In addition, Hastings is higher than national averages in terms of the number of lone parent households and people who provide 50 or more hours of unpaid care a week (all from CCG health needs).
Funding and programmes
Within this context, there is a strong focus on reducing health inequalities in local plans and strategies – including the ‘Healthier Town’ strand of the Community Strategy and Healthy Hastings and Rother programme led by the CCG which aims to improve health and wellbeing through community hubs and social prescribing support.
There are also several large programmes and initiatives underway in Hastings, recognising the need to continue to focus on opportunities for economic revival and tackling disadvantage.
Resident priorities identified through the Big Local partnership include The Big Local in North supporting community centres, providing more free or low cost East Hastings learning opportunities, and supporting leisure, health and environment initiatives. DfE Opportunity Area Addressing social mobility amongst children and young people. This (until 2020) includes a key strand on mental health and resilience.
£812k for Destination White Rock. A project to support use of the Coastal Communities beach, provide business and commercial space and support the Fund BMX/Skateboarding park on the seafront.
A ten year development programme (from 2011) run by a not-for- profit economic development company aiming to expand the local Sea Change Sussex economy and generate jobs. This includes areas in Hastings town centre, and an innovation park in the north west of the town. A bid being prepared for A new scheme from Government that could secure £25m for jobs, the Town Fund homes, skills and actions to reduce carbon emissions.20 Age-friendly and Hastings Voluntary Action is one of five organisations in England inclusive volunteering awarded a Lottery/DCMS grant to test out initiatives to overcome fund barriers for volunteering for the elderly. These include a Volunteering Club, recruiting Champions and training other VCS organisations.
Table 5: Funding and programmes in Hastings
19 Local Strategic Partnership presentation (July 2019) Scoping the Future of Regeneration in Hastings. 20 The Council has £173k to develop the bid with a Town Investment Plan due by the end of summer 2020. 25 Mental health, wellbeing and the natural environment: case studies of four areas in England
3.1. The natural environment in Hastings
Overview
There is an abundance of natural areas within and immediately around Hastings. One third of the borough is estimated to be green space, and 90% of households have access to open space within 300m.21 The natural environment in Hastings includes: a designated Special Area of Conservation; three nationally designated Sites of Special Scientific Interest; eight local nature reserves; and 25 local wildlife sites. Hastings Borough Council lists ten gardens, 16 allotment sites, and over 30 playgrounds. There are three major parks - Hastings Country Park borders the town in the east, and Combe Valley Park to the west. Alexandra Park is in the town centre, and has won awards for green heritage.
The High Weald AONB and South Downs National Park (SDNP) are both nearby.
Habitats range from ancient woodlands in the middle of densely packed housing areas to alluvial flood plains and, unique to the south east coast, the spectacular sandstone cliffs of Hastings Country Park Nature Reserve. The local authority is very proud of the variety and quality of its green spaces as places where wildlife can thrive and places where the local community can enjoy wildlife and enjoy quiet contemplation. (Hastings Borough Council Parks website page)
The majority of spaces are managed by Hastings Borough Council but there are also different arrangements in place. Sussex Wildlife Trust manage two nature reserves, and some small areas of woodland have been purchased by the local community. In other sites, maintenance and upkeep often involves local resident groups or the Biodiversity Action Groups co-ordinated by The Conservation Volunteers.
Almost all of the people interviewed felt that Hastings had high quality green spaces and recognised the diversity of what was on offer.
“There is no excuse – it’s everywhere!” (Strategic staff, local authority)
Alexandra Park was often singled out as being one of the best in the country, and Hastings Country Park was described as ‘a real gem of a space’ (Delivery stakeholder interview). Through community consultation as part of the open spaces audit, the Council had also heard about the value of small patches of open space at neighbourhood level:
“It’s just the freedom of picking up a football, kite, taking a dog onto a patch of land.” (Strategic staff, local authority)
Efforts to clean up the beach were also referenced in some of the interviews.
21 Hastings Borough Council (2009) Hastings and St Leonards Sustainable Community Strategy, p.36. 26 Mental health, wellbeing and the natural environment: case studies of four areas in England
“Half of Hastings is all about the beach and the sea. People help and do beach cleaning – there has been a push to get people volunteering.” (Delivery staff, small community group).
Local barriers in Hastings’ natural environment
There were a number of Hastings specific barriers to accessing the natural environment raised during the fieldwork. Some of these related to Hastings’ topography.
“Hastings is really hilly which is a huge barrier. You can be close to something but there’s a massive hill in the way.” (Strategic staff, local authority)
Hills were a particular barrier for accessing the Country Park, especially when walking from the town centre, where the options were climbing up a steep hill or getting an expensive funicular railway (that was often out of service out of season). The Country Park was described as having a number of additional barriers including parking charges, a busy main road to navigate if coming by bus, and footpaths that had been closed for a number of years due to land slippage. Its size could also mean a lack of an obvious or easy place to gravitate towards. However, a project is now underway in partnership with Groundwork to construct a new straw bale visitor centre to help address this issue (see page 30 for more information).
“Once you’re up there you have to walk 2.5 hours to get to the cafe. There is no real anchor place to go.” (Volunteer, small community group)
Whilst many people valued the woodland spaces in Hastings, these were acknowledged as having their own set of challenges for access and usage. This could be a negative reputation or connotation that certain woods were not safe, or the fact that they were unwelcoming with overgrown paths, dog muck and a ‘bleakness’. Some of the smaller parks and gardens in the town centre were described as suffering from some of the social problems that occur in areas of high deprivation.
‘ASB, drugs and alcohol, rough sleepers – that can spill out onto the opens paces and they become no go areas. We want to reclaim that for family use and the wider community.” (Strategic stafff, local authority)
The poor transport system in Hastings was mentioned by almost every interviewee. The Hastings Borough Council’s Sustainable Community Strategy emphasised the need for a high quality bus network in the town, given 30% of residents do not have a car. However, services were generally described as being irregular, expensive, and taking long routes around the town.
“Transport costs are problematic. For a large household in an outlying area of the town, you need that money for utilities and food.” (Strategic stafff, local authority)
Despite the efforts to clean up the beach, there were also views expressed that it was dirty and intimidating in the town centre. Several interviewees mentioned that it was fairly common for families to live in Hastings and never access the beach.
27 Mental health, wellbeing and the natural environment: case studies of four areas in England
“In Hollington and Ore some kids have never seen the sea. We’re only 5 miles across, but people don’t have cars, buses are expensive, and a day out costs money,” (Strategic staff, local authority)
Very few interviewees talked about accessing the South Downs National Park (SDNP) and High Weald AONB, and felt that bus routes there were not well publicised or did not exist in the first place.
3.3. Local provision in Hastings
Overview of what is available
In Hastings, mapping focussed on organisations and projects with some form of engagement activities with the natural environment that either directly or indirectly promote wellbeing. This generated:
• 44 opportunities that broadly fall within the scope of the research, although the number available to local residents is likely to be far higher – for example, there were organisations and groups providing multiple one-off events or activities over the course of a year and these were not counted individually.
• The majority of the opportunities were provided by organisations solely operating within Hastings, and four others were operating in the area directly outside Hastings
• Ten were national charities with either a local or regional branch.
The activities in Hastings primarily focussed on interacting directly with nature. The majority of these were opportunities that involved an element of conservation or gardening projects. The most common activities that fell into the ‘experiencing nature’ category included outdoor exercise, walking groups, or taking part in events outdoors where there were activities such as arts and crafts.22
Whilst the majority of opportunities were open to anyone, nine of these had specific health promotion messages. A further nine were more targeted at specific groups. Overall, it was possible to see how the combination of different projects were addressing identified health inequalities in the local area. For example:
• Projects that reach older more isolated people such as the wide range of Walking for Health groups on offer
• Families in deprived areas – with the Pocket Park in Ore directly reaching those living nearby in a deprived neighbourhood of Hastings; the courses at Mallydams Wood for families referred by other services they were in contact with; and some Project Rewild
22 The mapping exercise did not capture every outdoors exercise opportunity – as explained on page 34, there is a co-ordinated effort in the town around physical activity in the outdoors and many examples are listed by the Active Hastings Partnership on Facebook. However, these listings drop off the main feed, and it is hard to accurately account for all the ‘live’ opportunities. The mapping exercise also did not list every allotment society (where people have to pay to be members) as this was felt to be outside of the scope of the research. 28 Mental health, wellbeing and the natural environment: case studies of four areas in England
courses that aim to encourage families to spend time together outside (partnering with housing associations to reach people).
• An emphasis on physical activity – with projects that contribute to tackling the obesity challenge and encouraging more people to be healthy and active in the town.
• Education Futures Trust play a key role for working age adults facing different vulnerabilities – providing three courses targeted at adults over 19 in receipt of benefits that are all focussed on developing skills in the outdoors.
• Projects for refugees – with a project to bring Syrian families into Bohemia Walled Garden and the LINKS project run by Hasting Voluntary Action that involves some outdoor activities with refugees.
Who is providing what in Hastings?
Local stakeholders at both strategic and delivery level felt that Hastings benefited from many projects and initiatives operating in the natural environment, making use of the many green spaces in and around the town. Some of this was attributed to regeneration schemes often being accompanied by smaller pots of money available for groups to apply for. Others felt that the range of small projects reflected the community spirit in Hastings where ad-hoc and ‘under the radar’ things were commonplace.
“It might just be an informal thing such as local groups that coordinate dog walking or find each other on social media.” (Strategic staff, local authority)
The main clusters of organisations and activities in Hastings are outlined below drawing primarily on the organisations that took part in interviews or fieldwork visits, but with additional insight from the mapping.
Local grassroots community organisations focussing on a particular green space
Half of the opportunities identified in the mapping were delivered by small community organisations or individuals. The fieldwork involved visiting two small parks which had active resident groups working in them, and three interviews were conducted with representatives from groups associated with other specific parks in the town.
The majority of activities led by resident groups were focussed on conservation tasks to maintain access to spaces, drawing on the time and skills of volunteers. There were also numerous examples of providing events in specific parks and open spaces. Some of these had a health and wellbeing focus (for example, tai chi classes or walks) but were mostly focussed on encouraging residents to get involved and spend time together outdoors.
29 Mental health, wellbeing and the natural environment: case studies of four areas in England
Figure 5: Examples of small community groups in Hastings
Those involved in small community groups were acutely aware of the socio-economic challenges in the area, and felt that their location meant they were inevitably reaching those from more deprived backgrounds.
“We don’t target at risk or vulnerable groups. But those people are in amongst the general population so we do reach them - people on their own, or the elderly, or those who want to remain connected.” (Volunteer, small community group)
“A lot of groups do community stuff to get their funding – it’s the opposite way round for us, the community comes first.” (Volunteer, small community group)
Several interviewees cited cases of regular volunteers and participants they knew were struggling with their mental health and wellbeing. However, they also felt that they did not have the expertise to support them (nor was this their role), beyond providing access to a space where they might benefit from time outdoors. Some resident groups facilitate access for more specialist organisations to run activities in their spaces – for example, Bohemia Walled Garden has an arrangement for a local recovery college and a group that supports Syrian refugees to have access to its plots.
30 Mental health, wellbeing and the natural environment: case studies of four areas in England
Local VCS organisations with particular specialisms
“We ran mental health courses on confidence building. Through that we started taking participants out for walks – so the idea grew from there, seeing the benefits of being outside, and looking at the world around them.” (Delivery staff, larger local charity)
The mapping identified approximately eleven opportunities that were provided by local voluntary sector organisations who have more of a specialism. The fieldwork involved a visit to three projects and three further interviews in this category. These ranged from small organisations with one or two individuals up to larger local charities with a town wide remit.
Activities that fell into this grouping in Hastings were more targeted at people at risk of poor wellbeing, or having experienced mental health issues in the past. These wellbeing needs were being addressed in a variety of ways - for example, engaging people in running outdoors for the first time, encouraging families from a deprived neighbourhood to spend time outdoors in the woods, and mindfulness walks for people accessing a community wellbeing hub.
Figure 6: Examples of VCS organisations in Hastings
31 Mental health, wellbeing and the natural environment: case studies of four areas in England
Local projects based on a national model
There were seven projects identified in the mapping operating directly in Hastings that use nationally developed models – the fieldwork involved one visit to a Walking for Health group, and five interviews with individuals whose work also fell into this category. The key organisations involved include TCV and ParkRun (who both have a health and wellbeing focus), as well as the RSPCA (although the Wild Things model only operates in one other location aside from Hastings).
“The health walks have run for 15 years and are very well attended. They cover areas of high deprivation in the town.” (Delivery staff, national charity)
Figure 7: Example of a larger national charity operating locally in Hastings
The Sussex Wildlife Trust and The Marine Conservation Society also provide volunteering opportunities focussed clean-up and conservation tasks.
Significant investment and partnership with Groundwork
Groundwork have a number of significant initiatives underway in Hastings and are a key partner for community engagement and management of several large open spaces in the future. In Hastings Country Park, The Hidden Heritage project has been funded with £277k investment from the National Lottery Heritage Fund to provide new activities and events focussing on hidden stories and the park’s past. This was a bid in partnership with the local authority. The investment involves two funded posts for education and outreach, and will also involve improved paths and interpretation across the park.
A new visitor centre is being constructed which will be the first straw bale public building in Hastings – this is funded by the Borough Council and the North West Europe Interreg programme. The aim is to create a new destination that will draw people to the park – with a café, a focus for activities and a place to meet. This includes a natural play area as part of the external landscaping. In Combe Valley Park, Groundwork are
32 Mental health, wellbeing and the natural environment: case studies of four areas in England
supporting a Community Interest Company (CIC) there and starting work on a future vision for the park - for example, having a training and education centre.
Whilst neither of these have an explicit focus on wellbeing, Groundwork are aware of the importance of a volunteering offer and the benefits this can bring. As part of the work in the Country Park, they are developing a programme around horticulture for unemployed people, and applying for European Social Fund (ESF) funding through the Connecting Hastings and Rother Together (CHART) programme. This will target more deprived wards and offer work training, job brokerage support. Participants will have the opportunity to be outdoors and enjoy what is on their doorstep, whilst learning about communication, safe working, punctuality and team working.
“We are looking at whole range of things we can offer. It’s not just about making the park more accessible and beautiful. We can bring in other sources of money if we develop an employment and training programme to get people job ready for the environmental sector. We want to make sure every pound we get from funders goes as far as it can..” (Delivery staff, regional charity)
Groups/events with a campaigning or awareness raising focus
These do not tend to have an explicit wellbeing focus but cover issues such as active travel (an annual cycling festival), encouraging families to spend time outside (for example, local neighbourhood events such as ‘Summer Streets’ arranged by the Active Hastings Partnership). Two projects were repeatedly mentioned in interviews:
Figure 8: Campaigning and awareness raising examples in Hastings
National parks and AONBs
The High Weald AONB and the South Downs National Park both have a strong health and wellbeing focus in their strategies, and for the latter, projects that explicitly reach out to groups more at-risk. However, due to their location, it is hard to establish to what extent these benefit people in Hastings.
• The High Weald AONB’s management plan recognises the contribution that nature can make to health and wellbeing and the importance of accessible countryside.
33 Mental health, wellbeing and the natural environment: case studies of four areas in England
“The High Weald AONB is characterised by perceptual qualities, features and cultural associations that enrich character components, enhance health and wellbeing and foster enjoyment and appreciation of the beauty of nature.”23
The main activities of the AONB are primarily focussed on management, and advising local authorities and other partners. There is reference to greater community involvement – primarily through a range of volunteering opportunities around practical conservation, rather than anything directly referencing health and wellbeing.
• South Downs National Park is developing a Health and Wellbeing strategy, and has a new dedicated Health and Wellbeing Officer. A future aspiration is to develop priority places in the park where engagement and health and wellbeing activities can take place.24
“The focus on projects and delivery is fundamental for us as a national park. It’s on our doorstep – we have to make the best use of that.” (Strategic staff)
There is a focus on projects to help boost the numbers of underrepresented groups in the park (known to be young adults, BAME communities, people with disabilities, and living in deprived areas).25 One example includes Artscape – which was a 12 week programme to bring people into the landscape and produce art work based on their experience of being in the environment in nature.
How activities are promoted in Hastings
Hastings Borough Council lists all its parks, gardens and allotments with information available on each – these pages do not contain links to relevant FOPG, but do signpost ideas for walks and give an overview of what happens in each space. Many of the FOPGs have Facebook pages which are updated regularly with pictures and events.
There are several directories where people could potentially find out about activities or organisations in Hastings delivering projects or activities in the natural environment. However, as the mapping exercise revealed, some of these could be out of date, only cover one particular angle or theme, or not be clear about which projects were still running.
• East Sussex Community Information Service is a free online database at county level which hosts different local and community information. ‘Nature, wildlife and outdoor places to visit’ is one of the filters.
23 High Weald AONB (2019) Management Plan 2019-2024. 24 South Downs National Park (2014) Partnership Management Plan: Shaping the Future of your South Downs National Park (2014- 2019). 25 South Downs National Park article ‘National Parks are the natural health service”
34 Mental health, wellbeing and the natural environment: case studies of four areas in England
• Transition Towns have a Hastings Green Pages on their website
• Active Hastings uses Facebook to promote physical activities that are low cost or free – this includes some activities that are not traditionally seen as sport or physical activity, recognising their broader remit as a partnership
• Hastings Voluntary Action have a directory of all their members on their website – and you can search by key terms
• 1066 website which is a one-stop guide for residents in Hastings and St Leonards. This lists environmental groups, and has some events listed (though not many of these include opportunities identified in our mapping).
How projects are funded in Hastings
The main sources of funding that stakeholders referenced in interviews, or were identified through mapping in Hastings include:
For smaller VCS and community organisations:
• FOPGs generating income through membership fees, donations, charging a small amount for refreshments at events, or plot holder fees. • FOPGs targeting small pots of money (for example, £5-10k) through the Sussex Community Fund, Asda, Tesco. • Hastings Borough Council and the local CCG have funded small projects • One group had secured a large grant from the National Lottery Heritage Fund but this was to rebuild a wall, and a small number of community engagement activities
Larger VCS/more targeted provision:
• The Active Access for Growth Fund • Housing associations • Hastings Opportunities Area funding • National Lottery Community Fund • East Sussex College • A small charge to participants for the Walk2Run course • The National Lottery Heritage Fund for the Hidden Hastings projects in Hastings Country Park
The Walking for Health programme run by TCV was commissioned by East Sussex Public Health but at the time of the research this funding had come to an end and the future of the walks were uncertain. Changes at the county council meant that Public Health were no longer directly managing lots of third sector organisations and were instead commissioning a primary supplier to oversee the grants. There was a break in service whilst they did some asset mapping ahead of future funding. The GreenGym programme had been funded by the CCG but this was no longer running.
35 Mental health, wellbeing and the natural environment: case studies of four areas in England
A few other sources of funding were mentioned in the stakeholder interviews - the CCG had a small grants scheme targeting third sector providers of up to £10k (this ran for three rounds). Sussex Lund Trust funds grants up to £10k for green improvements – primarily in the High Weald but projects in Hastings have also bid for this and been successful - for example, Education Futures Trust for a secret garden at their offices for outdoor learning. Sussex Community Foundation has a grants programme with several awarded under the environment theme (for example, to Hastings Country Park to support improvements to the park).
Future plans in the area
Many of the interviewees involved in directly delivering projects or running resident groups talked about their future plans and aspirations. These included expanding particular groups or sessions that had been successful and working with other organisations nearby to engage more local residents – for example, Ore Community Land Trust were keen to get the local nursery involved in the woods to draw in more families. Others were applying for small grants to help support conservation activities.
3.4. The local system in Hastings
Overview
Hastings Council is a borough council within the East Sussex County Council area. The Public Health team is part of East Sussex County Council, and the Health and Wellbeing Board also sits at this level. Hastings and Rother CCG is one of three CCGs in East Sussex, and is part of the Sussex Health and Care Partnership which includes the local authorities, health and care providers and CCGs from across Sussex. The Partnership has responsibility for the Sustainability and Transformation Plan for the area.
Hastings Borough Council strategies emphasise the ‘extraordinary’ offer in Hastings, and the role of the natural environment in creating a safer, healthier and more sustainable place.
“All the wildlife sites and key open spaces in the town support a health functioning ecosystem that contributes to a better quality of life and to people’s sense of wellbeing.”26
Public Health and NHS documents at county wide level highlight the need to address pressing health inequalities in Hastings, and the Healthy Hastings and Rother CCG programme aims to place prevention and early intervention at the heart of the solution. The Sussex Health and Care Partnership Strategy acknowledges the importance of shifting from demand management to prevention, and how this is the responsibility of the ‘whole system’, dependent on the work of a number of partners.27 The Partnership’s Prevention Board objectives include taking an asset based approach to supporting wellbeing – but whilst physical activity is mentioned, there is no reference to the role of the natural environment.
The overall impression from the documents and interviews is that stakeholders at Hastings borough level acknowledge the potential of the natural environment for supporting wellbeing of
26 Hastings Borough Council (2014) Hastings Local Plan The Hastings Planning Strategy 2011-2028. 27 Sussex Health and Care Partnership (2019) Strategic Delivery Plan: Response to the Long Term plan. 36 Mental health, wellbeing and the natural environment: case studies of four areas in England
the local population, including those most at risk, but there is no partnership or network that entirely owns the agenda.
“There is nowhere where those more structured conversations are taking place.” (Strategic stafff, local authority)
This was compared to the other side of East Sussex where a partnership called Greenhavens of 75 community organisations protecting green spaces had formed. Their work includes encouraging people to get involved in projects outdoors to help maintain positive mental health and wellbeing.
However, there are a number of other partnerships and groupings in Hastings that have some level of interest and involvement in the natural environment, and in some cases, make the explicit connection to the benefits it can provide for people’s wellbeing.
The system in Hastings can be characterised as consisting of the following elements:
• A number of key players and partnerships – particularly around physical activity (local authority led), Groundwork’s involvement in Hastings Country Park and Combe Valley Park and support within the voluntary sector to connect groups. These partnerships see the natural environment as one possible way of improving wellbeing but it is not their core focus. They have a clear sense of their connecting and facilitating roles across a range of organisations and how these can contribute to the wider agenda.
• A local authority proud of its parks and with strategic commitment to protect and enhance the natural environment.28 However, in reality the local authority is too stretched to lead or co-ordinate community engagement with spaces on any town-wide level. At the time of writing this report, an open spaces audit was underway being led by leisure and planning and involving community engagement.
• Grassroots or community-led initiatives having irregular networking events and opportunities for ad-hoc connections (for example, through word of mouth, or participating in town wide events and festivals where different organisations come together). However, sustaining connections in between is more challenging- there is no forum to bring these groups together and the council funded post that used to do this has been cut.
• A less visible role for some key partnerships – for example, the Sussex Nature Partnership , Health and Wellbeing Board, and East Sussex’s Environment Partnership – mainly due to the large geographical area they cover.
• Varying levels of engagement from key environmental charities – with some very active in Hastings, but others focussed more on projects elsewhere in East Sussex. This
28 Hastings Borough Council (2010) Environmental Policy (2010). Retrieved from www.hastings.gov.uk/environmentalhealth/strategies_policies/environmental_policy/.
37 Mental health, wellbeing and the natural environment: case studies of four areas in England
is combined with a challenge for the local AONB and National Park in targeting Hastings again due to the large geographical areas they cover.
Partnerships and networks in Hastings
Key partnerships
The Active Hastings Partnership primarily plays a connector role for organisations in Hastings who are involved in promoting greater physical activity. It is led by Hastings Borough Council in partnership with East Sussex Council Public Health (having grown out of a Sport England programme) and brings together organisations from different sectors to address barriers to participation in physical activity, and improve what is on offer locally.
“It’s for anyone who can use sport and physical activity as a tool to achieve their aims.” (Strategic stafff, local authority)
The Active Hastings Partnership was one of the main ones that interviewees were aware of or actively involved with. This was primarily local authority and health stakeholders, and larger delivery organisations who emphasised its role in “providing some level of coordination” (Delivery staff, national charity).
The focus of the Active Hastings Partnership is not on the natural environment, but the network does consider participation in physical activity through different interventions, which include the outdoors. There is some representation from the environment sector, with TCV and Project Rewild sitting on the partnership. However, those involved acknowledged that more connections could be made, and that there were some obvious gaps (for example, other relevant departments within the local authority).
The main strengths of the partnership were identified as promoting collaborative working and spotting connections between a wide range of providers within the context of limited resources – “our remit is to pull people together, rather than compete over bids” (Strategic stafff, local authority).
Hastings Voluntary Action (HVA) supports the development of voluntary and community groups in Hastings, and networks and collaborations between different groups. One aspect of HVA’s role involves direct support to organisations starting different projects, drawing on an asset based community development approach.
“We have helped people set up walking and running groups, community gardens and a whole range of things. Our job is to help people do something of benefit.” (Strategic stafff, large local charity)
Through their connecting and facilitating role, HVA runs the Hastings Community Network (HCN) where voluntary groups and representatives from other sectors meet four times a year to discuss thematic issues. The environment is one of these, and a recent HCN event was ‘how can improving the environment benefit our health and quality of life’.29 This involved 42 representatives from 32 organisations across different sectors attending, with presentations on
29 This took place in October 2019 within the timeframes of the research, and Renaisi attended to introduce the research 38 Mental health, wellbeing and the natural environment: case studies of four areas in England
the wider sustainability agenda in Hastings, and open space conversations on the physical benefits of outdoor activities, healthy and sustainable food environments and challenging food poverty. Some of the main actions arising from the event including sharing information about projects and activities online via East Sussex Community Information Service, as well as engaging with the Local Strategic Partnership and the East Sussex Environmental Partnership.30
Those involved described the benefits HCN could bring – “HCN is a godsend and smaller groups do need to be represented at those events. It is the perfect vessel for it.” (RSPCA interview). It was seen as being a positive way to raise awareness of other things happening in the local area – but as with any network, could face challenges in maintaining the momentum and connections in between physical meetings.
Other partnerships and groupings
There are a number of other partnerships, networks or more informal task-driven groupings in Hastings that were mentioned in the interviews:
• The East Sussex Healthy Weight Partnership – led by East Sussex County Council and currently developing a new plan for the partnership based on Public Health England whole systems work. This will involve a focus on the natural environment and its role in reducing obesity.
• Social prescribing pathway - a two year project is underway (which started in early 2019) to create an integrated East Sussex social prescribing pathway. This is being led by South Down Community Association, working with others to develop the scheme. A previous attempt had been made under the Healthy Hastings and Rother programme to raise awareness of community projects and services amongst GPs, but this latest project aims to streamline different social prescribing services and develop an approach for the whole county. The new scheme will have link workers aligned to the primary care networks that are already in existence.
• Hastings Environment Network – this is a volunteer run group that aims to raise awareness of environmental issues and support local environmental groups and activities. The web presence suggests that it is not consistently active, beyond networking drinks once a month.
Partnerships at county level
The Sussex Nature Partnership was viewed as being largely focussed elsewhere in the county by different stakeholders, and not playing a specific role in bringing organisations together or sharing information at a level where different stakeholders in Hastings might benefit.31
There is an Environment Strategy for East Sussex (developed by the East Sussex Strategic Partnership) that has three explicit priorities to improve mental wellbeing through activities in open spaces; address the issue of these spaces being under-valued as resources for the
30 Hastings Community Network (2019) How can improving the environment benefit our health and quality of life – event write up. 31 The Sussex Nature Partnership’s website was updated during the course of the research with an outline of the natural capital approach they are developing. East Sussex County Council are listed as the secretariat. 39 Mental health, wellbeing and the natural environment: case studies of four areas in England
community where people ‘can connect with and benefit from being in the natural environment’; and providing better access. 32 However, no stakeholders mentioned this partnership in the interviews, and the Strategy itself does not contain any Hastings specific detail about the natural environment.
Interviewees were asked whether the Health and Wellbeing Board had any involvement around the natural environment in Hastings, and the majority felt this was not the case currently – but also questioned whether it would be feasible given their East Sussex county wide remit. Whilst its strategy emphasises the importance of prevention in reducing health inequalities, there is no mention of the role of the natural environment in this.
Strengths and enablers in the local system
There were a number of strengths in Hastings that stakeholders identified as helping to support connections between the natural environment and its preventative role in better mental health and promoting wellbeing.
The involvement of individuals within East Sussex County Council’s Public Health team in other area initiatives such as the Active Hastings Partnership and with the South Downs National Park was viewed as a positive development - supporting connections between the respective organisations. The Public Health team were also clear on the role they could play with regards to the natural environment.
“Part of my role links people being active in the natural environment. That involves working with partners on the ground who are doing that delivery’ (Strategic stafff, health sector)
Other stakeholders were aware of the work that the Public Health team were doing to develop a whole system approach to tackling obesity, and the fact there was recognition within this that the natural environment could play a role and support improved wellbeing.
In a similar vein, Hastings and Rother CCG were regarded as being engaged locally, working with East Sussex County Council Public Health colleagues to address behaviour and lifestyle changes. Some of the direct investment by the CCG included targeted work in local communities that help to get people out and about accessing outdoor spaces. This included the community hubs in Hastings, and funding organisations such as Education Futures Trust. These links were largely attributed to staff who had moved between East Sussex County Council and the CCG and were able to forge productive relationships. However, as outlined earlier, the funding role of the CCG had recently shifted, with investment being targeted at commissioned programmes.
Finally, a key strength in the local system and environment sector in particular was the long standing work of The Conservation Volunteers running GreenGyms (although these had stopped at the time of the fieldwork) and Walking for Health which was viewed as a tangible example of an organisation fulfilling the wellbeing and natural environment agenda. One of the main individuals involved had been working in Hastings for 20 years and was well connected with both statutory partners and partnerships, as well as different green spaces across the area.
32 East Sussex Strategic Partnership (2011) Environment Strategy for East Sussex.
40 Mental health, wellbeing and the natural environment: case studies of four areas in England
Biodiversity Action Groups operate in many spaces and the local authority valued being able to work with TCV and “identify what they could do and which sites they could help with.”
Challenges in the local system in Hastings
A number of barriers were identified that could hinder or make it more difficult to instigate and sustain activities in Hastings. Some of these related to the location of Hastings at one end of the county. Many larger charities are based in Brighton and focus their activities there. The size of East Sussex can also mean that organisations are spread thinly and have to prioritise who to engage with in terms of different partnerships. For example, the South Downs National Park have four Health and Wellbeing Boards, 15 district and borough councils and 15 CCGs in their area.
The changing role of the local authority was cited as a significant factor, with funding cuts meaning that the core team in the Parks Department has been reduced. They could still play a role in managing spaces, and coordinating with other partners to ensure open spaces remain open, but with more constraints.
“There was a time when we could do more. Our ability to deliver support for projects in green spaces to get people active in them is limited. We’re more focussed now on reaching other organisations who can help deliver those things on our behalf.” (Strategic staff, local authority)
This extended to other departments – Active Hastings had a smaller team than when it first started. Others who were working in relevant areas (for example, Rights of Way) felt that due to the pressures on their time, health and wellbeing was on the edges of their roles and they had limited capacity to develop things from scratch, even though they could see the potential benefits. Another interviewee reflected that these pressures meant it was reliant on key individuals to drive things forward.
“If someone wants to work with other groups and build things then it works well. But other departments might just see it as more work and more cost.“ (Strategic staff, local authority)
Although short term project funding is an issue across the voluntary sector, some stakeholders in Hastings described how it had been a while since the area had received a substantial multi-year grant, and that there was no consistent revenue funding for new projects – “It’s all very hand to mouth.” (Delivery staff, regional environment charity)
Challenges around partnership working were often attributed to a lack of a shared agenda, and different motivations amongst local level groups. Smaller resident-led groups tended to be more focussed on their patch, making more strategic conversations around co-ordinating environmental activity hard. Larger environmental charities were seen as having their own priorities - as outlined earlier, the Sussex Wildlife Trust manages two nature reserves in Hastings and involves volunteers in this, but do not run any Hastings specific projects at present. Frustrations were expressed that despite the recognition of how important the natural environment is for mental health and wellbeing there was no joining up between different interests and specialisms.
41 Mental health, wellbeing and the natural environment: case studies of four areas in England
Finally, there was a desire amongst some stakeholders operating at a more strategic level or delivering projects across Hastings for the social prescribing project being developed to lead to more GPs being aware of different community projects in the natural environment and signposting patients to them prioritising prevention.
“The area we have not yet cracked is GP engagement. We did try to set up an exercise referral programme, but it wasn’t the right timing. We hope that the new social prescribing framework being created will see the Active Hastings Partnership having a key role.” (Strategic stafff, health sector)
Local plans and strategies
The table below summarises a) actions relating to access and the quality of the natural environment b) the link between the natural environment and health and wellbeing benefits in a variety of local policy documents and strategies. This is not exhaustive but illustrates where the connection is made between investing in green spaces and ensuring they are accessible, and the link to health agendas.
Natural environment Health and wellbeing/natural Strategy references environment Council wide
Hastings Community • The strategy • There is explicit reference Strategy (2009-2026) recognises the to green spaces being (Hastings Borough Council) contribution of the important for health – seaside location, allowing for contact with valleys and varied nature, mental health wildlife make to the benefits and encouraging special character of people to be physically Hastings active. • A commitment to conserve and enhance this, so everyone has access to well- maintained open space.
Hastings Local Plan (2014) • Contains a key chapter • One of the headline on the natural (Hastings Borough Council) objectives in the plan is the environment, with an importance of a healthy emphasis on natural environment for increasing access and personal wellbeing (as well improving site as economic growth and management in areas with nature prospering communities). conservation • Explicit link between the significance. network of green spaces and its function to ‘increase
42 Mental health, wellbeing and the natural environment: case studies of four areas in England
Natural environment Health and wellbeing/natural Strategy references environment opportunities for healthy living’ (food growing, and spaces for recreation and exercise). Green and open spaces
Hastings Open Spaces plan • A framework for future • References that the plan (2006) (Hastings Borough open space and play links to the ‘healthy living’ Council) provision (for sites agenda with examples managed by the given of taking part in council) looking at the walks in green spaces, or amount, distribution growing food. and quality of • Acknowledges the role a provision. network of green spaces • An emphasis on can play a role in health making sure that the promotion – particularly network of green increased activity and spaces at borough and mental health. neighbourhood level • Recommendation for the are accessible to all – Council to promote the recognising that (at the health benefits of green time of the plan), the spaces. quality of smaller spaces is poorer, and there is a need to enhance provision in more deprived areas
• Proposes a management plan and an active Friends group for every open space.
Green infrastructure study • Part of the evidence Not referenced (2016) (commissioned by base for Hastings Hastings Borough Council) Borough Council Development Management plan • Highlights the need to link green infrastructure, improve access for pedestrians, and increase the
43 Mental health, wellbeing and the natural environment: case studies of four areas in England
Natural environment Health and wellbeing/natural Strategy references environment biodiversity of existing spaces.
• Acknowledges work that has taken place locally to develop cycle routes across the town.
Open space and play space • Started in 2019 as part • The audit links the poor audit (current) of informing the Local health outcomes in Hastings to the need for a (Hastings Borough Council) Plan review - aims to update the evidence local network of parks and open spaces ‘to provide base in Hastings and them with the opportunity consider the long term to improve their health and use of informal open quality of life. space, its significance for residents, and where there are deficiencies and surpluses in the area. • The background documentation for the audit sets out the benefits of open and play space for recreation, exercise, interaction as well as ecological value. • The audit covers 175 different spaces. Health
Public Health report 2018/19 Not applicable • Includes data which shows (East Sussex County that the use of outdoor Council) space for exercise has decreased in East Sussex.
• One reference to role of the physical environment in supporting wellbeing (but not explicitly the natural environment)
44 Mental health, wellbeing and the natural environment: case studies of four areas in England
Natural environment Health and wellbeing/natural Strategy references environment
Public Health report 19/20 Not applicable • Primary focus of the annual (East Sussex CC) report is on health and housing. • It does link access to green space to good health and wellbeing, and references East Sussex Public Health working with local planning to improve the local environment to maximise health and wellbeing
Summary of Healthy Not applicable • Recognises the Hastings and Rother – environmental causes of working together to reduce health inequalities health inequalities (alongside social and (Hastings and Rother CCG) economic, lifestyle and behaviour) but no explicit reference to the role the natural environment can play in the publicly available summary.
Health and Wellbeing Board Not applicable • No explicit mention in the strategy – East Sussex summary of the role of the (2016) (summary) natural environment in prevention
Hastings Sport and Not applicable • The strategy uses a broad Physical Activity Strategy definition of physical (2016-2020) (Hastings activity that includes Borough Council) recreation, living and travel as well as sport.
• References the importance of accessing leisure facilities and green spaces to help achieve this – and working with providers of parks and open spaces to maximise their use for recreation and physical activity.
Table 6: Local strategies in Hastings
45 Mental health, wellbeing and the natural environment: case studies of four areas in England
Middlesbrough
46 Mental health, wellbeing and the natural environment: case studies of four areas in England
4. Middlesbrough case study
4.1. Middlesbrough context
The area
Middlesbrough is located on the south bank of the River Tees and is the largest town in the Tees Valley. Middlesbrough Council is one of the five unitary authorities that form part of the Tees Valley Combined Authority which has responsibility for transport, infrastructure, skills, business investment, housing, culture and tourism.
Middlesbrough has a vibrant leisure and cultural scene offering large scale outdoor events and is also home to a £14 million contemporary art gallery. The town is well served by public transport, with direct rail connections to other major cities in the North such as Leeds, York, Liverpool and Manchester.
As a post-industrial town, Middlesbrough has experienced social and economic challenges. Previously, the main economic drivers were steelmaking, ship building and chemical industries. Over the last fifty years, residents in Middlesbrough have been impacted by the changing economy since the departure of the manufacturing industry in the area.
Despite the decline in industry, Middlesbrough has benefited from a growth in modern technology. The £250 million development project ‘Digital City’ aims to create more than 2,000 jobs particularly for digital and creative businesses and new age process industries. In addition, Teeside University has a strong recognition in the town, and is renowned for producing digital businesses and hosting the Animex festival annually.
Population challenges and at-risk groups
Middlesbrough is one of the 20% most deprived areas in the country, and often ranks lowest in measures of deprivation and poverty. The unemployment rate is 7% which is amongst the three highest unemployment rates in the UK.33
Life expectancy for both men and women in Middlesbrough is lower than the England average. Inequality varies across the town and there is an 11 year difference in life expectancy across different wards.34 Levels of physical activity amongst adults are low with just over half (52%) identified as being ‘active’.35 Excessive alcohol consumption is a specific challenge in Middlesbrough where the rate of alcohol-related harm hospital admissions is significantly worse than the average for England.36 Similarly, recent figures estimate that the prevalence of opiate and/or crack cocaine use in Middlesbrough is more than two times higher than national estimates.37
33 Office for National Statistics (2019) Regional labour market statistics in the UK September 2019. 34 Community Foundation (2017) Tees Valley’s Vital Issues 2017, Healthy Living, p.7. 35 Tees Valley Sport (2018) Physical Activity Levels by Local Authority. Retrieved from https://www.teesvalleysport.co.uk/knowledge- research/adults/physical-activity-levels-by-local-authorities/. 36 Public Health England (2019), Local Authority Health Profile 2019, Middlesbrough. 37 Public Health England (2017) Estimated prevalence of opiate and/or crack cocaine use 2016/17. 47 Mental health, wellbeing and the natural environment: case studies of four areas in England
“It’s an old town. It’s a quite poverty-stricken area. There are big issues with drug addiction.” (Delivery staff, small community group)
Suicide and self-harm are additional health challenges in Middlesbrough. The rate for self-harm hospital admissions is 391, worse than the average for England.38 Middlesbrough’s suicide rate (17.4 per 100,000 population), is 70% higher than the national average and significantly higher than anywhere else in the Tees Valley.39 The Tees Suicide Prevention Strategy Plan aims to contribute to the reduction of the local suicide rate and is a key focus in reducing health inequalities.40 This is a multi-agency partnership which includes early alert protocols, a dedicated suicide prevention post across the four local authorities, and is supported by a range of grassroots projects that aim to support people to improve their mental health and wellbeing.41
Middlesbrough is the most densely populated and the most ethnically diverse local authority area in Tees Valley. Minority ethnic groups comprise 11.7% of the population.42 Middlesbrough is home to high levels of refugees and asylum seekers, due to resettlement schemes from places such as Syria.43 There are challenges around the extent to which such groups access health and wellbeing services.
Funding and programmes
There are a number of local area-wide and neighbourhood initiatives taking place across Middlesbrough which reflects the changing nature of the town. These include regeneration programmes, physical activity initiatives, heritage projects and promoting volunteering:
£78m investment from the Lottery to reduce loneliness and isolation in people over 50 using asset based community development Ageing Better approaches to keep people active, and create opportunities for connections.
The focus is working with partners from all sectors to provide better North Ormesby Big Local quality housing, build local capacity and skills, and employment and training opportunities.
The five Tees Valley authorities have £843,125 of capacity funding to develop plans to transform the town’s economic growth prospects. MHCLG Towns Fund The focus is on improved transport, broadband, skills and culture. If successful, the bid could bring in £125m for the Tees Valley.44
You’ve Got This (until 2021) – A pilot across Middlesbrough and Redcar & Cleveland authorities to increase physical activity and Sport England: South address stubborn inequalities. The pilot involves working in four Tees Local Delivery Pilot communities where the wards where the wards are high on the IMD, partnering with local agencies and residents to co-produce and change the culture and environment around physical activity.45
38 Public Health England (2019) Local Authority Health Profile 2019, Middlesbrough. 39 Community Foundation (2017) Tees Valley’s Vital Issues 2017, Healthy Living, p.3. 40 Tees Suicide Prevention Strategic Plan 2016/17-2020/21 41 This includes some of the projects that are discussed in subsequent sections – for example, Men’s Sheds. 42 Office for National Statistics (2011) Census 2011. 43 Cleveland Police’s Corporate Services Department: The changing nature and complexity of demand in Cleveland 44 The Council has £173k to develop the bid with a Town Investment Plan due by the end of summer 2020. 45 Tees Valley Mayor (n.d) Mayor Welcomes Funding for Multimillion-pound Town Deals. Retrieved from https://teesvalley- ca.gov.uk/mayor-welcomes-funding-for-multimillion-pound-town-deals/. 48 Mental health, wellbeing and the natural environment: case studies of four areas in England
Middlesbrough has benefitted from several large arts and culture programmes, including Great Places Tees Valley (2018-2020) run by Tees Valley Combined Authority and funded by the National Lottery Heritage Fund and Arts Council England (ACE). This created participatory projects and events including one which explored the Arts and culture history and impact of the River Tees. The ACE programme Creative People and Places (2019-2024) also focusses on three wards in Middlesbrough to increase the number of local people taking part in arts and culture to improve health, wellbeing, education and employability.
Table 7: Funding and programmes in Middlesbrough
4.2. The natural environment in Middlesbrough
Overview
There is considerable access to the natural environment in and around Middlesbrough. The town is situated close to the countryside, ten miles from the North York Moors National Park, and is also near the North Sea coast. Of the total 997 hectares of open space in Middlesbrough, 77% of this is publicly accessible.46
“There is quite a bit of open space. There are a fair few parks including large greens. People can play football and do more formal activities. There are links from the heart of Middlesbrough to the countryside south of our area. We have a number of walking routes in the area.” (Strategic staff, local authority)
In Middlesbrough, the natural environment includes: 11 allotment sites; 32 amenity and natural green spaces; three local nature reserves; 19 local wildlife sites; six memorial gardens; 34 parks and public gardens; 27 play areas; and 14 Beck valleys.47 There are major parks including Albert Park, which is one of the six parks in Middlesbrough to win a Green Flag award.
“We have amazing green spaces. Albert Park, for example, is an oasis…” (Participant, local environment charity)
The majority of parks are managed by the Council, and Tees Valley Wildlife Trust is responsible for 15 nature reserves across the region. Middlesbrough is also situated on the edge of the North York Moors National Park.
Middlesbrough has recently received funding from the Forestry Commission’s Urban Tree Challenge Fund where £500,000 will go towards planting 1200 trees across the town. This will focus on more deprived wards, with the Council delivering the scheme in partnership with Groundwork North East and Cumbria.
46 Middlesbrough Council (2017) Open Space Needs Assessment 2017, p.9. 47 Middlesbrough Council (2017) Open Space Needs Assessment 2017. 49 Mental health, wellbeing and the natural environment: case studies of four areas in England
Local barriers in Middlesbrough’s natural environment
The majority of barriers to accessing the natural environment in Middlesbrough were identified by interviewees as being related to the population challenges faced in the area. Interviewees mentioned that many families and children in the town rarely go to the natural environment areas immediately around Middlesbrough.
Cost was often cited as a major barrier – with the perception that activities or spaces had a cost attached to them although this was rarely the case.
“People don’t initially get involved in the groups – they think it’s going to cost something.” (Delivery staff, small community group)
Middlesbrough is relatively well served with public transport, but given the high levels of social deprivation, transport costs could be an additional barrier. In addition, some interviewees felt that there was a lack of understanding about what means of transport were available to access the natural environment.
“The increasing cost of public transport is an issue, and not owning a car. This is illustrated by how many people as part of this project come by bike – at least half! It really does impact upon what you can or can’t achieve or do in relation to the natural environment.” (Delivery staff, small community group)
The maintenance and safety of spaces was raised in a number of interviews. Some green spaces were perceived as attracting anti-social behaviour, and perceptions of poor lighting were also cited as barriers to usage.
A less common issue was a lack of awareness of which natural environment spaces could be accessed although those that did raise this felt it was significant. On a practical level, the Tees Valley is prone to flooding and surface water levels are high which means that the paths on open spaces can be muddy, and become less accessible.
4.3. Local provision in Middlesbrough
Overview of what is available
The majority of local interviewees in the Middlesbrough case study felt that there were good levels of outdoor opportunities that might benefit people’s wellbeing and that this provision had been increasing in recent years. Interviewees highlighted that local parks within the town provide different offers to residents, including outdoor exercise, community events, and groups undertaking conservation activities. Middlesbrough was described as having a strong ‘green movement’ with many pockets of green spaces in urban areas being used for grassroots growing projects. However, some interviewees felt that as many initiatives were project based, provision could also be short-term and ‘patchy’.
The mapping activity and stakeholder interviews focussed on identifying activities that take place in the natural environment, with either an explicit or implicit emphasis on promoting wellbeing:
50 Mental health, wellbeing and the natural environment: case studies of four areas in England
• There were approximately 44 opportunities that broadly fall within the scope of the research. Many organisations provide regular activities throughout the year on a one-off or ad hoc basis so the number of opportunities available to Middlesbrough residents is, in reality, higher. For example, some shared spaces such as community allotments have multiple partners coming in to work on the sites.
• Over half of the organisations were local and focussed entirely on Middlesbrough – with most of these being small community groups. Two were larger local charities.
• With larger programmes such as Tees Valley Wild Green Spaces some projects have finished and it is not clear how many opportunities are still live. With other multi-site programmes it is easier to count – for example, there are 11 walking for health groups running, and three pakruns.
• There were eight national organisations operating in Middlesbrough and the Tees Valley region – four of these were environmental charities, one heritage and three focussed on health/exercise.
The majority of opportunities identified involved interacting with nature. The most common activities in this category were focused on conservation and gardening, followed by projects focused on promoting healthy and sustainable lifestyles through farming and community food growing. The projects that involved experiencing nature included walking groups.
Of the activities identified, the majority were open to anyone, but four of these had a focus on improving health and wellbeing. These were mostly organised by national charities with a regional or local remit, with one exception of a walking group ran by an individual. Six projects were targeting people with a defined need.
The ways in which projects and opportunities reflected the needs of the local population in Middlesbrough is as follows:
• People on low incomes, with a focus on growing food – Middlesbrough Environment City’s projects across the town and the numerous community allotments and growing projects in deprived wards.
• Targeting people in insecure housing and drug or alcohol dependency – for example, In Harmony.
• Responding to the needs of refugees and asylum seekers – for example, Middlesbrough Environment City, and the Mary Thompson Fund.
• National charities providing localised support to people experiencing mental health issues primarily through horticulture and gardening – for example, Groundwork’s Men’s and Lad’s Sheds.
• Projects focused on tackling loneliness and isolation of older people – for example, Ageing Better in Middlesbrough lists the regular volunteering times for the different ‘Friends of’ groups in the town.
51 Mental health, wellbeing and the natural environment: case studies of four areas in England
Who is providing what in Middlesbrough?
The groups of organisations and projects taking place in Middlesbrough are outlined below, summarised from the interviews with local stakeholders or fieldwork visits with some additional information gathered through the local mapping exercise.
Local grassroots community organisations and individuals
The fieldwork involved interviews with two representatives from small community organisations associated with a specific park and an individual who had recently organised a walking group through social media.
The majority of the community organisations identified were FOPGs that were regularly working on the conservation of both green and blue spaces in Middlesbrough. The Council’s Green Spaces strategy refers to the diversity of these groups (from small to larger constituted groups). Examples include the Friends of Bluebell Beck who volunteer time for conservation work along the beck, as well as organising community and family events, and the Friends of Stewart Park who formed in 2007 to support a Lottery bid and now continue to promote the park as an attraction and do weekly horticultural work in partnership with park staff. Photo from Neighbourly article on Alley The mapping exercise also identified three organisations Pals focused on providing shared spaces for growing fruit and vegetables – examples included the Alley Pals who support residents to plant seeds, grow vegetables and organise community events in urban areas where there is a lot of dense terraced housing; and the People’s Park Community Allotment which provides a shared space for food growing. “I’m educating people about herbs that we can grow on our doorstep instead of buying things from big tea companies. The money I make from it… I invest the money into other green projects, [for example] art work with local people, educate them with gardening and get them involved with other projects.” (Delivery staff, small community group)
Most of the smaller community groups and organisations do not have a direct health and wellbeing focus, and their main aims are to educate people about maintaining and making use of outdoor spaces, and encouraging residents to get involved in these projects.
“We do events and activities in the park for the public, sometimes get public money.” (Delivery staff, small community group)
52 Mental health, wellbeing and the natural environment: case studies of four areas in England
Figure 9: Example of a small project led by an individual in Middlesbrough
Social enterprises The mapping exercise identified social enterprises that engage people with the natural environment. The fieldwork involved one visit with an organisation in this category.
These were more targeted in their approach and both worked with more at risk groups - one (Barefoot Kitchen) trains people with low incomes and insecure housing in gardening and horticulture. The other (In Harmony Food Revolution) delivers a food growing project called Growing In Harmony which aims to provide local organically grown food to people from all backgrounds in an area of high deprivation. In addition to that, they offer educational opportunities for diverse groups in the local community including training in horticulture, woodworking, sustainability and animal care.
“Almost all of them are long term unemployed… the vast majority we're getting referrals from routes to work, youth employment initiatives, mental health charities and we have people from youth offending.” (Delivery staff, social enterprise)
Larger local voluntary sector organisations There were approximately six projects that were provided by organisations in this category including local organisations that had a number of different projects available, or national organisations operating through a local branch. The fieldwork involved one visit and five further interviews with representatives of these organisations.
53 Mental health, wellbeing and the natural environment: case studies of four areas in England
On the whole, these projects were targeted towards people with a defined need, including: refugees and asylum seekers; people with mental health issues and disabilities; and older people. These projects included activities such as gardening48, farming, and eco-therapy.
Figure 10: Examples of projects from larger VCS organisations in Middlesbrough
Regional environmental organisations The mapping identified approximately six national environmental organisations (including the North Yorkshire Moors National Park, and the National Trust) operating across the Tees Valley or nearby. The fieldwork involved four visits and further interviews with representatives of organisations in this category.
Some opportunities in this category were open to anyone. For example, the North York Moors National Park has structured volunteering programmes for a range of ages which are focussed on conservation tasks through the Voluntary Rangers programme; opportunities for young people and families (the Explorer’s Club and Young Rangers), as well as leading walks as part of the ‘Breath of Fresh Air’ programme’. Their work includes a transport fund which has worked with a range of charities (including Grandparents Plus, Addaction, Justice and Peace) to bring people into the park and take part in walks.
“We offer an events and walks programme. Walks are put on for all kinds of people – for example, short walks for people returning to health and obesity; themed walks and guided ones with a specialist.” (Delivery staff, park authority)
48 BBC News (24 May 2019) Growing Middlesbrough project offers lifeline to asylum seekers. Retrieved from https://www.bbc.co.uk/news/av/uk-england-tees-48396197/growing-middlesbrough-project-offers-lifeline-to-asylum-seekers.
54 Mental health, wellbeing and the natural environment: case studies of four areas in England
There were also some key programmes in Middlesbrough engaging with at risk groups. The main examples that were mentioned in multiple stakeholder interviews (and were visited as part of the fieldwork) included Tees Valley Wildlife Trust’s Lifeskills programme, and Groundwork’s Men’s Shed. These organisations were aware of the challenges residents in Middlesbrough experience, as well as the benefits of engaging with the natural environment.
Figure 11: Examples of projects run by national organisations at a regional/local level in Middlesbrough
In addition, there are a number of key environmental organisations who indirectly do work that might contribute to improved health and wellbeing. This includes the Canal and River Trust who have a presence in Teeside (managing the Tees Barrage Park) and they promote access, pointers on how to enjoy the park, and educational opportunities. The Tees River Trust manages the Tees Catchment, and whilst there is nothing current that has a wellbeing focus, they were part of the National Lottery Heritage Fund River Tees Rediscovered project from 2014-19 which included different approaches to work with community groups and schools focussing on wildlife, activities to improve the natural environment and engage in spaces through different public events.
Local projects based on a national model
55 Mental health, wellbeing and the natural environment: case studies of four areas in England
Middlesbrough has several national programmes running locally. There are three Park Runs operating in Middlesbrough each week. For 12 years, Middlesbrough Environment City have run the Walking for Health programme in the town for all ages and abilities. There are nine walks that take place regularly all around an hour in length, starting from accessible places such as libraries, community centres and the bus station.
How activities are promoted in Middlesbrough
Middlesbrough Council has a page where they share information about the parks they manage – the page includes information on what the park is like, the FOPG, and opening hours. Other opportunities are publicised across a range of websites:
• Middlesbrough Environment City shares opportunities on their website where it is possible to filter the projects by, for example, food, horticulture, and community actions.
• Social Farms and Gardens have a page for North East England where they share information about any community growing projects in the area.
• Love Middlesbrough (the local tourism website) has a page for things to explore in and around Middlesbrough, including walks in nature.
• Some local community groups (for example, FOPGs and community growing projects) have their own Facebook pages where they share updates about the things they do
How projects are funded in Middlesbrough
The main sources of funding that stakeholders referenced in interviews, or identified though mapping in Middlesbrough include: For smaller VCS and community organisations:
• FOPGs have received funding through different sources including from the local authority, supermarkets such as Tesco, private businesses, and generating money through events. • Middlesbrough Council has a Community Grant Fund which includes small grants for residents and community groups (up to £1500) and the Community Chest Fund which is for more established groups • TKMaxx’s Neighbourly funding – the Alley Pals project received funding through this • The Tees Valley Nature Partnership has a community grant scheme to support community organisations to increase participation in nature and/or the outdoors. The primary aim of this funding is to enable small local groups to fund work that other grant schemes might not cover, or to supplement funding from other small grants. Larger VCS/more targeted provision: • Groundwork’s Men’s Shed project was funded through Ageing Better, Middlesbrough Council Public Health funding, the Thirteen Group, Tesco ‘Bags of Help’, One Stop ‘Carriers for Causes’ and Northumbrian Water. • The Tees Valley Wildlife Trust Lifeskills project was funded through National Lottery Community Fund Reaching Communities money.
56 Mental health, wellbeing and the natural environment: case studies of four areas in England
• Other sources of funding mentioned included the National Lottery Heritage Fund, Garfield Weston Foundation and Natural England (for the Tees Valley Wild Green Spaces project which ran until 2019) Many stakeholders expressed difficulty in accessing funding, particularly in the context of local authority cuts. Furthermore, the impact of a ‘postcode lottery’ on participants was apparent with some funding being linked to certain geographical areas.
“Local authorities are really restricted. Some funding from CCGs is restricted by area and we only get funding if we get people with the right postcodes.” (Delivery staff, national environment charity)
Future plans in the area
There are a number of initiatives to increase physical activity amongst more at risk groups that are continuing in Middlesbrough (including the Sport England Local Delivery Pilot and mental health hubs through MIND). These will include some opportunities for engaging with the natural environment through sport although this is not the primary focus.
One of the projects that featured as part of a fieldwork visit – Lifeskills – is due to reach the end of its Lottery extension funding, and the organisers were hoping to develop it into a self-sufficient model, and receive funding from the NHS or local authority to help in the interim.
Stakeholders also talked about how the ‘green revolution’ in Middlesbrough was set to continue with small groups and individuals starting up different growing activities on available spaces. The “Walk and Talk” Group outlined earlier started with one individual and he plans to continue organising regular outings for people in the local community as well as sharing videos where he talks about mental health on his Facebook page. He is currently having conversations with funders in the local community to help him set up something more official.
4.4. The local system in Middlesbrough
Overview
Middlesbrough is unitary authority within the wider Tees Valley Combined Authority Area. Public Health South Tees is a joint function across Middlesbrough and Redcar and Cleveland, and the Live Well Board is the joint Health and Wellbeing Board. Tees Valley CCG was formed in 2020 bringing together responsibilities for health services in the five Tees Valley areas. Tees Valley CCG has responsibility for the STP for the area.
The natural environment assets in Middlesbrough are well recognised in different strategies. There is a high-level commitment to the natural environment including increasing usage and access to the natural environment and maintaining its quality – for example, in the Green Spaces Strategy, Local Plan and Sustainable Community Strategy.49
“Green spaces can provide good opportunities for physical activity to support good health and these opportunities need to be available to all members of the
49 See page 59 for more detail of these documents 57 Mental health, wellbeing and the natural environment: case studies of four areas in England
community. Where necessary, consideration needs to be given to those who may have special needs or access to facilities.” (Middlesbrough Sustainable Community Strategy)
There is a strong consensus in the town around the importance of sustainability. Middlesbrough Council has developed the One Planet Middlesbrough Action Plan (2016-2025) which involves ten different partners to make Middlesbrough a more sustainable community. This helps to provide an overarching framework for a range of actions. As part of the ten principles in the plan, there is reference to restoring and protecting biodiversity, creating new habitats and role a large and diverse network of open spaces can play in supporting health and recreational activities. The health and happiness section mentions improving the natural and urban environment ‘to create healthy and sustainable opportunities to improve economic and social opportunities for community and volunteer engagement.’
Overall, the system in Middlesbrough is characterised by:
• Strong existing partnerships – particularly in the environment sector through the Nature Partnership. There is a willingness to work more closely with Public Health.
• Commitment to prevention – in strategy documents (for example, Local Plan, Prevention Strategy) and through the PH South Tees and the Live Well Board and that this can only be achieved through partnership working across sectors and with local people. The benefits of engaging with the natural environment are well understood with some crossover beginning to happen.
• Large and well-established organisations that work across a range of sustainability areas, including wellbeing and the natural environment. For some this is an organisational priority (North York Moors National Park), and others part of a large programme of work (Middlesbrough Environment City), or through being a regional charity delivering projects that address the needs of targeted groups.
• Grassroots activity - but largely below the radar of more formal partnerships
• Less emphasis across policy documents on physical activity – whilst Middlesbrough is one of the Sports England LDP areas, there does not appear to be an overarching Physical Activity Strategy in place (although there were references to a previous Active Middlesbrough Strategy, and the Tees Valley Sport partnership has an active web presence).
Partnerships and networks in Middlesbrough
Key partnerships – environment
There is no single forum in Middlesbrough where the crossover between the natural environment and health and wellbeing is the primary focus. However, the local system has some key environmental partnerships in place. These include:
The Tees Valley Nature Partnership which was described by many interviewees operating at a more strategic level as being important locally, and contains a range of local and regional
58 Mental health, wellbeing and the natural environment: case studies of four areas in England
stakeholders. The Nature Partnership’s role is largely strategic linking different local initiatives and advocating for people spending time in nature. One of the main priorities is helping more people realise the health benefits of engaging with the natural environment, and their Business Plan (2019-22) is explicit about the well understood and evidenced benefits of exposure to nature, as well as outdoor physical activity for mental health.
In recognition that there is unequal access to the natural environment across the Tees Valley, one of the identified actions includes working with health partners to develop practical solutions to increase the use of outdoor spaces, and to train members of the Partnership to better understand the culture and terminology of public health. The Nature Partnership described how they have an informal relationship with Public Health South Tees, and this is still developing as they work out how best to support each other.
Middlesbrough Environment City is a charity (rather than a partnership) but works closely across the public, private and voluntary sector to deliver their projects to promote and encourage healthy and sustainable living (for example, through food growing, energy efficiency, active travel and outdoor play). They receive some funding from Public Health and are responsible for leading the community engagement in the ‘One Planet Living’ approach in Middlesbrough. They are also a member of the Nature Partnership. Middlesbrough Environment City are involved in other area wide programmes – for example, supporting the development of the Sport England Local Delivery Pilot.
Several stakeholders mentioned a Green spaces forum supported by the Wildlife Trust which brings together different FOPG to share experiences and information.
“It really connects the group… having someone at the centre point is key, positive and good for groups like us.” (Delivery staff, small community group)
The One Planet Middlesbrough plan references supporting volunteer and FOPGs to manage and be involved in open spaces, but earlier strategy documents also suggest that in the past this support has been sporadic due to challenges around staff resources.
Health partnerships
Health partnerships in Middlesbrough appear to be primarily through formal statutory mechanisms and partnerships involving Public Health South Tees: 50
Mental health is one of the themes that Public Health South Tees are working in partnership with the CCG and VCS organisations to address. This includes implementing the Tees Suicide Prevention Strategy, training the workforce in mental health promotion and a Community Health Champions programme of volunteers to promote positive wellbeing. Public Health South Tees also support different physical activity initiatives – including the Sport England pilot. Interviewees
50 Public Health South Tees was formed in 2018 as a joint public health team across Middlesbrough and Redcar & Cleveland. 59 Mental health, wellbeing and the natural environment: case studies of four areas in England
from Public Health South Tees described how their role often involves signposting and disseminating information about different projects that are taking place in the area. They felt that there was growing awareness of ways to improve health and wellbeing that did not rely on medical interventions, and that the natural environment could be crucial in achieving the five ways to wellbeing. However, they also felt they could do more to link with environmental charities and groups and be more explicit about the benefits of using outdoor spaces for improving wellbeing.
The Live Well South Tees Board is the joint Health and Wellbeing Board and aims to enable and promote multi-agency support. One of the priorities that Public Health South Tees have recommended includes embedding a stronger focus in local plans on population health and the wider determinants of health – this includes more emphasis on wellbeing, prevention and mental health.
Well-established organisations working at a local and regional level in partnership with others
The partnerships above exist alongside a strong presence from key environmental and health charities referenced earlier that work closely in partnership with other organisations in the area and have a strong focus on promoting the benefits of the natural environment for wellbeing. For example:
Tees Valley Wildlife Trust are very active across the five local authorities and on the Nature Partnership. They also used to run the Tees Valley Wild Green Spaces project - which ended in 2019 and aimed to increase appreciation and understanding of natural heritage in open spaces and increase local people’s conservation skills..
The North York Moors National Park have a clear commitment to promoting the Park for wellbeing purposes. The Park is explicit in its Business Plan (2017-20) about their responsibilities as a National Park to promote the benefits of the park for health and wellbeing, and have conducted research into the social return on investment for government on the health and wellbeing of people using the park. They also state a commitment to develop working relationships and joint initiatives with Tees Valley local authorities and Public Health teams.
The presence of well-established national charities and partnerships is also replicated in the voluntary sector for health with MIND in Middlesbrough being involved in many national programmes (such as the Sport England LDP, and working with Tees Valley Sport to bring a new regional hub to the Tees Valley to help more people with mental health problems get physically active).51 Whilst more on the therapeutic end, MIND also run the EcoMinds programme.
51 Tees Valley Sport (n.b.) Mind funds nine new regional hubs to help more people with mental health problems get physically active. Retrieved from https://www.teesvalleysport.co.uk/adults/mental-health-regional-hub/. 60 Mental health, wellbeing and the natural environment: case studies of four areas in England
Other groupings
• The Middlesbrough Voluntary Development Agency promotes and develops the VCS in the area, and part of its ‘sector connector’ directory involves a function to search for organisations in ‘environment/conservation and heritage’.
• Social prescribing – there are references to a previous initiative to develop social prescribing in South Tees (from 2014/15) across the two local authorities and CCG. This was not taken forward at the time, but since then, in light of the NHSE Long Term Plan for a social prescriber in every Primary Care Network, discussions have taken place with key partners to develop a scheme. MIND have also produced a local paper sharing their experiences and views on the social prescribing agenda.52
• Tees Valley Sport’s remit covers Middlesbrough. It is one of the 43 Active Partnerships that exist in England which have a responsibility to roll out Sport England programmes and funding. They have several programmes aimed at adults, including supporting young adults into employment and the national ‘This Girl Can’ initiative.
Strengths and enablers in the local system
The main strengths in the local system in Middlesbrough that stakeholders identified included:
• The availability and variety of green spaces – from allotments, community growing sites, to nature reserves, the Moors, and Beck Valleys – with considerable interest in how to encourage communities to engage with these spaces.
• Well-established residents groups involved in different types of green spaces. The community spirit in Middlesbrough was seen as a local strength, with projects starting up with relatively small pots of community funding.
• An active Nature Partnership that those in the sector were aware of and keen to develop relationships with – though understandably this was more the case for larger charities.
• An emphasis on growing food locally and different organisations working together to address food poverty through the Middlesbrough Food Partnership. This work also has a natural synergy with encouraging people to spend time outside and being involved in a social activity.
Challenges in the local system in Middlesbrough
Despite the commitment to the benefits of the natural environment, and its role in health and wellbeing across different partnerships and organisations in Middlesbrough, some interviewees felt that it was debatable as to whether this understanding filtered through to the communities they were aiming to engage.
“There is a top down appetite, we know what the links are and the evidence, and we have vulnerable communities, and proven activities that work, so there
52 MIND Middlesbrough and Stockton (2019) Getting it Right Social Prescribing and Mental Health. 61 Mental health, wellbeing and the natural environment: case studies of four areas in England
is recognition at the top that it is what we should be doing. I couldn’t speak specifically as to whether those communities feel the same.” (Delivery staff, regional environmental charity)
However, a common view was that more could be done to communicate the benefits of engaging with the natural environment to practitioners from different sectors working with more vulnerable people.
“Awareness and knowledge about what we do – and in particular the awareness of professionals that work with the groups we focus on. We try very hard to liaise with social workers – but word doesn’t always spread about us.” (Delivery staff, national charity)
An overall lack of coordination or a whole systems approach was identified as being the main challenge in Middlesbrough. Whilst there was strong consensus that there is a lot happening there is no explicit framework to encourage both individuals and communities to fully benefit from the natural environment. There were criticisms that too much money locally went to the NHS and the activities and projects identified in this mapping were reliant on short-term and ad hoc funding.
“It’s a bit siloed, the system doesn’t support those who want to make changes.” (Delivery staff, regional environmental charity)
Whilst there is strong strategic commitment amongst larger organisations working in partnership, the number of smaller community organisations could also be a barrier to making connections across the town. One stakeholder described how.
“There is no middle person to make those connections. Some smaller organisations are proactive, and others might not see that what they are providing is part of a bigger picture.” (Delivery staff, regional environmental charity)
This was also exacerbated by organisations lacking confidence to share what they are doing, particularly as many were in competition for the same pots of funding. Some in the voluntary sector felt it was unrealistic for smaller organisations to commit to partnerships when priorities in Public Health could change quickly, and they were not funded for their time to network and collaborate.
Public Health stakeholders also felt it could be hard for them to find out what was going on with no one directory to post opportunities.
Finally, several interviewees discussed challenges around establishing social prescribing in Middlesbrough with GPs not prescribing prevention activities.
“It’s health led so less creative – there might be buy into the natural environment, but then it is still about medication and talking therapies.” (Delivery staff, regional environmental charity)
62 Mental health, wellbeing and the natural environment: case studies of four areas in England
The large footprint for social prescribing across South Tees was identified as another reason why it had been hard to get off the ground.
Local plans and strategies
The table below summaries the a) actions relating to access and quality of the natural environment and b) the link between the natural environment and health and wellbeing benefits in a variety of local policy documents and strategies.
Natural environment Health and wellbeing/natural Strategy emphasis environment Council wide
Sustainable • References developing • Highlights that green spaces Community Strategy the high-quality provide an opportunity for (2008-23) network of green physical activity to support spaces, parks, nature good health and that these reserves in opportunities need to be Middlesbrough available to all of the community – including • Includes protecting or consideration of those who regenerating existing have special needs natural environments and creating new ones • References how parks provide informal leisure and exercise opportunities
Middlesbrough • Includes a commitment • References improving health Strategic Plan (2018- to improving the and wellbeing and reducing 22) environment within inequalities – through self- Middlesbrough and care, community-led making sure open prevention and early spaces are well- intervention but no link made designed, clean and to the natural environment safe
Green and open spaces
Green Spaces Public • The strategy • The health benefits chapter Spaces Strategy (2007- recognises the identifies the wealth of 2012) opportunity to make research showing that use of the green and contact with the natural open spaces across environment can positively Middlesbrough and impact physical and mental provide a town-wide health. network of high quality, • References that many people high value green might not be aware of the spaces, with opportunities for exercise or
63 Mental health, wellbeing and the natural environment: case studies of four areas in England
Natural environment Health and wellbeing/natural Strategy emphasis environment neighbourhood and ‘contemplating nature’ that local ones alongside exist in Middlesbrough’s urban open spaces. • It includes priorities for the Council and actions • It reviews the opportunities to to improve the quality reduce physical and mental and provision of green health inequalities through spaces, and involve “green exercise” and local people more. encourages the Council to form links with health and GPs for referrals
Tees Valley Green • The strategy proposes • Acknowledges the Infrastructure Strategy a network of green importance of green space (2008) (Tees Valley infrastructure corridors and corridors to enhance and Joint Strategy Unit) and space in the Tees promote health and wellbeing Valley which will • This includes the need for enhance the quality of opportunities for exercise, the environment, and sport, and active recreation create more in green spaces opportunities for access and recreation
One Planet • Framework based on • References the importance Middlesbrough Action ten principles of of open spaces being used to plan (2016-2025) sustainability that relate support health and to environmental, social recreational activities and economic aims. • Advocates the role of • Includes priorities for volunteers in managing and protecting, restoring and increasing engagement creating new natural habitats
Open Space Needs • Assessments of the • The assessment includes an Assessment (2017) quality and value of audit of the contribution to (Middlesbrough green spaces in recreation and wellbeing, Council) Middlesbrough, which including potential value in inform policy making. terms of health and wellbeing. • This involves site visits to open spaces and assessing based on their quality and strategic value. Health
64 Mental health, wellbeing and the natural environment: case studies of four areas in England
Natural environment Health and wellbeing/natural Strategy emphasis environment
Public Health South Not applicable • Includes analysis of the level Tees: Annual Report of physical inactivity in (2018) (Middlesbrough Middlesbrough and Council and Redcar & references the Sport England Cleveland Borough LDP to help address this. Council) • It summarises the strategies developed to reduces health inequalities and makes some reference to the role of green and open spaces in health outcomes – recognising the assets that exist in the two LA areas • References strengthening the work between transport and health to maximise benefits of sustainable travel.
Middlesbrough Joint Not applicable • Provides the principal vision Health and Wellbeing and strategic framework for Strategy (2013-2023) improving health and (Middlesbrough Health wellbeing and confronting and Wellbeing Board) health inequalities in Middlesbrough.
• Outlines the challenges around lifestyle and behaviour – including lack of physical activity
• Commitment to tackling the social causes of poor health and wellbeing which includes acknowledgement of the impact of the environment (including natural)
Table 8: Local strategies in Middlesbrough
65 Mental health, wellbeing and the natural environment: case studies of four areas in England
Pendle
66 Mental health, wellbeing and the natural environment: case studies of four areas in England
5. Pendle case study
5.1. Pendle context
The area
Pendle is a rural area in the south east of Lancashire and includes the Forest of Bowland Area of Outstanding Natural Beauty. Pendle Borough Council is a district authority within the Lancashire County Council area.53 Pendle is made up of urban areas including the three main towns Barnoldswick, Colne and Nelson as well as large areas of green spaces. The countryside is dominated by the iconic Pendle Hill, which is a popular destination for locals and tourists from afar.
Pendle expanded as an industrial area in the early 19th century when textile mills and terraced housing for their workers started to dominate the area. Over the course of the following century, the population grew from 10,000 to 70,000 as small villages evolved into industrial towns. There are many accessible walks along the Leeds to Liverpool canal throughout the area.
As a result of the rapid growth, employment still remains highly dependent on the manufacturing sector but residents in Pendle have been negatively impacted by the changing economy – today, there are fewer jobs and the wage levels have remained below the national average.54
Despite the changing economy, Pendle has benefited from an entrepreneurial spirit and is now a hub for advanced engineering businesses, many of which contribute to the local aerospace industry, and are a source of high value employment. In addition, the quality of the natural environment and elements of built heritage are some of the drivers behind the growing tourism in the area.55
Population challenges and at-risk groups
Pendle’s beautiful green spaces and picturesque villages contrast with parts of its towns which are among the most deprived in the UK. The 2019 Indices of Deprivation revealed that Pendle was the 36th most deprived area out of 317 in England.56 Almost one-third of Pendle’s population live in the area’s most disadvantaged urban neighbourhoods.57 In contrast, there are no LSOAs ranked in the worst deprived 20% outside the urban areas of the M65 corridor.58
Poor housing, low incomes, and poor transport links were some of the challenges stakeholders mentioned in the interviews.
53 Lancashire County Council (2020) Pendle district. Retrieved from: https://www.lancashire.gov.uk/lancashire-insight/area- profiles/local-authority-profiles/pendle-district/. 54 Pendle Borough Council (2015) Pendle Local Plan Part 1: Core Strategy 2011-2030. 55 Ibid. 56 Lancashire County Council (2020) Pendle district. Retrieved from: https://www.lancashire.gov.uk/lancashire-insight/area- profiles/local-authority-profiles/pendle-district/. 57 Pendle Borough Council (2015) Pendle Local Plan Part 1: Core Strategy 2011-2030. 58 Ibid. 67 Mental health, wellbeing and the natural environment: case studies of four areas in England
“People living in Pendle have been bereaved, have low income, face poverty, are unemployed, face language issues, anti-social behaviour…the list is endless.” (Strategic staff, regional charity)
A total of 10,293 children in Pendle (44.7% of the population) are living in poverty.59 In 2017, 17.3% of households were in fuel poverty, which is the highest rate in Lancashire and the fifth highest rate in England.
Unemployment was a common theme in the interviews. However, between 2009 and 2017 employment in the area rose by nearly 10% and Pendle has a very high proportion of private- sector jobs in comparison to the national averages.60
Economic deprivation has taken its toll on Pendle’s health outcomes. The mental and physical health of people in the area is generally worse than the England average and figures for life expectancy at birth reveal that Pendle district has both male and female averages that are below the national figures.61 Over a fifth of the population have a long term health problem or disability, which is more than the national average.62 In addition to this, people suffering from depression in East Lancashire (9.4%) is slightly higher than the national average (9.1%) and Pendle was one of the six local authorities in Lancashire and South Cumbria ICS that has rates of drug misuse death that were significantly worse than the English average.63 Poor health outcomes in Pendle were a common theme in the interviews:
“Purely from a health outcomes point of view, Pendle is in the bottom three in Lancashire. We have a lot of social deprivation – young mortality, people with heart problems, people with mental health issues, and people who are overweight…” (Strategic staff, local authority)
A third (33%) of adults aged 16 and up are inactive in Pendle, compared to the national average of 27.7%. The population in Pendle largely comprises of white and Pakistani ethnic groups – 17.1% of the population is Pakistani compared to the North West average of 2.7%. Pendle’s Sport and Leisure Strategy (2019-2024) described that inactivity within the Asian population is more prevalent (31%) than in the White community (25%).64
Despite these challenges, Pendle was described as having an entrepreneurial spirit.
“I suppose the positive side of that is that it's kind of like a quirky and entrepreneurial place.” (Volunteer, small community group)
Funding and programmes
Given the numerous challenges of deprivation in the area, there are several large programmes and initiatives in the area of Pendle looking to address these. For example:
59 Lancashire County Council (2020) Pendle district. Retrieved from: https://www.lancashire.gov.uk/lancashire-insight/area- profiles/local-authority-profiles/pendle-district/. 60 Ibid. 61 Public Health England (2019) Local Authority Health Profiles: Pendle. 62 Pendle Borough Council (2019) Together an active Pendle: Pendle's Sport & Leisure Strategy (2019-2024). 63 Cumbria County Council. (n.b.). Mental Health, Suicide & Learning Disabilities. Retrieved from https://www.cumbria.gov.uk/elibrary/Content/Internet/536/671/4674/17217/17220/43544113545.pdf 64 Pendle Borough Council (2019) Together an active Pendle: Pendle's Sport & Leisure Strategy (2019-2024). 68 Mental health, wellbeing and the natural environment: case studies of four areas in England
Pendle Enterprise and These are two of the Council’s partnerships to deliver development Regeneration (PEARL) & and regeneration projects for a more prosperous Pendle. Growth Lancashire Ltd
Focussed in the ward of Bradley in Nelson. Their priorities are to help Bradley Big Local provide affordable housing and services as well as bring about Community Land Trust environmental improvements across the ward.
In 2019, Nelson was identified as one of the towns for inclusion in the Government’s Towns Fund programme, enabling it to potentially Stronger Towns Fund access up to £25 million for the regeneration of Nelson. The focus of the programme will be to improve connectivity, provide social and cultural infrastructure and boost growth.
Pennine Lancashire is one of the Sport England Local Delivery Pilots. They were given almost £10 million in funding to deliver the pilot – £3 Together an Active million of Pathfinder funding (test and learn phase) and a potential Future (TaAF) further £7 million Accelerator funding. The programme wants people to be more active, improve mental wellbeing and help people live happier, healthier lives. Pendle has an allocation of this funding.
Pennine Lancashire is one of 5 trailblazers for childhood obesity. Childhood Obesity Included in the Pennine Lancashire programme is the role of planning Programme in creating environments that facilitate physical activity and healthy eating.
Table 9: Funding and programmes in Pendle
5.2. The natural environment in Pendle
Overview
The area of Pendle has an abundance of natural areas, including both blue and green spaces in and around urban areas. Stakeholders described how residents can access nature from wherever they are in the area, whether that is to a big open green space, a canal side or a small pocket garden.
“Nature is on the doorstep in Pendle, we are very lucky. As Pendle has a post- industrial heritage, we have canal walks that runs along everywhere. There are simple ways people can get out there.” (Delivery staff, local charity)
Pendle consists of 786 open spaces including parts of the Forest of Bowland Area of Outstanding Natural Beauty; 17 parks (eight of which have Green Flags); five nature reserves; numerous playing fields and sports pitches; the River Calder and Pendle Water; the canals; plentiful allotments and smaller pocket gardens. The Open Space Audit (OSA) from 2019 presented the following breakdown of types of open spaces:65
65 Pendle Borough Council (2019) Pendle Local Plan Part 2: Open Space Audit, p.26. 69 Mental health, wellbeing and the natural environment: case studies of four areas in England
Number of open spaces sites Type of open space (OSA 2019) Allotments 57 Amenity Greenspace 244 Cemeteries 16 Civic Spaces 14 Green and Blue Corridors66 37 Natural Greenspace67 239 Outdoor Sports 88 Parks 17 Play areas 74
Total 786
Table 10: Open spaces in Pendle
The audit found that areas close to the edge of settlements are well served by open space sites. In contrast there is a significant lack of open space sites within inner urban areas, especially in Nelson, Colne and Brierfield. The outdoor sports and park areas are relatively well distributed across Pendle.68 However, access to open spaces does not necessarily mean that people use them.
Most of the parks, playing fields, sport pitches and nature reserves are managed by the Council but there are also different arrangements in place for managing the open spaces. For example, Forest of Bowland Area of Outstanding Natural Beauty, Ribble Rivers Trust and FOPGs across the borough manage open spaces as well.
Local barriers in Pendle’s natural environment
There were Pendle specific barriers to accessing the natural environment identified in the interviews. The main barrier that was raised by almost every interviewee was the transport system in Pendle – both in terms of poor transport links and expensive fares. This barrier was particularly acute for people who do not have access to a car.
Fear of crime, anti-social behaviour and poorly maintained open spaces were all raised as potential barriers for accessing the natural environment. Austerity was given as one of the reasons for the poor state of the open spaces.
“There is a lot of change going on with the parks in the area. We do not have the money because of austerity so we cannot do much maintenance. We get complaints because of the state of the parks.” (Strategic staff, local authority)
66 Often include a river, canal, disused railway or public right of way. 67 Including woodland 68 Pendle Borough Council (2019) Pendle Local Plan Part 2: Open Space Audit. 70 Mental health, wellbeing and the natural environment: case studies of four areas in England
Despite the efforts by local groups to clean up open spaces, some of those interviewed felt that littering is an increasing problem in the area.
“For me it seems to be more rubbish in the environment. Even when you go up on the hill, you will find rubbish there.” (Participant, local environment charity)
As the area of Pendle has an abundance of nature, some of those interviewed felt that residents in the area spend less time there because they simply take it for granted.
Another barrier that was raised was the lack of information about which activities residents can undertake when spending time in the natural environment. Some said that the Council only advertised the natural environment itself, but not ways to engage with it.
“A lot of people we work with are suffering from isolation and health issues. They might be living close to natural spaces, but they need supported intervention – for example, transport or a group of people to comfort and support them. Simply having access to green spaces is not enough.” (Delivery staff, local environment charity)
5.3. Local provision in Pendle
Overview of what is available
In Pendle opportunities and projects were included in the mapping that are either explicitly or implicitly focusing on promoting wellbeing. This included:
• 48 opportunities that broadly fall within the scope of the research, although it should be noted that this does not encompass all opportunities that are likely to be available to residents in Pendle and focussed primarily on the three biggest towns (Nelson, Barnoldswick and Colne).69
• Over half of the mapped opportunities were provided by organisations, small community groups or individuals solely operating within Pendle, and other opportunities were run within and directly outside Pendle or solely just outside Pendle. Two were national charities with a regional branch.
69 This number is likely to be far higher as many of the mapped organisations provided multiple opportunities and events throughout the year. Additionally, this research found that many activities in Pendle were organised by individuals or small grassroots organisations that did not have any official communications channels apart from e.g. a flyer on a local advertisement board. Therefore there may be opportunities in place particularly in smaller villages that were not identified through this research 71 Mental health, wellbeing and the natural environment: case studies of four areas in England
The majority of the mapped opportunities in Pendle primarily focussed on interacting directly with nature – for example, offering gardening activities, or involving an element of conservation. Many organisations provided multiple activities – for example, Pendle Hill Landscape Partnership provided walking groups, nature arts and crafts sessions, conservation activities as well as family events. The most common type of activity that fell into the ‘experiencing nature’ category included walking and other types of exercise such as running or Tai Chi.
Most of the mapped activities were open to anyone interested, and a small number of these had an explicit focus on improving wellbeing. Four projects were specifically targeting people suffering from mental health other wellbeing issues. Almost all delivery stakeholders that were interviewed highlighted that they were aware of the benefits of spending time in the natural environment for people’s mental health and wellbeing – however, some felt that they did not want to advertise this as it might scare people off from coming along.
The mapped activities addressed numerous health inequalities in the local area, for example:
• Projects that reached unemployed people who are also socially isolated such as Pendle Hill Landscape Partnership’s programme, People Enjoying Nature.
• Projects that reached older more isolated people such as the Up & Active walking groups on offer.
• Projects that focused on increasing physical activity in the borough to tackle issues around obesity and other health-related issues such as Pendle Leisure Trust and Trawden AC.
• Projects that reached minority groups in the area such as Idle Women and In-Situ
• Projects that reached families in deprived areas through gardening activities in smaller pocket parks such as the Healthy Growth Allotment project in Barnoldswick.
Who is providing what in Pendle?
Local strategic and delivery stakeholders felt strongly that the residents in Pendle benefited from a wide range of opportunities engaging people in the natural environment. Many of those interviewed in the initial stage of this research project mainly spoke about opportunities offered by larger organisations such as Pendle Leisure Trust, Pendle Borough Council and Pendle Hill Landscape Partnership. However, the fieldwork and mapping activity found that many opportunities were also being organised by small community groups.
“It is more grassroot-led and quite organic.” (Delivery staff, local sports charity)
The main groups of activities taking place in Pendle are outlined below, summarised largely from the initial stakeholder interviews and the fieldwork visits, as well as desk-based mapping.
72 Mental health, wellbeing and the natural environment: case studies of four areas in England
Local grassroots community organisations focussing on a particular green space
The mapping activity identified approximately 17 opportunities delivered by small community groups. The vast majority of these groups were FOPGs run solely by volunteers undertaking conservation and gardening activities in their local parks or nature reserves, as well as organising ad hoc events for the public. The fieldwork involved one visit to a litter picking group and one interview with a representative from a pocket garden.
Most of the projects in this category did not have a specific health and wellbeing focus, although it was a common theme in the interviews. All of those interviewed acknowledged the benefits of spending time outside on people’s mental health and wellbeing, and many of them described having experienced those benefits themselves.
“Many mums coming to our sessions are suffering from depression and isolation. I feel it can be a bit ‘’cliquey’ in toddler groups sometimes, but at the allotment it is a common ground – we are doing an activity together and it is bringing people out of themselves.” (Volunteer, small community group)
Figure 12: Examples of community projects in Pendle
73 Mental health, wellbeing and the natural environment: case studies of four areas in England
Local organisations with particular specialisms
The mapping identified approximately 10 opportunities provided by local organisations with a specialism in either the environment, health promotion or arts. The fieldwork involved a visit to two projects in this category, and two further interviews. These ranged from small organisations run by a few individuals in a specific area to larger organisations working across the borough.
The opportunities in this category in Pendle were more targeted at people at risk of poor mental health and wellbeing, or who had a mental health condition. The opportunities ranged from physical activities such as running, walking and Tai Chi and to gardening and horticulture activities.70 Despite having an overall focus on mental health and wellbeing, many of those interviewed described that they did not explicitly talk about this with their participants.
“The staff receive basic mental health training, and we are aware of the participants’ specific issues. It is important to have a space where it is non- judgemental, where they do not have to talk about what is going on in their lives. They can just come here and do what they want – it is more of a relaxed environment for people.” (Delivery staff, local leisure charity)
Figure 13: Examples of VCS projects in Pendle
In addition, the Community Prevention and Engagement Team was also mentioned as a key provider in Pendle by many of those interviewed. This is a service delivered by Lancashire Care NHS Foundation Trust and South Cumbria NHS that aims to tackle the social exclusion that people with mental health problems experience. Pend le Leisure Trust
70 For example, Idle Women (2020) Idle Women Mud to Medicine - Grow Wild observation project. Retrieved from vimeo.com: https://vimeo.com/379748161. 74 Mental health, wellbeing and the natural environment: case studies of four areas in England
Regional organisations and partnerships with particular specialisms
Pendle had regional organisations operating at a local level and partnerships specialising in sport and leisure activities, heritage, arts and the environment – this accounted for approximately 16 opportunities in the mapping. The fieldwork involved a visit to three projects, and five interviews in this category.
Most of the opportunities in this category were open to anyone, but references to wanting to focus more on mental health and wellbeing in the future were common in the interviews. Some organisations specifically targeted people having a mental health condition or being at risk of poor mental health and wellbeing, whilst others worked with people from this category by default.
Figure 14: Project examples from Pendle delivered across the borough
Local projects based on a national model
The mapping activity found approximately four opportunities in this category that operate in Pendle using a nationally developed model. The fieldwork included a visit to one project – a walking group. Two of the mapped opportunities have a specific focus on health and wellbeing.
75 Mental health, wellbeing and the natural environment: case studies of four areas in England
“It is more of a social event and we enjoy the natter after the walk. We even have 2-3 meals out a year where we go to a hotel and have a good meal.” (Volunteer, local charity)
Figure 15: Examples of projects based on a national model in Pendle
Groups/events with a campaign or awareness raising focus
The yearly Pendle Walking Festival, South Pennines Walk and Ride Festival, Active Lancashire and Together an Active Future in Pendle were some of the opportunities found in this category. All of these have a specific focus on encouraging physical activity in the borough of Pendle and around.
How activities are promoted in Pendle
There are several ways people could potentially find out about opportunities or organisations in Pendle delivering activities in the natural environment. However, there is no one place to find information and the mapping activity revealed that many opportunities might be out of date.
“Everything’s kind of run separately, you really have to hunt for everything. If you’re lucky you might be on a Facebook page and they have reshared information about another activity – everything relies on things being shared.“ (Delivery staff, local charity)
• Pendle Leisure Trust shares information about different opportunities on their website and on their social media channels. Their project The Good Life Project also share other opportunities on their own Facebook page.
76 Mental health, wellbeing and the natural environment: case studies of four areas in England
• Let’s Walk in Pendle has a page where they share information about various walking groups and walking opportunities across the area.
• Most FOPGs have their own Facebook page where they share different opportunities.
• Friends of Pendle Parks Facebook page is run by former Mayoress of Pendle and shares information from all the different parks pages.
Council leaflet advertising parks How projects are funded in Pendle
The main sources of funding that stakeholders referenced in interviews, or identified through mapping in Pendle include:
For smaller VCS and community organisations:
• FOPGs mainly generate their income from donations, smaller grants from the council or other larger local organisations such as Pendle Leisure Trust • The small pocket garden received funding from Incredible Edible and donations to buy tools for gardening • Small projects received funding from their host organisation, but often only small pots of money and therefore relying solely on volunteers – one of them having a focus on mental health and wellbeing received funding from the Mental Health Trust • Pick Up Pendle received a small pot of funding from a corporate company to start up their project • Some projects delivering social prescribing activities have received funding from the CCG
Larger VCS and more targeted provision:
• Pendle Leisure Trust, Pennine Lancashire Community Farm, The Wildlife Trusts for Lancashire, Manchester and North Merseyside, The Ribble Rivers Trust, Forest of Bowland AONB, South Pennines Local Nature Partnership, Incredible Edible have all been funded by either the National Lottery Community Fund or Heritage Fund. • Apart from receiving funding from the Lottery, The Wildlife Trusts for Lancashire, Manchester and North Merseyside have received funding from NHS, European Social Fund and Our Bright Future for their Myplace project. • Pendle Leisure Trust also receive funding from corporate partners. • Burnley Football Club in the Community is funded by Burnley Football Club and charitable fundraising.
77 Mental health, wellbeing and the natural environment: case studies of four areas in England
There was a sense in some of the delivery interviews that funding was too restrictive, which made it difficult to deliver work with additional wellbeing benefits.
“The procurement rules are so tight, and it removes the ability to deliver secondary benefits. If we could use small sums of money for a sign or a bench, we could encourage more people to engage with the natural environment.” (Delivery staff, regional environment charity)
A common theme in the strategic interviews was that a couple of organisations have received funding for the same four-year period. This means that they have the means at present to provide numerous activities across the borough. However, in order to continue, these organisations need to be financially sustainable by the end of the funding period. This worried many of those interviewed as the people they work with would not be able to afford to pay for their services and they felt insecure about what the future would hold for them.
“Collectively we have been receiving different funding streams. We are now in a period where we got some money to do some stuff. We are in a good place at the moment, but that will change. (Delivery staff, local arts organisation)
Future plans in the area
Many of the interviewees involved in delivering projects in Pendle talked about their plans and hopes for the future. These included developing partnerships with similar projects, bidding for additional funding to continue offering free opportunities to their target groups, and looking into how to exist after the funding period has ended. Future plans included:
• Pendle Leisure Trust is working with Canal & River Trust to have people adopt small stretches of the canal
• Ribble Rivers Trust is working to create nature reserve areas in urban settings so that people can walk through a nature reserve rather than along roads
• Ribble Rivers Trust is also working together with Lancashire County Council to understand what people want from nature, and what would make them use it more
• The Good Life Project is looking is working to set up a network for other horticulture projects in the area called the Green Alliance – the idea is to make it easier for people to find the support they need and the activities that suit their preferences.
• Together an Active Future in Pendle started in January 2020 and will include an in-depth research looking at health and wellbeing outcomes across the borough.
5.4. The local system in Pendle
Overview
Pendle Borough Council falls within the Lancashire County Council area. The main responsibility for Public Health sits with Lancashire County Council. The Lancashire Health and Wellbeing Board is also at county level. East Lancashire CCG covers Pendle. The Pendle Health and
78 Mental health, wellbeing and the natural environment: case studies of four areas in England
Wellbeing Partnership Group is co-ordinated by Pendle Borough Council and the CCG, and brings together different partners to promote a place-based approach to community health and wellbeing (alongside public sector partners, membership includes Pendle Leisure Trust, Burnley FC in the Community and the local CVS). Healthier Lancashire and South Cumbria is the Integrated Care System partnership for the area.
In Pendle, there is a strong focus on improving health outcomes in local plans and – including in Pendle’s Local Plan Part 1 which emphasises the importance of providing better access and links to the natural environment to improve the health and wellbeing of local residents.
Pendle Council also has a Sports and Leisure Strategy – Together an Active Pendle (2019-24) which aims to increase physical activity amongst people in Pendle. The allocation of funding from the Sport England Local Delivery Pilot is one resource to help deliver this, and there is a programme lead shared between Pendle Borough Council and the Pendle Leisure Trust.71
In addition, there is a commitment across the area to increasing access to the natural environment. Whilst there is no overall partnership or network that leads any work around this, there are a number of formal and informal partnerships that have some level of interest and involvement in the natural environment. Some of these have a strong focus on mental health and wellbeing, and there are also local strategies in Pendle that make the link between spending time in the natural environment and improved mental health and wellbeing.
Overall, the system in Pendle can be characterised as consisting of the following elements:
• A number of larger key players – there were a handful of organisations in the area that were mentioned by almost all interviewees – some of which worked solely in the natural environment (for example, horticulture and conservation activities), whilst others worked in the physical activity, arts and health sectors and are aware of the link between the natural environment and improved mental health and wellbeing. Many of these key players worked closely with each other and the Council as well as supported smaller grassroots initiatives. Almost all of the key players were funded by the National Lottery Community Fund for a limited period of time.
• A number of key individuals – many of those interviewed specifically mentioned specific individuals that were playing a key role in the local system.
• Community-led – many of those opportunities this research came across were led by individuals or community groups. They were in some cases being supported by larger charitable organisations the Council.
• Educational partnerships – some of the opportunities worked together with educational institutions to provide for example official horticulture courses to improve people’s employability skills.
71 Pendle Borough Council (27 June 2019) Together an Active Future Programme [report]. Retrieved from https://www.pendle.gov.uk/download/meetings/id/23640/item_19_together_an_active_future_programme. 79 Mental health, wellbeing and the natural environment: case studies of four areas in England
Partnerships and networks in Pendle
“It’s no one in Pendle taking a lead in this. It’s more grassroots and quite organic.” (Delivery staff, local sports charity)
Key partnerships
The existing partnerships and networks that this research came across were mostly focussed on increasing physical activity amongst its residents.
Pendle Leisure Trust is an independent charity that works in close partnership with the Council and other key players in the borough. The charity is a major provider of sports, arts, entertainment and health and community programmes throughout Pendle. The Trust operates three leisure centres, a spa, golf course, athletics and fitness centre, a theatre and arts, culture and enterprise centre in the area.
The main focus of the Trust is not on the natural environment, but to increase physical activity and improve overall wellbeing for local people in Pendle. However, they have a number of opportunities (including the therapeutic horticulture programme, The Good Life Project, and the walk and talk programme, Up & Active walking scheme) that include spending time in the outdoors and are very much aware of the benefits this can bring. .
Active Lancashire is the strategic lead for Sport and Physical Activity in Lancashire. They are delivering one of the Sport England-led Active Partnerships to increase physical activity across Lancashire. Active Lancashire collaborate with Pendle Borough Council, Pendle Leisure Trust and Burnley Football Club in the Community amongst others in the Pendle area. The focus of the partnership is not on the natural environment, but the network does encourage physical activities including in the outdoors.
Other partnerships and groupings
• Burnley, Pendle & Rossendale CVS (BPRCVS) supports volunteer-led activities and help people in the region to access these activities. In addition to this, they have a social prescribing programme where they link people to volunteering opportunities to improve their mental health, health and wellbeing. Many of the opportunities they have on offer are taking place in the outdoors.
• Green Alliance – the Good Life Project (delivered by Pendle Leisure Trust) is currently working to set up a Green Alliance – a partnership looking into how they can create a stronger link between social prescribing route and opportunities offering horticulture activities in the area.
• Pendle Hill Landscape Partnership was mentioned by almost every interviewee as an organisation facilitating opportunities connecting people with the natural environment. They run their own programmes but also collaborate with others such as the Community Prevention and Engagement Team, the Ribble River Trust, Pendle Leisure Trust and Burnley Football Club in the Community. Forest of Bowland Area of Outstanding Natural Beauty leads the partnership, with funding support from the National Lottery Heritage Fund. They have a strong wellbeing agenda.
80 Mental health, wellbeing and the natural environment: case studies of four areas in England
• Local Nature Partnerships – Lancashire Environment Forum is listed on the Government’s website as the Local Nature Partnership in the Pendle area. However, there is little information available about what types of activities the forum has undertaken to date and whether it is still active. Pennine Prospects is delivering the neighbouring South Pennines Local Nature Partnership and it works to manage and improve the area natural, cultural and heritage assets. Pennine Prospect works across local and regional administrative boundaries in the area of South Pennine.
• Social prescribing – The Burnley, Pendle & Rossendale CVS is s working closely with East Lancashire’s Clinical Commissioning Group since 2014 to run a scheme of social prescribing. In addition, the Community Prevention and Engagement Team matches individuals who suffer from poor mental health and wellbeing with community projects across the area. The Community Prevention and Engagement Team does not officially advertise itself as a social prescribing scheme, but it is sitting under Lancashire & South Cumbria NHS Foundation Trust and it is working in a similar way to the BPRCVS. The Community Prevention and Engagement Team was often referenced in the interviews. It works closely with Pendle Hill Landscape Partnership, the Good Life Project and other nature-based projects in Pendle. The BPRCVS was not referenced much in the interviews but many delivery organisations in Pendle said they had participants coming through GPs.
Strengths and enablers in the local system
There were a number of strengths in Pendle that interviewees identified in the interviews. Despite the lack of overall coordination, many of those interviewed highlighted the thriving voluntary sector and the entrepreneurial spirit in the area.
“The smaller organisations are doing fantastic work with very little money. The voluntary sector is so important.” (Strategic staff, regional VCS organisation)
A strength in the area is that there are many opportunities delivered by engaged individuals, small community groups or other small local charities. Many of those interviewed mentioned specific individuals who are highly engaged and well-known in the community. These individuals have taken a lead setting up projects as well as helping others to set up their own projects.
Challenges in the local system in Pendle
One of the main challenges identified in the interviews was a lack of coordination.
“There is a lot of grassroots activity, but it is a bit piecemeal at the moment as it is not coordinated.” (Strategic staff, local authority)
Many of those interviewed said that the absence of a shared agenda meant that they missed opportunities for possible collaborations that could improve the local offer.
“Everybody’s got their different agendas. Sometimes it’s quite difficult to engage with people and other organisations.” (Delivery staff, local charity)
81 Mental health, wellbeing and the natural environment: case studies of four areas in England
Many interviewed also felt that this meant people who might benefit from activities to engage them with the natural environment are not being reached. As outlined above, there are some existing social prescribing routes in place in Pendle, but those who refer people through those routes are not always aware of all the opportunities on offer.
Another major challenge in the area mentioned by all interviewees was a lack of stable funding. Due to many years of austerity, there has been a cutback of local authority services and facilities and the voluntary sector is asked to do more with less.
“Austerity is a big issue. We don’t have as many opportunities as we did in the past and there’s more political will to be doing more, but less resources to do it.” (Strategic staff, regional environment charity)
As there is less funding available, some of those interviewed said that one of the biggest challenges in the area is competition as all projects go for the same type funding, and larger VCS organisations are often best placed to secure this.
Even though one of the main strengths in the area is a high proportion of engaged individuals, this was also seen as a challenge amongst many of those interviewed. Relying on a handful of individuals make it difficult to scale the activities and to sustain them in the long run.
“There is usually a specific individual giving a project a lot of time but then their circumstances change. In addition to this, many projects depend upon people from other organisations who are increasingly stretched because of austerity in many different ways – so they can't give it a sustained support.” (Volunteer, small community group)
Local plans and strategies
The table below summarises a) information relating to access and the quality of the natural environment, b) the link between the natural environment and health and wellbeing benefits in a variety of local policy documents and strategies. The list is not exhaustive but shows some of the different ways the connection is made between the natural environment and health and wellbeing agendas in the area of Pendle.
Natural environment Health and wellbeing / Strategy emphasis natural environment Council Wide
Our Pendle Our Future: • The strategy sets out to • The strategy Pendle’s Sustainable protect and enhance acknowledges the Community Strategy Pendle’s land, habitats importance of reducing (2008-2018) and species health inequalities.
• In the ‘care for our environment’ section, the strategy highlights the link between quality
82 Mental health, wellbeing and the natural environment: case studies of four areas in England
Natural environment Health and wellbeing / Strategy emphasis natural environment local neighbourhoods and the impact on people’s wellbeing.
Pendle Local Plan Part 1: • The framework sets out a • One of the strategic Core Strategy (2011-2030) plan for how to improve objectives is to protect, – adopted in 2015 the environment in enhance and improve Pendle. access to green open spaces, sport and recreation facilities to improve health and wellbeing. • The framework recognises that the planning system can play an important role to encourage social interaction and creating healthy communities. Green and open spaces
A Landscape Strategy for • The strategy sets out to • The strategy wants to Lancashire (2000) by inform future planning maximise opportunities Lancashire County policy. for conserving Council landscape heritage and enhancing historic landscape character, which have links to quality of life.
Borough of Pendle: Parks • This is the second parks • Health and wellbeing is Strategy (2007-2017) by strategy in Pendle – the one of the priority Pendle Borough Council framework sets out to areas in the strategy. provide accessible high • The strategy sets out quality opportunities for seven actions informal recreation and relating to health and community events. wellbeing. For example – working to investigate assess, develop and promote new ways of using the Parks to improve health and wellbeing; working closely with the Local Primary Care
83 Mental health, wellbeing and the natural environment: case studies of four areas in England
Natural environment Health and wellbeing / Strategy emphasis natural environment Trust on development plans and health inequality priorities; develop “Health Walks” in partnership with the Primary Care Trust, Pendle Leisure Trust and others – promoting physical exercise and wellbeing within the natural environment; encourage residents to walk and cycle to their local park; placing seating on appropriate areas in the park to create spaces for reducing stress levels.
Pendle Open Space Audit • The audit provides an • The audit specifically (2019) by Pendle Borough analysis of the current states that open Council open space provision in spaces encourage Pendle looking at the increased levels of quantity, quality and physical activity and accessibility of these improve mental and spaces. physical health. • The audit provides recommendations for what areas the Council should work on to improve or increase the number of open spaces.
Pendle Green • The main aim of the • The main aim is to Infrastructure Strategy: future green infrastructure protect enhance green Scoping Report (2019) by strategy is to help support infrastructure in Pendle Borough Council the protection, Pendle. One of the enhancement and wider aims of the provision of green strategy is to through infrastructure in the area the main aim promote of Pendle. more active lifestyles and thereby improve people’s health and wellbeing.
84 Mental health, wellbeing and the natural environment: case studies of four areas in England
Natural environment Health and wellbeing / Strategy emphasis natural environment
Pendle Playing Pitch • The strategy is providing • The vision of the Strategy (2016-2026) by an overview of the strategy is ‘To provide Rossendale, Pendle and number and quality of an accessible, high Burnley Councils sports pitches across the quality and sustainable three areas. network of sport pitches and other • It provides action plan for associated outdoor how to improve the sports facilities, which planning, management provide opportunities and usage of sports for participation by all pitches. residents at all levels of play from grassroots to elite and maximises opportunities for realising health benefits’ Health
Lancashire Health and • The strategy aims to Wellbeing Strategy (to improve health and 2020) by Lancashire wellbeing outcomes in Health and Wellbeing a targeted and Board sustainable way to help reduce health inequalities.
• The strategy mentions that services including environmental health and management of greenspaces is part of what helps people stay healthy.
• Using outdoor space for exercise / health reasons is on the list of things that the strategy wants to improve.
Together an active • The strategy provides an • The strategy sets out Pendle: Pendle’s Sport & overview of the different to increase physical Leisure Strategy (2019- outdoor pitches available activity in the area, and 2024) by Pendle Borough in Pendle. There is also a one way Pendle plans Council separate section on to do that is through using their parks and
85 Mental health, wellbeing and the natural environment: case studies of four areas in England
Natural environment Health and wellbeing / Strategy emphasis natural environment green spaces as informal greens for more sport recreation and leisure opportunities.
The Pennine Plan: Not applicable • From the foreword: ‘In Improving Health, Care delivering Together A and Wellbeing in Pennine Healthier Future we Lancashire (2018) by want to harness Healthier Pennine everything that is good Lancashire about Pennine Lancashire, our people, our communities, our volunteers, our open spaces and our services.’
Table 9: Local strategies in Pendle
86 Mental health, wellbeing and the natural environment: case studies of four areas in England
6. List of documents
6.1. Birmingham
Birmingham City Council (2008) Birmingham Health and Wellbeing Board Sustainable Community Strategy (2017) Health and Wellbeing Strategy – “Birmingham 2026” agenda paper from 4th July 2017.
Birmingham City Council (2013) Green Greater Birmingham Chambers of Living Spaces Plan. Commerce (2018) Birmingham Economic Review 2018. Birmingham City Council (2018) Birmingham City Council Plan 2018-2022. Hölzinger & Grayson (2019) Birmingham Health Economic Assessment& Natural Birmingham City Council (2018) Capital Accounts. Birmingham Tree Policy. Lamb, N. Appleton, S. Norman, S. Birmingham City Council (2019) Tennantm M. (Eds.) (2017), Thrive West Birmingham Health Profile 2019. Midlands, An Action Plan to drive better mental health and wellbeing in the West Birmingham City Council (2019) Midlands. Birmingham Walking & Cycling Strategy consultation draft. The Wildlife Trust for Birmingham & Black Country (2017) Summary of the Birmingham City Council (2019) Public Birmingham and Black Country Nature Health Green Paper 2019. Improvement Area Ecological Strategy 2017-2022. Birmingham City Council (2019) Birmingham Parks Service Annual Report West Midlands Combined Authority (2017) 2018/2019. Physical Activity Strategic Framework. Birmingham Health and Wellbeing Board (2017) Health and Wellbeing Board Strategy – committee paper July 2017.
6.2. Hastings
Active Hastings Partnership (2016) East Sussex County Council (2019) Picture Hastings Sport and Physical Activity East Sussex: Annual report of the Director Strategy 2016-2020. of Public. Health 2018/19.
East Sussex County Council (2017) East Sussex County Council (2020) Health Hastings and Rother needs and assets and Housing Annual report of the Director profile 2017. of Public Health 2019/20.
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East Sussex Strategic Partnership (2011) Hastings and Rother CCG (2019) Health Environment Strategy for East Sussex. Hastings and Rother: Working together to reduce health inequalities. East Sussex Health and Wellbeing Board (2016) Healthy Lives, Healthy People High Weald AONB (2019) Management strategy. Plan 2019-2024.
Hastings Borough Council (2009) Hastings Kit Campbell Associates (2006) Hastings and St Leonards Sustainable Community Open Spaces Plan Final Report. Strategy: Refreshed Strategy 2009-2026. Local Strategic Partnership presentation Hastings Borough Council (2012) Hastings (July 2019) Scoping the Future of Local Plan Green Infrastructure Study. Regeneration in Hastings.
Hastings Borough Council (2014) Hastings South Downs National Park (2014) Local Plan The Hastings Planning Strategy Partnership Management Plan: Shaping 2011-2028. the Future of your South Downs National Park (2014-2019). Hastings Community Network (2019) How can improving the environment benefit our Sussex Health and Care Partnership health and quality of life – event write up. (2019) Strategic Delivery Plan: Response to the Long Term plan.
6.3. Middlesbrough
Cleveland Police’s Corporate Services Middlesbrough Health and Wellbeing Department (n.b) The changing nature and Board (2013) Middlesbrough Joint Health complexity of demand in Cleveland’. and Wellbeing Strategy (2013-2023).
Community Foundation (2017) Tees Middlesbrough Partnership (2008) Valley’s Vital Issues Healthy Living. Sustainable Community Strategy (2008- 2023). Middlesbrough Council and Redcar & Cleveland Borough Council (2018) Public MIND Middlesbrough and Stockton (2019) Health South Tees: Annual Report. Getting it Right Social Prescribing and Mental Health. Middlesbrough Council (2007) Green Spaces Public Spaces Strategy (2007- Office for National Statistics (2011) 2012). Census.
Middlesbrough Council (2016) One Planet Public Health England (2019) Local Middlesbrough Action Plan (2016-2025). Authority Health Profile Middlesbrough.
Middlesbrough Council (2017) Open Space Tees Suicide Prevention Taskforce (2016) Needs Assessment. Tees Suicide Prevention Strategic Plan (2016/17-2020/21). Middlesbrough Council (2018) Local Plan (2018-2023).
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Tees Valley Joint Strategy Unit (2008) Tees Valley Green Infrastructure Strategy.
6.4. Pendle
Cumbria County Council (n.b.) Mental Pendle Borough Council (2007) Borough of Health, Suicide & Learning Disabilities. Pendle Parks Strategy 2007-2017. Retrieved from https://www.cumbria.gov.uk/elibrary/Conte Pendle Borough Council (2008) Our nt/Internet/536/671/4674/17217/17220/435 Pendle Our Future: Pendle's Sustainable 44113545.pdf. Community Strategy (2008-2018).
Healthier Pennine Lancashire (2018) The Pendle Borough Council (2015) Pendle Pennine Plan: Improving Health, Care and Local Plan Part 1: Core Strategy 2011- Wellbeing in Pennine Lancashire. Healthier 2030. Pennine Lancashire. Pendle Borough Council (2019) Pendle Idle Women (2020) Idle Women Mud to Green Infrastructure Strategy: Scoping Medicine - Grow Wild observation project. Report. Retrieved from vimeo.com: Pendle Borough Council (2019) Pendle https://vimeo.com/379748161. Local Plan Part 2: Open Space Audit. KKP (2016) Playing Pitch Strategy (PPS) Pendle Borough Council (27 June 2019). for Rossendale, Pendle and Burnley: 2016- Together an Active Future Programme. 2026. Retrieved from Lancashire County Council (2000) A https://www.pendle.gov.uk/download/meeti Landscape Strategy for Lancashire. ngs/id/23640/item_19_together_an_active_ future_programme. Lancashire County Council (20 February 2020) Pendle district. Retrieved from Pendle Borough Council (2019) Together lancashire.gov.uk: an active Pendle: Pendle's Sport & Leisure https://www.lancashire.gov.uk/lancashire- Strategy (2019-2024). insight/area-profiles/local-authority- Public Health England (2019) Local profiles/pendle-district/. Authority Health Profiles: Pendle.
2 Mental health, wellbeing and the natural environment: case studies of four areas in England
7. Organisations and projects that took part in the qualitative research
7.1. Birmingham
Balsall Heath City Farm Countrymen UK Social Farms and Gardens Birmingham Council – Dosti Women’s Group Climate Change and Sport Birmingham Sustainability Friends of Cotteridge Park Spring to Life Birmingham and Solihull MH NHS Foundation Good Gym St Anne’s Hostel Trust Highbury Orchard The Active Wellbeing Birmingham BVSC Community Society
Birmingham and Black Legacy West Midlands TCV Birmingham Country Wildlife Trust Martineau Gardens Welcome Change Canal and River Trust PHE West Midlands
7.2. Hastings
Bohemia Walled Garden Hastings Borough PHE South East Council – Active East Sussex County Hastings, Parks Pocket Park Community Council – Public Health, Garden Ore Rights of Way, Planning Hastings Community Network Project Rewild Education Future’s Trust Hastings Voluntary South Downs National Fellowship of St Nicholas Action Park
Friends of Hastings Hastings and Rother Sussex Wildlife Trust County Park CCG TCV
Friends of Combe Valley Hastings Wild Things Transition Town Hastings Park (RSPCA) Walk2Run Groundwork London and Ore Church Mice Nursery South Walking for Health (TCV) Ore Community Land Trust
2 Mental health, wellbeing and the natural environment: case studies of four areas in England
7.3. Middlesbrough
Camphill Village Trust Tees Valley Nature Tees Valley Wildlife Trust Partnership Friends of Fairy Dell Park Middlesbrough Council North Yorkshire Moors Groundworks NE National Park Public Health England
Mary Thompson Fund People’s Park Public Health South Tees Community Allotment Middlesbrough In Harmony Environment City Walk and Talk Group Chat MIND
7.4. Pendle
Burnley, Pendle & In-Situ Pennine Prospects Rossendale Council for Voluntary Service Inspiring Grace Pick Up for Pendle
The Community Lancashire County Ribble Rivers Trust Prevention and Council The Evaluator Engagement Team - Myplace (The Wildlife Lancashire Care NHS & Trust for Lancashire, The Good Life Project South Cumbria NHS Manchester and North Foundation Trusts The Open Gate Merseyside) Community Garden Forest of Bowland Area Pendle Borough Council of Outstanding Natural Up & Active Beauty Pendle Hill Landscape Partnership Healthy Growth Allotment project Pendle Leisure Trust
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