“We’re Here, We’ve Got Changed, We’re Going Out”: Wild Swimming Groups as Ecologies of Care

Spending time in or around bodies of water or ‘blue spaces’ can benefit human health and well-being. A growing body of evidence suggests immersion in blue space, e.g., participating in ‘wild’ swimming, can be particularly beneficial for both physical and mental health. To date, wild swimming and health research has primarily focused on the experience of individuals who swim in the sea. Empirical studies of the health-promoting potential of swimming in freshwater environments, such as lochs and lakes, are lacking, despite the popularity of this practice in many countries and the vastly different physical and hydrological properties of freshwater and coastal environments. The aim of this study was to explore the relationship between loch (lake) swimming and health and well-being for adults living in Scotland and determine the importance of perceptions of place and risk in this relationship. Semi-structured interviews were conducted with twelve wild swimmers who regularly swim in lochs in Scotland. Interview data were analysed thematically using Nvivo. The findings suggest loch swimming has a variety of health and well-being benefits that can be categorised over three domains of health: physical, mental and social. Of these domains, mental health benefits e.g., mindfulness promotion, resilience building and increasing one’s ability to listen to their body, were particularly prominent. Our findings also highlight important physical and hydrological characteristics of loch environments, e.g., calm water conditions (relative to the sea), which contribute to positive wild swimming experiences. Finally, the perceived risks of loch swimming and mitigation strategies for these risks are established. Collectively, our findings further support the notion that wild swimming is a unique health-promoting practice. Our findings also highlight differences (in terms of experience and perceived risk) between swimming in freshwater and coastal environments, which can inform public health and water management policy.

There is growing interest in blue space as a natural environment that may foster well‐being. Blue space encourages mindful, immersive, and connected ways of being in and interacting with place. A popular blue space activity that may promote well‐being is wild swimming (WS). Existing research suggests that swimmers find WS meaningful because it supports well‐being. However, the meanings attributed to WS by wild swimmers likely depend on the characteristics of place, such as water conditions and temperature, which may have a unique influence. The present study aimed to explore the meanings ascribed to WS by a Victorian cohort of wild swimmers. Participants comprised 47 wild swimmers (31 women, 15 men, 1 non‐binary person, mean age = 55.5 (11.7)). Participants answered demographic items and five open‐ended, qualitative questions about WS. Data were analysed using template thematic analysis. Five key themes were identified: ‘Always a swimmer’: Starting wild swimming; ‘You feel euphoric’: Psychological well‐being; ‘Still going strong’: Physical well‐being; ‘Chatting at the buoys’: Social connectedness; and ‘The sea is my home’: Connectedness to nature. Swimmers found WS meaningful because it promoted well‐being by (I) allowing continuity of a ‘swimmer’ identity; (II) promoting positive mood states and possibly facilitating swimmers to feel energised, calm, meditative, focused, authentic and masterful; (III) aiding physical fitness, healthy ageing and physical pleasure; (IV) enhancing social connectedness as swimmers formed friendships and communities; and (V) fostering nature connectedness as swimmers communed with and observed their sea surrounds. The findings indicate that Victorian wild swimmers, like their counterparts elsewhere, value WS because of the enriching ways in which it fosters well‐being. Among the first studies to explore WS in Victoria, Australia, this study contributes to a growing body of research which suggests that engaging in blue space promotes wellbeing. Policy implications. WS may have potential as a strategy for improving well‐being in the wider population. As an activity that cultivates social connectedness, it could form part of a social prescription for those identified as being at risk of loneliness. Additionally, WS may have potential as a complementary, nature‐based therapeutic intervention. Read the free Plain Language Summary for this article on the Journal blog.

Early mortality experienced by people living with mental health issues (hereon termed consumers) is largely preventable. Healthcare professionals perceive healthcare system inadequacies such as diagnostic overshadowing, stigma and fragmentation of physical and mental healthcare services can be resolved through effective integration approaches. Service- and individual-level integration approaches involve multidisciplinary teams collaborating and coordinating care to holistically meet consumers' physical and mental health needs. Evidence suggests appropriately trained healthcare professionals can deliver effective integrated treatment without financial or organisational restructuring. Specialist nursing positions such as Physical Health Nurse Consultants can support and integrate physical and mental health care. Consumers report the Physical Health Nurse Consultant as providing dedicated, integrated, coordinated and holistic mental and physical health care. This study aimed to explore the Physical Health Nurse Consultant role from the perspectives of healthcare professionals. A qualitative exploratory study design was used. Fourteen healthcare professionals participated in individual interviews or focus groups. Interview recordings were transcribed, and thematically analysed. Three themes were identified: (i) role functions, including integration of physical and mental health care, (ii) impact on consumer physical health outcomes and (iii) impact on service delivery. Healthcare professionals perceive the Physical Health Nurse Consultant effectively integrates physical and mental health care and subsequently support the continuation and embedding of the role in routine practice. Future research is required to explore healthcare professionals' experiences and perceptions of how these roles be translated to routine clinical practice. Examining the professional development requirements, service provider constraints and economic implication to achieve these outcomes also warrants attention.

Wild swimming is currently experiencing a surge in popularity as people avowedly attempt to reconnect with the natural world. Previous research has positioned wild swimming as a solitary pursuit whereby individuals retreat from society to connect with or overcome nature and better themselves. This article draws on an ethnographic examination of a wild swimming group in Australia and reveals that while being in nature and personal fulfillment are key motivations for these wild swimmers, it is the social interactions that facilitate a deep engagement with their local “bluespace.” We argue that rather than swimming away from the world, by “wayfaring” together these swimmers become connected to their environment, and each other, simultaneously. Such findings indicate potential social, health, and environmental benefits of collective wild swimming.

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The burden of non-communicable diseases (including poor mental health) is increasing, and some practitioners are turning to nature to provide the solution. Nature-based interventions (NBIs) could offer cost-effective solutions by reconnecting individuals with nature, but the success of these interventions depends partially on the way in which people engage with blue and green spaces. We conducted a scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and Cochrane guidelines to establish the evidence base for treating poor mental and physical health with NBIs. We searched five databases and the grey literature. Exposure was the active engagement with natural environments. The primary outcome was mental health and the secondary outcome was physical health defined using established metrics. All data were extracted to a charting table and reported as a narrative synthesis. 952 studies were identified, of which 39 met the inclusion criteria. 92% demonstrated consistent improvements across any health outcome where individuals engaged with natural outdoor environments. Mental health outcomes improved across 98% of studies while physical and cognitive health outcomes showed improvement across 83% and 75% of studies respectively. Additionally, we identified 153 factors affecting engagement with nature, 78% of which facilitated engagement compared with 22% that reduced engagement. Aspects such as the sense of wilderness, accessibility, opportunities for physical activity and the absence of noise/ air pollution all increased engagement. Further research (accompanied by a global improvement in study design) is needed to establish the magnitude and relative effect of nature-based interventions, and to quantify the compounding effect of factors that improve engagement with green and blue spaces. Nevertheless, this review has documented the increasing body of evidence in support of NBIs as effective tools to improve mental, physical, and cognitive health outcomes, and highlighted key factors that improve engagement with the natural world. Open Science Framework: https://doi.org/10.17605/OSF.IO/8J5Q3.

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Green spaces have been shown to have many benefits for physical and mental health. Recently, blue spaces have been introduced as another field of research and have been suggested to have similar health effects. This scoping review summarized the current state of the knowledge on how blue space exposure (views and visits) affects mental health (depression, anxiety, stress, and associated biomarkers). A keyword search was developed for PubMed, Web of Science, Embase, and PsycINFO. Identified articles were then imported into Rayyan and put through a title review, an abstract review, and finally a full-text review. Five articles were found to have direct relevance to the study. Two articles showed that blue space visits had benefits to general mental health and possibly depression. Two studies investigated blue space views, one showing benefits for general mental health and the other showing benefits for depression. One study showed that both blue space views and visits had positive impacts on mental health and that blue space visits had a stronger effect than merely viewing blue spaces. However, no articles discussed mental health-associated biomarkers. These studies all provide evidence that blue space exposure has a positive impact on mental health, but based on the small number of articles there is not enough evidence to conclude measurable changes in biomarker responses. Further areas of research include man-made/urban blue spaces, other mental health outcomes, virtual reality, and their effects on biomarkers. Highlights Views of and visits to blue space improve mental health. Visiting blue space has greater mental health benefits than blue space views. Blue space results in lower depression symptoms.

Service provision in psychiatric and social care is increasingly guided by recovery principles. However, little is known about the degree of consensus among stakeholders in diverse contexts on the components of care that most promote recovery. This study aimed to identify specific items of care that key stakeholders regard as most important in promoting recovery for people with longer-term mental health problems in institutional care, to measure consensus between and across stakeholder groups and countries, and to develop a conceptual framework of the most important domains of care. Ten European countries in various stages of deinstitutionalization participated in a series of conventional three-round iterative Delphi exercises. In each country individuals in four separate expert groups (service users, mental health professionals, caregivers, and advocates) identified components of care that they considered important to recovery and then rated their group's suggestions in terms of importance. Median and consensus ratings were measured. High-ranking items were grouped into domains. A total of 4,098 separate items of care were proposed by the 40 participating groups. Eleven broad domains of care important for recovery were identified: social policy and human rights, social inclusion, self-management and autonomy, therapeutic interventions, governance, staffing, staff attitudes, institutional environment, postdischarge care, caregivers, and physical health care. Consensus between groups and countries was generally high, but some modest differences in priorities were noted. The most consistently highly rated consensus domain was therapeutic interventions. Domains and components of care related to recovery principles were also viewed as important across stakeholder groups.

Back to table of contents Previous article Next article Professional NewsFull AccessWhen MH Care Is Isolated, Serious Sequelae ResultMark MoranMark MoranSearch for more papers by this authorPublished Online:3 Sep 2004https://doi.org/10.1176/pn.39.17.0390009Integrating physical and mental health services improves health outcomes and consumer satisfaction and promotes efficiency in health care financing.That's the message in a new report by the Bazelon Center for Mental Health Law titled “Get It Together: How to Integrate Physical and Mental Health Care for People With Serious Mental Disorders.”“The wall between physical and mental health care perpetuates a public health crisis,” said Chris Koyanagi, author of the report and policy director at the Bazelon Center for Mental Health Law, an advocacy group for people with mental disabilities based in Washington, D.C.“The lack of integration can leave chronic medical conditions undetected and lead to higher health care costs and needless suffering,” she emphasized.The Bazelon Center report lists barriers to integration of services and outlines four models for integration in programs around the country. These models include:The embedding of primary care providers within public mental health programs.Unified programs that offer mental health and physical health care through one administrative entity.Initiatives to improve collaboration between independent, office-based primary care and public mental health.Co-location of behavioral health providers in primary care offices.The first three are cited as models to integrate care for people with serious mental illness. The fourth, co-location, is best used for integration of services to consumers with mild to moderate mental illnesses; these people are seen mostly in primary care settings, according to the report.The report also spells out policy initiatives for service delivery, financing, monitoring, and quality assurance that public health and mental health systems can adopt to nurture integration of services through each of the models.Among the recommended initiatives areProviding start-up funds for establishment of embedded or unified programs to cover clinical and administrative needs. These monies could be provided by the public mental health authority or sought from foundations, businesses, government, and health care agencies.Stipulating the requirements that mental health agencies furnishing on-site primary care must meet—requirements related to delivery of care, development of a unified plan of care, information sharing, and case-management services.Ensuring that reimbursement rates reflect the cost of providing services and the time spent on care coordination for individuals with serious mental illnesses and co-occurring physical disorders.Placing the responsibility for providing primary care services to those with serious mental illness clearly on one entity.APA President-elect Steven Sharfstein, M.D., said the report underscores what psychiatrists have long known.“Mind and body are one,” he said. “Psychiatric physicians have always known that it is essential to bring mental disorders and other medical conditions together in primary care, the acute hospital, and across specialty settings.“The Bazelon Center report has it right,” Sharfstein said.“ An essential step in integrating mental disorders with all medical conditions is parity of insurance coverage. Another is bringing mental health specialists together with medical and surgical specialists. Integrating substance use disorders with all other mental disorders is another urgent priority. We have a long way to go.”An executive summary of “Get It Together” is posted online at<www.bazelon.org/integration>. The full report can be purchased online at<http://store.bazelon.org>.▪ ISSUES NewArchived

PurposeOpen water swimming (also known as outdoor or wild swimming) is a popular blue activity which has become of recent interest in the mental health sphere. Moreover, it is an accessible and low-cost activity, requiring little to no specialist equipment other than access to an appropriate blue space. Subsequently, it could be an effective and accessible intervention that supports mental health and wellbeing worldwide. This scoping review aims to summarise the open water swimming literature. Principal methods and resultsA comprehensive search, extraction and charting of relevant literature was undertaken, identifying 14 studies exploring the mental health and wellbeing benefits of open water swimming. The findings were synthesised and summarised for both quantitative and qualitative literature, addressing all scoping review aims, whilst also assessing the quality of the literature. Major conclusionsOpen water swimming may lead to improvements in mood and wellbeing, reductions in mental distress symptomatology, and was experienced as a positive, enriching process for many. Blue spaces involve embodiment, mindful presence, community and much more, offering for some a therapeutic accretion which sustains mental health and wellbeing across a lifetime. More robust evidence is needed before open water swimming may become a viable mental health resource.

PurposeThe purpose of this paper is to describe physical and mental health characteristics of incarcerated youth both internationally and in New South Wales (NSW) Australia. To outline current practices in the provision of mental and physical healthcare for incarcerated youth internationally and in NSW.Design/methodology/approachPopulation relevant literature will be outlined as applicable. Health service delivery will be discussed, with an emphasis on the experiences of NSW physical and mental health service provision for incarcerated youth.FindingsThis paper illustrates that in NSW there was a parity of provision between physical and mental healthcare, though there were deficits in what should ideally be provided. Internationally there was clear evidence that current minimum standards of healthcare in both physical and mental healthcare domains remain unmet.Practical implicationsProvision of physical and mental healthcare for incarcerated youth warrants global improvement. Further research into current provisions, across jurisdictions and subsequent standardisation of practice, will improve health outcomes for this vulnerable group.Originality/valueThis is the first paper to describe mental and physical healthcare provision in NSW for incarcerated youth framed within the broader context of international health service provision for similar populations.

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