What Forty Years of Practicing Psychiatry Has Taught Me About Getting Outside

When I graduated from what is now called Des Moines University in 1983, nobody was talking about green space as a mental health intervention. We had medications, therapy, and the hope that the two together could carry most people through. Forty years later, I still believe that. But I have also learned, both from the research and from watching patients over the course of careers and lifetimes, that what surrounds people matters more than we gave it credit for. 

Mental health disorders are now among the leading drivers of chronic illness and impaired daily life around the world, with rates of major depression continuing to rise (James et al., 2018; Hasin et al., 2018). I see the evidence of this every day in my practice in Des Moines. The need for effective, accessible support is real, and frankly, we don't have enough of the traditional kind to go around. Time spent outdoors in natural spaces — what researchers call nature-based interventions — has now been studied seriously enough to play a supporting role. Activities like group gardening, walking in green or blue spaces, and engaging in nature-based therapy produce real, measurable improvements in depression, anxiety, and overall mood across a wide range of people: healthy adults, older adults managing long-term conditions, and people with existing mental health diagnoses (Coventry et al., 2021). 

A beach posted with a do-not-swim advisory isn't a therapeutic resource. A lake rendered inaccessible due to algae blooms doesn't restore anybody. Protecting Iowa's water is also a mental health issue. The research on nature-based interventions assumes that people can actually get outside and use the spaces available to them — and in Iowa, that assumption is increasingly under pressure. Nitrate pollution, PFAS contamination, and harmful algal blooms regularly limit access to the state's beaches, rivers, and lakes. When we talk about protecting those places, we are also, whether we frame it this way or not, talking about the mental health of Iowans. 

What strikes me as a clinician is how approachable the dose turns out to be. The most effective programs in this body of research ran for eight to 12 weeks, with sessions between 20 and 90 minutes — not unlike a standard course of outpatient care (Coventry et al., 2021). Other research suggests that spending just 120 minutes a week in nature is associated with good health and wellbeing at the population level (White et al., 2019). Most of my patients could find that time if the spaces were there. 

Evidence is now strong enough to treat access to healthy outdoor spaces as part of how we support mental health — not a supplement to "real" care, but a genuine piece of the picture. And that means the fight for clean water and accessible natural spaces is a fight I think more people in health care should value. 

Forty years in this field has taught me to take what works seriously. This works.

References 

Coventry, P. A., Brown, J. V. E., Pervin, J., Brabyn, S., Pateman, R., Breedvelt, J., Gilbody, S., Stancliffe, R., McEachan, R., & White, P. C. L. (2021). Nature-based outdoor activities for mental and physical health: Systematic review and meta-analysis. SSM — Population Health, 16, 100934. https://doi.org/10.1016/j.ssmph.2021.100934 

Hasin, D. S., Sarvet, A. L., Meyers, J. L., Saha, T. D., Ruan, W. J., Stohl, M., & Grant, B. F. (2018). Epidemiology of adult DSM-5 major depressive disorder and its specifiers in the United States. JAMA Psychiatry, 75(4), 336–346. https://doi.org/10.1001/jamapsychiatry.2017.4602 

James, S. L., Abate, D., Abate, K. H., et al. (2018). Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017. The Lancet, 392(10159), 1789–1858. https://doi.org/10.1016/S0140-6736(18)32279-7 

White, M. P., Alcock, I., Grellier, J., Wheeler, B. W., Hartig, T., Warber, S. L., Bone, A., Depledge, M. H., & Fleming, L. E. (2019). Spending at least 120 minutes a week in nature is associated with good health and wellbeing. Scientific Reports, 9(1), 7730. https://doi.org/10.1038/s41598-019-44097-3 

About the Author

Dr. David Drake is a board-certified psychiatrist. He is a member of the Iowa Environmental Council Board of Directors. As an avid rower, he is active on the board of Des Moines Rowing, where he speaks for clean water for recreation and drinking. He is a past national president of Physicians for Social Responsibility (PSR). In his current part-time practice, he serves patients in Iowa and Colorado. He can be reached at drakeoffice@gmail.com.