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Greencare and Yurtification

For day at The Retreat 7 Jan 2016
by

rex haigh

on 10 May 2017

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Transcript of Greencare and Yurtification

Clinical features:
Containment and boundaries
Structure - check-in & check-out
Group principles
Range of activities
Evaluation - Recovery Star
Struggling with the elements, 2010-14
Where next?
Our asprations
for the future of
our local project:
small, medium and wild
Small:
That we will
get funded
to survive
beyond 2015
Medium:
That we will get a
sustainable system
to provide some MH
services for the NHS
Wild:
That we will take over
PD mental health services
from NHS providers
and run them better!
Needed:
A friend in a high place...

Highgrove?
But for the last word,
we must give apologies to the late
Sir John Betjeman
The Launch Party 2011
A very cold winter 2010
Wild weather winter 2011-12
Rebuilding no. 5
Then came the cold & rain
Do they want us?
They say they do,
but...
The
Growing Better Lives
Project:

Rex Haigh, Vanessa Jones, Fiona Lomas
Directors, Growing Better Lives CIC


Forest skills for excluded-from-school teenagers in Oxfordshire
Gentle care farming for frail elderly people in Staffordshire
An urban greencare project in central London
A residential therapeutic community for personality disorders in
Dunedin, New Zealand
A residential therapeutic community for addictions in Melbourne
A prison therapeutic community farm
in Thessaloniki, Greece
A residential therapeutic community
for severe mental illness in Bangalore
A therapeutic farm village for people with severe learning disability, and staff, in Yorkshire
A training programme for Young Offenders
in Worcestershire
Animal-assisted interventions for emotionally disturbed children in upstate New York
What do people think of Greencare?
Anecdotal evidence

Focus Group Discussions
Directions Group
Getting Ready Group
Intensive TC Group
Greencare therapists
Assistant Psychologists
“Sometimes if you have a difficult morning the only thing you want to do is go home… you go there you think about something else , you do something else, it can ease attention…”
“I suppose you could liken it to an athlete, so when they’ve done their work-out they then do their stretches to come down and this is a bit like that”
“There’s many a time I’ve walked out of the hospital and I still feel agitated but when I come here feel different”
“ I think going over there and interact in a different environment can make us bond better, when we bond there better then we can get on…”
“I see it as mindfulness on a big scale; peace, quiet…somewhere to chill”
“Here we’re in the open I think, we’re surrounded by the outside even though we’re in a room we’re still surrounded by the outside and I think that perhaps helps

“Very different…like here isn't a hospital…corridors people come down all the time”
“sitting around the table having lunch, the social side of it that's really important to me, and I really enjoy that”
“Gives up a chance to re-group I think, the journey here and then the lunch gives you a chance to start again, a chance to re-group”
“So we feel that we have achieved something and possibly go home and do it"
"like when we were doing the cooking and made the apple cake, and chutney – that was good fun, when we are all doing different bits and pieces. Teamwork, doing it together”
“I’ve enjoyed doing it cos I used to do art when I was younger so coming here I’m getting back to do what I used to do”
Triple Bottom Line
- Social (people)
- Ecological (planet)
- Economic (profit)
- Is the core of what we do in PD (helping people with unsustainable lives)
- Based on the group analytic concepts
- emotionally safe space and belongingness there
- the network of relationships does (most of) the work
- Adaptogenic = better mental equilibrium rather than 'cure'
- Healthier relationships with:
- our planet, our countries & cultures, each other, our patients, ourselves
- At the core of ENABLING ENVIRONMENTS
- Also fundamental: we work in an environment centre
- Organic allotment / composting / PV roof panels
- Minimal energy use in our yurt
- Public transport & shared lifts; Skype etc
- Off-grid and low impact (cob) buildings: next stage!


- All done in groups (treat several people at once)
- Much self-help (and often better at it)
- The groups make the environment themselves
- And usable, edible or saleable goods are produced
- The project attracts volunteers (eg assistant psychologists and associate psychotherapists)

A serious treatment in its own right - not just an add-on

- THERAPEUTIC COMMUNITIES
- everything is part of the therapy

- For people with very chaotic lives - across agencies
- High risk - long-term care coordination etc
- Definitive therapy - NOT an adjunct to TAU

- Pre-therapy / TC / post-therapy
- Impossible to NOT do therapy in this setting
Economic sustainability
Ecological sustainability
Social sustainability
Sustainability requirements:

What IS greencare?

- Therapeutic and social horticulture
- Animal assisted interventions
- Care farming
- Ecotherapy
- Wilderness therapy
- Rural crafts
- Forest and woodland skills & schools
- Green gyms
AND POSSIBLY
- Weather immersion
- Geological projects
- Ocean wildlife ...etc etc
Where does greencare happen?

- Health promotion
- Elderly and long-term care
- Drug and alcohol projects
- Prisons and offender management
- Schools and special needs education
- Mainstream mental health
- Specialist mental health
- Therapeutic communities
- Other therapeutic environments

What is greencare's theoretical and evidence base?

- Biophilia Hypothesis
- EU Conceptual Framework
- originally Fromm (a Frankfurt School post-Freudian):
"the connection that human beings subconsciously seek with the rest of life"

- in evolutionary psychology as
The Biophilia Hypothesis
by Kellert & Wilson (1993)

- 'Nature Deficit Disorder': Richard Louv (2005)
Last Child in the Woods
- Sempik J, Hine R, Wilcox D (2010)
Greencare: a conceptual framework. A report on the Working Group on the Health Benefits.
EU COST Action 866. EU COST Office, Brussels
Why does mental health need greencare?

- Disaffection with increasing technical and regulatory aspects of clinical practice - losing sight of the person

- Sense that we have lost touch with each other and the natural world in 'industrialised' health care, especially relevant in mental health

- Antidote to institutionalisation

- Less based in individual acquistive life style (with health as a commodity), and more in
inter
dependence and valuing relationships

- Congruent with - but different to - 'recovery approach'

- Can incorporate religious or non-religious spirituality

Where do we run this programme?
But the irony of our own sustainability
1. Rigorous research
2. Quality
Network
3. Vision
Containment and
boundaries
- check-in and check-out
- choice of activities
- subgroup minimum = 3
- all group-led
- and most importantly...
Activities & special events
Relationships
- Time & space
- Therapeutic framework of socialising and eating together
- Peer-group agreed ground rules
Structure:
- quality of relationship in greencare:



- experience of relationship with nature

- emotional instability with oneself and others
- extreme sensitivity to rejection / abandonment
- knowing and holding risk, eg suicidality and self-harm
Thank you!
www.growingbetterlives.org
Even more wild:
That Slough becomes a transition town and we are part of it1!
Examples from round the world...
So - much of it has been going on for years
But it's getting taken more seriously now...
As a treatment in its own right - not just as an adjunct to medication - but as a first line for treatment for severe 'mental illness'
Particularly powerful when used in conjunction with modern TC ideas
Linking across disciplines:

The 'golden thread'
of
RELATIONAL
PRACTICE
Spreading the idea: 'Yurtification'
Royal College of Psychiatrists
National Sustainability Award 2014
“With innovation and technology we seem to have forgotten to cherish the true beauty the world has to offer”

A C Van Cherub
John Muir
When one tugs at a single thing in nature, one finds it attached to the rest of the world.”

Anne Frank
“I have found that there is always some beauty left - in nature, sunshine, freedom in yourself.
These can all help you.”

First - our own sustainability:

(1) Funding from:
Social prescribing by GPs
Individual MH budgets
Public health prevention
Not one-off grants
Philosophy
Aesthetics
Utopias and temporalities
Value-based care
Spirituality
Evolutionary biology
Social sciences
Critical theory
Anthropology
Low impact architecture
Political theory
(2) New areas for us to work in:
CAMHS transitions programme
Animal Sanctuary therapy centre
Equine
Veterans
Addictions and dual diagnosis
Homeless - PIEs
With probation - PIPEs
The golden thread - EEs
Why GREENCARE matters for your Mental Health

Psychiatry
Psychotherapy
Psychology
Group analysis
Organisational dynamics
Occupational therapy
Public health
Health promotion
Outcome studies
Neuroimaging
Interpersonal neurobiology
Fair shares?
- our therapeutic community methodology includes 'democratisation' aka 'flattened hierarchy'
And the latest scheme - with our local NHS managers, the council and third sector organisations:
Growing the whole system to meet 'austerity challenges'
... rather like Permaculture's
"The problem is the solution"

Starting to see the whole town as 'The Therapeutic Community'


Hope College

Ideas from Transition Totnes, plus Sustainability, plus Permaculture - maybe a powerful mix!


But, just after that, we had
to leave the council garden centre - and were homeless for a few months.

Then it was winter again...

Our mission statement:
“Greencare is a holistic and economically viable alternative to treatment with medication and hospitalisation. Sustainability is about connecting people to each other and to nature, helping people to see that there is a life worth living, and on a planet that is worth living on.”

What is 'Growing Better Lives'?
- in other words, very similar to the impetus that set up Moral Treatment at the Retreat in the 1790s, in a contemporary setting
...any contact or interaction with the natural world
incorporated into the therapy programme
...the 'Quality of Relationships' that underlay the National Community PD programme 2002-2011, the Community of Communities, the RCPsych Enabling Environments award, the current PIPES in the Ministry of Justice's PD offender management programme, the development of PIEs for homelessness

...and 'Moral Treatment' over 200 years ago??
The care farm (a rice paddy) which long stay patiens work on in Taiwan
A rural TC planned near Mysuru in India
Some preliminary
findings...
- standard and 'less-standard' measures and methods!
Informal quotes
Observations of therapy in action!
More recently
Ecominds project evaluation:
- benefits to mental well being AND
- economic benefits!
The
Growing Better Lives
Greencare Project
What do we do?
The 'Yurtification' of mental health
Eating together
Own Produce
Importance of Animals
Unexpected Results!
Next Steps
Khiron House, Oxfordshire
Here at The Retreat?
GBL, Iver near Slough
Growing Well, Cumbria
University of Nottingham????
Directions Group
Getting Ready Group
Intensive TC Group
Greencare therapists
Assistant Psychologists
Focus groups
The yurt matters...
circular rooms, no edges or corners
a primitive and dynamic feminine element
Jungian ego and self as the centre of personality, symbol as a circle, 'the map not the territory'
in a circle people 'belong together': in straight rows they are individuals
non-hierarchical
a circle is a sign of connective continuity, a wholeness of safety and comfort
living in the round
wood and canvas, wool and cotton, slugs and mould, and the occasional robin...
connectedness to nature
sustainable and changingfire for shared warmth
but beware, nature can be problematic....
natural materials
Wild weather
Snowy winters
Rain and damp
but we survive and rebuild
Next: multifaceted evaluation?
Yurtification research questions?
theories around enrichment of 'the therapeutic frame'
what IS it about the yurt?
methods and ideas
NEXT...
Yurtification of the world!
starting with...
...see the pamphlet!
What does 'Growing Better Lives' do?
Greencare
Living & Learning
Research & SoFu
Diagnosis and Beyond
Dissemination and Lobbying
the sensory environment
the sound of cows, birds, sea (M25!), silence
looking out at green and growth
taste of 'fresh from the earth'
smell of the seasons
connected by the touching of doing
Full transcript