Emotional safety in the wilderness

An abundance of research demonstrates the health benefits of time spent in nature, but there is also a growing understanding of the stress and emotional pressures that can arise from sustained periods of time spent in remote or extreme environments. Many expeditions and outdoor adventure projects, particularly those aimed at young people, foreground these challenges as routes toward personal development. The problem is that for this growth to occur, an expedition needs to be an emotionally safe space where both leaders and participants feel comfortable in speaking out and managing distress. This is not yet always the case and, in some situations, a lack of confidence is leading to undesired outcomes.

To foster meaningful change in an extreme environment safely, there needs to be greater awareness, training and competency to protect the mental health of participants on expeditions and in remote areas. We need to take our mental health as seriously as our physical health needs.

I spent time contemplating this issue while onboard the Tall Ship Pelican of London on a voyage from Costa Rica to Bermuda. The trip was part of a six-month sailing expedition for young people, in association with the German Youth Development Programme, Ocean College, and youth sailing charity, Seas Your Future. These progressive organisations, like many in the sector, have become increasingly aware of the need for more robust training around emotional health. Alongside my role as Expedition Doctor, I was invited to deliver mental health and wellbeing training to the young people and crew.

Feedback from these sessions revealed that some staff members had received mental health training in previous roles, but had often found that it was not relevant to their particular line of work or had struggled to see how it could be applied in a difficult situation. Many echoed concerns I had heard before from expedition leaders, describing feeling ‘out of their depth’ and ‘under confident’ when having sensitive conversations with young people.

It is clear that a fresh approach to mental health training for participants and leaders on expeditions is required. To be effective, that training must be environment, resource and context specific. It needs to go back to basics, replacing jargon with practical skills for handling challenging situations in the field. It should also build on an ethos of the expedition community, providing networks of support that empower group self-care.

In 2019, my Fellowship took me to the USA to research the impact of ‘talking circles’ in American Indian and Alaska native communities. In these communities, talking circles bring together people from the community to share their experiences and provide support for one another in a way that normalises and de-stigmatises distress. There is also a focus on spiritual aspects of health, such as our connections to each other, our environment and our personal story.

The driving force behind my research was my desire, as a GP, to find alternative approaches to support an increasing number of emotionally distressed patients whose problems, I believe, derive from a lack of community and social support outside of healthcare.

From my research in the USA, I developed the ‘Three Channel Talking Circle’ model to introduce the benefits of talking circles to Western communities. The model brings together elements of American Indian and Alaska native practice. It is relevant to Western culture but respectful of its origins. I have successfully used the model to support healthcare workers and community members remotely during the pandemic, and talking circles will also be a core element of a trauma and moral injury recovery retreat programme for health and social care workers that I am developing alongside two other ChurchillFellows.

My experience as an Expedition Doctor has taught me that an expedition is also a special type of community, and during my work aboard the Tall Ship Pelican, I realised that the findings of my Fellowship are applicable to this setting as well. In response to the need I have seen, I have designed a mental health training programme for expeditions and remote settings that draws on my Fellowship findings and incorporates the Three Channel Talking Circle model.

Incidents involving mental health are not uncommon on expeditions. This training programme has been developed to provide a comprehensive emotional safety net for those working in the field. The programme is an expansion, not a replacement, of currently available resources, adding emphasis to the day-to-day emotional wellbeing of a group to help prevent the problems caused by distress before they arise.

I had the opportunity to trial ideas from the programme during my recent sea voyage - and received positive feedback - with both young people and crew describing the talking circle as a useful space to reflect on past experiences and find resonance in others’ stories, which they felt enhanced collective resilience and group cohesion.

It is my hope that, with a proper support programme in place, we will be able to open up the unique experiences and benefits that expeditions can offer to a wider group of people, including those whose struggles with mental health might currently exclude them.

Coping strategies learned in extreme settings can be applied throughout our lives, building long-lasting resilience, confidence and self-esteem. This is the power of time spent in the wilderness and, if harnessed safely, it could improve wellbeing for us all.