Intervention development of a nature-based programme for co-occurring mental health and substance use problems.

People experiencing co-occurring mental health and substance use problems can be disadvantaged due to lack of joined up services, and there is a clear need for more services that provide both mental health and substance use support in a holistic way. The development of interventions that are suitable for people with co-occurring  mental health and substance use problems is therefore a research priority. Evidence has shown that nature-based interventions, such as therapeutic gardening, conservation programmes, and wilderness programmes, could be used to support people with co-occurring mental health and substance use problems. However, questions remain as to what the key components are within such programmes which may lead to desired outcomes for this service user group, and how new programmes could best be designed and implemented. Without this knowledge, buy-in to this type of non-pharmacological approach and integration into existing mental health and substance use support remains difficult.  

Semi-structured interviews (n=35) were conducted with a range of stakeholders (service users, programme staff, wider health professionals, and local decision makers) to refine a theoretical framework for nature-based programmes for people with mental health and substance use problems which was proposed in previous research (Masterton et al, 2020; 2022). A second phase of semi-structured interviews (n=25) will be undertaken in Spring 2024 to test the acceptability and feasibility of a manualised version of the theoretical framework. This will provide guidance on moving intervention theory into practice.

Findings from phase one have improved theoretical understanding of nature-based programmes which support people with mental health and substance use problems and have provided a refined theoretical framework with lived experience perspectives at its centre. Refinements are related to the themes of: feelings of escape; having space to reflect; physical activity; self-efficacy; feelings of purpose; relationships; and shared experiences. However, findings also predicted challenges around buy-in, funding, and unequal access to programmes. In phase two, findings relating to the acceptability and feasibility of the manualised programme template will provide insight into best practice when looking to bridge the gap from theory to practical implementation within intervention development.

Current findings highlight how and why nature-based programmes appear to be effective, as well as perceived limitations of programmes. The phase two findings, which will also be presented at Lisbon Addictions 2024, will allow insight into how an intervention framework can successfully provide guidance during intervention implementation. The study provides support for holistic, non-pharmacological approaches for people with co-occurring  mental health and substance use problems, and moreover, may facilitate more effective development and implementation of such programmes.