The environments and contexts in which individuals are embedded have a clear role in triggering and maintaining mental health difficulties. Adventure and wilderness therapies provide a radically different environment and way of experiencing oneself. Such a context may facilitate change and support recovery and growth. This thesis examines the application of such therapies for individuals with mental health difficulties.
The first chapter reviews the evidence regarding sustained outcomes of adventure therapy for individuals with mental health and emotional disorders. Thirteen studies met the inclusion criteria, ten examining adolescents with mixed presentations and three focussing on adults with specific mental health conditions. There was evidence of significant follow-up outcomes (3-18 months) across the majority of clinical, behavioural, self-concept and quality of life measures. The promising findings, but generally ‘weak’ quality of these studies, call for further exploration of such approaches and more robust research designs.
The second chapter employed ethnography to examine sail-training as an adjunctive intervention for individuals open to Early Intervention for Psychosis Services (EIPS). The voyages presented a radical contextual shift characterised by purpose, structure and routine, an intensive and inescapable social environment, the introduction of challenge and adversity and a novel and changing ocean environment. This context supported several positive processes including active engagement and, through this, the development of skills, finding of roles, growing confidence, social-connection, resilience, and a shift in outlook characterised by aspiration for change. Individuals also experienced challenges, struggles and, at times, resistance. The approach has positive implications for social and functional recovery, and these are discussed in relation to its unique features. Areas for future research are also explored.
The final chapter discusses the broader implications of this research and introduces a process model developed during the empirical research. It concludes with the researcher’s personal reflections on the research process.