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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 possible. Objectives 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 Biophilia 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 religions. 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) Discussion: 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” Thomas 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 plants. 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.” 1881 Ecopsychology Relatively new, growing field Major research out of University of Illinois’ Landscape and Human Health Laboratory Findings: Green spaces, compared to “hardscapes,” dramatically reduced stress, hostility and increased concentration. The Famous Ulrich Experiment 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 Ecotherapy: The Green Agenda for Mental Health Improvement in symptoms after green exercise Outdoor Walk Indoor Walk 90% Self-Esteem 17% 71% Depression 45% 71% Tension 28% 94% said green exercise benefited their mental health. Ecotherapy: The Green Agenda for Mental Health 3 Major Recommendations Ecotherapy should be recognized as a clinically valid treatment for mental distress. 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 effectively. “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 members. 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. CFAR: 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 sponsors; 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 facilities.” - 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 federal levels. Organic livestock (USDA Regulations). 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 access suspicious or very limited: 14 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 Rehabilitation Act of 1973, United Nations Section 504 Covenant on Massachusetts Economic, Constitution Social, and Cultural Rights Olmstead Americans With Agreement of 1999 Disabilities Act Laws/Regulations in Other States Alaska South Carolina Montana North D.C. Carolina New Virginia Jersey North 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 calming. want to go out. Trends in Inpatient Hospitalization 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 groups 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. Smoking 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 know! 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 DIGNITY. Let’s turn the tables! Contact Info Coalition for Fresh Air Rights (CFAR) Jonathan Dosick, Coordinator Email: firstname.lastname@example.org 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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