We will meet many people with mental health problems, and many of the professionals who treat them. They have generously spoken to me, some on the condition of anonymity, in order to help others with their illnesses. Hopefully it will be clear from the case studies that there is no one cause of mental ill health, and that sometimes it’s not particularly clear whether there was one discrete ‘cause’ at all. I have outlined a little of the background to my illness, but like many of the others featured in this book, I don’t want to tell the full story, nor do I think it would help the reader particularly to know it. Similarly, I have avoided going into too much detail on my symptoms, partly because there are some things I would rather not relive. This has been the case for many of those I spoke to, and while this may mean there are still questions about what feels like an incomplete example, this is just how it has to be when sharing mental health problems with such a wide audience. There is a difficult boundary between showing honesty to help others (and, often, ourselves) and the need for privacy to protect ourselves too. Each person sets that boundary in a slightly different place, but the purpose of this book is not to educate you in my individual misery, but to show how powerful the great outdoors can be.

Of course, the idea that nature and outdoor exercise can be good for your soul is hardly new. Plato was apparently rather keen on the way exercise helped the mind, and a quote attributed to the philosopher says: ‘In order for man to succeed in life, God provided him with two means, education and physical activity. Not separately, one for the soul and the other for the body, but for the two together. With these means, man can attain perfection.’¹ Not a snappy enough quote to find its way on to Instagram, but you get the point.

More recently, the catchily titled British Manly Exercises, written by Donald Walker and published in 1834, agreed.² This manual insisted that exercise could not only improve physical health, but also make people happier. Walker wrote that outdoor exercise was good for ‘the mental faculties’.

Walker wasn’t alone in this belief when he was writing. In the long line of paintings hanging in the National Portrait Gallery in London, one stands out. It’s not just that the subject is a woman, which is rare enough in itself – it’s the fierce, far-sighted look in her eyes, the proud bearing of someone who has lived a life far more noble than some of those she sits alongside. Yet given the impact her work and ideas had on modern Britain, Octavia Hill is astonishingly little-known. She was a pioneer of social housing, getting deeply involved in her tenants’ lives as she tried to reform them. She was one of the founders of modern social work and also believed passionately in the great outdoors.

Hill’s love of open spaces stemmed from her time spent in places that were the very opposite: dark, dingy, dangerous slum housing which she felt made it even more difficult for the people she cared for to have decent, happy lives. In a newspaper article titled ‘Space For The People’, she wrote rather forcefully about the difference outdoor space could make to the people she worked with:

Hill wasn’t a particularly fluffy character. You wouldn’t find her tweeting life-affirming memes involving pictures of sunsets, even though she clearly believed that those sunsets could do a great deal of good in life. She was a true force of nature and, in being so, was a force for nature too. Some of the greatest green spaces in London are still open and safe today thanks to her campaigning. Hampstead Heath and Parliament Hill Fields, both of which feature later in this book as places where many men and women still restore their minds, were saved from development by her and others. So were areas around London which Hill called the ‘Green Belt’, a term we still use and debate regularly today. A campaign with John Ruskin to save the fells above Buttermere in Cumbria from development led to the pair hatching a plan for a trust that would conserve beautiful open spaces and historic buildings. Hill wanted to call it the ‘Commons and Gardens Trust’, but her legal adviser Sir Robert Hunter put forward the name ‘National Trust’. And that’s what it became.

More recently, though, proper research has come along to back up our centuries-old hunches about the great outdoors. Researchers in the 1970s and 1980s carried out a small study involving forty-six patients recovering from gall bladder surgery in a Pennsylvania hospital.⁴ Half of those patients had rooms whose windows faced a ‘natural scene’, while the other half could only see a brick wall. The study found that those who could see the natural landscape took fewer powerful painkillers, stayed in hospital for a shorter amount of time after the operation and did better when being assessed by the nurses. Similarly, prisoners whose cells had a natural view were less stressed and were less likely to need medical attention.⁵

But it’s not just physical illness that benefits from nature. Over the past few decades, researchers have found that contact with nature, whether through windows or as someone’s immediate surroundings, can:

Why the outdoors in particular? There are many indoor activities that people with mental illnesses swear by: art therapy, music, reading and dancing to name a few. But some researchers believe that being outdoors supercharges therapeutic activities to the extent that we heal better and notice the pain a little less as we go. Therapists who we will meet throughout this book agree with that point about the value of the outside in getting someone to open their mouth for the first time and explain what’s going on inside. Some projects even make the natural world a central part of their treatment: when we visit Operation Centaur in Chapter Seven, we will see how horses help people who find it very hard to talk about the problems causing their addictions. Horses can’t talk, and yet without one rambling around in front of the patient, the therapist can’t get started.

There are plenty of theories about why nature has a particular power over the mind. Many of them run along the lines that we as humans are part of nature and have evolved alongside it, and therefore our natural state is in nature. American biologist Edward O. Wilson argues that the profound effect of the great outdoors on humans is as a result of our innate connection to the natural world. This hypothesis argues that humans have an ‘innate tendency to focus on life and lifelike processes’ because they have evolved alongside or even as part of nature. Wilson points to the unconscious ways people gravitate towards nature by visiting zoos, spending more money on homes above water and surrounded by parkland, and by ‘dreaming of snakes for reasons they cannot explain’.⁹ So we are most ourselves in nature because nature has been an essential part of human existence. There’s even a term for it – ‘biophilia’ – coined by social psychologist Erich Fromm, which Wilson then took up to explain why it is that we respond to nature in a certain way. There are other names for it, too: if you want to sound like the sort of trendy person who watches Scandi films and furnishes their home according to hygge principles, then try the Nordic ‘friluftsliv’, which refers to the healing power of nature and humans’ need to be in the great outdoors. Biophilia helps us understand why we feel calmer when we look through the window at the trees outside, and even why that phrase ‘get back to nature’ is so compelling, even for city dwellers. It sounds like a posh word for what is common sense, but if we do think that humans have an innate connection to nature because we have evolved alongside and as part of it, we’re not doing a very good job of living out that conviction. We do not design our homes or towns with this deep emotional need in mind, and we certainly don’t structure our working lives around it. Most workplaces that aren’t dicing with employment law accept that workers need to go to the toilet and eat lunch. But there are few that see a connection to nature as being even vaguely important to their staff, save perhaps the odd garden centre or slightly annoying social media giant.

But understanding that nature isn’t merely incidental to our lives helps explain why there is so much power behind so many of the interventions in this book. If the biophilia hypothesis is correct, then why should it be a surprise that so many people find doing therapy outdoors much less daunting than between the four walls of a counselling room? It also has profound implications for the way we live that go far beyond the treatment of clinical problems and into what we consider to be good mental hygiene for every person.

This innate connection to the natural world could even mean that our minds heal when in the outdoors. Environmental psychologists Stephen and Rachel Kaplan have developed a theory called ‘Attention Restoration Theory’ (ART).¹⁰ ART states that time spent in nature can renew our attention spans when they are flagging after a hard day’s work – or an extended period staring at a screen. Their theory includes four stages of attention restoration in nature, which starts with our minds clearing of the things we’ve been focusing on and worrying about. Then the mental fatigue that we are suffering from as a result of the hard focus on work or a phone begins to lift. After that, we experience soft fascination, which involves paying attention without any real effort to the things around us, such as the sound of the bird, the view in front of us, water moving through a stream. Finally, we find ourselves relaxing to the point that our attention is restored and we are then able to think about our lives in a more constructive manner. Research suggests that we find it easier to resolve minor life problems when spending time in natural settings.¹¹

Similarly, it shouldn’t really come as a surprise that running helps your mind and your body, unless you’ve ended up assuming that the two are completely separate and can never influence one another. If you have, you’re in good company. It is only recently that society, and even the medical establishment, has started to acknowledge that our physical health and our mental health aren’t as separate as we assumed. Some medics now believe that the Cartesian divide between the two has limited our ability to understand the causes of illnesses such as depression, believing that they must be ‘all in the mind’, rather than perhaps related to the immune system or other physical processes. Breaking down that divide could have profound consequences for medical research, but on a more basic level, it also now means that we commonly accept that running, for instance, isn’t just good for your physical fitness but also your mental state. So much of this book is about doing things, rather than thinking things. One benefits the other.

In 2018, NHS Shetland shot to attention when it ordered its GPs to give ‘nature prescriptions’ to several patients with debilitating physical and mental health problems. Doctors handed out lists of bird walks and outdoor activities to work alongside their prescriptions for pills. January’s prescriptions included: ‘really look at a lichen’, ‘walk the core path at Lunga Water – look out for mountain hares’ and ‘step outside – be still for three minutes and listen’. In August, patients were told to learn about seaweeds, ‘turn o’er a rock and see what you see’ and ‘try “charming” a worm from the ground without digging or adding liquids… rhythm is the answer’.

The Shetland doctors reckoned they were the first to be handing out such formal nature-based prescriptions, but a less specific form of social prescribing has been going on for a lot longer. Helen Stokes-Lampard was Chair of the Royal College of General Practitioners, between 2016 and 2019, and made social prescribing one of her priorities. She argues that ‘social prescribing is just a fancy way of saying what GPs have been doing all the time’ in that doctors often end up helping people with problems that can’t always be treated with medicine itself: ‘It is not my job as a GP to be someone’s friend, their counsellor and so on. It is my job to identify what those patients need, and have places to refer people on to.’

The most famous social prescribing practice is the Bromley by Bow Centre in south-east London. The centre takes referrals from GPs of people who have problems that medicine can’t tackle, and helps those patients with money, housing or employment problems, as well as prescribing them walking, running, drama, yoga and so on. The doctors who use the service are strident...