Carl Dutton is a newly qualified Forest School leader, mental health nurse and psychodrama psychotherapist. Here he introduces the Forest School provision at Alder Hey Children’s Hospital in Liverpool and how they use the approach to support children with mental health needs.
Our Forest School is used for therapy for those young people who might need a different approach and where traditional talking only therapies might not work.
The Forest School has been developed in our local park attached to Alder Hey Children’s Hospital which serves the children of Liverpool but also the wider North West, North Wales, and the Isle of Man.
The park is a mixed use space which includes grassed areas, playground, adventure trails and a mixed wooded area which we use for our Forest School. It has a wide range of trees including rowan, sycamore, wild cherry, crab apple and Alder, which the hospital is named after. It has an open area where we have a parachute to cover/protect us from too much sun or rain.
The underlying philosophy for the Forest School is using a child centered approach with the emphasis on play, creativity, and problem solving as the model of therapy.
The sessions are run by my colleague Louise who is a dramatherapist and Forest School Leader and myself. We both have experience in delivering dramatherapy groups in clinic and school settings but believed that this could be done outdoors with nature as our therapy space.
Central to our model is to follow the child’s lead and be open to the numerous possibilities to be together in the park space. The model has the Forest School philosophy around exploration, play, and learning by doing and reflecting on what has been done together.
We also use the 5 Ways to Well Being approach as an overarching way of thinking about the sessions and encourage the young people to reflect on each session with those things in mind – Connect, Be Active, Take Notice, Learn and Give.
The 5 Ways to Well Being is a recognised public health model of maintaining mental health and well being and we find that young people are able to use its principles easily in discussion or to mark down in writing or drawing in the sessions.
The other measures we use to help gain valuable feedback on progress are the Connectedness to Nature Questionnaire by the RSPB and the Edinburgh Warwick Well Being check cards. They are an important part of the process in helping to see and show how young people have developed during the sessions.
Each session has a ritualistic aspect which helps with those young people who may suffer from anxiety or neurodevelopmental conditions such as ASD. It gives a sense of predictability and psychological containment also for those whose emotional regulation may be impacted by traumatic events or attachment issues.
We always start with a check in with each other, this can be verbal or non-verbal, to gauge how each young person is feeling/thinking but also how the group is as a whole. It might mean that we are aware that the group might need more time to work together with some drama/play based exercises to help with connectedness to self, others and the wider physical environment – maybe checking the space, how has it changed, parameters (boundaries), and previously created nature based art in the wooded area.
This is a very important aspect because it allows the young people time to arrive, be present physically and emotionally in the session, and allows them to reconnect with the space.
Ideas generated from previous sessions are offered to be done but this may also be ‘parked up’ if new thoughts/ideas are created and we then go with what the moment requires – a spontaneous approach which allows new ideas/possibilities to unfold and develop – this leads then to more creativity, which enhances a sense of locus of control but also self esteem.
“What we learn with pleasure, we never forget.” Alfred Mercier
During this time we often spend lots of time being playful in the space with different drama based activities which bring the group together. It might be that those drama games lead to the development of a drama based enacted story with woodland based activities included.
In one session we were struggling in a biblical downpour under our tarpaulin and the group decided they wanted to make different containers to collect the water off the tarpaulin. This developed into a group based story about boats on the sea, creatures from the deep, and songs about rain.
Each young person in the group developed the story some more with the whole group wanting to contribute by making containers from leaves/mud, boats to float on the collected water, and developing songs together about the rain.
Collectively we also learnt which leaves in the woods made good containers and also that some pieces of wood made as boats floated better than others.
As one young person said in a session:
“The adults in Forest School are very friendly and helpful and always make it lots of fun. I have learned so much in the outdoors and I have learned many skills that I can use in the future. I think Forest School can be for other children too as it will teach them that it’s fun in the outdoors and you can make fun things with fun ideas. You can give your creative ideas to anyone and they won’t doubt it.”
During these times our role as therapists is to facilitate ideas, be a mindful guide, and offer support/encouragement and feedback so that the young person can dream again with their thoughts and ideas.
Psychologically, as therapists we are finding ways for the young people to explore, test out, work on their own but as a group, reflect back what we notice about them in relation to the sessions, and share their frustrations but also delight in what they do.
“Finding the medium that excites your imagination, that you love to play with and work in, is an important step to freeing your creative energies.”
Sir Ken Robinson
Ending a session
Within the structure we give time to reflect on what we have done together, how it has made us think, feel, respond and notice within the session.
It helps develop the capacity to take time to notice ourselves, our relationships with others, and our environment.
One young person with ASD was able to notice a robin we had in each session who would visit us mostly at break time – free food was available and he spoke about how he had created bird feeders at home and what visitors he had. This led to him developing a number of bird feeders in our wooded area and seeing which one the robin and other birds were attracted to. We all enjoyed his ability to share his passion and also help create a number of bird feeders.
Some of our endings have included group stories to reflect what we have shared together or moments of silence and stillness just listening to nature together to help ground us all before we return to the hustle and bustle of life beyond the sessions and taking that feeling with us.
A final comment from a parent of one young person about the CAMHS Forest School:
‘He absolutely loved it and it did wonders for his confidence, social skills, and mental health.’
About the author
Carl Dutton is a mental health practitioner, psychotherapist and Forest School Leader. He works for Alder Hey Children’s NHS Foundation Trust for FRESH CAMHS working with young people. He has worked in the area of nature based therapies for 17 years and helped set up a Horticulture Therapy Program in schools across Liverpool. He has written and presented work extensively on using nature, horticulture and Forest School in Children’s Mental Health Services. He uses in particular art, drama, storytelling/making, and playfulness in the Forest School as well as outdoor activities.
Carl says: “A Forest School specifically to help support, maintain, and develop mental health and well being is something that can be set up and used within many settings including within a CAMHS service and all those services who engage young people in this area of work.”
Thank you to Muddy Faces for their permission to reproduce this article which first appeared in issue 4: Health & Wellbeing Focus of the free Outdoor Practitioner magazine.
To download the full magazine for free, or visit Muddy Faces’ Outdoor Hub, go to https://tinyurl.com/MFOutdoorHub