Outcomes on health, recovery and activity level for mental health service users attending a novel nature-based intervention: a prospective study

Purpose: Mental illness due to longstanding stress is increasing. It has been shown that service users with mental illness may benefit from nature-based interventions (NBI), including equine-assisted therapy, to support their health, recovery, and activity level of daily life. However, the evidence base to support this is still weak. The aim was thus to evaluate and provide knowledge of the possible effects on health, recovery and activity level from participating in a novel nature-based intervention among mental health service users with mental illness due to longstanding stress. Materials and methods: Forty participants took part in the study, which had a single group pretest-post-test design. The program was delivered in groups at a farm-based rehabilitation centre in a southern part of Sweden. It consisted of 24 weeks in two 12-week phases. Data were collected using well-tested questionnaires reflecting health, clinical and personal recovery, and activity level. Results: The analysis showed an improvement with medium to large effect sizes over time according to outcomes on aspects of health, recovery and activity level with exception for self-mastery. All outcomes were statistically significant with p-values <=.005. Conclusions: This novel nature-based program has the potential to be a recovery-oriented intervention that could enhance health, both clinical and personal recovery, as well as activity level for mental health service users. The intervention could thus also be a beneficial complement to current psychiatric care services.