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Alison Greenhalgh
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I am led over a wooden bridge across a small lake, down a narrow mud path, past a totem pole and towards an imposing Mongolian-style yurt. Surrounded by plant life, the sturdy door is held open and I duck inside. I'm offered a wicker chair, and although it's a little chilly a stove is being loaded with logs and stoked up.

If it wasn't for the dull, distant rumble of traffic, it would be easy to forget that we're just 10 minutes from the end of the Metropolitan line, halfway between Uxbridge and Slough, UK. But with a beautiful incongruity, that's where Growing Better Lives resides.

The community interest company has co-leased the site with the charity Groundwork since 2012, where they aim to provide a blend of Greencare (also known as ecotherapy) and elements of therapeutic community structure to engage, stabilise and enable people with personality disorder (PD). The service forms one aspect of the EMBRACE group, a collection of recovery-focused groups that accepts referrals from community mental health teams. The local ASSiST group, which aims to facilitate and maintain discharge from hospital, also feeds in.

As a small group of us sit down to the table in the middle of the surprisingly spacious yurt, consultant psychiatrist and codirector of the project Rex Haigh explains how Growing Better Lives began. “Local services didn't have that social glue which is essential for PD programmes. By coincidence I'd been involved in a group called COST Action, writing the conceptual framework for Greencare. There was a lot of it going on in Scandinavia, Holland, and Italy. It was in my mind as a very powerful, therapeutic thing, incorporating nature as part of therapy, so when I was setting up the Slough PD service I thought, wouldn't it be nice to have some Greencare in there? So we applied for an EcoMinds grant.” The money was partly spent on the yurt—”we decided we'd go for the biggest we could—21 foot”. Despite wind, rain, and a snow-induced collapse, it remains the centrepiece of the project.

There's certainly a wide range of activities for people who use the service. Therapeutic and social horticulture, rural crafts, and animal-assisted interventions are all available, mixed with more familiar therapeutic processes like checking in and mindfulness. Vanessa Jones, another of the five codirectors of the project, explains why it's important that service users are allowed free choice over what activities they undertake: “It's not prescriptive. We don't tell you it's going to be this or that. The rule is that there have to be three in a group at minimum, but if you just want to sit in the garden and be, then that's fine. It allows people to have choice and take responsibility.” Haigh agrees: “It's about not being in a power relationship where you're told what to do.”

In addition to the organised activities, there's something very healing about simply being on the site itself. The team have said in the past that it's hard not to do therapy here. “There are no corridors, no people in white coats with name badges, no entry systems, and no reception”, says Fiona Lomas, another codirector. “There are no corners.” With a beehive, a tropical greenhouse, a goldfish pond, and an outdoor pizza oven on site, it's hard to feel anything but delightfully disconnected from the rush of modern life. A scale model of an elephant, rumoured to have escaped from the nearby Pinewood Studios, completes the otherworldly effect.

The stove in the yurt now roaring, coats are removed, and the cups of tea continue to flow. The hope is that service users will find something therapeutic at Growing Better Lives that they haven't been able to find elsewhere. As well as in the surroundings, that rare kind of cathartic experience also seems to be found in the relationships they form with the people who help to run the project. Service user Leanne Ellaway tells me, “if they mention that something has gone on in their own lives, it makes you feel normal. It's not like any other place you might go because you feel ill there, but when they start chatting to you about their lives, even if it's something very trivial, it makes you feel so much more normal.”

“It's not them and us. You can speak to everyone, about what you want. It's very casual. We all work together to do everything here, which is lovely”, adds another service user, Sharon Fizzard. And they really do seem to do most things as a group: “even if it's just chopping chillies. We even danced in the kitchen last year”, continues Fizzard, to be met by a wry smile from Haigh: “I didn't do that”. Haigh may not be much of a dancer, but he admits to taking part in the competitive pond-dredging last year. It sounds like it was a heated contest: “We marked on elegance, quantity, and efficiency”, says Lomas.

The team were richly rewarded for their hard work and innovation last November when they picked up the Royal College of Psychiatrists Sustainability Award. For Daniel Maughan, a research fellow in sustainability at the Royal College and a judge for the award, they stood out: “Greencare saw the importance of how working with others in natural settings can be of great benefit to patients and they turned this idea into an innovative reality in their project.” The judges were also noted to have praised their “excellent environmental awareness across all aspects of the service”.

Sustainability is no niche interest anymore. The Royal College of Psychiatrists held its first summit on the topic in 2014, where issues including the huge carbon footprint of the UK National Health Service (NHS), inefficient, expensive overuse of medication, and poor utilisation of natural spaces were tabled. Maughan tells us more: “For the NHS to be able to continue providing high-value health care into the future, sustainable paradigms of health-care delivery need to be created that focus on prevention, patient empowerment, education, and community integration.”

To remain financially, socially, and ecologically sustainable, we need to start being proactive in changing the ways we work, Maughan continues. “We need to harness every available resource, if we are to cope with rising expectations and decreasing budgets. This means broadening our understanding about the resource we have available to us and making the best use of peer support groups, online therapy and education, third-sector organisations, and community support structures.” Everyone can make a difference, even if it's only by deciding to take email referrals instead of printed letters, or cutting down on unnecessary review appointments by prescribing depot injections at the longest reasonable interval.

As well as being sustainable in terms of the environment, which the project does with aplomb, they are also sustainable in terms of people. Some service users who currently attend Growing Better Lives are seeking training in peer mentorship, mental health nursing, and social work, creating a virtuous cycle of empowerment and support. “When someone who's been through it themselves starts to tell you about how they felt, it makes you feel like so much more of a human being. Your internal voice said you're not right, you're weird, you're not normal, but when you hear about someone who's been through it, has come out the other side and is doing a job like this, it gives you such a sense of wellbeing, that you can get over it and move on”, says Ellaway.

The inspiration felt by service users seems to emanate not least from the three of the five codirectors of Growing Better Lives who have had personal experience of mental illness and contact with local services. Jones has come full circle to complete a PhD and is starting to build an evidence base for the project. The team use mostly qualitative methods and are affiliated with the Centre for Social Futures, a research division of the Institute of Mental Health at the University of Nottingham, Nottingham, UK.

In addition to strengthening the evidence base for the services they already offer, the team want to branch out. Among their many ideas is the provisionally named GreenFamilies project, which will aim to get entire family units of people with PD spending time in their healing environment, hopefully preventing the all-too-common scenario of children being removed from a home. Psychoeducation groups for families and friends of people who attend the existing project seem to be a well supported endeavour among the team too.

When asked what other services could do to emulate their ethos, Haigh offers a suggestion that he feels might be surprising: “Never see people by themselves. Always see them in groups, or with more than one member of staff, so you never have a dyadic relationship, so it can all be held in a network of relationships. Relationships have to be the absolute focus of the work, rather than symptoms or medication.” Lomas answers in no less striking a way: “You don't recover by being boxed in, you recover by branching out, by experiencing different things, by challenging yourself”, which just about sums up Greencare in a sentence.

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Alison Greenhalgh