Stepped Wedge Cluster Randomised Trial of Social Prescribing of Forest Therapy for Adults with Mental Illness

Brief name: Forest Therapy (AKA Shinrin-Yoku "Forest Bathing"). Materials: Questionnaires, Omron HEM-7600T electronic blood pressure monitors. Mode of delivery: Face-to-face. Number of times: 10 weekly 1.5hr sessions. Duration of each step: Duration of each step: A new group (‘cluster’) of participants (n=6-10) will commence every week at the first site (Gold Coast) until all participants (n=40) have completed the control and intervention (and follow-up) periods. After this data collection will commence at the second site (Sydney) where weekly clusters of participants will commence until all participants have completed the study. Further clarification is as follows: Data collection will be completed at site 1 (Gold Coast) and then commence at site 2 (Sydney). At individual sites clusters will commence weekly, and the order of commencement will be randomised. This group commencement comprises the ‘wedge’ of the study (i.e. each cluster of participants is a wedge), and weekly commencement comprises the ‘stepped’ aspect of this design. Once commenced the cluster will complete a 10-week control period, and 15-week intervention (and follow-up). Monitoring of adherence: The Forest Therapy Guide will complete a checklist of attendees at each session. Procedures: Each 1.5hr session will have the same structure: • pre-walk data collection, • introduction to Shinrin-Yoku/Forest Bathing, • sensory tuning activity – designed to ground participants using a combination of breathing exercises and gentle physical movement activities, • introduction to forest and local environment – overview of the physical space the walk will be conducted in, including important ecological, historical and cultural information, • creative and sensory activities – each walk has a combination of creative and sensory based activities. These are designed to facilitate mindful activity in the forest environment through creative and sensory means, and include activities like: o focusing on a specific nature point in the distance for a few minutes quietly, o collecting fallen objects such as leaves, rock, etc and creating a collective artwork, o creating a sound map of the area using paper/pens, o exploring textures in the natural environment by safely touching trees, grass, etc. • sit spot – this is an opportunity for participants to sit quietly and observe nature in a safe and calm environment, • tea ceremony – prior to winding up the walk, participants will be invited to share a cup of tea and their favourite part of the experience, • post-walk data collection. Intervention clinical staff: Maximum ratio of 3 participants: 1 clinician, including: Intervention Guide: Certified Forest Therapy Guide (International Nature and Forest Therapy Alliance-INFTA). Other staff: Allied Health Workers/Mental Health Nurses. Location: Baree Badalla Reserve, Gold Coast, and Kuringgai Wildflower Garden, Sydney.