I was interning in a psychiatric hospital on an inpatient ward a couple of years ago. One of the things that I did a lot during this internship was walking with patients on the hospital grounds and gardens. I saw an immense shift in their emotional state when doing so and the team was happy that I, as an intern, had time for things like that when obviously they were quite busy with other duties. At the time, I probably couldn’t fully grasp how valuable a little walk in nature can be, especially for someone enclosed in an inpatient setting.
During COVID-19, we might all have felt isolated and maybe even imprisoned in our own homes at times. I have never been an inpatient in a hospital, but I have often contemplated what that must be like. Health care professionals, of course, just want the best for their patients, and they provide them with the best help and support that they can offer. Nevertheless, being an inpatient means spending days, weeks, or even months at a time in an environment that might seem unfamiliar, uncomfortable, impersonal, or even hostile. With extra restrictions in place that don’t allow patients to independently leave their ward or the hospital grounds – even if this is for their own safety and well-being – this can clearly create quite an intense situation.
I was wondering what we know about inpatients’ experiences of managing mental health and well-being during a stay in a psychiatric hospital. It turns out that especially young people name supportive relationships with staff as one of the most beneficial aspects of inpatient treatment (Freake et al., 2007; Biering, 2010; Moses, 2011).
Unfortunately, staff members don’t always have a lot of time for 1:1 interactions and rapport building. A literature review examining 13 studies with data collected over 35 years found that around 50% of staff time is spent interacting with patients. Psychiatric inpatients spend a large amount of time apart from staff and even away from other patients (Sharac et al., 2010).
At the same time, we know that there is enormous potential for very simple social and physical activity to have a benevolent effect on patients’ well-being. In 2018, a scoping review discussed the benefits of walking for mental health (Kelly et al., 2018). The evidence was clearest for symptoms of depression, but evidence was also found regarding the beneficial effects of walking for anxiety, psychological stress, psychological well-being, social isolation and loneliness.
I could see this first-hand when walking with patients out in nature. The symptoms that they experienced before our walk were often shaped by boredom, loneliness or a lack of meaning and purpose in their day. My internship took place during the spring and summer time and the place where I worked was full of flower beds coming to life, twittering birds and colourful butterflies. There was even a horse paddock close to the hospital grounds so we were able to pause for a minute, look at the horses enjoying the sun and interacting with them when they came over to the fence.
The conversations that evolved from these walks might have seemed like small-talk on the surface but they were actually somewhat profound. I heard about patients’ childhood spent in nature, about what animals they like and what pets they had when they were younger. When their mood started to lift, I sometimes heard about their future dreams too, often closely connected to what they were experiencing in the here and now:
When I’m better, I want to spend more time in nature.
I might like having a dog again in the future and going on long walks with him every day.
This was such a small contribution that I could provide in the grand scheme of things but it surely didn’t just make the patients’ day more meaningful. These walks made my day as well. They showed me that even though I wasn’t a trained clinical psychologist yet, I could offer something. And they showed me the enormous potential of using nature as a means to calm ourselves.
If you’d like to find out more about the benefits of walking, in this video, Associate Professor Jen Wild discusses why walking might help us with our mental health: https://www.youtube.com/watch?v=4b__f0c8rSM.
Biering, P. (2010). Child and adolescent experience of and satisfaction with psychiatric care: a critical review of the research literature. Journal of psychiatric and mental health nursing, 17(1), 65-72.
Freake, H., Barley, V., & Kent, G. (2007). Adolescents’ views of helping professionals: A review of the literature. Journal of adolescence, 30(4), 639-653.
Kelly, P., Williamson, C., Niven, A. G., Hunter, R., Mutrie, N., & Richards, J. (2018). Walking on sunshine: scoping review of the evidence for walking and mental health. British Journal of Sports Medicine, 52(12), 800-806.
Moses, T. (2011). Adolescents’ perspectives about brief psychiatric hospitalization: What is helpful and what is not?. Psychiatric Quarterly, 82(2), 121-137.
Sharac, J., McCrone, P., Sabes-Figuera, R., Csipke, E., Wood, A., & Wykes, T. (2010). Nurse and patient activities and interaction on psychiatric inpatients wards: a literature review. International journal of nursing studies, 47(7), 909-917.
Pictures from the open source platform pexels.com.