Green Care is a structured and facilitated intervention led by a trained practitioner that takes place in natural surroundings, recognising the instinctive connection between nature and health.
Green Care Programmes are designed, structured and facilitated for individuals with a defined need to achieve clear patient-orientated outcomes and use a person-centred approach to increase the benefits and ensure safety.
The programmes involve the active and regular engagement of the individual with meaningful nature-based activities delivered by trained practitioners to create a sense of achievement, personal responsibility and self-confidence and offer opportunities to learn new skills; by taking place within a social setting they also promote feelings of inclusion and belonging.
There are a wide range of nature-based activities that can be used in these programmes, including horticulture and food growing, farming and animal assisted services, and environmental and wildlife conservation.
The benefits of Green Care, identified in research, come from three active processes:
- time in nature
- time being active and occupied
- time in a positive social environment.
Although these different processes work separately and all have potentially equal value, they are often interdependent and mutually supportive. In addition, within these processes, you also have i) a relationship between a practitioner and the patient/beneficiary and ii) the nurturing of plants and animals.
The skill of the practitioner is to adapt the 3 processes to suit the needs of people attending the programme. For example: break time and get togethers are as much a therapeutic activity as doing gardening; spending time noticing and being immersed in nature is also therapeutic and means that the practitioner must manage the natural resource separately as well as in connection to the therapeutic programme.
The natural resources used in the activities form an integral part of the therapeutic process and, unlike some other occupational therapy activities, the ‘result’ is important because it is alive: if the plant or animal doesn’t thrive it will not produce the same outcomes for the patient’s health and wellbeing.
All of this develops a unique style and approach to Green Care which differentiates it from other activities that may take place within a natural setting.
Many nature-based activities are available in the daily life of the general population, such as taking ‘green’ exercise (eg running, walking, cycling in the countryside or green spaces), interactions with animals (eg horse riding and dog walking), gardening/horticulture (including growing food), farming, forestry and environmental conservation. People usually make a conscious decision to incorporate these ‘Everyday Life’ activities into a healthy lifestyle; it is important that they have the ability and opportunity to do so in order that they can derive for themselves the benefits of time in nature and time being active and occupied.
In A review of nature-based interventions for mental health care (2016) Bragg & Atkins identified a range of activities that sit between Green Care and those in ‘Everyday Life’, aimed at helping the general population to prevent chronic ill-health – they refer to these as Health Promotion activities. These tend to be targeted at people who are ‘at risk’ of ill-health or need some additional support and encouragement to manage their health.
Whilst the Health Promotion programmes may share many of the characteristics of Green Care they are usually not as structured or targeted to the needs of the individual and may not be facilitated by a trained practitioner. The range and level of outcomes for the individual is therefore less certain which may make them unsuitable for some people’s needs; conversely the less structured and more social focus of the delivery may be more appropriate to others.
Bragg & Atkins (2016) described nature-based activities are being on a spectrum. The ability to move between Green Care, Health Promotion and Everyday Life nature-based activities as an individuals’ health needs change is a unique strength of the sector.
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 also integrate gardening into their personal (everyday) life.
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.
Green Care Coalition 