A Sustainability scholar speaks: How Bethlem's green spaces inspire calm

Inspired by Bethlem Royal Hospital’s beautiful grounds, Specialist Registrar Jacob Krzanowski - one of RCPsych's Sustainability scholars - explores the positive impact of nature on our health and wellbeing.

When I first began working at the Bethlem in August 2017, I arrived not knowing what to expect. Friends who had spent time there hinted that the green grounds meant the site moves at a gentler and calmer pace.

That September, I went for a run after work, and ventured beyond the apple orchards which I could see from the ward. I found out then that the site is a seemingly endless quilt of meadows and dense forests with tall, thick trees that create a continuous canopy high above you. It all feels somehow impossible and precious.  

Although staff come to and leave the site, I found out it is our occupational therapists (OTs) who most understand the richness and possibility of the Bethlem’s grounds.

Over the years they have been instrumental in weaving its green space into the care of service users. Hoping to contribute in some way, I was very lucky to have met the Bethlem’s Lead OT Peter O’Hare.

Following some discussion and planning, we set up a Forest Therapy group in autumn 2017. Each week service users from various wards joined us for an hour as we took time to move slowly in wonder. 

As I stayed on into the new year it seemed to me that many people simply were not aware of the setting in which we worked; that the green space was there in spite of changing seasons and was always open for us to explore. While with the Home Treatment Team, I began a walking group with colleagues for 30 minutes once a week.

I still reflect on how such a brief time could feel so unrushed when moving through the trails. On our return to the offices the smiles and light steps felt as though they spilled out into the space. And the work always got done. 

Since leaving the Bethlem, I have been fortunate to continue promoting the impact of nature on our well-being.

Last summer I joined the Centre for Sustainable Healthcare in Oxford and was selected as one of the Sustainability Scholars here at the Royal College of Psychiatrists. In the months that have followed I have been working with an incredible team to develop the Green Walking Project. 

The project’s aim is simple: the promotion and advocacy of enhanced access to green spaces for our general adult inpatients. We hope to do this by creating the Green Walking Guide, which will address key questions and considerations faced by wards in starting their own walking groups; and by supporting the establishment of new green walking groups in trusts across England through the Green Beacon Site program.

Fortunately, the project itself has come about during a time when there is a growing interest in understanding the role of nature on our wellbeing. There is certainly a public enthusiasm which is reflected in a growing international interest to discover an evidence base behind our intuitions. 

Through the Green Walking Project, I have met and spoken with incredible professionals across the NHS who are motivated and interested in change. Many of these have been the OTs and activity coordinators who do so much of the promoting and implementing of green care. From these conversations and discussions, I have come to understand how much can be learned from integrating ideals of sustainability into healthcare. 

As I have worked on the project, my awareness of walking as a practice has also grown. It has become a basic pattern like breathing which creates a rhythm to our day, moving us through the world often in the company of others.  Of course, walking in green spaces as an intervention is hopeful in its simplicity and availability.

At the same time, grappling with what lies beneath this simplicity has shaped my understanding that providing mental health care is a complicated, delicate exchange which depends on collaboration across professions and sensitivity to the needs of those for whom we care. 

Recently, on my way to the Bethlem while on call, I spoke to someone on the train who knew the hospital site. Excitedly they asked if I knew of the grounds, how spectacular and grand they were? Even a year later, I share that amazement. My hope is that the grounds will remain and remind us of how much can be gained from taking the time to go out and enjoy its incredible paths, fields, and forests.