Complex evidence

Despite their immediate and intuitive appeal, both greencare and PIEs have struggled in the past to provide a conveniently simple and clear evidence base for their effectiveness.

We might see this as 'absence of evidence' as 'evidence of absence' - that is, evidence of a lack of any real impact for such work. Or we might see this as being a new area, that has not yet received enough research attention - or simply not been a priority for research funding.

Or equally, and far more radically, we might say that these approaches - much like the therapeutic community approach before them - challenge the unsuitability of narrowly positivistic research traditions for such more holistic approaches to health.

Researching greencare

Nevertheless, there has been extensive and serious interest in greencare as a research field, and there is a growing evidence base to confirm the health benefits. Much of this research currently comes from Europe and North America. But there are now research groups, at, for example, the Universities of Nottingham, Essex and Exeter. For an outline of this research, see the Exeter University Green exercise. Meanwhile, in Japan, a government-backed research programme has begun to produce a very wider range on beneficial impacts of 'forest bathing' ( 'shin run yoku' ).

Some years ago, the UK Royal college of Physicians Richard Thompson, gave a talk to Thrive UK on the healthcare benefits of gardening, linked here. And Natural England have published a commissioned report - "A review of nature-based interventions for mental health care". This research seeks to explore the issues of complexity in research here, and sets out the steps required to enable a greater number of nature-based interventions to be commissioned in mental health care.

From this, it would seem that if more research were to be devoted to this area, and better perhaps constructed for the complexity of the subject matter, there is plenty of evidence to suggest effects yet to be uncovered.  There is also a useful conceptual mapping of researchable and researched interactions between the multiplicity, by Exeter's ECEHH. which indicates the complexity of interactions, that have tended to confound the findings of more simplistic research approaches.

Researching PIEs

Until recently, most studies of PIEs have been couched as evaluations of the effectiveness of particular services, or sometimes of a group of services, to demonstrate the approach as a whole. There has been very little formal research into the nature of PIEs, and the interactions in a PIE that may be most useful; and what studies there have been have been qualitative in methodology.