Green Healing by pengxiuhui


									Green Healing:
 Policy and Possibility
   Jonathan     Judene
    Dosick    Shelley, MPH

Alternatives 2008
Buffalo, New York
October 31, 2008
The Presenters
    Jonathan Dosick is a
      consumer/survivor and mental health
      rights advocate. He founded and
      continues to coordinate the “fresh air”
      effort in Massachusetts.

    Judene Shelley works at the
      National Empowerment Center
      and plays outdoors as much as
 Green healing: what it is and can
 be, history, uses, the science and
 theories regarding it.

 How can green healing be utilized?

 A unique effort in Massachusetts:
 fresh air rights
Why Green Healing?
 “Green” is in: the urgency of
 taking care of the environment.
     Design, energy, and organic food.
     Health care is one of the last fields to
     go green.
     Going ‘green’ esp. important for mental
     health, which is an inexact science.
“In medical care…our connection
with nature must be re-examined.”
  “When you are in nature, it makes you
   realize that there are far larger things
than yourself. This helps to put problems
    into perspective. It is the only place
  where the issues facing me don’t need
    immediate attention or resolution…
     it can be a way to escape without
          fully leaving the world.”
                        – Lauren Haring, student
Theory developed by Edward Wilson, 1984:

  Humans have a deep genetic
  need for contact with nature.
 Who doesn’t look forward to good weather
 and outdoor activity?
     Why is “taking a walk” considered an
     easy way to reduce stress?
        Why do people complain of “cabin
        fever” in the winter?
Nature and Spirituality
  Nature is the basis for most spiritual movements and
  It gives us a sense of something larger than ourselves,
  something pure and created by a mystical force.
  As our daily life becomes further removed from nature,
  our sense of spirituality (and wellness) diminishes.

“The air smiles with bright serenity…
the invalid himself with eyes, ears, and
nostrils, drinks in the delights of colors,
songs, and perfumes.”
                       -St. Bernard (1090-1153)
 Why do we need to connect with nature?

How has nature helped with our recovery?
Green Healing:
   A Brief History
“Moral Treatment”
 Developed by English Quakers in 18th century.
 Fundamentals of “Moral Treatment”:
    Mental health conditions are medical problems that
    can be cured, but patients must be treated humanely.
    Opposed prevailing ideas that mental health
    conditions were part of the social hierarchy and didn’t
    deserve care.
    Corporal punishment, chains, and mechanical
    restraint eliminated.
    Ample access to fresh air, outdoor gardens that
    patients worked on, warm baths, and empathy –
    patients considered “brethren.”
 In 1796, William Tuke opened the Retreat in York.
 “Moral Treatment”

Scattergood          Friends Hospital,
   1748-1814      Frankford, Pennsylvania
Visited Retreat         Opened in 1817
19th Century Innovators:
Florence Nightingale
 Nurse and Health Care Reformer (1820-1910)
                      English nurse in Crimean War (1854-
                      56) between UK, France, Ottoman
                      Empire and Russia

                      France and UK: 3x deaths from
                      disease than combat

                      Wrote about hospital atmosphere -
                      considered fresh air and light of
                      top importance.
“Nature alone cures…nursing must put the patient in
the best condition for nature to act upon him.”
                                     -Notes on Hospitals, 1859
19th Century Innovators:
Dorothea Dix
Mental Health Reformer, 1802-1887
                      Shocked by conditions seen in
                      mental health asylums.
                      Testified to U.S. Congress,
                      proposed 1.225 million acres
                      be put aside for asylums.
                      Prone to depressive
                      spells, for which she
                      took refuge in nature.
                      Wrote a book about

                       Thomas Kirkbride
      Created master plan for asylum construction
19th Century Innovators:
Frederick Law Olmsted
Landscape Architect and Urban Planner, 1822-1903
                         Designs Include:
                            Central Park
                      Emerald Necklace, Boston
                          McLean Hospital
                           Biltmore Estate
                       Grounds of U.S. Capitol
                     Delaware Park/Buffalo Park
                      System and State Hospital

“The charm of natural scenery is an influence
of the highest curative value.”
          Relatively new,
          growing field
          Major research out of
          University of Illinois’
          Landscape and Human
          Health Laboratory
          Green spaces, compared
          to “hardscapes,”
          dramatically reduced
          stress, hostility and
          increased concentration.
       The Famous Ulrich
     Robert Ulrich, University of Delaware, 1984.
Compared two groups of people recovering from
surgery. One group had a view of trees, and the
        other had a view of a brick wall.

 “strong” painkillers given over one week:
        5.26                     3.53
  The Green Agenda for Mental Health
  Improvement in symptoms after green exercise
              Outdoor Walk    Indoor Walk




94% said green exercise benefited their mental health.
The Green Agenda for Mental Health
       3 Major Recommendations
 Ecotherapy should be recognized as a
 clinically valid treatment for mental

 Inequality of access to green space should
 be addressed as a human rights, social
 justice and discrimination issue.

 All health, social care and criminal
 institutions should be required to ensure
 access to green space.
“No Child Left Inside”
                             Children are spending
                             more time inside, and
                             less playing outside.

                             Alienation from nature
                             worsens mental and
                             physical problems.

                             Nature helps kids learn
                             to deal with stress more

 “As the young spend less of their lives in natural
 surroundings, their senses narrow…this reduces
       the richness of human experience.”
III. The Fresh Air
Movement In Mass.

 Access to Nature is a Human Right!
      CFAR: An Overview

CFAR is a loose coalition of consumer/survivor activists, disability
rights groups, lawyers, advocates, professionals and family
It is a joint project of M-POWER, a consumer/survivor activist
group, and the Disability Law Center, the Protection and
Advocacy office for Massachusetts.
I founded CFAR when I discovered that a hospital I had spent some time in was
 no longer letting people outside. Going outside at that and several other hospitals
were, for me, very important for maintaining quality of life during troubled times.
The Coalition for Fresh Air Rights
Our Mission
   To pass legislation making “daily
   access to fresh air and the
   outdoors” a “Fundamental Right”
   under law for ALL mental health
   inpatients and DMH residents.
   To spread word about increased
   denial of fresh air and the
   importance of outdoors access to
   people in Mass. and beyond.
CFAR’s achievements
 Filed three bills:
 – House #2871 (2005-06); 13 sponsors;
 – House #1905/Senate #1120 (2007-08); 20
 Researched all psychiatric units in Mass.
 Direct discussion and negotiation with
 opposing sides, supporting organizations,
 and legislators.
 “Fresh Air Follies” satirical skit
 330+ member mailing list (please join!)
 Feature story in Boston Globe; mention in
 other newspapers, periodicals and blogs
 locally, nationally and worldwide.
Expert Testimony
“If we want to provide humane care…we need to make sure
that access to “fresh air” is a regular feature of treatment
regimens today.”
                                                  -   Robert Whitaker, Author
“The weight of the scientific evidence tells us that providing
mental health patients access to the outdoors is humane and
effective care.”
                                  - Dr. Frances E. Kuo, University of Illinois
“Access to the outdoors [is] a necessary part of health for all
people, especially those receiving treatment in inpatient
                                             - National Empowerment Center
“[Denying fresh air] really boils down to not treating people
with the simple respect and human decency they’d deserve.”
                       -Dr. James Grohol, founder of website
Fresh Air Is A Right…
           …but for who?
  Prison inmates on state and
federal levels.
 Organic livestock (USDA

 What does this say about how we
     are viewed by society?
  Psych Hospitals in Mass.
 never responded                                        some access to
    to survey:                                            fresh air:
       11                                                    28

suspicious or
very limited:

     problematic                                  no access to
   smoking situation:                              fresh air:
            6                                         13

 There are a total of 72 psychiatric hospitals and units, public, and
  private, in Massachusetts. Almost 600 beds are in “no fresh air”
 hospitals, but that number could easily be up to 3 times as much.
Legal Basis For Fresh Air
Equality of all people with medical/mental conditions

                     U.S. Constitution
Act of 1973,             United Nations
Section 504              Covenant on
     Constitution        Social, and
                         Cultural Rights
                                Americans With
 Agreement of 1999              Disabilities Act
Laws/Regulations in
   Other States
Alaska                           South
           Montana    North
 D.C.                Carolina

             New                Virginia
 Idaho               Dakota

            New                  West
Missouri   Mexico    Oregon     Virginia
Arguments Against
Fresh Air Access
Taking patients out could result in patient
‘escapes’, possibly harming self/others
Risk of hospital liability
“Average” length of stay is shorter
Insurance companies: “If they’re well enough to
go out, they’re ready to go home.”
Not enough money for construction, staffing
Hospitals charged with keeping people safe

     We’re not interested in people being unsafe!
Other ‘reasons’ for
denying fresh air
It’s too cold in   Geriatric patients
 winter to let      don’t ask to go
people outside.        outside!

                   Just because they
Winter chill can
                    can’t ask doesn’t
be bracing and
                    mean they never
                     want to go out.
Trends in Inpatient
 Usually short stays, during which
 meds are adjusted and pts.
 discharged quickly (before meds
 can kick in anyway)
 Leads to rehospitalization
 Overworked staff rely on clinical
 methods; less activity or therapy
 Less/no aftercare planning
Staying Inside is Unhealthy

 Stale indoor air with no circulation; smell
 of cleaning chemicals
 Increased transmission of illness
 Fluorescent light disrupts circadian
 rhythm, causes headache, depression and
 can exacerbate dissociation.
 With less structure, patients have no
 distraction from their negative thought
 patterns and others’ problems.
Very Difficult Issue!
Is it fair to force people to   Nonsmokers often
stop a longtime habit           share small spaces
when in an acute state?         with smokers – much
                                secondhand smoke.
Do nicotine replacements
                                People with respiratory
work well?
                                ailments can’t go out.
Would nicotine                  A few hospitals only
withdrawal affect body          let people out to smoke,
chemistry, interfering          so people starting to
with medication changes?        smoke just to get out.

        Any ideas are welcome!
The Future
                  Legislative bill to be
                refiled for 2009-10.

                 Increased presence
                –tell everyone you

                 Web site coming soon!

                  Please fill out “fresh
                air in your state.”

The sky’s the limit!
Thank You!!!
Core Principles of Psychiatric
Rehabilitation (USPRA) #7:
All people are to be treated
      with respect and

   Let’s turn the tables!
Contact Info
Coalition for Fresh Air Rights (CFAR)
     Jonathan Dosick, Coordinator
     Phone: (617) 947-6549
     C/O M-POWER
     98 Magazine Street
     Roxbury, MA 02119

Access to Fresh Air and the Outdoors is not only a
 Fundamental human right, It’s good treatment.

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