Green Care sits within a spectrum of nature-based activities which range from:
Everyday life – these activities are available in the daily life of the general population – such as taking ‘green’ exercise (e.g. running, walking, cycling in the countryside or green spaces), interactions with animals (e.g. horse riding and dog walking), gardening/horticulture (including growing food), farming, forestry and environmental conservation;
health promotion – these activities are aimed at the general population – such as green exercise initiatives (e.g. Walking for Health schemes), Animal Assisted Activities, community gardening and food growing projects, community farming, city farms and Environmental Conservation Groups. Engagement with these activities can be used to prevent chronic ill health;
Green Care – these are more targeted therapeutic or treatment interventions which are specifically designed for people with a defined need and are delivered by trained/qualified practitioners.
Figure 1: The different context in which an individual may engage with nature
[source: Bragg, R., Atkins, G. 2016. A Review of the nature-based interventions for mental health care. Natural England Commissioned Reports, Number 2014]
Activities can straddle or cross these categories, allowing participants to move between a treatment intervention, health promotion programme and everyday activity within nature as their health and well-being needs dictate.
For example, an individual recovering from a stroke may be referred to a structured gardening programme (Green Care) to work on self-confidence, general mobility and key muscle strengthening; to further their rehabilitation they may move on to a community gardening group (health promotion) providing more social interaction and local support and integrate gardening into their personal (everyday) life.
In order to assist commissioners to make most effective use of nature-based interventions, a further model – more directive, and consistent with the emerging preventative-focused health and public health systems – has been proposed by Thrive and then adapted slightly by CFUK.
Figure 2: Engagement with nature by different populations
- General population – refers to everyone
- Particular population – refers to particular groups within the general population such as communities that rank highly in Index of Multiple Deprivation in which individuals are ‘at risk’ rather than ‘at need’ of treatment interventions
- Special populations – is a term used by Diane Relf to describe those with an identified healthcare need such as disability groups and those with defined ill health
People usually make a conscious decision to incorporate the ‘Everyday Life’ activities into their lifestyle and it is important that they have the ability and opportunity to do so. Public Health messaging can be used to encourage these activities.
Engagement with ‘Health promotion’ activities may be through personal choice or it may have been suggested/advised by a health, social or community worker, by family member or friend, and attendance can be either on a regular or ad-hoc basis; funding is usually for the project as a whole and may come from public health, local authority grants or from the voluntary or private sector.
Engagement with ‘Green Care’ activities will typically be through referral via health or social care services (although service users in receipt of personal care budgets may commission their own services) and people attending these interventions will follow a facilitated and structured programme on a regular basis; funding is paid per individual for the care/treatment service provided by the intervention.
Moving from Everyday Life to Green Care activities, the needs of the individual become more acute, the support/care required is more intensive and the cost of the service increases. Professional standards and the use of trained practitioners are key features of Green Care interventions.