Outdoor nature-based therapeutic recreation programs
Understanding their effectiveness from the perspective of people living with mental illness.
Mental disorders are a leading cause of ill-health and disability globally. The World Health Organization estimates that around 450 million people currently live with a mental disorder. Examples of mental illness include major depressive disorder, schizophrenia, and bipolar disorder.
In Australia and internationally, it is acknowledged that people living with a mental illness benefit from a multifaceted approach to support their health and wellness. As such, community-based mental health organizations are striving to encompass a holistic approach to service provision that includes psychosocial and physical wellbeing.
The emergence of outdoor nature-based therapeutic recreation exemplifies how mental health services are diversifying to facilitate personal mental health recovery for adults residing in community settings. Examples of therapeutic recreation nature-based activities include nature walks, swimming, gardening, horseback riding, canoeing, and adventure therapy.
A new qualitative systematic review provides a comprehensive overview into the type of outdoor nature-based therapeutic recreation experiences that people living with mental illness perceive enhance meaningful engagement and facilitate their own realisation of mental health recovery.
Lead author of the review, Caroline Picton, from the University of Wollongong, Australia, explains the importance of the systematic review: “It is important to understand how nature-based therapeutic recreation activities are meaningful and helpful for recovery from the perspective of persons living with mental illness. Conducting a qualitative systematic review of the existing evidence from persons with mental illness who have participated in therapeutic recreation greatly assists in program design and delivery”, she says.
Eighteen research articles provided data for the study. Participants were men and women aged 19 to 73 years who had a diagnosis of a mental illness, live in the community, and have been referred to a therapeutic recreation program by mental health services. The type of programs, services, or initiatives offering outdoor nature-based recreation activities included adventure camps; therapeutic recreation, sporting, gardening, and community-based leisure programs; and healthy lifestyle programs that are primarily focused on the use of recreation to enhance mental health recovery.
From the 84 findings extracted from the included studies, two synthesized findings were formulated. The findings encompass perceived enjoyment and social inclusivity, and making a positive contribution to mental health recovery through psychosocial and physical means.
“There are numerous barriers which can impact negatively on mental health recovery”, says Picton. “Amongst these barriers is the experience of social isolation which necessitates that the individual, already made vulnerable because of the presence of distressing symptoms of mental illness, overcome the existence of stigma, discrimination, loneliness, and social exclusion. Since therapeutic programs are socially inclusive, it helps reduce social isolation and lessen the impact of stigma. In the current climate of COVID-19, these findings emphasise the significance of social inclusion, and some individuals will need much greater support to stay socially engaged for their mental wellbeing”, asserts Picton.
Many of the nature-based activities posed positive challenges for individuals to extend themselves and instilled a sense of purpose, self-determination, renewed identity, and accomplishment. “It is evident that increased enjoyment of physical activity and increased levels of physical activity are an added bonus for persons who may otherwise not participate in other forms of exercise”, says Picton.
One of the findings of the study that surprised the lead author was the importance of enabling environments to support people when undertaking therapeutic recreation:
“Some of the studies involved combined participation with mental health professionals, such as playing soccer together or participating in an adventure camp together. For example, one program known as Recovery Camp acted as a conduit for persons with a lived experience to share their unique insights to enhance the learning of undergraduate nursing students. In this regard, the use of the therapeutic recreation enhanced the therapeutic alliance and strengthened collaboration”, says Picton. “This is important for persons who may have difficulty engaging with mental health services and offers an alternative avenue for professionals to engage in constructive ways and build upon for future collaboration”, Picton continues.
The study concludes that people with mental illness value nature-based therapeutic recreation activities, and their insights should be involved in the planning and design of meaningful programs. The therapeutic use of recreation is perceived as enjoyable and is freely chosen, both of which act as strong motivators for meaningful engagement. The findings suggest that it is plausible to provide therapeutic recreation activities that offer social interaction, physical activity, and regular exposure to nature to act as mediators for improved mental health.
“Further community-based initiatives are urgently needed to facilitate individuals’ own realisation of their recovery in less clinical settings”, says Picton. “This review created a strong evidence base to make these associations with personal mental health recovery.”