In this blog, Raphaela Berding-Barwick and Divine Charura explore ongoing collaborative research with diverse communities – particularly including migrants, refugees and asylum seekers – into the benefits of green social prescribing to health and wellbeing.

During the COVID-19 pandemic, ‘stay at home’ guidance and other lockdown restrictions aimed at minimising social mixing not only confined us to stay indoors for a long period, but also exacerbated already existing inequalities and drew attention to the poor living conditions of many marginalised communities. For example, although exercising outside in the local area was allowed and encouraged, many individuals did not have access to places where this was possible, due to living in low-income urban areas with no, few, or poor-quality green spaces.

Since the pandemic, the value of green spaces for improving quality of life, mental health and wellbeing has gained increasing attention. Gesler in his writings on ‘therapeutic landscapes’ recognised nearly three decades ago that there are places where ‘physical and built environments, social conditions and human perceptions combine to produce an atmosphere which is conductive to healing’ (1996, 96). More recent studies highlight the positive impact of exercise or nature-based activities on mental and physical health (for example, Dadvand and Nieuwenhuijsen, 2019), thus recognising the value of community-based approaches to increase health and wellbeing, in contrast to clinical treatment. This is acknowledged through green social prescribing, which, as part of NHS Universal Personalised Care, seeks to use the potential of community nature-based activities, groups, and services for individuals to increase their health and wellbeing.

Green Social Prescribing

In 2020, the Humber and North Yorkshire Health and Care Partnership secured £500,000 of national funding from a cross-governmental programme (including the Department for Environment; Food and Rural Affairs; NHS England; Natural England; Sport England; Department for Levelling Up, Housing & Communities; and Department of Health & Social Care) seeking to transform mental health services, and to increase social prescribing, as it is set out in the NHS long term plan. Through this funding, Humber and North Yorkshire became one of the seven ‘test sites’ established in England to examine the impact of connecting people with the outdoors and nature through referrals to ‘green’ and ‘blue’ (including access to rivers, lakes and seas) projects and activities within communities on improving their mental health and wellbeing.

It was through the Humber and North Yorkshire Green Social Prescribing Programme and HEY Smile Foundation that Divine Charura, Professor of Counselling Psychology at YSJ, along with five community organisations in Hull, received funding to run ‘test and learn’ green social prescribing projects with communities from ethnically diverse backgrounds. At YSJ, this funding is facilitating participatory research with migrants at the University’s Haxby Road allotments to generate practice-based evidence from the voices of migrants themselves of the potential of community gardening in preventing and tackling mental ill health for ethnically diverse communities.

Participatory approaches are especially valuable to explore matters of health and wellbeing with ethnically diverse groups, including migrants, refugees and asylum seekers. How these topics are viewed often varies between cultures, and they might be different to understandings of mental health which prevail in health systems in the Global North. This carries the risk of not only stigmatising individuals who suffer from poor mental health but also the activities, projects and services which seek to alleviate these issues in the context of social prescribing. It is therefore essential to challenge and unsettle the status quo of standardised health and wellbeing questionnaires as they are often used by mental health practitioners. In academic literature, it is increasingly recognised that care and research need to be culturally informed if it is to be effective (Sabbioni et al, 2018; Kaslow et al, 2010; Mafura and Charura, 2022). These reflections have guided the development of the research that we are running at the Haxby Road allotments.

Evaluating Test and Learn Projects

In addition to the allotment, we are conducting participatory research with the community organisations in Hull who have also received funding from HEY Smile Foundation as ‘test and learn’ sites to develop evaluation tools for their green social prescribing projects. Aiming to bring the research process to community organisations through using a bottom-up approach, this research seeks to place social justice centre-stage through building on the expertise of community organisations, who work directly with diverse communities and who have their own opinion about standardised health and wellbeing assessments, for example through clinical questionnaires.

The value of this approach was revealed during the first workshop we held in Hull with the five community organisations. While developing a quantitative evaluation tool to measure the impact of green social prescribing on wellbeing, the groups criticised clinical questionnaires as they are currently used to ask about mental health and wellbeing. For example, the groups noted that these questionnaires asked about perceptions of negative health, instead of asking about positive feelings about mental health and wellbeing. Rather than focusing on what is good, these modes of asking questions therefore emphasise that there is something wrong with people.

Conducting participatory research at the allotments and with community groups allows us to not only explore the value of nature and green activities for wellbeing, but also to emphasise the voices of communities who participate in green social prescribing activities and challenge status-quo approaches to measuring mental health and wellbeing. These voices are often marginalised despite their role in these activities. We hope that this research will have impact on understanding the mental health and wellbeing of ethnically diverse, and often marginalised, groups, but also on promoting a person-centred and culturally informed approach to health and wellbeing.

References

Dadvand, P., & Nieuwenhuijsen, M. (2019). Green space and health. Integrating human health into urban and transport planning: A framework, pp. 409-423.

Gesler, W. (1996) ‘Lourdes: healing in a place of pilgrimage’, Health & Place, 2(2), pp. 95-105.

Sabbioni, D., Feehan, S., Nicholls, C., Soong, W., Rigoli, D., Follett, D., … & Waters, F. (2018). Providing culturally informed mental health services to Aboriginal youth: the YouthLink model in Western Australia. Early intervention in Psychiatry, 12(5), 987-994.

Kaslow, N. J., Leiner, A. S., Reviere, S., Jackson, E., Bethea, K., Bhaju, J., … & Thompson, M. P. (2010), ‘Suicidal, abused African American women’s response to a culturally informed intervention’, Journal of Consulting and Clinical Psychology, 78(4), 449.

Mafura, C., & Charura, D. (2022). ‘I then had 50 stitches in my arms… such damage to my own body’: An Interpretative Phenomenological Analysis of Izzat trauma and self‐harm experiences among UK women of South Asian heritage; Counselling and Psychotherapy Research, 22(2), pp. 458-470.