A Sustainable Nido for Community Mental Health Care

If we can build therapeutic calming communities, people in distress won’t need to be in different environments, they will feel more at home amongst us all.

A sustainable Nido is about protecting our Earth environment and our mental health conterminously.  Health preservation is nested within the homeostasis of Earth’s ecosystems, as it is within our bodily systems, they are intrinsically linked and interdependent.

The economic imperative through various stages of capitalism has embedded competition within human relationships, with consequences for mental and physical health. As consumers we have needed to compete against each other amid market forces, across the lifespan to be successful at school, at work and with those less fortunate than ourselves.

The impact of failing to be competitive can be hard to recognise without realising how social distress impacts our bodies. Prolonged exposure to stress hormones is linked to premature morbidity and mortality. Trauma imposed welfare cuts and wage stagnation now means people are continually worried about how they are going to feed their families or heat their homes. Cuts to public services means there is risk of isolation. This uncertainty is not the fault of the individual, trying to deal with our hostile socio-political environment is stressful. Survival of the fittest under capitalism, and associated ills, such as violence and abuse is impacting our health and compromising the earth for profit.

This proposal is to improve the environment rather than pathologising the individual. People cannot recover from something that is not their fault, but they do need access to services able to provide authentic understanding, sincere belief, and practical support, for example, people dealing with trauma related abuse and violence need to receive trauma-informed therapies stepped-up to meet their needs, with time provided for building trusting relationships.  

The cornerstone of this idea is for mental health services to begin auditing what can be done to reduce the environmental impact of service delivery for the longer-term provision of care, whilst making the most of community assets and developing equal partnerships with citizens, especially those who find themselves isolated from mainstream conversations.

Some ideas to begin with (from a coastal and rural perspective), by no means exhaustive:-

-          recruit locally wherever possible, reducing distances travelled to work to cut down on CO2 emissions

-          engage with local schools and colleges for careers advice in-line with local contexts and challenges

-          provide opportunities for refugees to work in our localities and lobby for resettlement packages for their families   

-          engage with all stakeholders and citizens shared visions for their communities and local resources, build a sense of pride in isolated and deprived localities' natural assets, as elsewhere, not just with usual orgs but every interested party

-          invest in developing local initiatives, work with local schools, colleges, and health care providers to develop get into health care placements and apprenticeships

advocate for people living in isolation if they find being alone distressing

-          start young and continue across the life span; look beyond usual sources, make health care information easy to understand and more accessible to groups with protected characteristics

-          assure people living with distress that poverty is not their fault, look at system failures, roadblocks to care

-          be proactive about employing people with visible and hidden disabilities into health care to build on lived experience

-          identify and build upon living values in local contexts and provide safe psychological spaces to talk

-          prevent bullying and harassment in health care services; effective care cannot be implemented under these conditions

-          recognise and be open about the effects of staff burn-out, implement change to protect staff and the people they care for

-          Build integrated care services into communities more broadly than ICS, involving lived experience leaders, peer groups, self-help groups, and therapy networks upon an equal footing, ‘no decision about me without me’

-          use remote technologies to cut down on travelling whilst maintaining 1:1 therapeutic interventions locally

-          Share transport to work and use pool cars for home visits. This may require employing more resources which could be cost-prohibitive. Another option could be to rearrange diaries and abolish caseloads for shared team working.

-          Two people on duty working interdependently to permit breaks

-          Build upon natural resources within our landscapes for therapeutic metaphor and for actual calming locations, even the most deprived localities have beautiful scenery

-          Implement parity of esteem for physical, psychological, and learning differences, factor-in the effects of poverty, isolation and stress mediated cortisol

-          Audit the environmental impact of every intervention, even if funding and logistics prohibit current change to build an evidence base for future improvement