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Nature to nurture the mind
Over two thousand years ago, Hippocrates, the father of modern medicine said “nature itself is the best physician”. Instinctively we may know that he was onto something – being out in nature usually makes us feel better, whether it’s a walk in the forest, time spent at the beach, or a picnic in the park. As a case in point, the recent restrictions of the COVID-19 pandemic curtailed access to nature for many, and the decline in our individual and collective psyche was noticeable.
But can being out in nature be more than just a mood lifter? The evidence of mental health benefits from spending time in nature is growing. Contact with nature is associated with improvements in memory and attention, lower stress levels, reduction in symptoms of depression and anxiety, and healthy sleep patterns.
Nature-based interventions – programs and activities where individuals engage with the natural environment with the aim of improving their health and wellbeing – have been increasing as a result. These vary from nature walking groups to community gardening, ecological conservation projects to exclusive forest ‘wellness’ retreats.
Almost half of Australia’s population experiences a mental health condition at some point in their life, with the most common being anxiety, depression, and substance abuse. The impact of enduring mental illness on people's lives is significant, limiting many people's ability to work, study and socialise. In 2023-2023, we spent $13.2 billion on mental health services across the country. Despite this, enduring mental health disorders that were not improved by treatment, rehabilitation or prevention activities are estimated to cause 13% of Australia’s total burden of disease.
With the increasing social and financial burden associated with the prevalence of mental illness, there is an urgent need to explore alternative, cost-effective interventions that can be used alongside traditional treatments.
Despite their cost-effectiveness and minimal invasiveness, nature-based interventions are not routinely offered in Australian mental health services.
While nature-based interventions may improve mental health and wellbeing in the general population, can they confer the same benefits for individuals with long-term mental health conditions?
Professor Julaine Allan, Professor of Rural Health at Charles Sturt University, specialises in mental health and addictions, and with colleague Dr Nicole Snowdon is assessing how nature-based interventions may provide mental health benefits and could be structured to implement within existing mental health services.
“What we’re hoping to do is bring opportunities for nature connection to people with chronic mental health conditions and who are potentially socially isolated, socioeconomically deprived, and systematically demonstrate whether people get lasting benefits from it.” She elaborates: “The idea of nature having an effect on people fits into the ‘wellness’ space and vibe, but we need a western scientific diagnostic medicine approach to determine any benefits if we want to use nature-based interventions within mental health services more broadly.”
Central to that effort, Prof. Allan is completing a study on Nature Walking Groups, exploring how structured, clinician-facilitated walks in nature can support individuals with severe mental health conditions. In collaboration with the University of Wollongong, Illawarra Shoalhaven Local Health District and researchers at the Charles Sturt Rural Health Research Institute, the study enabled ten participants receiving long-term mental health support to attend weekly one-hour nature walks for 12 weeks, alongside their usual treatment.
The scheduled walking sessions occurred in natural environments such as coastal zones, bush, national parks and botanical gardens. Participants were invited to walk at their own pace, with or without social company, but remaining with the group. Mental health clinicians facilitated each group, planning walk locations and transport to and from each walk, addressing any mental health concerns, and conducting brief introductions and debrief sessions at each walk.
“We measured participant well-being and mood levels before and after the walks”, explains Prof. Allan, “and at the conclusion of the study, we did interviews and collected observations from all of the participants to capture their experiences and any organisational insights”.
All of the participants benefited from participating in the Nature Walking Groups, recalling feeling calmer, more relaxed and less anxious after the walks. One initially-sceptical participant was surprised at the effect the nature walks had: “It really did calm me down, given me a serenity mood as we were walking…I was surprised at how much it did help”. Another described: “It got me to this place, a bit like mindfulness that in the moment, I can be happy, sort of thing. Instead of always tumultuous on the inside – I can get to a happy place by visiting nature”.
In addition to having improved mood and energy, participants often reported feeling less alone with their mental health problems. The social aspect of the group walk, engaging with other participants in a natural setting, helped reduce isolation, building confidence and increasing social connections. Being around others who similarly struggled with mental health problems, being accepted and understood by both the participants and the facilitators, led to “knowing that you are not alone”, in the words of one participant.
Overall, the study participants found the Nature Walking Group enjoyable, rewarding and beneficial and hoped it would be offered again in the future. Importantly, participants appreciated that the nature walks were facilitated by trained mental health professionals who were compassionate, nonjudgmental, and supportive. Prof. Allan notes, “our participants didn’t think they would join a nature walking group if it had not been tailored specifically to people using mental health rehabilitation services. And this has been borne out in practice – although they all expressed they would love to join a walking group, most did not feel ready for it, and following up with them three months after the completion of the study, none of them had”.
“It’s a fairly small evidence base that nature-based interventions have a positive impact”, concedes Prof. Allan, “but it’s a start”. The Nature Walking Group template is now being used to accrue more evidence for using nature-based interventions in mental health services. Prof. Allan’s team is currently assessing The Man Walk, focusing on an older cohort of men with chronic conditions of social isolation or mental health concerns, and a youth-focused program called Human Nature for young people who are not engaging with traditional mental health services. “We’re working with a number of non-government organisations running these nature-based projects, doing the data collection and increasing the evidence base for this type of approach over time,” she says.
The main outcome from the Nature Walking Groups study, above the immediate benefits it afforded its participants, is that it is providing the basis for an implementation and evaluation guide for others to undertake similar nature-based interventions. “We’re creating a ‘how to’ guide for other organisations to trial these interventions”, explains Prof. Allan. “From how to do a risk assessment, how to organise the walks, what the project leader does, who does the training, how many facilitators you need…very practical set-up instructions. And then evaluation tools and data collection measures to evaluate the program you’ve run, from mood scales to Fitbit tracking to monitor sleep patterns and physical activity.” It’s all set to make it easier for organisations to participate, and continue growing the evidence base for nature-based interventions in mental health services.
Nature walking groups can capitalise on the health and wellbeing benefits of both being in nature and connections with others, and through the efforts of Prof. Allan and her team, the evidence base is accruing to legitimatise it as an evidence-based health intervention to complement traditional mental health treatments.
Hippocrates may have been onto something, all those years ago. He said: “If you are in a bad mood go for a walk. If you are still in a bad mood, go for another walk”. Some of us might just need that extra assistance to go for a walk.
Impact summary
- Research areas: mental health services
- Research problem: assessing the mental health benefits of nature-based interventions for individuals with long-term mental health conditions, developing the evidence base and best practices for integrating nature-based interventions into mental health services
- Collaborators/countries: the University of Wollongong, Illawarra Shoalhaven Local Health District, the Charles Sturt Rural Health Research Institute
- Outcomes: evidence-based guidelines for integrating nature-based interventions into mental health care, training programs for mental health professionals
- Impact: potential for low cost, sustainable nature-based mental health support options for those with long-term mental health conditions
- Beneficiaries: mental health clinicians, service providers and individuals accessing mental health support
Read more about the Nature Walking Groups study.
