An innovative role emerging placement led Joseph Courtney to land his first newly-qualified role leading a project on green therapy and sustainability. Here he reflects on what’s been achieved to date.
Above left to right: Kebba Jadama, Support Worker, Nadine Gale-Coleman, OT, Kelly Speed, OT and Joe Courtney, Green Therapy OT, in front of sunflowers grown by service users on the community allotment in Keighley
Back in 2023, when I was a third-year occupational therapy student, I was lucky enough to undertake a fascinating role emerging placement in the sustainability department at Bradford District Care NHS Foundation Trust.
This involved looking into the use of nature therapy within the trust and writing a business proposal for the hiring of a specific ‘green’ occupational therapist (Courtney and Euden 2023).
The placement was supported by Emma Clarke, Environment and Sustainability Manager, who worked with Natural England to secure funding for this role through the Bradford Nature Recovery Project, in addition to trust funds.
In November 2023, after graduation, I stepped into this temporary-funded role, as Green Therapy Project Development Officer.
The first six months were focused on understanding what the trust already offered and what clinicians thought we could offer in future. From this, it seemed that we had previously offered some green therapy, but it was very much because of specific clinicians being interested in it personally.
Previously community gardens had been set up at both of our inpatient sites, but had fallen into disuse. Often this was because the member of staff who originally set them up had moved on and no one had taken over. This was one challenge to overcome: how to make green therapy more sustainable.
One unique feature of this role has been that I sit within the sustainability team, but work with clinical colleagues; this has been a real help in getting things going.
Older people’s community mental health
One of the few areas of the trust where green therapy was already established was older people’s community mental health. The team had been intermittently running a gardening group for several years before this project started.
However, they had run into several barriers, including health and safety red tape and the fact the site they were using was closed for renovations.
Our ordinary little allotment group has given each member a role and a purpose they didn’t know was missing. But the most meaningful of all is the reaffirmation that their recovery is achievable, through doing and connection.”
One of the first goals of the project was to get this group up and running again, by making sure they could use our own community allotment and that they were well resourced. Once this had happened, we eventually managed to get them back to the now renovated community garden centre.
This group now runs every Monday afternoon from there, with the benefit that we also have access to an indoor space for when the weather is bad. The group has doubled in numbers and we always looking to allow more service users to join.
Following on from the success of this allotment group, we decided to set up a similar group for the adult team on our own allotment. This took several months to get set up, mainly because of the first aid courses staff were required to take to be able to use the allotment.
Eventually, in September 2024, we launched the group, deciding to meet once a week on a Wednesday morning.
When we launched it, we had no idea just how popular it would prove to be. From the very start we have had attendance of between eight to 12 service users, who’ve really helped to shape the activities the group does.
While focused on growing and gardening, we have varied sessions including nature arts and crafts, nature photography, music jamming and bingo. We also like to have themed sessions including Halloween pumpkin decorating and Christmas wreath making.
This group have really become a tight knit support group, the success of which has helped lead to nature programmes with external organisations and to the potential creation of a group service users can attend after discharge.
Kelly Speed, an OT in the Adult Community Mental Health Team, said: ‘Our ordinary little allotment group has given each member a role and a purpose they didn’t know was missing. But the most meaningful of all is the reaffirmation that their recovery is achievable, through doing and connection.’
The Canal and River Trust
The first collaboration that was established was with the local Canal and River Trust, which was keen to get more integrated into healthcare using nature.
I had originally presumed any activities undertaken with them would have to be based along a canal and/or river, but they also carry out educational activities elsewhere. Therefore, the first programme set up with them was on our inpatient wards.
This was part of their lottery-funded Water Ways Nature Connection Programme. We set up an eight-week programme for both our Bracken ward (older peoples) and our Dementia Assessment Unit.
Each session would focus on different nature activities related to our rivers and canals. These included craft sessions, nature quizzes and virtual reality trips along the canal.
These sessions proved to be very popular with our service users and led to at least one service user setting herself a discharge goal of attending the Canal and River Trust’s own community programme on discharge.
Following on from this successful programme, we looked at what could be done out in nature, on our actual canals and rivers.
The Canal and River Trust runs a separate programme with an emphasis on physical health, funded by Sport England. In December 2024, together we arranged to put on a canoe taster session that nine service users and five members of staff attended, with overwhelmingly positive feedback.
As a result, we arranged an eight-week programme to run from March, alternating between walking and canoeing each week, all facilitated by the Canal and River Trust.
Each session attracted between eight and 12 service users; some attended every session and others preferred to drop in when they could, and both service users and staff reported how much it had helped their mental health.
Other partnerships
We are fortunate, as a trust, to be so close to the Yorkshire Dales, and it had been an aim from the start to investigate how we can utilise this nature resource for our service users benefit.
The Yorkshire National Park Authority has been a fantastic partner to make this a reality, and it has facilitated a walk for several of our community mental health teams, whose service users from these more urban areas have less access to green spaces.
One of the most well-received activities we have undertaken with our community service users has been a tree planting day, in collaboration with local green organisation YorGreenCIC.
Nine service users attended, with seven members of staff, to plant over 300 trees above the village of Silsden, just outside of Keighley. This was part of a wider community project to plant thousands of trees, also in collaboration with the Woodland Trust.
Inpatient wards
We have two inpatient hospitals within the trust, Lynfield Mount and Airedale Centre for Mental Health (ACMH). At the start of the project the inpatient wards were the easier place to get things up and running, as the wards had courtyards available to immediately start working in and the service users were all there, in the same place.
However, we have had to think about the activities people can access on the inpatient site and managing risk; it hasn’t been possible to deliver activities such as the canoeing sessions and trips to the Yorkshire Dales.
Both these inpatient groups incorporate a mixture of nature activities, mostly centred around gardening and walking, which encourage getting out into nature, but also include other nature activities done indoors, such as seed planting, nature arts and crafts and nature bingo.
Suzanne Williamson, an OT at the Airedale Centre for Mental Health commented: ‘Inpatient mental health wards can feel very clinical and adopting our outside spaces for nature-based therapeutic interventions provides escapism from this.
‘These activities also promote behaviour activation opportunities, where our service users see improvements in their wellbeing and are given the opportunity to continue within this occupation after discharge with connections to CMHT pathways.’
Virtual reality
One challenge we had from the beginning was how we engage service users in nature who either can’t leave the ward or are reluctant to. One novel solution to this was using virtual reality (VR).
We’d met a company that was developing a VR programme for an NHS trust in London. This was specifically designed to be used with its dementia patients, but the programme itself involved the user sitting in a virtual nature setting.
They had four different nature settings they could choose from, and we were fortunate enough that the VR company lent us a headset with the programme installed for us to try out.
Over several months, we trialled this with service users in a range of inpatient settings. The results were overwhelmingly positive, with our service users describing it as helping them to reduce anxiety.
Especially positive feedback was from our dementia ward, where it helped calm some previously quite agitated service users. We found it particularly helpful on our dementia ward for reminiscence with patients and opening conversation with our staff.
Subsequently, we commissioned our own Yorkshire-based nature VR programme to be made. We now have five locations around the county available for our service users to visit virtually, inspiring them to visit these places on discharge.
These headsets have been especially popular when wards are doing mindfulness sessions; rather than service users having to do these in a small clinical room, they can now do so while virtually immersed in the Yorkshire countryside.
Other connections
When I was an occupational therapy student, I knew little to nothing about nature therapy and never imagined it would be part of my career as an OT. One of the aims of this project has been to change that for future students, not just to make them aware of it, but also to ensure once they graduate, they already have some knowledge and experience in the field.
Therefore, we have worked closely with the University of Bradford to embed nature therapy within the syllabus. This has involved me holding several sessions for the students on nature therapy at the university, plus us holding sessions for students on placement with the Canal and River Trust. We have also started to offer a role emerging placement with Natural England.
In September 2024, we held our first nature week; this was a chance to promote the project across the trust, but also to introduce new activities and expand them to staff. We held several activities across the week, including a nature survey, a forest bathing session for staff and a nature photography competition for both service users and staff.
Since starting this project, I have given many presentations about the project and am being increasingly asked to share what we are doing here in Bradford. To support the case for making this role permanent, a local film company was commissioned to create a short film for us to summarise the project.
Next steps
We’d like to expand the project to other teams and locations across the trust and we are already in talks with several other teams to replicate some of the programmes we have been running. A particular goal would be for every team to have access to an allotment space for their service users.
We are also hoping to expand collaborations with local nature organisations would like to work with Mind in Bradford to strengthen community pathways and improve physical health.
Other areas to focus on include staff wellbeing, staff horticultural training, and making better links with other trusts.
However, there are some barriers, including staffing, the green therapy role not yet being permanent, the ‘red tape’ involved to get things off the ground, and no real outcome measures to record the success of our groups so far. We are currently in talks with psychologists within the trust to work more closely together to improve this.
Courtney J and Euden P (2023) Working to develop services through green therapy, OTnews, 31(11): 50-53
Words JOSEPH COURTNEY,
Green Therapy Project Development Officer, Bradford District Care NHS Foundation Trust
[email protected].
The film is available to watch via the QR code, or contact the author for a written report on the project
