working today
for nature tomorrow
Nature and psychological well-being
English Nature Research Reports
Report Number
533
English Nature Research Reports
Number 533
Nature and psychological well-being
Linda Seymour
Policy & Research Development Manager
mentality
134-138 Borough High Street
London SE1 1LB
May 2003
You may reproduce as many additional copies of
this report as you like, provided such copies stipulate that
copyright remains with English Nature,
Northminster House, Peterborough PE1 1UA
ISSN 0967-876X
 Copyright English Nature 2003
Contents
1. Introduction....................................................................................................................7
2. Aspects of nature which may promote mental health and psychological well-being....7
3. Risk and protective factors for positive mental health and well-being..........................9
4. The impact of access to nature on psychological well-being ......................................11
5. UK social policy ..........................................................................................................12
6. Recommendations ­ changing social policy discourse................................................14
7. References....................................................................................................................15
7
1. Introduction
Nature and access to it is often associated exclusively with the countryside and rural areas. In
fact just over a fifth of the population of England live and work in rural areas and so access to
nature is much more likely to be within urban or semi-urban surroundings. The natural world
is made up of rocks and soils as well as plants and animals and their supporting habitats.
Given the built-up, industrialised and technological context of many contemporary lives, it
can be easy to forget that the natural world provides the physical and spiritual framework
within which we exist.
As a consequence the natural world offers the potential for significant positive affect on
individual and community psychological well-being.
This briefing is designed to:
 identify the nature and extent of benefits to people's psychological well-being from
contact with nature;
 describe risk and protective factors for positive mental health and well-being and how
contact with nature impacts on these factors;
 outline the relevant UK social policy framework;
 Set out recommendations for English Nature on appropriate lines of action
2. Aspects of nature which may promote
mental health and psychological well-being
Environmental effects on mental health and psychological well-being can be divided into
physical, social and cultural properties (Freeman 1984):
Environmental effects on mental and physical health
Physical Social Cultural
Intervening variables
Nervous System
Intervening variables
Psychiatric illness Physical illness
8
Aspects of the physical environment which have been shown to have a negative impact on
mental well-being include:
 high population density: stress, anxiety, aggression, increased sense of physical and
emotional vulnerability (Freeman 1984, Brain 1984);
 noise: stress, anxiety (Tarnopolsky & Clark 1984);
 information/stimulus overload: stress, anxiety (Freeman 1984).
Indicators of mental well-being, for example trust, tolerance, participation and feelings of
safety, are directly influenced by environmental factors, notably population density? For
example the probability of helping a stranger is inversely related to the level of environmental
stimulation, which includes density of pedestrians and motor traffic (Freeman 1984). Noise
decreases the sense of connection between people and decreases the probability that people
will help each other (Walter 1982).
In a major study, Lewis and Booth found that while those living in rural areas had a much
lower prevalence of mental disorder, people living in built up areas with access to gardens or
green, open spaces had a lower prevalence than people in built up areas with no such access
(Lewis & Booth 1994).
Other evidence shows that improving the urban environment leads to reductions in overall
psychiatric morbidity. Dalgard and Tambs for example, challenge the view that the quality
and proximity of social support is the key factor influencing mental health and argue that
changes in the environment are more significant. Unfortunately, their research does not
identify the specific significance of individual environmental changes, so it is not possible to
assess whether parks and green, open spaces had a greater impact on mental well-being than
other environmental improvements (Dalgard & Tambs 1997).
There is an extensive literature concerned with trying to explain why cities are bad for mental
health: key factors include higher stress and less stable social conditions. In England, based
on the results of a survey of 6000 adults, stress appears to be a major health problem.
(Rainford et al 2000). In 1998 24% of men and 29% of women reported having suffered `a
large amount of stress' in the past 12 months. Reported stress levels have risen steeply since
1995, when the overall percentage was 21%, but now appear to have stabilised. Stress is
highest in the age group 25-54, peaking at 35-44. Self-reported general health, which includes
people's own perceptions of their stress levels, has been shown to be a strong predictor of
mortality (ibid). This illustrates the potential value of research that explores people's own
perceptions of how access to nature promotes psychological well-being.
Generally, the health of people living in rural areas is better than that of people in urban areas
(Watt et al 1994). Urban residence is associated with a higher prevalence of neurotic
disorders and those living in built up areas have a much higher prevalence of psychiatric
morbidity, alcohol and drug dependence (Paykel et al 2000). For young people, rates of
mental disturbance in children and adolescents are lower in rural areas than in urban areas.
The figures for conduct disorders (eg truancy, vandalism, drunkenness, delinquency, antisocial
behaviour) for example, are 4% in rural areas and 9% in urban areas.
However in recent years, the romanticised image of the countryside as a place of peace and
respite, seems to have been replaced by a growing awareness of the problems associated with
9
living in rural areas. Much of the literature on rural issues argues that idealised views of the
country obscure the extent of rural disadvantage, aptly summed up in titles like Not seen, not
heard and You can't eat the scenery (ACRE et al 1999)
It may be that the countryside is no longer idealised. Extensive media coverage of for example
foot and mouth and the plight of farmers, the closure of rural shops, schools, pubs and banks
and rural homelessness and unemployment have combined to create an impression of rural life
under stress. A number of organisations have been established to draw attention to stress in
rural areas and to highlight aspects of rural life which damage mental health including ACRE,
the Rural Stress Information Network, the Institute of Rural Health and ruralMinds.
A national survey on public attitudes undertaken in 1995 demonstrated that nine in ten people
value the countryside and that there is a very strong desire for greater opportunities to access
rural areas (Countryside Commission 1997). The most important benefit from visiting the
countryside was the sense of relaxation and well-being. Fresh air and peace and quiet were
also valued.
Henwood (2002) provides several explanatory frameworks for the mental health benefits of
contact with nature. These include:
 `stress recovery' ­ immediate psychological benefits from contact with nature (Ulrich
1979, 1983, Ulrich et al 1991);
 `attention restoration' ­ longer term psychological benefits from contact with nature
(Kaplan and Kaplan 1989, 1995).
More recently the Countryside Agency has taken a forward look at the state of the countryside
by 2020 and various likely scenarios (Countryside Agency 2003). They describe a future
where countryside areas will be under more stress in terms of increased households, changes
in land use and economic generation and the impact these changes will have on quality of life.
They also offer four possible ways forward which will demand resource and planning input
from central and local government.
3. Risk and protective factors for positive
mental health and well-being
Mental health is more than the absence of mental illness and has been described as
the emotional and spiritual resilience which enables us to enjoy life and to survive pain,
disappointment and sadness - a positive sense of well-being and an underlying belief in our
own worth and the dignity and worth of others (HEA 1997).
Mental health and psychological well-being influences how we think and feel, about ourselves
and others and how we interpret events. It affects our capacity to learn, to communicate, and
to form and sustain relationships. It also influences our ability to cope with change, transition
and life events.
Mental health may be central to all health and well-being because how we think and feel has a
strong impact on physical health. There is a growing body of research that demonstrates the
impact of mental health on physical health. Much of the research in this area is concerned
10
with how the social environment acts on biology to cause disease (Marmot & Wilkinson
1999).
What has been called `stress biology' looks at the relationship between chronic stress and the
nervous system, the cardio-vascular and the immune systems, influencing cholesterol levels,
blood pressure, blood clotting and immunity. Chronic anxiety, insecurity, low self esteem,
social isolation and lack of control over work appear to undermine mental and physical health.
Perceived low control beliefs, such as powerlessness and fatalism, accounted for more than
half the mortality risk for people of low socio-economic status (Bosma et al 1997).
The power of psycho-social factors to affect health makes biological sense. The human body
has evolved to respond automatically to emergencies. This stress response activates a cascade
of stress hormones that affect the cardio-vascular and immune systems. The rapid reaction of
our hormones and nervous system prepares the individual to deal with a brief physical threat.
But if the biological stress response is activated too often and for too long, there may be
multiple health costs. These include depression, increased susceptibility to infection,
diabetes, high blood pressure and accumulation of cholesterol in blood vessel walls, with the
attendant risks of heart attack and stroke (Brunner & Marmot 1999).
Sustained stress or trauma increases susceptibility to viral infection and physical illness by
damaging the immune system (Stewart-Brown 1998, Cohen et al 1991 and 1997, Marucha et
al 1998, Vedhara et al 1999). Depression has a significant impact on health outcomes for a
wide range of chronic physical illnesses, including asthma, arthritis and diabetes (Turner &
Kelly 2000) and is a risk factor for stroke (Jonas & Mussolino 2000, Ostir et al 2001).
Depression increases the risk of heart disease fourfold, even when other risk factors like
smoking are controlled for (Hippisley-Cox et al 1998). Lack of control at work is associated
with increased risk of cardiovascular disease (Bosma et al 1997, Marmot et al 1991,
Niedhammer et al 1998).
Conversely emotional well-being is a strong predictor of physical health. Men and women
who scored highest in a survey on emotional health were twice as likely to be alive at the
study's end. The link between subjective feelings of happiness and good health held even after
controlling for chronic disease, smoking, drinking habits, weight, sex and education
(Goodwin 2000).
The social environment can also act to promote mental and physical well-being. Recent
research on social capital and inequality suggests that how individuals and communities feel levels
of trust, tolerance and participation - may be a critical factor in determining health.
(Wilkinson 1996 and 2000, Cooper et al 1999, Kawachi et al 1997, Kawachi & Kennedy
1999).
Social capital consists of the informal and formal networks, customs and relationships that
make up our individual and community interactions. The key elements of social capital have
been summed up into four broad themes:
 social resources, eg informal arrangements between neighbours or within a faith
community;
 collective resources, eg self-help groups, credit unions, community safety schemes;
 economic resources, eg levels of unemployment, access to green, open spaces;
11
 Cultural resources, eg libraries, art centres, local schools
(adapted from Cooper et al 1999)
Mental health promotion ­ or public mental health - covers a very wide range of activities
concerned with strengthening the mental and psychological well-being of individuals,
families, organisations and communities. It can be seen as a kind of immunisation, working to
strengthen the resilience of individuals, families, organisations and communities ­ as well as
to reduce conditions which are known to damage mental well-being in everyone, whether or
not they currently have a mental health problem (HEA 1998).
Mental health promotion works at three levels: and at each level, is relevant to the whole
population, to individuals at risk, vulnerable groups and people with mental health problems.
 Strengthening individuals - or increasing emotional resilience through interventions
designed to promote self-esteem, life and coping skills, eg communicating,
negotiating, relationship and parenting skills.
 Strengthening communities ­ this involves increasing social inclusion and
participation, improving neighbourhood environments, developing health and social
services which support mental health, anti-bullying strategies at school, workplace
health, community safety, childcare, self-help networks and so on.
 Reducing structural barriers to mental health - through initiatives to reduce
discrimination and inequalities and to promote access to education, meaningful
employment, housing, services and support for those who are vulnerable.
4. The impact of access to nature on
psychological well-being
Can access to nature enhance the protective factors for positive mental health and diminish the
risk factors for poor mental health? Programmes known from the research literature to protect
mental health are sometimes delivered in natural settings, although this briefing is unable to
draw any conclusions about increased efficacy of mental health promotion programmes
offered in a natural setting rather than any other situation.
They can also be delivered at three levels of prevention:
 universal interventions for an entire population, eg all young people of a certain age
or all residents of a particular community;
 selective interventions for those groups deemed to be high-risk, eg lower socioeconomic
groups or women from ethnic communities;
 indicated interventions for groups where a problem has already occurred, eg people
with an existing mental ill health problem.
Universal and selective approaches are proactive whereas indicated ones are reactive (Nelson
et al 1999)
12
Exercise has been shown to reduce anxiety, enhance recovery from brief psychosocial
stressors (Taylor 2000) and reduce clinical depression (Mutrie 2000). Exercise schemes are
regularly offered within a natural setting, for example the `Island Health Walk Scheme' in the
Isle of Wight was established by the West Wight Primary Care Group in 1999. Short
volunteer-led walks are offered for those who lack confidence or physical ability to walk
alone. While targeted at people with mental health problems and learning disabilities, these
walks are particularly beneficial for older people and have been very successful in enabling
older people to make new friends and forge community links. User feedback has
demonstrated enhanced self-confidence, self esteem, improved physical fitness and increased
independence. (Contact: Health Promotion, Isle of Wight Healthcare NHS Trust, St Mary's
Hospital, Newport, Isle of Wight. Email: rosie.rae@iow.nhs.uk)
A recent review of diet and physical activity which supports the `biophilia hypothesis' closeness
to nature increases well-being ­ advocates the adoption of physical activities within
nature. The authors have described this synergy `green exercise' (Pretty et al 2003).
`Green Gyms' are emerging as a national movement which offers people a way of meeting
others, getting physically fit and improving the natural environment. Local evaluations have
demonstrated a range of physical and mental health benefits, including reductions in
symptoms on the Hospital Anxiety and Depression Scale and improvements in quality of life.
`Play in the Parks' is an initiative within the Nottingham Social Action Research Project
(SARP) which uses play programmes for children in a deprived area to build social capital.
Key features include the employment of local people as play workers, building networks
between parents and different groups of young people (as opposed to running one off
sessions), involving young people in planning activities, building reciprocity into the project
and celebrating cultural diversity. (Nottingham SARP 2002)
It must be noted that although there are some examples of universal, proactive mental health
promotion offered within natural settings these are in the minority. In the main, initiatives
target those at high risk or already in receipt of mental health services. However two
illustrations from English Nature programmes provide a more proactive model.
For example the work in school grounds which develops wildlife gardens and ponds, run
through English Nature's `People and Nature' initiative, (English Nature 2002) is coherent
with what is known about mentally health promoting schools. School mental health promotion
programmes that promote positive mental health are more effective than brief class-based
programmes designed to prevent mental illness and changes to the schooľs climate and ethos
are crucial to successful outcomes (Wells et al 2001).
Another English Nature programme which encourages the participation of volunteers (ibid)
also supports broad mental health promotion aims and outcomes. A systematic review of
volunteering has shown that it increases opportunities for social participation and decreases
social isolation (Wheeler et al 1998).
5. UK social policy
There are a range of social policies relevant to nature and well-being from health, social care
and health and other government agencies. The National Service Framework for Mental
Health (NSFMH) (Department of Health 1999) includes a mental health promotion standard -
13
Standard One - which aims to ensure that health and social services promote mental health
and reduce the discrimination and social exclusion associated with mental health problems.
This standard includes mental health promotion across whole populations, as well as
programmes for individuals at risk and vulnerable groups, for example black and minority
ethnic groups, people in prison, who sleep rough and people with drug and alcohol problems.
Key settings for mental health promotion are schools, workplaces and neighbourhoods.
Performance will be assessed nationally, by a long term improvement in the psychological
health of the population, measured via surveys of psychiatric morbidity among adults aged
16-64 living in private households in Great Britain, and a reduction in suicide rates. Local
Development Plans must demonstrate action to promote good mental health.
The National Suicide Prevention Strategy (Department of Health 2002) has as one of its seven
goals the promotion of mental well-being for the entire population. Degraded physical
environments are known to be deleterious to positive mental health and increase risks for
vulnerable individuals and populations.
The Social Exclusion Unit has recently announced a review on mental health (SEU 2003). At
the launch event Barbara Roche, Minister for Inequality and Social Inclusion, announced that
the focus would be on employment opportunities and social networks for people with mental
health problems who are some of the most socially excluded people. She also emphasised that
"The Government is committed to building thriving, sustainable communities - environments
in which we would all like to live. They will only be sustainable if they are fully inclusive and
cut to the core of social exclusion and poverty. This new programme of work is vital to
realising that goal." The Neighbourhood Renewal Unit will shortly be embarking upon a
similar area of work.
Quality of life seems to be impacted by exposure to nature (Henwood 2002) and this issue has
moved up the policy agenda. The Local Government Act 2000 placed a duty on local
authorities to produce long-term community strategies with their partners to improve the
quality of life in their local area (HMSO 2000). Since the International Earth Summit in 2002
there has been increasing pressure on local authorities and their partners to ensure that their
activities and plans are based on the principles of sustainable development. The Audit
Commission piloted a series of `Quality of Life' indicators in local councils during 2001
(Audit Commission 2002). There are a range of social, community involvement and
environmental indicators, many of which can provide measures of the impact of nature on
psychological well-being.
The Forestry Commission is the government department for forestry in Great Britain. The
Commission manages all state-owned woodlands in Britain but since the 1980s their
objectives have widened considerably. Greater emphasis is now placed on the potential
environmental and social contribution of woodlands, as well as forestry's role in sustaining
rural communities (Gillam 2002). The Commission produced a new range of 40 indicators of
sustainable forestry in 2002 and these included information about people and forests.
The Urban Parks Forum (UPF) is a not-for-profit organisation set up to help those committed
to the planning, design, management and use of public parks and open space
(www.urbanparksforum.co.uk). UPF first came into being to promote the regeneration of
public parks and open spaces in towns and cities throughout the UK and to support the
investment being made in our parks by the Heritage Lottery Fund.
14
They also aim to provide a network for the exchange of experience and information:
to identify and promote best practice through events, research, networking and publications;
to provide a channel of communication between local and central groups and other
organisations; and to promote the sustainable future of public parks and public open spaces.
This brief overview is by no means comprehensive but what seems clear is that, although a
range of mental health and other policy has relevance for programmes on nature and
psychological well-being, no agency, with perhaps the exception of the Audit Commission,
has yet made the essential link between the potential positive impact nature could have on
psychological well-being as a discrete outcome.
Most existing mental health policy focuses on improving access to and quality of service
provision for people who use services. The NSFMH does have a standard on mental health
promotion but this also tends to concentrate on existing service users. Universal proactive
programmes are largely missing.
The newly established National Institute of Mental Health (England) (www.nimhe.org.uk) has
developed a devolved regional structure but its goals are tied into national policy. So for
example social inclusion and mental health promotion have been conflated into one
programme and the primary aim for the next financial year is to enable implementation of the
national suicide strategy (Appleby 2003). Even in areas of England where the natural
landscape is more widespread, such as in the northeast or southwest, the focus is not on the
inherent health promoting benefits of nature, rather on ameliorating the stresses associated
with rural life or the delivery of a health promotion programme within a natural setting..
Social exclusion agencies are beginning to target people with mental health problems. They
are concentrating on opportunities for employment as a way out of social exclusion. There is
also an emphasis on social networks and opportunities to participate, both of which are
offered by programmes that access nature or are delivered in natural settings. However this
connection has not yet been made.
Policy from agencies more directly concerned with the natural world focus more on
environmental sustainability or biodiversity. They have not yet identified the purely mental
health promoting elements of access to nature in either urban, semi-urban or rural settings.
Perhaps only the Audit Commission with its voluntary `Quality of Life' indicators has come
closest to marrying two complementary sets of policy goals.
6. Recommendations ­ changing social policy
discourse
The significant issue is to shift social policy discourse so that it recognises the contribution of
nature to social objectives and therefore to protect and enhance biodiversity and healthy
ecosystems. There is a desire to demonstrate the synergy between the social and
environmental spheres of sustainable development (Hanna 2003). Three areas of activity
necessary to drive the change in discourse have emerged from the information in this review
and although they are not necessarily sequential, the first underpins the second and third:
15
 consolidation of the evidence base through systematic review and collation of
qualitative and quantitative data from current initiatives;
 development of demonstration projects trying out and evaluating established and new
approaches that bring together nature and social objectives.
 work in partnership: health and nature organisations need to share and exchange
expertise to develop mutually credible initiatives and policy discourse.
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