Using nature to treat mental health patients

Using nature to treat mental health patients


By Rose Hoban

The impulse to retreat to nature to improve and sustain one’s mental health has a long history — from the times of Hippocrates, who’s often credited with saying “nature is the physician of diseases,” to Henry David Thoreau who voyaged into the woods to “live deep and suck out all the marrow of life.”

More recently, doctors in Japan have been writing prescriptions for their patients to take walks in the woods.

Too often, though, people with mental health problems end up spending their days in rooms lit by artificial light, with little access to fresh air, sunlight, natural greenery or opportunities to exercise.

That reality began to wear on Nora Dennis. 

Dennis, 44, spent years training to become a psychiatrist, climbing the clinical and corporate ladders. By her late 30s, she was an adjunct professor at Duke’s medical school, seeing “a lot of patients.” She also spent several years as the director of behavioral health for Blue Cross and Blue Shield of North Carolina. 

“I had been really pursuing achievement in a more conventional way to get more roles in larger and larger organizations and feeling like that was the way that I was going to change people’s lives and change the world and create more opportunity for people with mental illness to receive the care and support that they needed,” she said.

But she was becoming frustrated with institutional medicine — and with the way patients in hospital psychiatric units were confined.

“People were desperate to go outside,” she said. “Who among us would choose to spend eight days without seeing the sun on your face except for through a window and with fluorescent lights?”

One night in 2022, a dream pushed her in a different direction. “I woke up and I told my husband, ‘I know what I want to do with my life,’ ” Dennis recalled, adding that she then mulled over that idea for about six months.

Then in 2023, with the help of her parents — both retired physicians — Dennis purchased nine acres in rural Orange County between Chapel Hill and Hillsborough and began to build a place where people with serious mental health problems can spend the day outside, help tend to vegetables and flowers in the gardens and care for animals while receiving intensive psychiatric treatment.

Dennis filed paperwork with the state Department of Health and Human Services last month to obtain a license to run Jubilee Healing Farm. Once all the paperwork is approved by the county and the state, she can open. Dennis said she hopes it can be within a few months.

Thinking big, starting small

Jubilee will become one of 15 care farms in North Carolina, facilities that use nature and farming practices as a key part of helping to restore mental health for patients with everything from anxiety and depression, to bipolar disorder and schizophrenia. People receive therapy at facilities on the property while getting a chance to get their hands dirty in the fields or nurture the rabbits and chickens. 

For now, Dennis is thinking small. 

“We’re thinking, six to eight clients with two health care providers, a peer support specialist and a licensed clinical social worker,” she said. “I would be here to provide medication management and then, obviously, leadership and supervision.

“In that context, we offer clinical services that are combined with the outdoors.”

Her vision is to serve people recently discharged from a psychiatric hospital who are transitioning back into the community, in particular those on public insurance. To serve these folks, she hopes to offer “partial hospitalization,” a regimen designed to stave off the need for a full-blown hospital stay by having people in treatment for multiple hours a day. There would be “intensive outpatient” programs, where patients might spend half of their day in treatment. In addition to the more traditional talk therapy sessions, time will be built in for activities such as cultivating blueberries and blackberries, hoeing a row of greens or caring for long-haired angora rabbits. 

“I have this whole idea about the rabbits because they are these peaceful, little sweet creatures and they have to be brushed every day or they get tangles,” Dennis said, citing research showing that tending to and petting animals can be calming for people (and rabbits) and even reduce blood pressure.

“Most of us have had the experience of being in nature and in connection with the nonhuman world, and having somewhat transcendent experiences of feeling deeply peaceful, feeling less anxiety, feeling a sense of connection and calm, and feeling less anxiety about our … our purpose and our worthiness,” Dennis said. 

Psychiatrist Nora Dennis shows off seedlings for sale in a hoop house at Jubilee Healing Farm in Orange County. Credit: Rose Hoban

More formal therapy services will take place inside a newly renovated barn, an indoor facility with a kitchen, a circle of sofas and overstuffed chairs for group therapy sessions, and private rooms for individual therapy. The building is bathed in natural light.

Included in the barn is an open space for exercise, yoga or dance instruction, activities that Dennis worries are too often accessible only to the affluent.

“I’m wanting to support everybody’s right to move, everybody’s right to have fresh, healthy food, everybody’s right to sunlight,” Dennis said. “Trying to make sure these are available, especially when mental illness is part of the story, is really important.” 

“Each day there is movement. It’s not just all in your mind, right? It’s embodied,” she added. “It’s embodied not only in your own body, but also in the body of the earth and the plants and animals.”

Being patient

Right now, Jubilee Healing Farm looks like a work in progress. Deer fencing surrounds nearly two acres of newly planted fields and a hoop house filled with seedlings. There’s a hutch with three fuzzy angora rabbits. Two large fields have young plants, scrubby blueberry and blackberry bushes and rows of tiny green plants. In one corner of the fields are some scrawny fruit trees. 

Dennis said her grand plan could take a decade or more to achieve, but there will be steps along the way that bring fulfillment. “These plants are going to be producing blueberries in two years,” she said, waving her hand at rows of foot-high plants. 

Local farmer Howard Allen, a member of the Jubilee Healing Farm board, helped Dennis with a plan for the fields: fruit, an herb circle, orchards and a market garden. Allen also provides some therapeutic opportunities at his facility, Faithfull Farms, where he hosts clients and staff from a counseling center in Durham. 

shows a field with rows of young bushes surrounded by fencing. In the distance a cloud-filled sunset appears over a row of trees.
Volunteers helped Dennis plant hundreds of blueberry and blackberry bushes at Jubilee Healing Farm which will eventually provide outdoor opportunities for mental health patients. All the fruit will donated to a local food charity. Credit: Rose Hoban

“My advice was to do the things that were going to be long-term up front, which didn’t need any maintenance or major maintenance after being established,” Allen said. “Then things like the market garden, those things will be for last because they need almost day-to-day management, and it requires a lot more attention.”

Allen, who left a job as a chef and adjunct culinary arts professor to start a farm near Carrboro about seven years ago, provided Dennis with a dose of reality: It’s better to acknowledge that everything won’t happen overnight.

“​​Before I started doing this, and even at the beginning of doing this, I was really in a hurry,” Dennis said. “If something was delayed by a month or by a week, I would freak out about it.” 

Dennis says she’s getting used to having a more flexible timeline. That’s been therapeutic for her as she works to develop a natural, unhurried place where people with mental health problems can be nurtured as they nurture the flora and fauna around them.

“I think there’s something actually really soothing about that,” Dennis said.

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