Going for a green walk in a park or countryside where one is surrounded by nature reduces depression whereas walking in a shopping centre or urban setting increases depression.

This is the message of Mind, a leading UK mental health charity that this week is launching a new "green agenda" for mental health based on the concept of "ecotherapy".

The campaign is backed by two studies commissioned from the University of Essex. One study looked at the effect of "green" exercise such as walking, gardening and conservation work on mental health, and the other compared the impact of outdoor versus indoor exercise on mental wellbeing.

Mind is calling for ecotherapy to be recognized as a "clinically-valid frontline treatment for mental health problems".

They mention a report where 93 per cent of GPs admit to prescribing drugs because of a lack of alternatives. For instance, a well recognized effective treatment in the UK is Cognitive Behavioural Therapy (CBT), but the average waiting time in some areas is four years, says Mind.

They are not advocating ecotherapy as a replacement for drugs, but they want doctors and the National Institute for Clinical Excellence (NICE) which issues guidelines and approval of treatments, to recognize it has an important contribution to make alongside existing treatments.

Other countries are already prescribing ecotherapy as a treatment for mental distress. For instance in the Netherlands and Norway, GPs can prescribe their patients a stay in a care farm. The Netherlands has 600 care farms and Norway 400 care farms. The UK has only 43, and none of them is directed at mental health.

Ecotherapy is about getting out of doors and becoming active in a green environment as a way of boosting mental health, say Mind. This includes taking regular walks in the countryside or the park, flying a kite, or taking part in a gardening therapy project.

In the first study of its kind to examine the effects of green exercise on people with mental health problems, the researchers examined 20 members of local Mind groups who took part in two walks, one in a country park and one in an indoor shopping centre, to test the impact on self-esteem, mood and enjoyment.

The results showed that:
  • 71 per cent reported decreased levels of depression after the green walk.
  • 22 per cent felt their depression increased after walking through an indoor shopping centre and only 45 per cent experienced a decrease in depression.
  • 71 per cent said they felt less tense after the green walk.
  • 50 per cent said they felt more tense after the shopping centre walk.
  • 90 per cent said their self-esteem increased after the country walk.
  • 44 per cent reported decreased self-esteem after window shopping in the shopping centre.
  • 88 per cent of people reported improved mood after the green walk.
  • 44.5 per cent of people reported feeling in a worse mood after the shopping centre walk, 11 per cent reported no change and 44.5 per cent said their mood improved.
  • 71 per cent of people said they felt less fatigued after the green walk and 53 per cent said they felt more vigorous.
The country park walk took the participants around woodlands, grasslands and lakes in Belhus Woods Country Park in Essex. The indoor walk was around a shopping centre complex in Essex.

The report refers to a Department of Health paper issued in 2004 estimating that a 10 per cent increase in adult physical activity would "benefit the UK by 500 million pounds per year, saving 6,000 lives; this calculation does not include the potential economic impact of improved mental wellbeing".

The report says there are four main reasons why people enjoy green exercise:

(1) Natural and social connections. For example watching wildlife, evoking memories of happier earlier times such as special outings and spiritual feelings.
(2) Sensory stimulation: colours and sounds, fresh air, excitement, fun, escape from pollution, contrasts with urban life, being exposed to the weather.
(3) Activity: learning manual skills, physically challenging activities such as digging, cycling.
(4) Escape from modern life: time to think and reflect, clear the head, get away from pressures and stress.

The World Health Organization (WHO) says that depression is set to become the second largest single cause of ill health by 2020.

According to a report by Eurodiet in 2001, the average UK adult now uses 500 fewer calories than 50 years ago, which is the equivalent of not running a marathon once a week.

The Mind report mentions other research giving evidence of the beneficial impact of living near green space and being active out of doors. This includes for example prisoners in Michigan where those whose cells overlooked farmland and trees had fewer sick visits than those whose cells overlooked the prison yard.

Mind's Chief Executive Paul Farmer said:

"Mind sees ecotherapy as an important part of the future for mental health. It's a credible, clinically-valid treatment option and needs to be prescribed by GPs, especially when for many people access to treatments other than antidepressants is extremely limited. We're not saying that ecotherapy can replace drugs but that the debate needs to be broadened."

"Hundreds of people have benefited from the green projects run by our local Mind associations but if prescribing ecotherapy was part of mainstream practice it could potentially help the millions of people across the country who are affected by mental distress," he added.

In conclusion, Mind recommend that:
  • The health profession see ecotherapy as a clinically-valid treatment for mental distress.
  • Doctors consider ecotherapy when prescribing treatments for patients in mental distress.
  • People on care plans have access to green spaces.
  • Health and social care referrals include care farms.
  • Health and social care budgets consider the cost-benefits of ecotherapy.
  • All health, social care and criminal justice institutions offer access to green space.
  • Town and country planners incorporate mental wellbeing in their design.
  • Public health campaigns promote the benefits of green exercise.
Click here for the full report from Mind: Ecotherapy, the Green Agenda for Mental Health (PDF reader required).

Written by: Catharine Paddock
Writer: Medical News Today