Policy and Possibility
Dosick Shelley, MPH
Buffalo, New York
October 31, 2008
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
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?
A Brief History
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
Corporal punishment, chains, and mechanical
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.
Scattergood Friends Hospital,
1748-1814 Frankford, Pennsylvania
Visited Retreat Opened in 1817
19th Century Innovators:
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
“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:
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
Created master plan for asylum construction
19th Century Innovators:
Frederick Law Olmsted
Landscape Architect and Urban Planner, 1822-1903
Emerald Necklace, Boston
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.”
Major research out of
University of Illinois’
Landscape and Human
Green spaces, compared
stress, hostility and
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:
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
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
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.
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,
“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.
“If we want to provide humane care…we need to make sure
that access to “fresh air” is a regular feature of treatment
- Robert Whitaker, Author
“The weight of the scientific evidence tells us that providing
mental health patients access to the outdoors is humane and
- 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 PsychCentral.com website
Fresh Air Is A Right…
…but for who?
Prison inmates on state and
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:
problematic no access to
smoking situation: fresh air:
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
Act of 1973, United Nations
Section 504 Covenant on
Constitution Social, and
Agreement of 1999 Disabilities Act
Missouri Mexico Oregon Virginia
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
Do nicotine replacements
People with respiratory
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!
Legislative bill to be
refiled for 2009-10.
–tell everyone you
Web site coming soon!
Please fill out “fresh
air in your state.”
The sky’s the limit!
Core Principles of Psychiatric
Rehabilitation (USPRA) #7:
All people are to be treated
with respect and
Let’s turn the tables!
Coalition for Fresh Air Rights (CFAR)
Jonathan Dosick, Coordinator
Phone: (617) 947-6549
98 Magazine Street
Roxbury, MA 02119
Access to Fresh Air and the Outdoors is not only a
Fundamental human right, It’s good treatment.