‘Going somewhere quiet in nature helps me relax and recharge’

Have you ever had a moment where you felt drawn outside for a walk at lunchtime after a stressful morning at work? Or taken a deep breath of cool air as you noticed the spring flowers starting to bloom during a cold February day? Perhaps you're an avid 'twitcher', or you enjoy glamping holidays or wild water swimming to 'get away from it all'. Maybe, like me, you bought a camper van in what appeared to be an early mid-life crisis, persuading your partner with the argument 'if not now, then when?'). 

Perhaps, in your professional practice, you have advised service users to explore the wonders of the outside world. It appears to be common knowledge that 'taking a walk outside' can help to regulate mood and have a behaviourally activating effect on those experiencing depression. The question is, why are we not doing more of this? 

I am a Forensic Psychologist working in inpatient settings, and I'm also in training to become an Ecotherapist. Here, I hope to guide you through the introduction of a scheme to bring Nature Based Approaches (NBA) into the Forensic Inpatient setting. I have invited a service user to contribute too, to talk about his experiences of completing NatureWell – an NBA accredited course developed by the Natural Academy (a Community Interest Company based in Bristol).

The importance of the natural world in mental health

Human development, through periods such as the age of enlightenment in the 17th and 18th centuries and the principle of Cartesian Duality (the separation of mind from body), has widened the divide between the human experience and the natural world (Fisher, 2013). This has led to the development of an egocentric and anthropocentric position – the idea that the natural world is not sentient, but humans are, and we can therefore control and use the natural world as we (humans) see fit. The modern world has separated us from, and made us fearful of, our natural selves. Over the last ten years increased displeasure with modern existence and a growing mental health crisis has shifted focus towards the application of Nature Based Approaches (NBAs), aiming to bring therapeutic focus back to a biophilic and equitable relationship with the natural world. 

The Western World has looked to other cultures for inspiration and guidance in this, through approaches such as the practice of Shirin-Yoku (forest bathing: Mitazaki, 2018), horticultural pursuits (Armstrong et al., 2023), and wilderness therapies (Coventry et al., 2021) in both green (land) and blue (water) spaces. One of the main aim of NBAs is to increase participant's nature connectedness, which has been identified as 'an individual's subjective sense of their relationship with the natural world' (Pritchard et al., 2019, p.1145).

Researchers at the University of Derby, led by Professor Miles Richardson, have proposed five pathways to nature connectedness which promote a more sustainable relationship with the natural world. These pathways are senses (tuning in to nature through the senses), emotions (noticing the emotions and feelings nature brings), beauty (noticing the beauty of nature), meaning (nature bringing meaning to our lives) and compassion (caring and taking action for nature). 

The emerging evidence indicates that NBAs can have a significant restorative impact on the health and wellbeing of participants (Bettman et al., 2024; Shrestha et al., 2024) particularly when the approaches used are immersive in delivery (Shrestha et al., 2024, Rowsell et al., 2024). NBAs are embedded in a model of embodied cognition – the notion that cognition is not a singular process based just on a computational model of cognition, but rather that our central nervous system responses play a central role in our cognition and subsequent experiences. As such, experiences with the natural world can elicit powerful feelings of awe which often occur in a sacred realm separated from the daily mundane (Keltner, 2023) and development of a deep emotional bond with the natural world (Richardson, 2024). Both of these experiences can lead to increased overall mental wellbeing and an increased likelihood of action to take care of the natural world around us. 

Forensic inpatient environments have the particular challenge that access to the natural world is exceptionally limited, due to the individual's risk and legal status. Restrictive practices have been shown to adversely impact service user's recovery journeys through increased negative affect such as anger, loneliness and hopelessness (Bowers et al., 2017). Garden spaces are often designed with this in mind, and many forensic inpatient services are now thinking carefully about the access this population has to natural environments. Examples of UK-based enterprises which have begun to use NBAs in the forensic domain include the Grow Transform Belong Community Interest Company, founded by Dr Sarah Lewis in 2022 which incorporates NBAs in its Principles of Growth interventions of prison reform; and the Royal Horticultural Society's 2024 Plant Sharing Scheme, in partnership with HM Prison and Probation Service in Birmingham, Cardiff, Manchester, and Liverpool.

The staff experience of training in NatureWell

Inpatient forensic mental health services provide accommodation, treatment, and support for men and women who have been diagnosed with severe mental health problems and are considered to pose a risk to the public. Oxford Health Foundation Trust has 157 beds across forensic inpatient services providing care for men and women in medium, low, pre-discharge and learning disability settings. In the Winter of 2023 to 2024, nine members of staff from our Male Medium Secure services attended NatureWell training delivered by the Natural Academy. NatureWell is an accredited programme which gives participants the skills to deliver NBAs designed to encourage health and wellbeing outcomes, using the five pathways to nature connectedness proposed by the University of Derby's Nature Connectedness Research Group.

As a team, I don't think we knew what to expect from the training, especially as we were due to be training outside in the winter months, but we were all pleasantly surprised by our experience. The Natural Academy employs a training model which is grounded in experiential learning, as such, we became both the subjects and the trainee practitioners in the training process. We started by learning how to ground each other in a natural environment and understanding the purpose and the function of starting each session with this fundamental process. 

Steadily we moved on to learning about the five pathways of nature connectedness and why it was important to consider each one. Our task in the final couple of days of the six-day training course was to facilitate each other in a NatureWell session using one of the pathways, which we completed together on a wet and cold February day. 

Since we attended the training, our NatureWell skills have been used in both structured programmes and in ad hoc interventions on the ward. We have continued to develop our skills through Continuing Professional Development sessions with our trained staff team and we are thinking about how we can improve our green spaces within the unit alongside our Trust's Green Spaces Coordinator and service user group. 

Post training, we have also completed a qualitative evaluation of the experiences of our staff who attended the training (currently in preparation for submission for publication). In our evaluation, the staff outline the connections they felt both with each other as a team and those connections further developed with the natural environment as a result of the training. 

"Getting to know your colleagues a bit better, hearing their stories about their own experience with nature and because we're people from lots of different backgrounds, different countries. Hearing what, what they're experiencing, what things they've done in nature, or what it means to them. I think, yeah that was very bonding"

The staff also expressed they felt the NatureWell approach will help our service users better regulate emotions through "lowering stress levels", "feeling free" and increased access to "fresh air" alongside improving therapeutic alliances through shared experiences in natural spaces (you are sharing an experience together, being outside, with the weather and what you are seeing, nature, wildlife and birds"). Our staff also felt that the NatureWell programme would provide useful skills which could be applied up to the point of, and beyond, discharge such as mindfulness, increased tolerance for frustration, and emotional regulation "If we introduce those approaches to [service users], the more they will be sustained at the point of discharge"

Below I have invited a service user, who we will call 'Tommy', to speak about his experiences of completing the NatureWell programme together in Autumn of 2024. The purpose of delivering the intervention was to promote Tommy's health and wellbeing through connection with nature and the outside world. We also aimed to develop healthy coping strategies which Tommy could take with him on his hospital pathway and eventual discharge into the community. 

A service user's journey

'I am currently in hospital on a rehabilitation ward. Kathryn, my psychologist, suggested I do the NatureWell course because I mentioned I like walking in nature in one of our sessions and she felt it would be good for my mental health journey. At first, I wasn't quite sure what the course would entail, but I soon realised that it was a good opportunity to be outside in nature more often.

For the NatureWell course, firstly we needed to do a risk assessment to make sure that we were all safe which was quite easy to do. We then went into the meadow on the hospital grounds. There was no one else about. We did a grounding which involves sitting comfortably and closing our eyes. We noticed everything around us and all the nature sounds like the birds and the wind in the trees. We did this before every session, and it made me feel very calm and relaxed. It made me appreciate the here and now. 

We went around the meadow finding things which meant, or represented something, to us. We then used a Y shaped stick with some wool or string to make a nature loom [see photo above, left]. We added the items which had caught our eye such as a feather, flowers or leaves to the loom to represent the Beauty pathway. These items represented a feeling or a memory. This was good because I didn't know what I would see or need beforehand, I had to slow down and take my time. I was surprised to still see flowers around at that time of year (autumn) and I noticed some plants I had not seen before. This made me appreciate the different seasons in nature. 

In another session we went to a local lock by the river. We sat on some benches and made a bird feeder by taking the core out of an apple, adding seeds, tying some twigs together and stringing this through the cored apple [see photo above, right]. The twigs were for the bird to stand on when eating the apple and seeds. I tied my bird feeder into a tree on the hospital grounds. The pathway we were exploring with this exercise was Compassion: it was really relaxing and made me appreciate nature in the autumn and wintertime.

During some of the sessions, we visited a local arboretum. This was a great place to go and reminded me of my childhood when I used to go to a similar place to walk and run which made me miss the woodland. I really liked being on my own in nature sitting on a bench (with Kathryn nearby for safety) and observing my surroundings. It made me feel that going somewhere quiet like this can really help me relax and feel revitalised. At one point, we saw a muntjac deer grazing in the trees. We stood and watched it for a while before it wondered back into the forest. 

On one occasion, I had two circular pieces of card, and I reflected on these how being in nature made me feel using different coloured pens. The brambles I saw gave me nostalgia for childhood and bought back memories of picking blackberries. During another session, I drew a tree on a piece of paper and some leaf shapes cut out of paper [see photo below]. 

I wrote on the leaves different emotions I felt and added some real leaves into the mix! I wrote that I am in awe of nature and enjoy solitude at times. It relaxes me. I felt thankful, alive, and nostalgic for the past. I felt hope that seasons continue to occur as I saw leaf colours that were changing and berries growing. I felt regret for not spending more time in nature but vowed to make more time to do this in the future. 

I felt the whole course was really useful. I have made a change in that I like to just sit in a natural setting such as the garden of a local church and the meadow on the hospital grounds. I continue to use the grounding exercises that I learnt on the course when I do this which helps me feel calmer. I also have been walking more in the local area such as in a nearby woodland and along the river. Walking around, appreciating nature is really good for me, I realised through the course that being in a natural setting helps me to recharge my batteries. The part I struggled most with the course was checking my watch too often. Eventually I was able to stop doing that quite as often which helped me to relax more.

The future of the nature project

The future of our nature project is looking bright, with networks forming with other interested Trusts. We continue to run NBAs on our wards in both individual and group sessions which has been enjoyed by many of our service users. We are working with the Natural Academy to develop an in-house train the trainer programme which will help roll out the project to other wards in our Trust. 

Finally, on a personal note, I am planning many more joy filled nature-based weekends and holidays away in my camper van!

• Dr Kathryn Rowsell, Forensic Psychologist, Oxford Health Foundation Trust. [email protected]. 'Thank you to Professor Geraldine Akerman for her help with preparing this article.'

References

Armstrong, A., Nolan, C., Cremin, K., Turner, N., & Lawlor, G. (2023). The Relationship Between Horticulture, Recovery and Occupational Therapy in Mental Health: A Scoping Review. Occupational Therapy in Mental Health, 40(4), 345–370. 

Bettmann, J. E., Speelman, E., Blumenthal, E., Couch, S., & McArthur, T. (2024). How Does Nature Exposure Affect Adults with Symptoms of Mental Illness? A Meta-Analysis. International journal of mental health nursing, 33(6), 1889–1907. 

Coventry, P. A., Brown, J. E., Pervin, J., Brabyn, S., Pateman, R., Breedvelt, J., Gilbody, S., Stancliffe, R., McEachan, R., & White, P. L. (2021). Nature-based outdoor activities for mental and physical health: Systematic review and meta-analysis. SSM - population health, 16, 100934. 

Fisher, A. (2013). Radical Ecopsychology: Psychology in the Service of Life. Albany: State University of New York Press.

Grow Transform Belong. (2022). Our Principles of Growth. 

Keltner, D. (2023). Awe: The Transformative Power of Everyday Wonder. Random House Publishing.

Miyazaki, Y. (2018). Walking in the Woods: Go Back to Nature with the Japanese Way of Shirin-Yoku. London: Aster. 

Pritchard, A., Richardson, M., Sheffield, D., & McEwan, K. (2020). The Relationship Between Nature Connectedness and Eudaimonic Well‑Being: A Meta‑analysis. Journal of Happiness Studies. 21(3),  1145-1167. 

Richardson, M. (2024). The Blackbird's Song and Other Wonders of Nature: A Year-Round Guide to Connecting with the Natural World. New River Books. 

Rowsell, K., Gordon-Rawlings, T., & Hunt, D.F. (2025). "The First Thing They'll Do Is Take a Huge Deep Breath In": A Qualitative Analysis of Nature Based Interventions in Forensic Inpatient Services. [Manuscript in Preparation]. Oxford Health Foundation Trust. 

Royal Horticultural Society (2024). Prisoners in England and Wales are growing plants for their local communities. 

Shrestha, T., Chi, C. V. Y., Cassarino, M., Foley, S., & Di Blasi, Z. (2023). Factors influencing the effectiveness of nature-based interventions (NBIs) aimed at improving mental health and wellbeing: Protocol of an umbrella review. Environment International 18(7).