Mental Health & the Outdoors

Learn Over Lunch with St. Luke’s Health System | Watch Mental Health & the Outdoors

Speakers: Brian Huck, Licensed Clinical Social Worker, has been working with children and adolescents at St. Luke’s Children's Center for Neurobehavioral Medicine for the past ten years. Additional information from Dr. Christopher Streeter, MD-Child and Adolescent Psychiatrist.

Brian Huck “I am an outdoor enthusiast. My father was an outdoor enthusiast and got me interested by taking me outside; kayaking, hiking, backcountry skiing… that’s really important to note where I come from because it shapes my view and my experiences in nature. I am also a father and a husband and I also enjoy taking my children out and exposing them to the outdoors because I recognize how important that has been in my life...I was really excited when I was approached about talking about how outdoors and being in nature might intersect with children and adolescent mental health.” 

Dr. Streeter supported Brian Huck on the information and preparation for the Learn over Lunch.

Main Topics Today

  1. Mental Health Trends and Suicide Rates In Idaho for Teens and Young Adults

  2. Contributing factors to the current trends that could be mitigated by spending more time outdoors

  3. How outdoor recreation can positively impact mental health

  4. Local programs that promote outdoor recreation as part of a comprehensive solution

  5. The value of Idaho's outdoors and public spaces for development and mental health for children/teens

General Statistics

  • In the decade prior to Covid there was a 40% increase in adolescents reporting “feelings of persistent sadness and hopelessness as well as suicidal thoughts and behaviors.”

  • Approximately 50% of mental health concerns develop by the age of 14 and 75% by the age of 24.

  • Suicide is the second leading cause of death in adolescents

  • 2/3 of adolescents don’t have access to adequate mental health care

  • The U.S spends more money per capita on mental health care than any other nation.

  • Around 20 percent of the population met criteria for mental health related illness prior to Covid. In teens this number increased to between 37-44% between January and June 2021. [13]

“I firmly believe that nature brings solace in all troubles” -Anne Frank

Bronfenbrenner, Coined the Bio/Neo-Ecological Systems Theory 

Uri Bronfenbrenner was born in Russia (1917) and emigrated to the U.S. when he was 6 . He earned his Doctorate in Psychology from the University of Michigan and he later developed Ecological systems theory which views individuals' development not in isolation but influenced by the environment (broken down into 5 levels) and how they perceive their environment.  

  • “This information is meant to emphasize the importance of the environment that we live in and interact with and how that affects our development. Individual development is not in isolation, it is influenced by our environment” - Brian Huck

Epigenetics: how the environment and behaviors change the way genes are expressed.

We are increasingly recognizing the influence the following factors have upon the way our genes are expressed:

  • Chemical, physical, psychological factors

  • Stressors associated with school, peers, family

  • Exposure to drugs and alcohol

  • Social media use and excessive time on electronics

  • Poor nutrition

  • Noise and air pollution

  • Sedentary behaviors

Headwinds

  • Craig Brod, PhD introduced the term “Technostress” to acknowledge the impact of increasing utilization and reliance on technology in our daily lives. 

  • Increase in urbanization and modernization of our immediate surroundings and distancing from our temporal evolutionary roots.  

  • Eco-anxiety refers to anxiety associated with changes happening in our environment (weather patterns, natural disasters, illness, etc.) 

  • Richard Louv “defines nature-deficit disorder, as characterized by depression, hyperactivity, aggressiveness, reduced motor development and coordination as well as overweight and obesity.”

Opportunity Cost: The potential benefit one misses out on when choosing an alternative over another one (time spent on electronics/time spent outdoors).

“This concept makes sense from a mental health perspective. If we choose to spend our time on electronics, indoors, or on social media, we miss out on the benefit of being able to be outdoors… What we practice is what we become good at.” - Brian Huck

NIH Environmental Influences on Child Health Outcomes (ECHO) Program

An initiative to advance our knowledge on the effects of environmental exposure on children’s health and development specifically in rural and underserved populations. As of September 2023, ECHO has gathered data from over 107,000 participants and 64,000 children. This program targets the below five areas. Idaho is one of the states that receives some of this funding, for grants and research to better understand what is the impact of the environment on children’s mental health and their development. There is still very limited research into this. 

  • Pre-, peri- and postnatal

  • Upper and lower airways

  • Obesity

  • Neurodevelopment

  • Positive health, happiness and sense of wellbeing

Physical Health & Mental Health Connection

120 minutes of outdoor activity a week in 20–90-minute increments provides reduction of depressive and anxiety related symptoms.  

  • Cardiovascular

    • Exposure to pollutants in the air can have a negative effect on cvs.

    • Exercise is known to promote cardiac health through exerkines. 

    • Cardiac events commonly result in anxiety, depression, ptsd and increased risk of suicide.  

  • Dental

    • Periodontal disease and missing teeth are associated with depression after accounting for other factors (socioeconomic, gender, medication, behavioral factors and diabetes).  [1]

    • Dry mouth related to medications

    • Poor hygiene practices 

  • Gut Microbiome 

    • “Second brain” Enteric nervous system- produces neurotransmitters (glutamate, gaba, dopamine, norepinephrine, serotonin, etc.). [8]

    • Gut microbiome diversity has been associated with multiple psychiatric conditions including MDD, bipolar, anxiety, schizophrenia

  • Viruses

    • Covid, HIV, Varicella-Zoster, etc. 

  • Concussions

    • CTE -increases in depression, impulsivity, anger

  • Substance Abuse

    • 48.7 million people 12 or older had a substance use disorder

    • 13.5 % of young adults age 18-25 had both substance use and mental health disorder in the past year (2021)

There are all kinds of outdoor opportunities: sports, recreation, hobbies, walks, gardening, nature observing, scavenger hunt, and work. All of this has a positive impact, but our intention in being outside is a big factor in what we take away from it.

Nature Based Therapies (NBT)

In 2020, an estimated 10,000 clients received NBT.

Care Farms (Europe) 

  • Horticultural/Live Stock setting used in whole or part for promoting mental and Physical Health

  • Health, Social and Educational experience 

  • Warm Springs Care Farm

    • Mission: is to improve the mental health and well-being of families with restorative care farm experiences and therapies.

    • Warm Springs Care Farm is a not for profit 501(c)3 located on the east end of Boise, Idaho. We partner with different therapeutic practitioners and agencies to offer farm-based therapies for children, adolescents and young adults.

Forest Bathing- Shinrin-Yoku (Japan)  

Walking Counseling

  • 45-60 minute Therapy session while walking in the outdoors (There is a greater benefit from nature path walking v/s urban walking) 

Wilderness Therapy Programs 

  • Wilderness/Nature base setting

  • Require one or more overnight stays (indication that longer programs 20 + days have greater efficacy then shorter programs 10 days or less) Length of stay often 3 + months. 

  • Have interpersonal and challenged based elements

  • Wilderness Therapy Idaho (bluefirewilderness.com)

Hypothesized m\Mechanisms of Nature Based Treatments

  • Attention restoration theory

    • ART= mental fatigue associated with modern life and depleted capacity to direct attention. 

  • Stress reduction theory

    • SRT=There is an innate connection to the natural worlds and therefore being in nature can activate the parasympathetic nervous system

  • Opportunities for social connecting

  • Increase physical activity

  • Experience basic elements of life/high accountability environment

  • Opportunities for challenges and collaborative problem solving 

  • Goal setting

  • Planning

  • Regulation/focusing skills

  • Reciprocity

  • Fostering introspection

  • Self-efficacy

Forest Bathing

After one-time practicing forest bathing, the mean mental well-being of participant (n=24) using the warwick-edinburgh mental wellbeing scale (wemwbs) increased from 47.8 + 3.2 to 54.3 + 4.0 (p<0.01). After three times, mental well being score increased to 56.3 + 4.0. Three participants prior to intervention met threshold for possible mild depression and 6 met threshold for probable depression. [14] 14 item scale range 14-70, <41 Probable depression; (41-45) possible minor depression. N=16 completed all three Forest Bathing sessions. 

Walking Counseling

  • Pilot study conducted in Germany at an acute psychiatric hospital showed mild reduction in endorsed depressive symptoms on the phq-9 (pre=16.94 –post= 12.94) following therapeutic focused time in the gardens and forest outside the hospital averaging 3 x a week for an average of 4 weeks.  

Barriers to Accessing the Outdoors

  • Social economic status

  • Modeling

  • Urbanization/Development

  • Legal/Liability

Barriers to Accessing NBT (Nature Based Therapy)

  • Financial

  • Insurance

  • Organizations

  • Providers

Patient Statements

  • “I feel like I am able to concentrate better.”

  • “I feel less stressed and better.”

  • “It is easier to talk.” 

  • “I feel more awake and enjoy the fresh air.”

  • “Easier to open up.”

  • “Easier to practice mindfulness and grounding techniques.” 

  • “I was able to do activities I had never done before, like rafting, mountain biking, climbing.”

Website References

anxiety in teens is rising: what's going on? - healthychildren.org

'green acres' really is the place to be if you want mentally healthier kids - (studyfinds.org)

References

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Ashton Caldwell