Which of the following three areas do care farm clients on a
range of care farms find the most beneficial part of their
experience, the social aspect, working in a farm environment
or carrying out manual tasks with tangible outcomes?
by
Simon Robert King
being an Honours Research Project submitted in partial fulfilment of the
requirements for the BSc (Honours) Degree in
Agriculture with Environmental Management
2011
Contents
List of Figures ............................................................................................................................... 4
List of Tables ................................................................................................................................. 5
List of Appendices ........................................................................................................................ 6
Acknowledgements .......................................................................................................................... 7
Executive Summary ......................................................................................................................... 8
Chapter 1. Introduction .................................................................................................................... 9
Chapter 2. What is care farming? ................................................................................................ 11
2.1 Green care ............................................................................................................................ 11
Chapter 3. History of care farming ............................................................................................... 16
Chapter 4. What is the client base? ............................................................................................ 17
4.1 Mental health ........................................................................................................................ 17
4.2 Other groups......................................................................................................................... 17
Chapter 5. Conventional therapies .............................................................................................. 19
5.1 Drug based ........................................................................................................................... 19
5.2 Therapy sessions................................................................................................................. 19
5.3 Other treatments .................................................................................................................. 19
Chapter 6. Current status of care farming .................................................................................. 20
6.1 UK .......................................................................................................................................... 20
6.2 Europe ................................................................................................................................... 20
6.3 Future of care farming......................................................................................................... 20
6.4 Its importance for agriculture ............................................................................................. 20
Chapter 7. Indication of a research gap...................................................................................... 22
Chapter 8. Research Methodology Design ................................................................................ 23
8.1 Research question............................................................................................................... 23
8.2 Secondary research questions .......................................................................................... 23
8.3 Research approach ............................................................................................................. 23
8.4 Research strategy ............................................................................................................... 23
8.5 Interview design ................................................................................................................... 24
8.6 Interview techniques ........................................................................................................... 25
8.7 Limitations of the research ................................................................................................. 25
Chapter 9. Results ......................................................................................................................... 26
Chapter 10. Discussion ................................................................................................................. 30
10.1 Question 1 – What is your favourite activity? ................................................................ 30
10.2 Question 2 – Do you prefer working with animals or other tasks? ............................ 30
10.3 Question 3 – What sort of things have you learnt since being here? ........................ 31
10.4 Question 4 – What new skills have you learnt and where would you use them?.... 32
10.5 Question 5 – Do you work as a team on the farm, and what do you do as a
team? ........................................................................................................................................... 32
10.6 Question 6 – Does having friends at the care farm make it a better experience? .. 33
2
10.7 Question 7 – Do you enjoy working in the countryside? ............................................. 33
10.8 Question 8 - Have you ever done anything like this before? ...................................... 33
10.9 Question 9 – In your own words what is the best aspect about coming to the
care farm? ................................................................................................................................... 34
10.10 Question 10 - Has coming to the care farm helped you in any way? ...................... 35
Chapter 11. Conclusion and recommendations ........................................................................ 36
11.1 Further research possibilities ........................................................................................... 36
Chapter 12. References ................................................................................................................ 37
3
List of Figures
Figure 1 - Figure showing the umbrella nature of the term Green Care. Source - Green
Exercise (Undated) ............................................................................................................. 11
Figure 2 - Social benefits to care farm clients of attending a care farm ............................... 15
Figure 3 - Diversity in Care Farms - Source: Hine et al, 2008 ............................................. 17
Figure 4 - Characteristics of care farm with differing focus. Source: Hine et al, 2008 .......... 18
4
List of Tables
Table 1 - Table showing the clients favourite activity ................................................................... 26
Table 2 - Table showing if clients prefer working with animals or not ........................................ 26
Table 3 - Table showing what areas clients have learnt skills in since being at the farm ....... 26
Table 4 - Table showing what new skills clients have learnt ....................................................... 27
Table 5 - Table showing where clients would use their skills ...................................................... 27
Table 6 - Table showing if clients work as a team ........................................................................ 27
Table 7 - Table showing what clients do as a team ...................................................................... 27
Table 8 - Table showing whether clients enjoy working as a team ............................................ 28
Table 9 - Table showing if clients have met new friends at the care farm and if they keep
in touch ................................................................................................................................................ 28
Table 10 - Table showing if clients feel having friends at the care farm makes it a better
experience ........................................................................................................................................... 28
Table 11 - Table showing if clients enjoy working in the countryside ........................................ 28
Table 12 - Table showing if clients have done anything like CF before (in terms of working
outside or with animals for example) ............................................................................................... 29
Table 13 - Table showing client’s favourite aspect of being at the care farm ........................... 29
Table 14 - Table showing how attending the care farm has helped the clients........................ 29
5
List of Appendices
Appendix 1 - Information on the modes of action of anti-depressants……..……. 45
Appendix 2 - Copy of an interview sheet used during the research ……….……..47
Appendix 3 - Tables of interview results …..…………………………………...……49
6
Acknowledgements
I would like to take this opportunity to express my sincere gratitude to all those
who have helped me with this dissertation, particularly my tutor Alison Monk for
guiding me through the process. Also Gaynor Orton and Doeke Dobma for their
support with contacting care farmers and promoting my work. And to all the care
farms that I visited during the course of my study, thank you for the warm
welcomes and help I received before, during and after my visits.
Finally thank you to the proof readers who corrected the mistakes throughout my
work.
7
Executive Summary
Green care and more specifically care farming (CF) is becoming a more
mainstream method of aiding vulnerable sections of society. It can be used to
target a wide range of social groups, from those with mental health issues to
disaffected young people and also those suffering from drug or alcohol addictions.
A wide range of client groups means that the care farms are varied both in terms
of client types and also in what services they offer, indeed these tasks change with
the seasons. There is a substantial amount written in the literature on the benefits
of working outdoors, working in a social environment and using tasks with tangible
outcomes to provide mental or physical health benefits as well as education and
social inclusion. However there is little research on what the clients find the most
beneficial aspect of the experience.
Clients most enjoyed the social interaction, forming new friendships and working
as a team. Being valued as part of a team was considered an important part of CF.
However many of those interviewed enjoyed the whole experience, and it was
recognised that this is what made attending the care farm useful.
The main findings indicated that the experience helped each client in an individual
manner. This suggests that CF needs to reflect this, having a range of activities so
that clients can choose what suits them best. However there were activities that
the majority of people enjoyed to a certain extent, such as looking after the
animals or just generally being outdoors.
8
Chapter 1. Introduction
Care farming (CF) is defined by Hine et al. (2008) as a growing movement to
provide health (both mental and physical), social or educational benefits through
farming for a wide range of people. In general, care farms are targeted at
disadvantaged people, whether this is mentally or physically (Di Iacovo and
O’Connor, 2009). The growth of CF is due to multifunction agriculture becoming a
cornerstone of the European Agricultural Policy, offering not just food, but
preserving the character of the countryside and giving wider social benefits
(Renting et al. 2008). CF is not just about care in the traditional sense but also
teaching people how to maintain and promote both health and social rehabilitation
(Haubenhofer et al, 2010). This corresponds with Di Iacovo and O’Connor (2009)
who comment that the most important outputs of a care farm are health,
education, therapy and potentially, employment. CF is a partnership between
agriculture and the care sector (Hine et al 2008) (Dessein, 2008). Care farms are
often less intensive than commercial production units, instead operators provide
services that society needs, by increasing links between urban and rural areas
(Hassink 2002). However farmers still have to generate an income and CF is a
form of diversification, which allows a farm to stay in business (Hine et al, 2008).
The importance of green spaces for good mental health has long been theorised,
however it has recently come to the fore again, the idea of humans having an
attachment to nature was proposed by E. Wilson in 1984, with a theory called
biophilia. This connection between humans and nature, a product of evolution in a
‘bio-centric world’, is ‘innate’ or hereditary (Kellert, 1993). Grahn and Stigsdotter
(2003) report how the discovery of the importance of green spaces, is more of a
‘rediscovery’, reporting on their usefulness in helping with stress, obesity,
cardiovascular disease and diabetes, by increasing people’s outdoor activity.
There is increasing evidence to support the theory that the presence of natural
areas contributes to quality of life, indicating the social and psychological benefits
that enrich societies are of primary importance (Chiesura, 2002). Lewis and Booth
(1994) proposed that there is a link between high levels of psychiatric morbidity
and urban living; corresponding with the link between poor physical health and
susceptibility for mental health problems (Halliwell et al, 2007). CF tries to fulfil
both of the above requirements by providing physical tasks in a natural
environment. It is the usefulness of the tasks carried out that gives the selfconfidence and self-respect that makes CF successful (Nilsson et al, 2007).
Nilsson et al. (2007) also report that the CF experience gives important positive
social contact with the farmer and other clients, developing social skills.
Whitelaw et al (2008) state that mental health and well-being are made from three
parts, social, emotional and psychological. Good mental health is the balance of all
three, or ‘peace of mind’ (Douglas, 2007). Even though there is much literature on
the benefits of physical activity for health and the importance of green spaces, the
implications of these for mental health have not been well explored, due to the
diverse and multifaceted nature of this area and its potential complexity in a trial
situation (Whitelaw et al, 2008). Additionally a lack of clarity in definitions of mental
health and environments, these are personal concepts, and mean different things
to different people Douglas (2005).
However CF is not just for those with mental health issues, West Mercia
Constabulary are investigating the use of CF to rehabilitate convicted people. By
using the care farms to engage, teach skills and improve the quality of life of the
offenders the force hopes to cut re-offending and provide after prison care much
more cheaply (West Mercia Constabulary, 2008). Care farms are often used as
9
centres for education, particularly for children. Teaching them how the countryside
operates and where food comes from is an area that will increase in importance,
multifunction agriculture will move the countryside closer to urban areas and it is
vital that people understand how and why agriculture produces food.
CF comes under the wider umbrella of green care. Green care is the use of nature
to provide health, social or educational benefits (Sempik et al, 2010). Green care
does not have to take place solely in green environments, animal assisted
intervention (AAT) for example is not limited in this respect, and the animal can be
taken to any situation within reason to gain the valuable effect, (Haubenhofer et al,
2010).
10
Chapter 2. What is care farming?
2.1 Green care
There are many types of green care; the main areas will be covered in depth
below, along with the evidence base for CF. Figure 1 below shows how it is the
umbrella term for many different therapies. CF is one part of green care,
encompassing many of the areas below.
Figure 1 - Figure showing the umbrella nature of the term Green Care. Source - Green Exercise (Undated)
11
2.1.1 Social Therapeutic Horticulture
Social therapeutic horticulture (STH) has developed from rehabilitation and
occupational therapy with extensive use in vulnerable groups throughout the US
and UK (Sempik and Aldridge, Not Dated). Nilsson et al (2007) comments how
recent studies have shown nature can lower stress levels, restore powers of
concentration, and alleviate irritability. There is a difference between horticultural
therapy and therapeutic horticulture, typically horticultural therapy has clinical
goals, whereas therapeutic horticulture gives for generalised benefits (Sempik and
Aldridge, 2006). By creating a green space, clients can form a sense of belonging
and identity, whilst integrating and interacting with the local community (Sempik et
al, 2005). Starting and finishing a task with a tangible output gives increased selfefficacy and coping ability (Sempik et al, 2010). STH is a well proven therapy with
the health benefits of participants well documented (Hine et al, 2008).
2.1.2 Animal Assisted Therapy
There has been much research into the use of animals as therapy for people with
mental illness. They provide an ‘uncritical ear’ and ‘attentive eye’ stimulating a
response in patients who would otherwise not respond to people (Beck and
Katcher, 1996). This is because clients, typically those suffering from depression,
have been hurt by words in the past, animals do not use words, and the client can
befriend the animal when they cannot befriend humans (Beck and Katcher, 1996).
Animals also have no hidden agenda and provide the challenge that some clients
need to tempt them from being withdrawn (Hassink, 2002). Beck and Katcher
(1996) agree stating how animals draw attention outwards, leading to relaxation.
Social support from pets maybe a replacement for lacking human support
(McNicholas and Collis 2006). In terms of wider benefits, research by Serpel
(1991) suggests that owning a pet may improve physical health as well as mental,
although this can be more longer term. Animals do not having the linguistic
capacity to hurt the clients, they do not pre-judge or talk down to them, this links
with how the farmer should treat the clients, the farmer uses enthusiasm and
knowledge to interest the clients and in return is often seen as a figure-head
(Hassink 2002). However, Berget et al (2007), suggest that only some persons
with mental disorders would find occupational therapy with animals beneficial. AAT
is also used as a therapeutic aid for children; it was found that children interacted
with the animals in much the same way as they would with a therapist (Mallon,
1994). The success of AAT can be explained as being due to three distinct
reasons; learning new tasks through the intervention led to more self-confidence,
the intervention was a catalyst, improving the response of the conventional
psychiatric treatment, and finally that the patient experienced a pleasurable social
interaction that reduced fear of new situations, apparent in follow-up work (Berget
et al, 2008). This study however only had a short period before the follow-up work,
and therefore other effects may have been seen after this time. Another study into
the effects of contact with a pet, found that conversational and social skills
improved over a 12 month period (Barak et al, 2001). Sempik et al, (2010) also
suggest that contacts with animals are a catalyst to social exchanges, as they give
common ground or a subject of discussion.
However when using animals as part of therapy it is important to consider the
welfare of the animal as it may not adjust to having a large amount of human
12
attention, therefore animals with the correct temperament and behaviour must be
selected and these animals should have intense human contact during their early
life and into adult hood (Hassink, 2002). The farmer should have a positive attitude
towards the animal; this gives less negative interactions and higher production
(Hemsworth et al, 1993). However bringing patients into contact with animals does
increase risks particularly in terms of zoonotic diseases and animal bites (Beck
and Katcher, 2003). An example of AAT is the Greatwood charity, which takes in
retired or rescued racehorses, retrains them, with the aim of rehoming them.
However the charity also provides an opportunity for children with special needs to
interact with the horses, learning life skills and emotional literacy in the process
(Greatwood, not dated).
2.1.3 Ecotherapy
Mind (2007) describes ecotherapy as a free, natural, accessible treatment for
improving mental health. Ecotherapy is the exploration of relationships between
oneself, nature and others; this may be carried out by meditation, directional
walking or spending time alone in a natural setting. This puts the participants in a
mutual healing connection with nature (Jordan, 2009). Ecotherapy.org (undated), a
company that carries out ecotherapy, describes potential activities; directional
walking, for example walking south to remember childhood experiences, can help
to relive and share situations that have caused stress in the past. Evidence
indicates that the better quality one’s relationship with nature, the better one’s
mental health will be (Burns, 2007). Intervening with nature can be part of
ecotherapy; for example the Offenders and Nature schemes in which offenders
voluntarily take part in outdoor work experience (Forest Research Group 2007).
These are hard physical tasks undertaken in small teams, and the results can be
seen and appreciated by both the offenders and the public (Forest Research
Group, 2007), this scheme allows the offenders to develop skills and qualifications,
reducing the dependency on crime when released. The client’s health is improved,
they are more socially included, and the environment benefits (Haubenhofer et al,
2010).
2.1.4 Facilitated Green Exercise and wilderness or nature
therapy
The association between physical inactivity and poor mental health has increasing
evidence, as does the relationship between poor mental health and limited access
to nature (Whitelaw et al, 2008) (Pretty et al 2005). Therefore therapies that
address poor mental health would be expected to include physical activity and
exposure to nature. Hine et al (2011) comments that social contact and interaction
with the environment are the attractions to outdoor exercise, and better physical
health leads to a more positive mental health state. With nature and wilderness
therapy the aim is to incorporate a third party into the therapy situation creating a
client, therapist and nature relationship (Berger, 2009). The focus on nature and
the client’s relationship with their peers provides the therapeutic environment,
however the client has to be removed from distractions and their previous
destructive environment (Russell et al, 1999). Nature is unpredictable and
uncontrollable, taking part in nature therapy allows clients to develop the ability to
cope with unexpected situations and show flexibility (Berger, 2006). Clients have
13
to engage with an unknown environment, with unfamiliar people, learning basic
skills and undertaking tasks, encouraging responsibility and emotional
development (Russell et al, 1999). Wilderness therapy is generally considered to
be a specific intervention, removing clients from their previous destructive
environment rather than being just about experiencing the wilderness
(Haubenhofer et al, 2010).
2.1.5 Biophilia
Humans have a hereditary, emotional connection with the natural world; this is
commonly called Biophilia (Kellert, 1993). Nature is a fundamental part of physical
and biological reality that affects all humans but particularly children (Kahn, 1997).
The brain evolved in a bio centric world (Kellert, 1993), the more humans could
understand and know about their environment, the more likely they were to
survive, evolutionary theory therefore supports the Biophilia theory (Kaplan, 1992).
The Attention Restoration Theory (ART) links with Biophilia in that nature is
recognised to relax and calm people. By becoming relaxed and accepted health
and well-being are increased (Aldridge and Sempik, 2002). In addition there is the
Psycho-evolutionary stress reduction theory (PET) which attributes the restoration
of one’s mental state, due to a reduction in stress (Hine et al, 2011). Experiencing
fascination of natural environments can increase the capacity for focusing
attention, reducing stress (Nilsson et al, 2007). People with easy access to natural
settings have better health than individuals who do not (Kaplan and Kaplan, 1989).
Working in a natural setting allows a sustaining and therapeutic relationship to
form with nature (Jordan, 2009), this could be a passive or active role (Aldridge
and Sempik, 2002).
2.1.6 Green spaces and Exercise
In the 2005 report, ‘Securing the Future: UK Sustainable Development Strategy’
published by the UK government (DEFRA, 2005) the ideas of social justice and
environmental equality were linked in recognition of research that shows a strong
relation between socio-economic deprivation and poor environmental quality,
including limited access to natural areas (Forest Research Group 2007). DEFRA
(2005) suggests it would be appropriate to extend existing ‘well-being indicators’ to
cover mental health and green space. The two key precursors of stress are
sensory deprivation and information overload, green spaces are quiet, often with
many shapes and colours, unlike a regulated urban space, helping to alleviate
stress and stimulate the senses (Douglas, 2005). Despite a limited evidence base
for the application of green exercise in the treatment of mental health issues, the
British Trust of Conservation Volunteers (BTCV) operate ‘Green Gyms’ that carry
out nature conservation, reporting health benefits and increased social interaction
in participants (Peacock et al, 2007).There is growing evidence that such
exposure to nature is an antidote to the potential health problems of modern
lifestyles, particularly with the link between poor mental health and inactivity
(Whitelaw et al, 2008). A link has been shown between physically debilitating
illness and mental health problems (Bird, 2007). By using green exercise
improvements in self-esteem, moods and significant reductions in blood pressure
have been shown (Pretty et al, 2005). Large scale applications, such as the
creation of woodland in the grounds of Ninewells hospital in Dundee, are based on
14
evidence that views of and access to green spaces improves mental health and
recovery from disease (Fyall, 2010). Even though the environment is a major
consideration with modern urban designs, there is little provision for green spaces
in these areas (Burns, 2007), by increasing the green space in urban areas,
accessibility would increase, particularly for deprived areas (DEFRA, 2005).
However good mental health is not guaranteed by access to green spaces, the
Oxhey Estate, near Watford, had a higher than average rate of mental illness
despite good access to green spaces (Douglas, 2005). Similarly schoolchildren
can be conditioned by living in an urban environment, preferring this to rural areas
(Douglas, 2005).
2.1.7 Social interaction
Although not a therapy in itself, social interaction may be important as a concept
within green care for describing and exploring its benefits (Sempik et al, 2010).
People with mental illness can become excluded from society; CF seeks to
reverse this by carrying out activity which allows participants to socially interact.
Humans require social contact and a place in society, and therefore if removed
from either, their mental health suffers (Fisher, 2009). Working as a part of a farm,
allows the development of social skills (Hassink and van Dijk, 2006). The Health
Council of the Netherlands, (2004) indicates that it is the contact with nature that
aids social contact, however it has been proposed that any sheltered employment
could provide these benefits, not necessarily those in a natural setting (Sempik et
al, 2010). However client interviews suggest that working in nature was a very
important part of the experience (Sempik et al, 2005).
Figure 1 below shows the type of social benefits care farm clients get from
attending the care farm. The most important benefits are creation of
independence, a work habit, development of social skills and personal
responsibility (Hine et al, 2008).
Figure 2 - Social benefits to care farm clients of attending a care farm
Care farms in the UK offer many different services including the development of
basic skills (87% of farms), of work skills (70%), of social skills (65%) and some
form of accredited training or education (63%) (Hine et al 2008).
15
Chapter 3. History of care farming
Benjamin Rush (1812) is one of the first physicians to suggest both labour and
nature as key components to helping those with mental illness. However caution is
advised when dealing with Rush, as he used blood-letting as part of his treatments
(Sempik et al, 2003). Nature based approaches for promoting health and wellbeing
are not new, they were used extensively in the Middle Ages, with sanatoriums
often having gardens or small farms attached to allow patients to indulge in
physical work (Bird, 2007). Indeed the benefits of a peaceful garden environment
were known during the time of Christ (Simpson et al, 1998). Victorian asylums
often had an attached farm, or extensive gardens that produced food for the
inhabitants and a surplus to sell, farming or gardening was used to stimulate the
patients (Sempik and Aldridge, 2006). By 1944 the use of gardening was recorded
as being useful in the process of rehabilitation, particularly in the case of injured
people (Colson, 1944). Sempik et al (2003) identifies the benefits of such activities
as providing a regular and structured set of movements. It developed further
during the 1950’s and 1960’s into rehabilitation and occupational therapy; however
by the 1970’s most hospital farms were closed.
16
Chapter 4. What is the client base?
4.1 Mental health
The main client group for CF are people suffering from mental health issues. Such
issues could be depression, older people with dementia, anxiety sufferers or even
clients with schizophrenia. Sufferers of any of the above conditions are commonly
prescribed drugs to reduce the severity of the symptoms. Such drugs include
Prozac, an anti-depressant, however when treatment is stopped this can cause a
relapse (Depression, 2010).
The benefits of being in natural surroundings for mental and psychological health
are becoming widely acknowledged (Douglas, 2007).
4.2 Other groups
A study by Hine et al (2008) showed the likelihood of developing dementia was
reduced in those people who took part in gardening or other physical tasks. The
Magdalen Project carries out CF for a range of clients including those with
Alzheimer’s, they have found that contact with the animals, is of great value to the
clients (Tresidder, Undated).
Figure 1 below shows the diversity in care farm types and the client groups that
they focus on. Often care farms have a mix of different client types (Hine et al,
2008).
Figure 3 - Diversity in Care Farms - Source: Hine et al, 2008
Figure 3 and Figure 4 show how care farms can be either be geared more towards
farming production or towards care. This focus changes depending on the care
farm and each situation. Some care farms are established with the sole intention
17
being to provide care; these tend to be smaller farms with less livestock or crops
than would be traditional to allow more time to be spent on care. Farms that are
geared towards agricultural production operate CF as a diversification, rather than
the main enterprise.
Figure 4 - Characteristics of care farm with differing focus. Source: Hine et al, 2008
Care farms do not confine their client base to just those with disabilities or mental
health issues. Many care farms work with disaffected or excluded young people.
By having a meaningful and tangible result from farming the land or caring for
animals, greater relevance is shown, compared with traditional education
techniques. With learning skills in a practical environment a work ethic can be
preceding a move to education or employment (Brown, Undated).
Clients that require rehabilitation from drug or alcohol dependence is a growth
area for CF. This group often needs healthcare in addition to social rehabilitation
and employment (Hine et al, 2008).
18
Chapter 5. Conventional therapies
5.1 Drug based
Medications are used to treat the symptoms in severe cases of mental health
disorders; however they have different effects and effectiveness with different
people (National Institute of Mental Health, 2010). Medications have the aim of
allowing the patient to lead as normal as possible life whilst living with a mental
disorder, side effects are common and can lead to the medication being
withdrawn. Antidepressant drugs can be divided into four main categories;
Monoamine oxidase inhibitors (MAOIs), Tricyclic antidepressants (TCAs),
Selective serotonin reuptake inhibitors (SSRIs), and Serotonin-norepinephrine
reuptake inhibitors (SNRIs), see Appendix 1 as to the modes of action of each
antidepressant type. Other treatments can be used; a more natural alternative to
anti-depressants for example is St John’s Wort, an herbal remedy which can be
used to alleviate mild or moderate depression (NHS, undated).
5.2 Therapy sessions
Therapy sessions allow clients to talk about their problems with a professional.
This helps them to share issues and get assistance, whether this is medical or
psychological. This approach has been shown to be as effective as antidepressant
treatment (Chilvers et al, 2000), and develops an ability to share future problems
before they become a major issue. Therapy sessions are known as cognitive
behavioural therapy (CBT) which is defined by The Royal College of Psychiatrists
(2011) as how you think about yourself, the world and others, and how what you
do affects how you feel and think. Interpersonal therapy (IPT) analyses
relationships between the service user and other people. Typically this revolves
around bereavement or problems with communication, this can be effective,
however it has not been properly explored as a technique yet (NHS, undated).
5.3 Other treatments
Electroconvulsive therapy (ECT) is the use of electrical shocks to counter severe
depression; this is often a last resort process (NHS undated).
19
Chapter 6. Current status of care farming
6.1 UK
As outlined above the UK has utilised nature for therapy since medieval times. The
prominent feature of care today is the integration into the community through
learning skills and an application of these in community project (Wilcox, 2007).
The UK has 80 recognised care farms currently operating (Haubenhofer et al,
2010).
6.2 Europe
Research on CF in Europe comes under the Cooperation in the field of Scientific
and Technical Research (COST) Action 866 in Green Care and Agriculture
(Wilcox, 2007). COST 866 aims to increase the knowledge of best practices in
green care in agriculture (Hine et al, 2008). The Netherlands is generally
considered to be the most advanced nation in terms of care farm numbers with
over 1000 (Haubenhofer et al, 2010). However Holland with its support centre and
its wealth of formal research is generally taken to be the model of good practice for
other nations (Wilcox, 2007). By diversifying into health and social care, small
farmers can be more economically viable, whilst being able to maintain their core
business and protecting the landscape character of small farms (Wilcox, 2007).
6.3 Future of care farming
CF is set to increase rapidly. Coinciding with the growth in multifunction
agriculture, supporting less intensive, smaller farmers, CF will provide for many of
society’s requirements. If the growth of care farms in the UK mirrors that of the
Netherlands it is possible that over 3000 will have been established in 10 years’
time (Howarth, 2010).
Giving individuals greater choice in terms of services used is the aim behind the
move towards individual budgets and direct payments, the Department of Health
(2005) suggests that this gives the greatest patient choice. Service users of
community care will be assessed by local councils as to what needs they have and
given cash payments which will allow them to purchase services according to
these needs and their preferences (NCFI, 2010). The individual arranges services
and equipment within the budget set (Lavender, 2008). Individual budgets refer to
a wider set of funding streams such as Disabled Facilities Grants or Independent
Living Funds for example, these are uncommon at this time. This move will benefit
CF in that it could be a more mainstream method of giving care, however clear
evidence of its benefits as opposed to other methods would be needed to
persuade people to attend.
6.4 Its importance for agriculture
Western European Agriculture is closely guided by policy, previously this has been
geared to low cost, commodity production. However recent Common Agricultural
Policy (CAP) reforms aim to give agriculture a more multifunctional role, and
20
reduce the income importance of commodity production (RDPE Network, 2010).
British agriculture in particular has suffered from numerous crises such as BSE,
Foot and Mouth and exceptionally low prices (Hine et al, 2008). The rationalisation
of the industry in response to these crises has created large specialised units with
low staffing levels; some 51% of farms have also diversified into non-agricultural
activities (DEFRA, 2010). Through this process the majority of the population have
become ‘disconnected’ from agriculture
The term multifunctional agriculture refers to agriculture’s wider impact on the
environment and society beyond producing food, and how this can be used to
enhance the environment and the sustainability of rural communities (Renting et
al, 2008).
CF is an excellent example of multifunction agriculture. It makes smaller farms
more viable, gives an environment for therapy and training and produces food
(Brown, Undated). By attending a care farm, therapy is not the only outcome,
clients are rehabilitated, learning new skills leading to, potentially, full time
employment (Hine et al, 2008). Wilcox (2007) gives another benefit in that the care
and attention the farm and the land receives is more than on a conventional farm.
The labour intensive nature of a care farm means that more people would have to
be employed, increasing the viability of rural communities (Brown, Undated).
By expanding into a different sector that is completely disconnected from
agriculture, but another necessity industry, a more reliable income stream can be
maintained free from market vagaries.
6.4.1 Limited workforce, rural mental health issues
For many people, not just clients of care farms, the countryside is considered a
haven which can be retreated to in times of stress (Lobley, 2005). With growing
evidence of mental health benefits and the need for multifunction agriculture this
trend looks set to continue. However this ‘rural idyll’ is refuted, with the
countryside, and farming in particular, accounting for more isolation, stress and
ultimately suicide than urban living (Lobley et al 2004). A decrease in farm
workers, increase in farm size and removal of many rural services leading to
isolation, compounding the isolation farmers face on a daily basis (Monk,
Undated). This isolation allows mental health issues to go untreated increasing
potential future problems (Hunter, undated). By internalising problems, without any
ability to share or discuss them, they become embedded and can lead to suicide
(Howarth, 2010). The issues with providing physical and mental health services to
rural areas are long-standing and well documented (Herzig and Murray, 1997). A
large, difficult to access, sparsely populated area coupled with efficiency savings
means most services are based in urban areas (Mind, 2010). Therefore rural
people have less access to services, this problem is particularly acute with mental
health issues, being more specialised (Mind, 2010). Since the Second World War
rural deprivation has been ignored, with preference for urban centres (British
Medical Association, 2005).
21
Chapter 7. Indication of a research gap
The process of reconnecting people with a natural environment with social
interaction has been used and studied for a long time. However little evidence
exists as to what the clients prefer during the care farm experience in terms of
carrying out manual work, being in a natural environment or being part of a social
group.
22
Chapter 8. Research Methodology Design
A research gap has been highlighted in terms of what clients most prefer in terms
of their CF experience. This project aims to ascertain whether it is the social
aspect of working as a team, the simple manual tasks, or the farm environment, or
that there is another part of the experience that is the most rewarding and
beneficial part of working on the care farm.
8.1 Research question
The research question is therefore
“Which of the following three areas do care farm clients on a range of care
farms find the most beneficial part of their experience, the social aspect, working in
a farm environment or carrying out manual tasks with tangible outcomes?”
8.2 Secondary research questions
As well as asking which of these three areas clients find most beneficial, the
following questions will be asked
1. Have you met new friends at the care farm and do you keep in contact
outside the care farm?
2. In terms of the skills you have learnt, where would you hope to use them?
3. In your own words, what part of coming to the care farm (Insert name of
care farm) do you most enjoy?
4. Has coming to the farm helped you in any way?
These questions will help to understand what the clients enjoyed about their
experience and why.
8.3 Research approach
The aim of the study is to find out the benefits for participants of CF. Participation
will be voluntary; however only care farms with clients over the age of 18 will be
asked for volunteers. The clients will have the aims and methods of the study fully
explained before it begins. Part of the process will be to emphasise no information
will be collected that will allow the participants to be identified and also that they
can leave if they find the interview uncomfortable.
8.4 Research strategy
Primary data collection of qualitative data is the best type to use in this situation.
Qualitative data allows more in-depth information to be collected, and is more
flexible in terms of changing question wording to fully explain meaning (Family
Health International, undated). Semi-structured interviews are the most
appropriate way of gathering the information as it will allow the participant to
express in-depth feelings and opinions about their CF experience (University of
Surrey, Undated). In addition any clarification of points raised can be dealt with
straight away and interviewees can expand beyond questionnaire style answers
on their opinions (Abu-Hussin, 2010). Informal interviews are essential for
23
developing an understanding of situations and people’s feelings about them
(Robert Wood Johnson Foundation, 2008). Interviewing in a low-pressure situation
can encourage participants to give more in depth responses (Robert Wood
Johnson Foundation, 2008). Carrying out interviews on the care farm, sat
informally means the participant will be under less pressure than if the interview
was carried out somewhere else. It is important to make participants feel
comfortable and to strike up a rapport (Connelly, 2003).
8.5 Interview design
A range of care farms will be approached to potentially interview their clients. This
will give a range of different client and farm types to get a representative sample of
care farms in the United Kingdom.
Each care farm would be approached through email to ascertain the possibility of
interviewing some of the clients. It would be made clear to the care farm that only
clients over the age of 18 would be suitable for interview. Once at the care farm
the participants will be asked to voluntarily take part in the research after fully
understanding the aims and purpose of the research. This is important as
participants may feel that due to the semi-structured nature of the interview
questions may come up that they are not comfortable with (Connelly, 2003).
Some participants may have mental health issues, however if they find the
interview uncomfortable they can leave at any time. No information will be
collected that might enable them to be identified.
Before the interview commences the interviewer will view the farm and the tasks
that the clients undertake, taking almost an ethnographical approach. This would
help with question prompting and show the participants that the interviewer has a
genuine interest in them and the farm.
Participant in the research is voluntary; good communication is needed so clients
understand the studies aims and how little time it will take, increasing participation.
Talking to the clients as a group would be preferred, when explaining this; they
can then individually decide whether to partake.
Some of the concepts that are explored in interviews require complex language
and words to convey them. However this can lead to a lack of understanding about
the question and therefore affect the answer given. When constructing the
interview questions it is important to closely think about who is going to be
answering them. All interview participants need questions to be easily understood
so they can give clear answers, so using clear language without fashionable
jargon which is polite is important (Keats, 2001). Similarly it is important not to
change the meaning of a question when formulating probing questions as follow
ups to standard interview questions (Fowler and Mangione, 1990), by using a
single interviewer this should be avoided.
Participants may refuse to answer questions on the basis they find them too
personal or intrusive. This will affect the results of the interview if the question is
central to the theme of the research. The questions that have been written are not
excessively probing and a thorough explanation of how the data will be used after
the interview will be given hopefully to satisfy participant’s worries.
The validity of the interview will be upheld with the interviewer having direct
contact with the interviewee (Abu-Hussin, 2010). When interviewing, standardising
the interview style and questions asked is often the most challenging aspect,
questions provided need to be of sufficient clarity to allow them to be asked
directly to the participant (Fowler and Mangione, 1990).
24
Before the interview is conducted a copy of the questions to be used in the
interview will be given to the care farm organiser for them to verify that such
questions would be suitable for the clients on their farm. In addition during the
creation of the questions, a questionnaire was sent to a care farm for evaluation
and the feedback used to modify the questions. This mainly centred on wording
and the use of certain terminology that would not be familiar to people not from a
rural background.
During the interviews with care farm participants it may be that people with
disabilities are asked to take part in the interviews. While this may mean that the
respondent needs longer to formulate an answer due to their impairment, however
having a disability does not mean that they should be treated any differently than
other participants (Keats, 2001). It is important to make notes during the interview
and to write these into a more detailed account as soon after as possible, to make
sure none of the information is forgotten (Robert Wood Johnson Foundation,
2008).
Once data has been collected it is important that it is stored carefully, with
reference to the Data Protection Act.
8.6 Interview techniques
It is possible to affect the responses of the interviewee in two major ways in
reference to sensitive topics. In particular the social characteristics of the
interviewer and any bias in the expectations of the interviewer can affect what
response is given. Matching the social characteristics of the interviewer with those
of the interviewee is important (Lee, 1993).
8.7 Limitations of the research
Only 24 interviews were carried out in an estimated population of 5869 clients per
week (Hine et al, 2008), therefore the research only represents 0.4% of possible
interviewees in any given week. Despite this a range of client groups were
approached, across a number of different care farms which all gave findings
consistent with the literature.
However the research process entails more work than other areas: the care farm
organisers firstly meet with the interviewer to ascertain whether they are prepared
to let them interview their clients. Once at the care farm it is important to meet the
clients, explaining what the aims of the interview are and how the data will be
used. Walking round the farm and viewing what the clients do is essential, since
this means any prompting can be done with an overview of the farm in mind. This
research method is highly time consuming and time constraints prevented any
more interview taking place.
25
Chapter 9. Results
Shown below are the results of the semi-structured interviews, these are
presented with the responses grouped.
Table 1 – Table showing the clients favourite activity. Source – King, 2011.
Q1
Favourite
Activity
Activities
involving
animals
All activities
Activities
involving
machinery
Activities
involving
construction
Activities
involving
horticulture
Activities
involving
cooking
Number of
Clients
13
8
8
3
3
1
Table 1 shows how the majority of client’s favourite activities involved animals.
Table 2 - Table showing if clients prefer working with animals or not. Source – King, 2011.
Q2
Do you prefer working with
animals?
Yes
No
Number of
Clients
17
7
Table 2 shows that a larger number of clients preferred to work with animals than
not.
Table 3 - Table showing what areas clients have learnt skills in since being at the farm. Source – King,
2011.
Q3
What sort of things have you learnt since
being here?
Caring for animals
Growing vegetables
Walling or fencing
Machinery operation
Chainsaw operation
Cooking
About life
26
Number of
Clients
18
9
5
3
3
3
1
Table 3 shows that most clients had learnt about caring for animals than any other
skills
Table 4 - Table showing what new skills clients have learnt. Source – King, 2011.
Q4a
In what area have you
learnt new skills
In relation to animals
In relation to gardening
In relation to machinery
In relation to construction
In relation to general or life
In relation to cooking
Number of
Clients
9
4
3
1
8
3
Table 4 shows that the greatest number of clients had learnt skills in relation to
animals care
Table 5 - Table showing where clients would use their skills. Source – King, 2011.
Q4b
Where would you use
skills learnt at the care
farm?
In employment
At home
On the care farm
Education
Voluntary work
Number of
Clients
10
6
3
2
2
Table 5 shows that many of the care farmers were hoping to use skills learnt in
employment
Table 6 - Table showing if clients work as a team. Source – King, 2011.
Q5a
Do you work as a team?
Yes
No
Number of
Clients
24
0
Table 6 shows that all of the care farmers have to work as a team
Table 7 - Table showing what clients do as a team. Source – King, 2011.
Q5b
What do you do as a
team
Horticultural work
Construction
Animal work
27
Number of
Clients
8
7
4
Table 7 shows that most of the clients have to work as a team with horticultural
work, followed by construction and work with animals.
Table 8 - Table showing whether clients enjoy working as a team. Source – King, 2011.
Q5c
Do you enjoy working
as team?
Yes
No
Sometimes
Number of
Clients
22
0
2
Table 8 shows that all but 2 of the clients enjoyed working as a team
Table 9 - Table showing if clients have met new friends at the care farm and if they keep in touch.
Source – King, 2011.
Q5d
Have you met new
friends at the care farm?
Yes
Yes and keep in touch
No
Number of
Clients
22
2
0
Table 9 shows that all of the clients had made friends at the care farm, but only
two kept touch outside it
Table 10 - Table showing if clients feel having friends at the care farm makes it a better experience.
Source – King, 2011.
Q6
Do they make coming to the care farm a better
experience?
Yes
No
Number of
Clients
24
0
Table 10 shows that all of the clients considered that their friends made coming to
the care farm a better experience
Table 11 - Table showing if clients enjoy working in the countryside. Source – King, 2011.
Q7
Do you enjoy working in the
countryside?
Yes
Yes its healthier (fresh air)
No
Number of
Clients
15
9
0
Table 11 shows that all of the clients enjoyed working outdoors, with 9 believing it
was healthier
28
Table 12 - Table showing if clients have done anything like CF before (in terms of working outside or
with animals for example). Source – King, 2011.
Q8
Have you ever done anything like
this before?
Yes
No, but similar
No
Number of
Clients
4
4
16
Table 12 shows that only 4 clients experienced the care farm environment before,
however 4 had experience something similar.
Table 13 - Table showing client’s favourite aspect of being at the care farm. Source - King
Q9
What is your favourite aspect of
being here?
Social side
The work and its variety
Everything
Being outdoors
Just getting away from everything
Having a structure to the week
Focus to get up in the mornings
Number of
Clients
15
11
6
6
1
1
1
Table 13 shows the client’s favourite aspects of being at the care farm. All of the
three main areas are well represented; this is explored more in the discussion.
Table 14 - Table showing how attending the care farm has helped the clients. Source – King, 2011.
Q10
Has coming to the care farm helped you
in anyway?
More confidence
New experiences
Better Health
Forget troubles
Enjoy being with others
Gives a purpose to everyday
Responsibility
Gets one out of the house
Ideas for the future
Working hard
Number of
Clients
16
9
3
2
1
1
1
1
1
1
Table 14 shows that over half of the clients believed they had gained in confidence
since attending the care farm, however having new experiences was also a
popular reason.
29
Chapter 10. Discussion
10.1 Question 1 – What is your favourite activity?
The most common participant’s favourite activity was working with animals (13
people). Animals need care and attention, giving a challenge to clients (Hassink,
2002), encouraging them to take responsibility. Clients suggested that they
enjoyed ‘caring’ for animals and having an animal relying on them for its food,
water and clean bedding.
Clients also liked creative tasks such as construction or cooking, however these
were more associated activities of farming. A proficiency in cooking would allow
greater independence in their homes. In addition learning new skills that can be
used gives more confidence helping recovery. West Mercia Constabulary (2008)
aim to use CF to improve the quality of life of offenders by teaching skills that
would allow them to be independent.
8 respondents enjoyed working with machinery. Initially this was a surprise since
many care farms do not have a need for large levels of mechanisation with the
manual tasks being an important part of the therapy. It could be concluded that
these participants may have been either more able to use machinery or had been
at the care farm for an extended time, taking on more complex tasks.
Only three people liked horticultural work, either planting, weeding or harvesting.
Horticulture can help to create a sense of belonging and identity (Sempik et al,
2005); however it can be hard work, particularly with weeding and planting.
Growing vegetables takes more patience, compared to the easier rewards of
caring for animals. This is suggested by participant 23 whom enjoyed growing
vegetables, but in terms of harvesting them, the final, rewarding stage. However
STH is well proven (Hine et al, 2008), and commonly used for therapeutic goals,
so it is surprising that clients did not have a preference for working in this area.
8 participants commented that they enjoyed everything that they did on the care
farm. This suggests that they enjoyed the other parts of the experience such as
being with others or working outside and what they actually did was not a major
part of the experience for them.
10.2 Question 2 – Do you prefer working with animals
or other tasks?
Question two, on reflection, overlaps Question one, if the participant said that they
enjoyed working with animals in Question one then they would answer Yes to
Question two, therefore not giving any more information. The majority of the
participants suggested they preferred working with animals, the use of AAT helps
to give more positive outcomes for the clients (Beck and Katcher, 1996), (Sempik
et al, 2010). Animals give a structure to the day in terms of feeding and cleaning
routines, this could be beneficial for particular autistic clients, who require a
structure to the day. Animals also give an opportunity for clients to take
responsibility, making sure animals are correctly fed and have adequate water.
30
Finally animals are living creatures that move and behave in similar ways to
humans, this makes them interesting to observe and understand in terms of
habits, likes and dislikes. This provides interest for the client and gives a talking
point, increasing social interaction.
More people said yes in this question compared with the previous question. This
could indicate that the wording of the questions 1 and 2 gives different results,
having a more closed question has not allowed people to explore other activities
that they enjoy before answering. Animals would be present on the care farm at all
times, but other tasks such as construction would appear more sporadically
throughout the year, so clients may prefer the greater variety offered by other
tasks but not dislike working with animals, giving the two different responses.
10.3 Question 3 – What sort of things have you learnt
since being here?
Most people had learnt new skills in relation to animal care (18); followed by
growing vegetables (13), two traditional farming activities. However again there
were a large number of responses that indicated skills being learnt in creative
tasks such as construction, cooking or chainsaw operation. With CF covering a
wide variety of farms, the clientele is also wide ranging, different clients have
different goals. One respondent commented that they had learned about life at the
care farm, suggesting life skills such as taking care of yourself and cooking are
also important goals, in addition to learning how to care for animals or grow
vegetables.
Service users can use horticultural skills outside of the care farm, by creating a
green space; they can create a sense of belonging and identity (Sempik et al,
2005). STH has proven benefits in terms of offering therapy (Hine et al, 2008).
Using the outdoors as a therapy tool can be successful, humans have an innate
connection with nature, as the key to survival was understanding nature (Wilson,
1993), making use of or rediscovering this connection can help recovery. Nature is
a fundamental part of physical and biological reality that affects all humans,
particularly children (Kahn, 1997).
Dry-stone walling featured prominently with four people suggesting that they have
learned it as a skill during their time at the care farm. Linking this with question 4,
all of these people said that they would use these skills in future employment. The
benefits of creative tasks are that they give a tangible outcome and are useful
(Nilsson et al, 2007).
Only three people commented that they had learnt about machinery operation.
The use of machinery would tend to be minimal by service users, since most
therapy is obtained from working with animals or growing vegetables. However
three people had also learnt about chainsaw use, this was for a certificate and was
conducted under close observation. This was only on one care farm and therefore
can be considered unusual.
31
10.4 Question 4 – What new skills have you learnt and
where would you use them?
Most people were hoping to use skills learnt in employment, with learning new
skills being an important part of helping service users to move towards
employment. This links with question ten in which most of the respondents
commented that they had developed more confidence, vital for finding
employment. Being part of a care farm helps to create and develop a work ethic
(Brown, undated), and with the variety of new experiences on offer, gives the
chance to learn new skills (Russell et al, 1999). Two people were hoping to go into
further education; these respondents commented that the area they most enjoyed
was caring for animals, suggesting that further education in animal care maybe the
result.
Not all skills learned on a care farm are designed to aid the search for
employment, often clients require skills just to help with their daily lives and
routines, four people commented that they had gained such general life skills,
including cooking. Seven clients said they could use the skills learnt on the care
farm at home, particularly in relation to cooking, gardening and animal care.
10.5 Question 5 – Do you work as a team on the farm,
and what do you do as a team?
Working as team was considered important by all of the participants at least some
of the time. The Forest Research Group comments that they use small teams for
physical tasks, because working as a team helps to increase social inclusion
(Hausenhofer et al, 2010). Three people commented that the team ‘banter’ helped
with meeting new people and making friends, working on a farm can help to
improve social skills (Hassink and van Dijk, 2006), similarly the farmer gives
important social contact (Nilsson et al, 2007). Many of the respondents
commented that they ‘have’ to work as a team in tasks; they have to rely on other
people and interact with them to complete a task. One of the main aims of a care
farm is to get clients to engage with an unknown environment, with unfamiliar
people, learning basic skills and undertaking tasks, encouraging responsibility and
emotional development (Russell et al, 1999). Even those that were less
enthusiastic about working as team recognised that it was important for completing
tasks.
One respondent felt that being actively involved in decisions about the running of
the care farm was a positive aspect. With many people suffering from at least
partial social exclusion due to their mental health problems, (Sempik et al, 2010),
becoming engaged with decision making and political processes can help service
users to become more socially active (Sempik et al, 2005).
Despite a limited evidence base for the application of green exercise in the
treatment of mental health issues, the British Trust of Conservation Volunteers
(BTCV) operate ‘Green Gyms’ that carry out nature conservation, reporting health
benefits and increased social interaction in participants (Peacock et al 2007).
32
10.6 Question 6 – Does having friends at the care farm
make it a better experience?
22 people enjoyed team work; only two people did not always enjoy working as a
team; however they conceded that they sometimes did. This reinforces the
findings of question five in that people enjoyed working as part of a team.
10.7 Question 7 – Do you enjoy working in the
countryside?
The benefits of being and working outdoors are well documented, having been
recognised since the time of Christ (Simpson et al, 1998); coinciding with the
popular opinion that the countryside is a haven to retreat to (Lobley, 2005). All the
respondents liked working outdoors; however two commented that this was the
case only in good weather. Evidence from other studies suggests that this is
widely the case; a study by Sempik et al (2005) indicated that clients preferred a
natural environment to an urban one, and indeed appreciated the chance to be
‘outside’. This study attempted to find out whether similar therapeutic conditions
could be created in any sheltered employment, not necessarily in a natural setting.
This theory was supported by organisers; however clients commented that the
natural environment was an important part of the experience. With reference to
this research four people commented that it was being out in the fresh air that they
particularly enjoyed, insinuating that this was healthier.
Six people specifically commented that they either liked or ‘enjoyed’ working in the
countryside, suggesting that they valued working there more than the others;
respondent 17 indicated that overall the best part of the experience was working
outdoors. However this was not the case for the other five that really enjoyed or
liked working in the countryside.
Two people explicitly said that they enjoyed working in the countryside because it
was healthier, linking with the common belief that natural spaces are better for
you, in fact the better one’s relationship the better one’s mental health will be
(Burns, 2007). This is further supported by the literature, a common theme being
that working in a natural setting leads to a sustaining and therapeutic relationship
with nature (Jordan, 2009).
One person indicated a dislike for the quietness of the countryside having come
from a city, but the next participant liked the quietness of the countryside.
Participant 18 remarked that being outdoors is the part of the experience that is
most helping to reduce their problems.
10.8 Question 8 - Have you ever done anything like this
before?
This was a new experience for the majority (21) of the respondents – therefore
they did not have any preformed ideas about what they did or did not like etc.
despite this being a new experience all of the respondents commented that they
enjoyed attending the care farm. This suggests that the experience was positive
for all of the respondents, however as only 24 people took part in the study, this
cannot be generalised to everyone that is part of a care farm.
33
Volunteering or working on other care farms was carried out by three participants;
this could suggest that once clients have worked on care farms they want to
extend the experience. Interviewees 19 and 24 suggested that their experience
gave them the confidence to offer help to others. This requires increased
responsibility with helping others, reflecting greater social responsibility and
awareness that could have come from the care farm experience.
Respondent two and three had worked both with animals and in the outdoors
before. They enjoyed this but did not like working in bad weather, preferring to be
indoors, which is completely understandable.
Participant 20 comments that they used to work indoors and did not like this, much
preferring the countryside and peace and quiet which they found therapeutic.
Respondent five has worked in construction, not in agriculture, although they also
commented that they enjoyed working outdoors.
10.9 Question 9 – In your own words what is the best
aspect about coming to the care farm?
There was no expected answer to this, the literature gave a generalised view that
clients liked working outdoors and that having tasks with a tangible outcome to
complete in a social environment enhanced the experience. However this research
found the social aspect was considered the best part by the majority (15) of the
participants; some however gave more than one reason.
For seven people the whole experience was good and they enjoyed working
outside, with others, carrying out tasks.
Only six people listed being outside as the most important aspect and these were
stand-alone factors either, they were combined with enjoying the social aspect. In
fact, respondent five commented that they enjoyed working outside, as a ‘group of
mates’ as well as being able to be creative in the tasks, it would be more accurate
to suggest that they enjoyed the entire experience than merely each part.
Respondent four doesn’t list the social aspect of the experience as being a
favourite part, but mentions how they enjoyed the chance to be creative in the
tasks. This links with their response to question five, where they suggested
working as a team ‘helps pass the time’, indicating that working as a team is not
their favourite part of being on the care farm. This result was unexpected; the
social aspect of working on a care farm is often cited as an important aspect both
by anecdotal evidence by care farm organisers and by the clients themselves.
However this person recognised the need to work together, with tasks such as dry
stone walling.
11 people commented that the tasks they undertook were the best part. Having
useful tasks with tangible outcomes is important to good mental health; indeed
secure employment reduces the likelihood of a limiting illness developing and
raises the chance of recovery (Bartley et al, 2004).
Some interesting answers were given, specifically that being part of the care farm
gives structure to the week, a focus to get up in the morning and allows one to get
away from everything. This corresponds with Warr (1987) who indicates that care
farms help to improve social identity and contact whilst structuring time.
34
10.10 Question 10 - Has coming to the care farm
helped you in any way?
15 respondents commented that they had gained in confidence during their time at
the care farm; nine people had gained new skills. These two areas could be linked
in that by learning new skills the clients gained in confidence. This is supported by
seven of the respondents who commented that they had learnt new skills and
increased in confidence. Russell et al, (1999) comments that working outdoors
and having a relationship with both nature and one’s peers a therapeutic
environment can be created, this encourages responsibility and development on
personal and social levels. Research by Hine et al, (2008) supports this; it found
that care farm service users gained in responsibility during their time at the
organisation. CF has been adapted to a certain extent by West Mercia
Constabulary in terms of their prisoner rehabilitation programs with the aim of
teaching skills to allow employment to be gained and the chance of reoffending cut
(West Mercia Constabulary, 2008).
One person commented on now having better health and were not in hospital
anymore; indeed one of the outputs of care farms is good health (Di Iacovo and
O’Connor, 2009).
There were three other separate answers for this question, namely it gave ideas
for the future, it gave responsibility and got the clients out of the house.
Respondent seven commented that it gave ideas for the future, for this person the
skills learnt were about working with animals which they hoped to use in
employment. Despite never having done anything like this before, they found
working with animals the best aspect of being at the care farm. This last response
was quite unusual since they were the only one that considered working with
animals to be the best part of attending the care farm. There is much evidence to
support the benefits of using animals as a therapeutic aid on farms. This can be
through several different mechanisms; the first being that learning about caring for
animals gives more confidence (Berget et al, 2008), which agrees with this
research since this person commented that they gained in confidence from
attending the farm and learning new skills. However there are other ways in which
successes of AAT can be explained, namely that the patient found the interaction
pleasurable and reduced fear of new situations, or that the intervention improved
the response of the conventional psychiatric treatment (Berget et al, 2008). In
addition to this contact with animals are seen as opportunities for social
exchanges providing a common subject to talk about (Sempik et al, 2010).
Participant 21 remarked that the most helpful part of the care farm experience was
being able to work hard. This person felt that hard work was something they had
not had the chance to do before. Work is important both in maintaining mental
health and in promoting the recovery of those who have experienced mental
health problems (Boardman, 2003).
Both participants 20 and 22 forget their troubles when they are at the care farm,
concentrating and focusing on the work and being with others. This links with
Boardman (2003). In interviews 19 and 24 the clients commented how being part
of a care farm has helped them through their illness, participant 19 said that it
gave a purpose to everyday.
35
Chapter 11. Conclusion and recommendations
All the interview participants enjoyed attending the care farms. No particular area
stood out in terms of client preference; however clients did enjoy the social aspect
of being part of the care farm the most. A variety of reasons were expressed for
enjoying the farm, encompassing all three of the areas outlined in the research
question. In terms of activities, working with animals was popular, something that
was expected. Clients enjoyed working outdoors, citing it as healthier.
The clients all found that the experience had helped them in different ways, some
of which were very personal. Most commented that they had more confidence,
with new experiences, however other reasons given included improved health and
being able to forget their troubles.
Each client has individual needs and requirements in terms of what they like and
what activities they enjoy. Farm organisers need to be flexible and mirror the
individual nature of clients with a range of activities which suit a wide variety of
people, with the option of tailoring work programs if necessary. Some activities
such as working with animals or working outdoors appeals to a variety of clients,
both these aspects would be important to include as part of the care farm
experience.
11.1 Further research possibilities
Increasing the number of clients interviewed would give a more representative
sample of the population. However this could just give a greater number of similar
findings, and client sensitivity makes interviews time consuming.
It could be possible to extend the research into new areas of the country, as this
study mainly focused on the West Midlands, there could be possible differences
between more rural or urban areas.
If it could be possible, researching possible links between previous occupations of
clients and what they enjoy now could show some correlations. For example if
someone had previously worked in construction it may be that they prefer more
creative tasks, however this is not necessarily the case.
Evaluating how the client has progressed during their time at the care farm is
important as it allows both the care farm organiser and any governmental
organisations the ability to quantify whether it has been a useful therapeutic
experience.
36
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Appendices
Appendix 1
Information on the modes of action of anti-depressants
Antidepressants are medicines that treat the symptoms of depression. There are
almost 30 different kinds of antidepressant, which fall into four main categories.
The different types of antidepressant work about as well as each other.
However, side effects vary between different treatments and people.
Selective serotonin reuptake inhibitors (SSRIs)
Typically users of antidepressants will be prescribed a selective serotonin
reuptake inhibitor (SSRI). These help increase the level of a natural chemical in
your brain called serotonin, which is thought to be a ‘good mood’ chemical. These
have fewer side effects than older drugs such as tricyclic antidepressants, and
cause less side effects. They can, however, cause nausea and headaches, as well
as dry mouth and problems with sexual functioning. Examples of this type of
antidepressant include sertraline, paroxetine, fluoxetine, citalopram, escitalopram
and fluvoxamine.
Some SSRIs should not be prescribed for children under the age of 18. Research
shows that the risk of self-harm and suicidal behaviour may increase if they are
used to treat depression in people in this age range. Fluoxetine is the only SSRI
that may be prescribed for under-18s, but only when specialist advice has been
given.
Tricyclic antidepressants (TCAs)
This group of antidepressants, which includes dothiepin, imipramine and
amitriptyline, is used to treat moderate to severe depression.
TCAs work by raising the levels of the chemicals serotonin and noradrenaline in
your brain. These both help lift your mood. Do not smoke cannabis if you are
taking TCAs because it can cause your heart to beat rapidly.
Side effects of TCAs, which vary from person to person, may include dry mouth,
blurred vision, constipation, problems passing urine, sweating, light-headedness
and excessive drowsiness. The side effects should ease after 7 to 10 days, as
your body gets used to the medication.
Monoamine oxidase inhibitors (MAOIs)
MAOIs, such as phenelzine sulphate, are sometimes used to treat depression.
If you are taking MAOIs, you will have to avoid food that contains the chemical
tyramine. This is normally found in foods that have been fermented or cured to
increase their flavour, such as cheese, pickled meat or fish. Your GP will give you
a list of food and drink to avoid.
45
Do not drink any alcohol or fermented liquids (even if they are alcohol free). Do not
smoke cannabis if you are taking MAOIs because it may affect the way these
medicines work, and it is not clear what effect this may have on you.
As MAOIs have the potential to interact with a wide range of medication, do not
take any other drug or medicine, including over-the-counter medication, without
checking with your GP first.
Common side effects of MAOIs include blurred vision, dizziness, drowsiness,
increased appetite, nausea, restlessness, shaking or trembling, and difficulty
sleeping.
There have been a number of cases where MAOIs have caused a dangerous rise
in blood pressure.
If you experience a stiff neck, severe headache, chest pains, vomiting or nausea,
or a fast heartbeat, seek emergency help immediately by dialling 999 and asking
for an ambulance.
The dietary restrictions and potential for side effects mean that MAOIs are used
very rarely, and are normally only prescribed when other treatments have not been
effective.
Other antidepressants
New antidepressants, such as venlafaxine, nefazodone and mirtazapine, work in a
slightly different way from SSRIs and TCAs. These drugs are known as SNRIs
(Serotonin-norepinephrine reuptake inhibitors). Like TCAs, these antidepressants
change the levels of serotonin and noradrenaline in your brain. Studies have
shown that an SNRI such as venlafaxine can be more effective than an SSRI,
though it is not routinely prescribed as it can lead to a rise in blood pressure.
(Adapted from NHS Choices, Undated).
http://www.nhs.uk/Conditions/Depression/Pages/Treatment.aspx
46
Appendix 2
Copy of an interview sheet used during the research, the questions in italics did
not form part of the research but instead were questions to lead the participants
into the main part of the interview.
Where is the farm near?
What is the farm like?
What size is the farm in acres?
Does it have animals?
What animals are there?
What sort of crops do you grow?
1. What are your favourite activities on the farm?
2. Do you prefer working with animals on the farm?
3. What sort of things have you learnt since being here?
Growing vegetables?
Cooking?
Caring for animals?
4. Have you learnt any skills you can use anywhere else?
Where would you use the skills?
Do you like learning new skills?
5. Have you met new friends at the care farm?
Does meeting new people and friends make coming to [
6. Do you have to work in a team?
What sort of things do you do as a team?
7. Do you like working in the countryside on the farm?
8. Have you worked anywhere like this before?
47
9. In your own words, what part of coming to the care farm (Insert name of
care farm) do you most enjoy?
10. Has coming to the farm helped you in any way? Why is this?
Source – King, 2011.
48
Appendix 3 – Tables of interview results
Table 15 - Table showing the grouped answers to question 1 - What is your favourite farm activity?
Source – King, 2011.
Q1
Favourite Activity
Int 2
Animals
Int 3
Animals esp horse
Int 8
Animals
Int 6
Animals
Int 7
Animals
Int 9
Animals
Int 10
Animals
Int 12
Animals
Int 13
Animals
Int 14
Animals
Int 15
Animals
Int 18
Animals
Int 20
Animals, particularly the pigs
Int 23
Harvesting vegetables
Int 1
Vegetables
Int 18
Gardening
Int 24
Machinery use
Int 22
Machinery
Int 21
Machinery use
Int 19
Machiney
Int 12
Machinery
Int 10
Machinery
Int 9
Machinery
Int 8
Machinery
Int 14
Wall Building
Int 4
Building
In 5
Joinery and would like more construction work
Int 9
Cooking
Int 11
Everything
Int 16
Anything outdoors
Int 17
Everything
Int 19
Everything
Int 18
Everything
Int 23
Bit of everything
Int 20
Range of work
Int 22
Range of work
49
Table 16 - Table showing if clients prefer working with animals or not. Source – King, 2011.
Q2
Do you prefer working with animals?
Int 1
Yes
Int 2
Yes
Int 3
Yes
Int 4
Yes
Int 5
Yes
Int 6
No
Int 7
No
Int 8
No
Int 9
Yes
Int 10
No
Int 11
Yes
Int 12
Yes
Int 13
Yes
Int 14
Yes
Int 15
Yes
Int 16
Yes
Int 17
Yes
Int 18
Yes
Int 19
No
Int 20
No
Int 21
Yes
Int 22
Yes
Int 23
Yes
Int 24
No
Table 17 - Table showing what sort of things clients had learnt. Source – King, 2011.
Q3
What sort of things have you learnt since being here
Int 1
Growing vegetables
Int 2
Making compost, looking after soil
Int 3
Making compost
Int 5
Growing vegetables
Int 11
Growing vegetables
Int 15
Growing vegetables
Int 16
Planting trees
Int 17
Growing vegetables
Int 18
Growing vegetables
Int 20
Growing vegetables
Int 21
Growing vegetables
Int 22
Growing vegetables
Int 17
Caring for animals
Int 16
Caring for animals
Int 1
Caring for animals
Int 3
Caring for animals
50
Int 6
Caring for animals
Int 7
Caring for animals
Int 11
Caring for animals
Int 12
Caring for animals
Int 13
Caring for animals
Int 14
Caring for animals
Int 15
Caring for animals
Int 18
Caring for animals
Int 19
Caring for animals
Int 20
Caring for animals
Int 21
Caring for animals
Int 22
Caring for animals
Int 23
Caring for animals
Int 24
Caring for animals
Int 1
Learning about life
Int 8
Cooking
Int 9
Cooking
Int 10
Cooking
Int 2
Drystone walling
Int 3
Drystone walling
Int 4
Drystone walling
Int 5
Drystone walling
Int 16
Fencing
Int 2
Chainsaw operation
Int 3
Chainsaw operation
Int 4
Chainsaw operation
Int 9
Machinery operation
Int 22
Machinery operation
Int 24
Machinery operation
Table 18 - Table showing where clients had learnt new skills and how they would use them. Source King, 2011.
Q4
Have you learnt any new skills and where would you use them?
Int 1
Yes, general life skills
Int 8
Yes, cooking
Int 9
Yes, cooking
Int 10
Yes, cooking, life skills
Int 19
Yes, gardening skills, at home
Int 20
Yes, animal and gardening skills, at home
Int 22
Yes, animals and gardening skills, at home
Int 2
Yes, in employment
Int 3
Yes, in employment
Int 4
Yes, in employment
Int 5
Yes, drystone walling, in employment
Int 6
Yes, animal skills, in employment
Int 7
Yes, animal skills, in employment
51
Int 11
Yes, machinery skills, in employment
Int 12
Yes machinery and animal skills, in employment
Int 13
Yes, animal skills, in employment
Int 14
Yes, machinery skills, in employment
Int 15
Yes, gardening skills, general use
Int 16
Yes, construction skills, on the care farm
Int 17
Yes, animal skills, other voluntary work
Int 18
Yes, general farm skills, in voluntary work
Int 23
Yes, general skills on the care farm
Int 21
Yes, general skills on the care farm
Int 24
Yes, general farm skills, in voluntary work
Int 6
Yes, animal skills, in further education
Int 7
Yes, animal skills, in further education
Table 19 - Table showing if clients had made new friends at the farm and whether they work as a team.
Source - King, 2011.
Q5
Have you met new friends at the farm and do you work as a team?
Int 1
Yes : Have to work as team, planting and weeding vegetables
Int 2
Yes meet up outside of the farm : Have to work as a team drystone walling
Int 3
Yes and keep in touch outside of the farm : Have to work as a team drystone walling
Int 4
Yes, helps to pass the time : Have to work as a team with drystone walling and garden work
Int 21
Yes : In the garden : sometimes like to work as a team
Int 11
Yes : Work as a team with jobs like mucking out
Int 12
Yes : Work as a team with jobs like mucking out
Int 13
Yes, only see them here though : Work as a team with animals
Int 14
Yes : Sometimes work as a team, some jobs are easier alone
Int 15
Yes : Work as a team sometimes, construction, or training fruit trees
Int 17
Yes like having team banter : Work as a team with vegetables
Int 9
Yes : Always work as a team particularly with horses
Int 10
Yes : Always work as a team
Int 16
Yes : Always work as a team
Int 5
Yes : Always work as a team
Int 6
Yes and have some banter : Always work as a team
Int 7
Yes and have some banter : Always work as a team, have some input into decision making
Int 8
Yes : Always work as a team particularly with horses
Int 18
Yes : Have to work as team, planting and weeding vegetables
Int 19
Yes : Wood sawing, planting vegetables : Like working with others
Int 20
Yes : Vegetable and wood work : enjoy working with others
Int 22
Yes : Vegetable and wood work : Like working with others
Int 23
Yes : like working with others
Int 24
Yes : do lots of team work, enoyable supporting each other
52
Table 20 - Table showing if clients consider that their friends at the care farm make it a better
experience. Source - King, 2011.
Q6
Do they make coming to the care farm a better experience?
Int 1
Yes
Int 2
Yes
Int 3
Yes
Int 4
Yes
Int 5
Yes
Int 6
Yes
Int 7
Yes
Int 8
Yes
Int 9
Yes
Int 10
Yes
Int 11
Yes
Int 12
Yes
Int 13
Yes
Int 14
Yes
Int 15
Yes
Int 16
Yes
Int 17
Yes
Int 18
Yes
Int 19
Yes
Int 20
Yes
Int 21
Yes
Int 22
Yes
Int 23
Yes
Int 24
Yes
Table 21 - Table showing if clients enjoy working in the countryside. Source - King, 2011.
Q7
Do you enjoy working in the countryside?
Int 2
Yes, only in good weather
Int 3
Yes, only in good weather
Int 4
Yes
Int 5
Yes
Int 8
Yes, enjoy being outside
Int 9
Yes, enjoy being outside
Int 10
Yes
Int 13
Yes, enjoy being outside
Int 14
Yes
Int 15
Yes like being outside
Int 17
Yes enjoy being outside
Int 1
Yes, do enjoy it, particularly the fresh air
Int 11
Yes, being out in the fresh air
Int 12
Yes, being out in the fresh air
Int 16
Yes, prefer being outside in fresh air
53
Int 6
Yes, more healthy
Int 7
Yes, its healthier
Int 18
Yes, love being outdoors, what is helping the most with problems
Int 19
Yes
Int 20
Yes, enjoy the countryside and peace and quiet
Int 21
Yes its good getting outside, more healthy
Int 22
Yes but it is too quiet
Int 23
Good to get outside
Int 24
Yes
Table 22 - Table showing if clients had experienced anything like the care farm before. Source - King,
2011.
Q8
Have you done anything like this before?
Int 24
Yes on another care farm project
Int 19
Yes on another care farm project
Int 2
Yes, worked in a garden centre and riding school
Int 17
Volunteer at another care farm
Int 3
No, never done this before
Int 4
No, always been inside
Int 5
No, but worked outside in construction
Int 6
No
Int 7
No
Int 8
No
Int 9
No
Int 10
No
Int 11
No haven't done it before
Int 12
No, never worked on farms before
Int 13
No haven't done it before
Int 14
No, but been coming to the care farm for a long time
Int 15
No haven't done it before
Int 16
Not really done it before
Int 18
No, never had a garden however do now
Int 20
No, worked indoors, did not like it
Int 21
No
Int 22
No, used to be a baker, like being on a farm
Int 23
No but used to work outside
Int 1
No, never done this before
Table 23 - Table to show what the clients favourite aspect of being at the care farm was. Source - King,
2011.
Q9
What is your favourite aspect of being here?
Int 1
Enjoy aspects of being here
Int 12
The whole experience
54
Int 13
The whole experience
Int 14
Everything
Int 15
Everything
Int 16
Everything
Int 2
Meeting new people
Int 3
Meeting new people
Int 5
Working with other as a group of mates
Int 6
The social side
Int 7
The social side
Int 8
The social side
Int 9
The social side
Int 10
The social side
Int 11
The social side
Int 15
The social aspect
Int 16
The social side, joking as a team
Int 19
Helping and supporting others
Int 24
Being in social group
Int 24
Being valued
Int 20
Social group
Int 4
Working outside
Int 5
Working outside
Int 17
Being outside
Int 20
Being outside
Int 24
Being outside
Int 18
Being outside
Int 4
Being creative in the tasks
Int 5
Being creative in the tasks
Int 7
Working with animals
Int 11
Learning new skills
Int 12
The physical work
Int 18
Having a go a new things
Int 20
Task variety
Int 21
The variety of tasks
Int 21
Using machinery
Int 22
The work and tasks, variety
Int 24
Having tasks with a tangible end
Int 23
Just getting away from everything
Int 24
Structure to the week
Int 20
Focus to get up
Table 24 - Table showing how clients felt the care farm experience had helped them. Source - King,
2011.
Q10
Has coming to the care farm helped you in anyway?
Int 1
Not in hospital anymore
Int 1
Better health
Int 2
More confidence
Int 3
More confidence
55
Int 4
More confidence
Int 5
More confidence
Int 6
More confidence
Int 7
More confidence
Int 8
More confidence
Int 9
More confidence
Int 10
More confidence
Int 11
More confidence
Int 12
More confidence
Int 13
More confidence
Int 14
More confidence
Int 15
More confidence
Int 16
More confidence
Int 18
More confidence that can do things
Int 19
Gave a purpose to everyday
Int 19
Helped one through illness
Int 20
Takes mind off problems
Int 20
Having to focus and concentrate
Int 6
New experiences and training
Int 7
New experiences and training
Int 12
New experiences and training
Int 17
New experiences and training
Int 2
New skills
Int 3
Learnt new skills
Int 6
Learning new skills
Int 7
Learning new skills
Int 17
Learnt new skills
Int 7
Ideas for future
Int 17
Responsibility
Int 16
Getting out of the house
Int 21
Working hard
Int 22
Forget troubles, can't wait for each session
Int 23
Enjoy being with others
Int 24
Helped one through illness
56