Bee therapy

It makes me smile when I hear senior leaders in the NHS tell me there is no evidence for the healing powers of nature, and telling me that nature-based therapy should not be funded, when I know some of these very same people leave the noise of the city on Friday evening, after a busy week, for a weekend break to Suffolk, the Lakes, or the Knoydart Peninsula. 

If nature is good for us, it is good for our patients too. 

To make claims that nature therapy can cure or prevent serious mental health problems is a little simplistic. This area is replete with poorly conducted, uncontrolled studies with ill-defined interventions and heterogeneous patient groups. But there is a reasonable consensus from research studies that outdoor nature-based activities led by health professionals have real health benefits such as:

• reducing anxiety 
• reducing depression
• omproving blood pressure
• increasing step count  

For further information, you can read an article in The Lancet Planetary Health on the effect of nature prescriptions on cardiometabolic and mental health, and physical activity.

Nature-based interventions also have other benefits which are harder to measure:

• People say that they feel more connected to and find more meaning in their local environment after a nature walk.
• They may enjoy conversations as they walk along with other people.
• They might have a laugh whilst enjoying a biscuit and a cup of tea.

These small pleasures are not to be minimised, and can be invaluable for patients and be a contributory step on the road to recovery, as anyone who has participated in these interventions will tell you. 

• The Wildlife Trusts evaluated a variety of nature-based therapies and concluded there could be financial savings as well as health benefits.
• Working together on conservation projects can foster a sense of collaboration and connection between staff and service users.
• If interventions are focused on practical conservation and survey work, there are additional benefits for nature as well as for the participants
• Lastly, implementing these interventions can be fun. It is a great feeling to be collaborating with patients and staff on work which has real value. 

We hope we’ve convinced you that nature-based interventions are worth doing. 

So, let’s look below at how your team might start to do some. 

We’re going to focus on how working with insects might improve wellbeing. However, the ideas can be applied to any type of wildlife. We are choosing to concentrate on insects because they are often overlooked, and although crucially important to our ecosystems they are not loved as much as trees or hedgehogs. They are also everywhere. No one can use the excuse they don’t have access to bees!

There is no one type of nature-based therapeutic intervention.

Therapies should be personalised according to the needs of the patient or the staff group you’re trying to help. And they can be tailored to the expertise and interests of the people who are going to deliver them.

The interventions that have been researched tend to be conducted

• In a small group
• Outdoors
• And led by a professional, either a health or social care practitioner and/or someone with expertise in nature or horticulture.

Read more about nature-based therapies on this page, and some ideas of how you can get started.

• When interviewing a patient to review their mental state or medication, why not do this outside sitting on a bench? After the formal part of the interview is over, perhaps take some time to enjoy together the insects around you.
• Go for a walk with a patient in a ward or community team garden or local park whilst having a chat and looking at flowers and insects.
• Try bringing some structure into this intervention by taking with you a Field guide or one of the simple ID guides published by the Bumblebee Conservation Trust (see our resources section).  You could see how many different types of bumblebee you can identify together. You might like to take photographs of the bees you find and look them up when you get back inside. 

• An educational nature walk focused on insects. This needs planning. You or one of your staff could do a walk around your locality near your team base or ward and find a few hotspots where there seem to be a lot of bees. Do a bit of homework identifying a few of these insects and learn a bit about them. Work out an easy, short walking route linking some of these hot spots. Then find a colleague and four or five patients or staff, and show them what you’ve found. Encourage them to use ID guides and make the identifications themselves. At the end of the walk, have a sit down and a cup of tea, revise and chat about what you’ve learnt, and encourage participants to share their previous experiences of insects and nature more generally. This can be a lovely way to round off the session.  
• Improving the NHS environment for insects. If you work in a hospital, do the ground staff mow the lawns excessively so that by May all the grass is brown and dead? Do they plant sterile bedding plants which don’t attract insects? Do they use pesticides to clear weeds on paths? If so, why not have a conversation with them? Can they join Plantlife’s No Mow May campaign and leave some areas of longer grass to grow in May and June to allow flowers to flourish and provide food for all the pollinating insects? Can they be more frugal with their chemical use? Would they be prepared to work with you to make a wildflower meadow?
• Linking up with community groups. We are psychiatrists, not ecologists- so most of us will need some help. Make contact with a local charity or community group such as a nature reserve, park Friends group, Natural History Society, or Wildlife Trust. If you don’t know where to find out about these organisations, contact the ecology or biodiversity officer in your local council, who will point you in the right direction. Perhaps one of these local groups might give you some advice about how to enhance you gardens or even run a workgroup with patients. And there may be opportunities for patients to get involved in volunteer groups, for example on local nature reserves.
• Taking part in nature surveys. There are several Citizen Science projects run by nature conservation groups designed to attract beginners into nature by supporting them to do survey work. The Bumblebee Conservation Trust run the BeeWalk survey scheme, which encourages people all across the country to define a short route where they can walk once a month in the spring and record all the bumblebees they see. This would be an ideal project for staff to work collaboratively with service users on. You do need a little bit of knowledge, but the Bumblebee Conservation Trust have excellent resources to help you. It is incredibly powerful to take part in a project knowing that you and your service users are contributing to the conservation of insects across the country. 

• Nature-based therapy, and insect watching in particular, is best done in small groups. There’s no point in pointing out a bumblebee to a group of twenty people, as most of them won’t be able to see anything.
• Keep the sessions short (30- 60 minutes is often quite long enough). People do get tired, particularly if the weather is warm. 
• In terms of content, keep it very simple. Most people don’t know the difference between a fly and a bee, and don’t know the difference between a honeybee and a bumblebee.
• Use the camera on your phone. Insects fly about a lot. Taking a photograph as soon as you spot something and then looking it up at your leisure to identify it prevents the frustration of your insect flying off before you’ve had a chance to look at its antennae! Photos can be shared too, so the whole group can have a look at the insects even if some of them didn’t get a good view initially.
• Although not terribly environmentally friendly, paper handouts always go down well. Not all our service users are IT literate, and some don’t have phones. If someone with artistic talent in your team can draw a picture of a few common bees and print it out, your participants will love this. Or print out PDFs from the Bumblebee Conservation Trust website. These handouts serve a therapeutic purpose and they can be a reminder of what was (hopefully) a happy session. Draw a little box by each bee illustration so people can tick off when they see a particular species. 
• Always leave time at the end because there’s usually one or two people who are keen and want to have a chat and get some advice. It is these people you want to encourage to get more involved and point them in the direction of local volunteer groups, or even help them set up a BeeWalk.  
• Wherever you do your session, make sure there is an accessible toilet nearby.
• Plan carefully - try to include routes that are suitable for wheelchair users and people with mobility restrictions.
• If you’re expecting service users to travel to a destination to meet up, make sure your instructions are crystal clear to avoid any ambiguity about where you are supposed to meet.
• Usually, about half the people who sign up for an event don’t turn up. So always over-book. Send a reminder text or email the day before if you have resources to do this. 
• Never do these sessions alone - always have at least two staff present - so one can concentrate on leading the session and the other can make sure everybody is all right and chat to people who may be distressed.
• If you work in a Trust with a Recovery College, ask them if they help coordinate and facilitate sessions. 
• It may sound patronising, but it is important to give advice about what to wear and what to bring. Sun hats, water, and sun cream are essential in the summer and warm clothes are essential in the winter. It does no harm to carry a spare umbrella, a bottle of water and a tube of sun cream in case anyone needs them. Pencils and notebooks are a good idea too. 
• Whatever you’re doing, involve the service users as much as possible. Splitting into teams at the end and having a simple quiz often goes down well.
• It can be quite nice to combine the educative component of a walk with a period of reflection and discussion afterwards. Make sure you allow time for this, so everyone can sit down and have an informal chat to wind down 
• Everyone loves a drink and a biscuit. Bringing along healthy (and even a few unhealthy) snacks and drinks can help smooth social interaction and is a nice end to the session.

The Planetary Health and Sustainability Committee are offering a service so that if you have any questions about delivering sustainable healthcare or nature-based interventions, you can contact us.

Please email the Chair of PHSC, Dr Dan Harwood: daniel.harwood@slam.nhs.uk