Eco Therapy and Spirituality in Forensic Mental Health: A Preliminary Outcome Study

PURPOSE: This qualitative study considers the outcomes of participation in a community based Eco-Therapy/Spirituality group for individuals affiliated with the Forensic mental health system in Ontario, Canada. Facilitated by Occupational Therapy/Spiritual Care, the group enabled weekly attendance at community nature spaces over 12 weeks. This study considers the research question: What is the meaning and experience associated with participating in an Eco Spirituality group for persons with mental illness residing in a forensic mental health setting? Despite the primacy of environment in many OT models; consideration of Eco concepts and related spirituality has been particularly limited. This study supports that conversation.

DESIGN: This qualitative study employed a design consistent with Interpretative Phenomenological Analysis (Smith, Flowers & Larkin, 2009). Researchers recruited participants resident at a rural Forensic mental health facility in Ontario, Canada. The inclusion criteria first required Eco Spirituality group participation. Further, participants were required to be over 18 years of age, have a mental illness diagnosis and reside under the jurisdiction of a Forensic disposition order.

A convenience sample met this criteria (n=9) including 2 females and 7 males; this was consistent with facility gender ratios. Age ranged from 31 to 66 with an average of 53. Diagnoses included schizophrenia, schizoaffective disorder, bipolar mood disorder and personality disorder. No payments, incentives or other benefits were provided to any participants.

METHOD: A standardized interview protocol was utilized with collected data coded for themes using an editing style of analysis. Three coders of varied professional background independently coded the data and together determined overarching themes. Following data analysis, the coding scheme was tested for consistency. Several methods were employed to establish trustworthiness.

RESULTS: Participant responses supported several themes related to the meaning and experience of participating in an Eco Spirituality group for individuals affiliated with the Forensic mental health system. The first: a sense of regenerative/restorative participation enabling feelings of freedom, escape and autonomy. A second identified a sense of connection to nature while a third spoke to the potential for open and unguarded reflection and relaxation. Finally, participants spoke to a strengthened human connection through shared experience in nature. Client participation or immersion in nature has been reasonably accepted in the mental health literature as a way to support wellness (Wilson et al., 2010; Kamitsis & Simmonds, 2017); these outcomes appear consistent.

CONCLUSION: In this study, Forensic affiliated participants spoke evocatively to the relevance and importance of participation in nature spaces and the related importance to their wellness. Practically, this study validates the potential for using community (or potentially facility) nature spaces to support wellness for persons with mental illness diagnoses. This is important as such spaces are free to access, and can support wellness, long after the Occupational Therapy clinical relationships conclude.

IMPACT STATEMENT: This study speaks to the use of nature spaces in supporting wellness. The opportunity to use nature spaces is an affordable option available to many clinicians. While modern design principles priorize natural light and views of nature to support enhanced affective response this study shows us that actual occupational participation in nature is the most powerful informer.

References

Kamitsis, I., & Simmonds, J. G. (2017). Using resources of nature in the counselling room: Qualitative research into ecotherapy practice. International Journal for the Advancement of Counselling, 39(3), 229-248. doi:10.1007/s10447-017-9294-y

Wilson, N., Fleming, S., Jones, R., Lafferty, K., Cathrine, K., Seaman, P., & Knifton, L. (2010). Green shoots of recovery: The impact of a mental health ecotherapy programme. Mental Health Review Journal, 15(2), 4-14. doi:10.5042/mhrj.2010.0366