ORCID

Abstract

Children and young people’s mental health and well-being has seen a dramatic decline. In the UK, this has been exacerbated by service retrenchment associated with austerity, with evidence of increasing health inequalities. Service innovation that is grounded in practice, has ongoing learning, and is co-designed with children and young people is required now. This can provide creative solutions within the local context and contribute to the fledgling evidence base that explores complex mechanisms of impact. This methodological reflection describes a co-design process of a bespoke, group-based ecotherapy programme: from early piloting using appreciative enquiry before COVID-19 by the mental health, public health, and Street Services team in the port city of Plymouth, to further developing an evaluation framework through an innovative, matched-funded academia–practice partnership. The findings showcase the benefits of a systems-based approach to public, multi-agency and academic collaboration, facilitated by peer and practitioner researchers and embedded researchers-in-residence. They highlight the need to consider nuances of specific (connecting with self, others, animals, nature) and non-specific active ingredients of the emerging and constantly adapting service (therapeutic relationship with practitioners/carers; nature as therapist, and group dynamics), as well as the value of pragmatic and participatory evaluation methods (distance-travelled, goal-based measures; and ethnographic, qualitative observation), to provide rapid, continuous, and real-time learning and improvement.

Publication Date

2025-05-01

Publication Title

International Journal of Environmental Research and Public Health

Volume

22

Issue

5

ISSN

1661-7827

Acceptance Date

2025-04-25

Deposit Date

2025-06-10

Funding

The service development project was funded by the Youth Investment Fund (https://www.plymouth.gov.uk/news/millions-be-invested-plymouths-young-people, accessed 20 April 2025). Peer researchers are employed by Improving Lives Plymouth and funded through the Changing Futures programme (https://www.gov.uk/government/collections/changing-futures, accessed on 20 April 2025), a joint initiative by the Department for Levelling Up, Housing and Communities (DLUHC) and The National Lottery Community Fund. This project is matched-funded by the National Institute for Health Research, Health Determinants Research Collaboration programme [NIHR151310]. The Plymouth Health Determinants Research Collaboration is part of the NIHR, hosted by Plymouth City Council in partnership with the University of Plymouth and with support from the NIHR Applied Research Collaboration for the South West Peninsula (PenARC). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results. Sophie Westwood is employed by the University of Plymouth and funded by the NIHR Health Determinants Research Collaboration. Grace Edmunds-Jones is employed by Plymouth City Council (a unitary local authority) and part-funded by the NIHR Health Determinants Research Collaboration for research, and the ecotherapy service is part-funded through the Youth Investment Fund. Thomas Maguire is employed by Livewell Southwest CIC Community Interest Company (Reg No 07584107) and is part-funded through the Youth Investment Fund for ecotherapy service delivery. Sue Hawley is employed by Improving Lives Plymouth, a registered Charity (No 1066776) and Private Limited Company by guarantee without share capital use of \u2018Limited\u2019 exemption (Reg No 2610208) and is funded through the Changing Futures programme. Hannah Avent was employed by Livewell Southwest CIC Community Interest Company (Reg No 07584107) during early pilot work and is an independent researcher. Jerry Griffiths, Rishi Bates, and Jane Marley are employed by Plymouth City Council. Gary Wallace and Ruth Harrell are employed by Plymouth City Council and funded by the NIHR Health Determinants Research Collaboration. Sheena Asthana is employed by the University of Plymouth and part-funded by the NIHR Health Determinants Research Collaboration. Felix Gradinger is employed by the University of Plymouth and part-funded by the NIHR Health Determinants Research Collaboration.

Keywords

child and adolescent mental health, ecotherapy, green/blue (social) prescribing, nature connectedness, nature—based approaches (NBAs), young people

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