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Greencare groups for personality disorder: the Growing Better Lives project

RCPsych Sustainability Summit 1 October 2014

rex haigh

on 28 August 2015

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Transcript of Greencare groups for personality disorder: the Growing Better Lives project

Clinical features:
Containment and boundaries
Structure - check-in & check-out
Group principles
Range of activities
Evaluation - Recovery Star
"I used to think that this greencare
was a heap of shit, but I went home
and realised I felt a lot better"
"This is the best
of the week"
"It’s not therapy-focused time, but time spent with the people you’re in therapy with, working together on cooperative projects. It helps to break down barriers that are sometimes formed in therapy. It is a calming and peaceful space"
Struggling with the elements, 2010-14...
So, where
are we going?
Our asprations
for the future of
our local project:
small, medium and wild
That we will
get funded
to survive
beyond 2014
That we will get a
sustainable system
to provide some MH
services for the NHS
That we will take over
PD mental health services
from NHS providers
and run them better!
A friend in a high place...

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,
Greencare for Personality Disorder: The
Growing Better Lives
Rex Haigh, Consultant Psychiatrist in Medical Psychotherapy
David Hare, Horticultural and Animal Assisted Intervention Therapist
Vanessa Jones, Research Lead
Fiona Lomas, Expert by Experience and Greencare Coordinator

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
Care farming for long-stay service users in Taiwan - to be developed along TC lines
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
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”
This Talk:

Sustainable? Psychiatric? Greencare? - RH
Struggling with the elements - DH
Our therapeutic methods - FL
Early qualitative findings - VJ
Where next? - RH

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
- Healthier relationships rather than 'cure'
patients, each other, countries & cultures, our planet, ourselves
- 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)

- Very chaotic lives - across agencies
- When DBT/MBT (etc) won't engage people
- High risk - long-term care coordination etc
- Definitive therapy - NOT an adjunct to TAU
- Quality of relationship
- Pre-therapy / TC / post-therapy
- Impossible to NOT do therapy
Economic sustainability
Ecological sustainability
Social sustainability
What IS greencare?

- Therapeutic and social horticulture
- Animal assisted interventions
- Care farming
- Green gyms
- Ecotherapy
- Wilderness therapy
- Rural crafts
- Forest and woodland skills & schools
- Weather immersion
- Geological projects

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

- Sense that we have lost touch with each other and the natural world in 'industrialised' psychotherapy

- Antidote to institutionalisation

- Less based in individual acquistive life style (with health as a commodity), and more in interdependence and 'reduce, reuse, recycle'.

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

What do we actually DO?
Some early qualitative findings...
1. Rigorous research
2. Quality
3. Vision
Containment and
- check-in and check-out
- choice of activities
- subgroup minimum = 3
- all group-led
- and most importantly...
Activities & special events
- Time & space
- Therapeutic framework of socialising and eating together
- Peer-group agreed ground rules
- 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!
Even more wild:
That Slough becomes a transition town and we are part of it1!
Full transcript