Occupational therapy from an ecosocial perspective of mental health

Abstract

It is described the experience of a therapeutic garden project located in the vicinity of the Psychiatry Service of the Guillermo Grant Benavente Hospital (HGGB) in Concepción, Chile, led by the Non-Governmental Organization Rebrota (ONG Rebrota) based on the ecosocial perspective applied in people with mental health needs. It aims to analyze this Eco-social Occupational Therapy experience as a practical tool for the transformation of territories, allowing occupational therapists to understand the interaction between society and nature as a socio-ecological process that impacts different spheres of human beings, especially in social participation and mental health. Using the descriptive methodology of the Eco-social Entrepreneurship Process Model, we carry out a practical orientation of actions so that communities, inserted in their natural and cultural environments, can discover themselves reflexively, generating collective health processes. Eco-social Occupational Therapy develops practices that improve health and promotes the well-being of individuals, groups and/or communities, generating a positive impact on socio-ecosystems and building healthier, more inclusive, and sustainable communities. Eco-social Occupational Therapy is an invitation to generate research-action projects to mitigate the social impact on nature in a context of the climate crisis, where we find communities in the genesis of transcultural knowledge that allows us to develop a transformative praxis for good living in tune with our environment; while improving their well-being and participation, from a human rights and occupational justice perspectives.

Keywords:
Mental Health; Occupational Therapy; Social Environment; Horticultural Therapy; Public Health

Resumen

Se describe la experiencia de un proyecto de huerta terapéutica ubicada en las inmediaciones del Servicio de psiquiatría del Hospital Guillermo Grant Benavente (HGGB) de Concepción, Chile, liderada por la Organización No Gubernamental Rebrota (ONG Rebrota) en base a la perspectiva eco-social aplicada en personas con necesidades de salud mental. Se objetiva analizar la experiencia de Terapia Ocupacional Ecosocial como herramienta práctica para la transformación de los territorios, permitiendo a los terapeutas ocupacionales comprender la interacción entre la sociedad y la naturaleza como un proceso socioecológico que impacta en diferentes esferas de los seres humanos, especialmente en la participación social y la salud mental. Utilizando la metodología descriptiva del Modelo Procesal de Emprendimiento Eco-social realizamos una orientación práctica de acciones para que las comunidades, insertas en sus entornos naturales y culturales, logren descubrirse reflexivamente generando procesos de salud colectiva. La Terapia Ocupacional Ecosocial desarrolla praxis que mejoran la salud y promueven el bienestar de las personas, grupos y/o comunidades, generando un impacto positivo en los socio-ecosistemas y construyen comunidades más saludables, inclusivas, sostenibles. La Terapia Ocupacional Ecosocial es una invitación a generar proyectos de investigación-acción para mitigar el impacto social sobre la naturaleza en un contexto de crisis climática, donde encontramos comunidades en la génesis de saberes transculturales que nos permitan desarrollar una praxis transformadora para el buen vivir en sintonía con nuestro entorno; mientras mejoran su bienestar y participación, desde una perspectiva de derechos humanos y justicia ocupacional.

Palabras-clave:
Salud Mental; Terapia Ocupacional; Medio Social; Terapia Hortícola; Salud Colectiva

Introduction

Contact with nature for therapeutic purposes is a well-used practice in various parts of the planet. The following publication describes and analyzes the experience of a therapeutic garden project located in the vicinity of the Psychiatry Department of the Guillermo Grant Benavente Hospital (HGGB) in Concepción, Chile, led by the non-governmental organization Rebrota (ONG Rebrota), in an international alliance with the UVIC-UCC University (Spain) based on the eco-social perspective applied to people with mental health needs.

ONG Rebrota is a community organization mainly of professionals and volunteers students of Occupational Therapy and Plant Biotechnology Engineering that provides knowledge of horticultural therapy and sustainability through the execution of eco-social projects in the Metropolitan Area of Concepción, to collaborate in the development of collective health and the environment.

Mental health

Mental health is one of the pending debts of contemporary societies. The World Health Organization (WHO) estimates that 25% of the world's population has mental health problems. The CoVID-19 pandemic worryingly worsened this panorama, bringing with it economic consequences and the mental health of the population. The importance of social determinants of mental health includes not only individual characteristics such as managing our thoughts, emotions, and interactions with others, but also cultural, economic, political, and environmental factors such as social protection, the standard of living, working conditions or social support (Organización Mundial de la Salud, 2013).

The history of mental health has been marked by the hegemonic idea of a “sane society” over those who suffer from “madness”, generating health/disease processes ruled one over the other, that is to say, both the illnesses and the responses towards them, constitute structural processes in every system and social group, and that, consequently, these systems and social groups not only generate representations and practices but also structure a knowledge to face, coexist, solve and eradicate suffering.

The most common exercise in hegemonic practices -especially in biomedical psychiatry- has been their detachment from the sociohistorical contexts in which they participate (Martínez-Hernáez & Correa-Urquiza, 2017). An exercise that is expressed in the naturalization and concealment of the social relations of production, both diseases and forms of treatment. Thus, in the first instance, the subject who suffers is transformed into an object and, therefore, reduced to a pre-social situation, psychobiological dysfunctions, and neuro-humoral and/or emotional imbalances.

The health/disease process operates in most of the current Latin American societies in a heterogeneous socio-cultural field, which implies the existence of different forms of inequality and social stratification, which suppose not only the presence of relations of socioeconomic exploitation but also of hegemony/subalternity in ideological-cultural terms, at the level of subjects, institutions, and social groups (Menéndez, 1994). The disorders of social origin are labeled and therefore treated as mental health problems, blaming the people who suffer from them. A psychiatrization of social malaise is produced (Rendueles, 2006).

Collective health

In the 1970s, health was relegated in Latin America, a time when most of the countries went through dictatorial political processes, and deteriorating social, economic, and health conditions. In this context, Collective Health emerges as a form of struggle and resistance, understood as the knowledge that seeks to study the social and health reality and, at the same time, propose alternatives to intervene positively in it (Velandia, 2005).

Within the framework of bringing together the contributions of the most diverse knowledge for the process of construction of collective health, the different resources of environmental sciences are essential for research and health practices. However, its scope is limited since health is not restricted to biological records (Cruz-Velandia et al., 2015). For this reason, the constitution of the theoretical discourse of Collective Health, with the introduction of the human sciences in the field of health, restructures the field, highlighting the philosophical, ethical, political, and socioeconomic dimensions of the health-disease process (Almeida-Filho, 2006). Thus, in Collective Health, health is not pursued as an objective; it is the energy of life. It is not only the result of the action of certain institutions (Community Health) but also responds to the feelings of individuals and human groups (Menéndez, 1994).

Socio-ecology

The human footprint in nature has been increasing exponentially due to factors such as deforestation, extractivism, and unplanned urbanization, generating imbalances in nature, and significantly diverting the natural behavior of ecosystems (Crutzen, 2002) causing the current climate crisis. Because of this, there have been unprecedented losses in biological and cultural diversity in recent decades. Therefore, the human relationship with ecological systems is breaking down in terms of livelihoods, governance, institutions, resource pools, and cultural traditions (Abel et al., 2006; Folke et al., 2007).

Damage to natural capital for quick economic returns generates a rapid disconnection with the land and can damage and even destroy cultures that have been closely linked to their environments (Cernea, 1997; Alfred, 2009). This also can lead to mental and psychological illnesses (Albrecht, 2010). Society is increasingly disconnected from nature, but never has such a large percentage of humanity been so far from it. As early as 2008, the WHO stated that mental disorders are the main cause of disability in middle- to high-income countries, and evidence suggests that this increase may, in part, be associated with increased urbanization (Sundquist et al., 2004) and detachment from the natural environments where people evolved and are therefore best adapted to (Kaplan & Kaplan, 1989). Therefore, it can be said that the problems traditionally categorized as “environmental” have social causes and consequences.

It seems that the human being has a certain tendency to seek and connect with nature, which is defined as the close relationship that the human being has with all living beings (Nisbet et al., 2009). This connection was proposed by (Wilson, 1984) who states that the human being brings this connection with him by keeping his roots in biology, from this conceptualization Biophilia is born, exposing that it is the innate tendency of all human beings to feel identified with nature, being this of genetic origin, and the result of our evolution in natural spaces. Reciprocally, “human” problems are linked to ecosystems and biodiversity (Anderson et al., 2015).

Socio-ecology deals with the interactions between society and nature, specifically, in the dynamic nature of their interactions (Kates et al., 2001), and environmental, conservation and health management has gained great importance because it promotes various advantages. However, it is also subject to challenges in which all types of social, political, and economic actors must participate (Olmos-Martínez & Ortega-Rubio, 2020), being as a contribution of new visions to different health processes, enriching the discussion with a transdisciplinary perspective.

Eco-social occupational therapy

Occupational ecology is defined as a double action-reflection movement, understood as the awareness of the ecological genocide that we are facing and that endangers ecosystems and humanity, as a moment of reflection. It must be followed by the taking of proactive measures to, through the occupation, restore the balance with Nature, as a moment of action (Algado, 2012). It is essential to understand how the occupational patterns of production within the framework of a neoliberal capitalist economy are damaging the environment from the search for economic growth that is unsustainable (Algado & Townsend, 2015). For this reason, it is essential to develop economic alternatives, such as social entrepreneurship (Algado & Oller, 2013), which seeks innovative solutions to the main social and ecological problems of the planet from an alternative to the neoliberal capitalist economy.

Occupational ecology is consistent with sustainable development and serene degrowth (Latouche, 2009), which proposes living with a standard of living compatible with a sustainable ecological footprint since the human occupation is the means to recycle, relocate, reduce and reuse. Also, the principle of responsibility that Jonas (1995) proposes to us emphasizes the importance of human action: act in such a way that the effects of your action are compatible with the permanence of an authentic human life on Earth.

Therefore, occupational ecology is proposed to support collective health processes, where communities, about their natural contexts, have the conditions to discover as part of their history and the natural environment. This enables the promotion of different spheres of the human being, mental health among them, and making effective the mutualism of the human with the environment, using occupational and ecological awareness, reducing the ecological footprint of our species on ecosystems and working actively for the restoration of the natural environment from human occupation. All this is for the development of Eco-social Occupational Therapy (Algado, 2012), based on the construction of healthy, inclusive, and sustainable communities, opening a field of possibilities for Occupational Sciences. The same author (Algado, 2023) has defined occupational ecology as the study of the deep and inseparable connection between human occupation and the ecological environment. Occupational ecology emerges as a field of study of occupational science from an interprofessional and transdisciplinary dialogue.

Thus, it also marks a path for eco-social development (Figure 1), using the Eco-social Entrepreneurship Process Model (Simó Algado, personal communication, March 10, 2022) which is constituted as a descriptive methodology based on 10 steps or procedures that allow the elaboration of a strategy for the evaluation, implementation, and investigation of eco-social projects, ensuring the parameters of occupational justice and sustainability. It guides and organizes the praxis of eco-social Occupational Therapy focused on social entrepreneurship and which seeks to develop contributions to mental health from a harmonious relationship of people with the environment and to do so by bringing individuals and communities closer to health, well-being, inclusion, and sustainability through the development of occupations in the natural environment, from a healthy way and that allows through actions to recover and mitigate the effects of climate change produced by humans.

Figure 1
Model proposal for eco-social enterprises by Algado (2012).

Therapeutic garden experience “Cerro Comestible”, an eco-social perspective of mental health

The therapeutic garden experience began in 2016, established thanks to the triple alliance between the Association of users and relatives of people with psychosocial diversity “Razón de Vivir”, the Occupational Therapy Unit (UNITO) of the HGGB Psychiatry Service and the NGO Rebrota, to recover an abandoned greenhouse to promote and develop an environmental culture with a therapeutic approach. The collaboration between them gives shape to the “Cerro Comestible” project, in an international synergy with the Miquel Martí i Pol garden project, developed at the UVic-UCC, Catalonia, Spain.

The analysis of this cooperative work is based on Salvador Simó's eco-social entrepreneurship model. Each of these phases is described below in the “Cerro Comestible” therapeutic garden experience.

Identifying occupational areas

Life is not a problem to be solved, but a reality that must be fully experienced.

Soren Kierkegaard

For occupational therapists, occupational areas are understood as environments where meaningful activities can be carried out, and where we can intervene whenever there is risk and/or occupational dysfunction, due to physical, psychological, cognitive, social, economic, or ecological causes.

Initially, the occupational therapists from ONG Rebrota organize a participatory diagnosis, linking the main actors involved in the project, to identify the occupational areas to be treated and contextualize them. For this, a D.A.F.O analysis is applied, which consists of evaluating the strong and weak factors that, as a whole, diagnose the internal situation of an organization, as well as its external evaluation, that is, the opportunities and threats (Sarli et al., 2015). It is essential to always start from the identification of the strengths, as well as the opportunities, not staying only in the negative aspects (problems and threats). The theme identified in Cerro Comestible is the lack of significant occupations in the natural environment for people with mental health problems, both at the level of productivity, leisure and self-maintenance. Thus, on the one hand, a context marked by the serious ecological crisis and, on the other hand, by a biomedical model of mental health, psychiatric stigma, and social and labor exclusion in mental illness where the CoVID-19 pandemic aggravates this situation.

Ethical, philosophical, and theoretical principles

A complex reality can only be approached from a complex intervention.

Edgar Morin

The transformation processes must be fueled by passion since we cannot start them from demoralization. It is necessary to overcome the current fatalism, to recover faith in the human being and in our ability to create a fairer and more beautiful reality. We must be resilient to face the difficulties of all projects. For this, we are inspired by the Ethics of liberation (Dussel, 2006), which prioritizes communities in a situation of exclusion, understanding that suffering, more than admiration, makes one think (Boff, 2001). We must also take care of our well-being and the environment and be in contact with those occupations and people that inspire us, subscribing to the postulates of Jonas's (Jonas, 2001) ethics of responsibility.

The actions of ONG Rebrota are oriented towards biophilia and socio-ecology, which permanently invites us to rethink our relationship with Nature; how we coexist among humans and with All. In turn, we are based on a humanist vision, seeking to recover human dignity, through horizontal relationships, decision-making, and teamwork, prioritizing the potential of people and community resources, from empowerment.

Occupational Therapy as a science and discipline provides content, both for the support of our practices and for their understanding and analysis, either from occupational justice and occupational ecology to related knowledge, such as permaculture, socio-ecology, and architecture, among others.

In this case, occupational justice and occupational ecology are the two main edges. We understand occupational justice as the fulfillment of the right of all people to participate in the occupations they need to survive, because they define them as significant, and because they contribute positively to their well-being and their communities. While Algado (2012) initially defined occupational ecology as a double movement of action-reflection, understood as the awareness of the ecological crisis that we are facing that endangers Life on Earth, now is the time of reflection, which must be followed by taking proactive measures, through human occupation, to restore balance with the environment, it is time for action. Thus, we propose a work from the validation of personal experience where what prevails is the being and its motivation to participate, without making a difference between those who come from the mental health network, from the general community, or those who facilitate the therapeutic processes. For the progress in the recovery of the natural space, teamwork towards the common good is relevant, but, above all, in the exercise of the will of those who attend this place, their respect for psychosocial diversity and natural biodiversity, to develop social and ecological awareness.

Creation of strategic alliances

When one dreams alone it is a dream, when two or more dream together it is the beginning of a new reality.

Helder Camera

The creation of alliances, with the public sector, the third sector, and the business sector, in collaboration with the university, has been crucial to ensuring the sustainability of the project. It was important to generate and maintain individual and collective alliances that would make it possible to take advantage of the work energy and not stop the synergy that this therapeutic space gained.

As already described, the “Cerro Comestible” project was born thanks to the articulation of 3 organizations, the “Razón de vivir” Association, the UNITO of the Psychiatry Service, and the NGO Rebrota. The first group facilitates the use of the greenhouse for the execution of the project and links its active partners for the co-construction of the space. The second entity collaborates with the therapeutic human resource, having occupational therapists to facilitate the exit of people from hospitalization and the use of green areas. While the third organization contributes with technical support from the area of agricultural production and horticultural therapy¹. As spaces are recovered, actors are added to advance the proposal.

Given the current destruction of community ties, aggravated by the recent COVID-19 pandemic, the fundamental thing is the recovery of the social fabric, creating new articulations between people and groups, generating instances that promote the exchange of knowledge and mutualism. Today there are more than 50 social organizations and public-private institutions that have formed a social fabric, with whom we share an interest in health and caring for nature and people (Figure 2).

Figure 2
Organizations participating in the Cerro Comestible project.

The objective of this network is to replicate, in other parts of the territory, the ecological actions practiced in the Cerro Comestible project.

Health with the color blue, territorial with purple, educational with pink, and environmental with green. Shapes represent the nature of the organization: rectangular is the public and hexagonal is the private organization.

Negotiate objectives and plan of action

Human action is our ability to create miracles.

Hannah Arendt

Once the occupational areas and the DAFO have been identified, we establish the objectives of the intervention from negotiation and consensus among the team, relating them to the Sustainable Development Goals of Cortés (2018), for example, Health and Well-being, Reduction of Inequalities, Sustainable Cities and Communities, and Life on Land Ecosystems. They can be considered considering the SMART methodology (Doran, 1981) that delimits in a very specific way how to outline the purposes of our project to increase the chances of success, promoting simple, measurable, achievable, relevant, and limited objectives in the time.

Holistic actions are promoted that broaden the concept of well-being, integrating the social and ecological from Eco-social Occupational Therapy. Likewise, considering the human-nature relationship from codependency and the benefits it offers on the physical, emotional, mental, and spiritual-existential, we use the horticultural therapy and popular education of Paulo Freire (Freire, 2005) as practical tools for the creation of an urban socio-ecological space, which contributes to the collective processes of human and environmental health, above all, in a State-administered property.

The planning of these actions is based on the opening of a therapeutic space adjacent to the HGGB Psychiatry Service, providing an alternative to the mental health processes of those who come there, and creating a healthy, community, and sustainable environment. The NGO Rebrota has currently set up 4 community work areas (A nursery for plant production, an orchard/edible forest for food production, composting for the production of soil and substrate, and an apiary area where bee melliferous hives are established), which has allowed prioritizing the actions to be carried out based on the needs for advancement of the therapeutic garden and this, in turn, allows people to choose, based on their interests, in which of the activities to get involved. Responsible people are always designated at the beginning of each day to encourage the participation of users and their families. Even though only one day a week has been set aside for volunteer activities, on average 60 people attend weekly given the diversity of actions that are carried out each day. The link with the general community is produced by various means, either through social networks, through the Universities in which we maintain alliances, through the media such as the local press and television, and even by personal invitation from those who already know the experience, always considering people with reduced opportunities to participate in society as the target population. This is essential to promote the well-being and social inclusion of people excluded by psychiatric stigma.

Financing

Only the fool confuses value and price.

Francisco Quevedo

Financing is key to the sustainability of projects. We consider both economic capital and social capital, which is understood as a series of resources available to individuals derived from their participation in shared social networks (Medina, 2011). To achieve this, we resort to 4 economic spheres:

Private: Direct financing through alliances with Mental Health Care Centers, who attend Cerro Comestible with their users to participate in horticultural therapy sessions. Also with Universities, mainly from the city of Concepción, undergraduate students of Occupational Therapy, Psychology, and Engineering in Conservation of Natural Resources, who attend the place (practice center) to contribute their knowledge to the project and collaborate with the therapeutic processes. This allows the payment of two occupational therapists members of the NGO Rebrota.

Public: Competitive funds such as the National Fund for Inclusive Projects (FONAPI- Fondo Nacional de Proyectos Inclusivos) of the National Disability Service, in which we built a vermicomposting factory to open a workshop for those who come to Cerro Comestible. Also with funds from the National Youth Institute (INJUV- Instituto Nacional de la Juventud), we provide knowledge to those who participated in theoretical/practical workshops on agroecology, while we installed technical irrigation systems, rainwater collection systems, and improved cultivation areas. Through the municipality of Concepción, we were able to access the construction of a greenhouse and sprouter. These infrastructures allowed us to reduce working hours in irrigation, establish meeting and work points, long-term planning, and germinate seeds in advance, which, in turn, allowed us to focus on other processes in the garden, such as creating socialization space and authorization of other cultivation spaces.

Civic: Donations and exchanges between people who give their energy to continue with the work zones. In addition, we generate alliances with other civil society organizations such as Fundación Desafío “Levantemos Chile”, which has collaborated in the redesign of work areas or the Cultural Center “La vertiente” who have involved us in the execution of their projects to benefit us with technical advice, purchase of inputs and construction of areas for cultivation.

Social enterprise: Our goal is to improve and increase the level of our economic income and move towards the formation of a social enterprise. The creation of a home organic waste collection service has allowed us to maintain an inclusive workspace with a therapeutic approach, where one person who attends the community garden receives an economic incentive. This leads us to our need to respond to the low employability that exists in the country towards people with psychosocial disabilities.

Education

Education doesn't change the world, it changes people. They are going to change the world.

Paulo Freire

We can enrich eco-social projects from strategies such as Service Learning, where students learn while providing a service to the community that becomes a living laboratory (Algado et al., 2014), in places of knowledge exchange. These projects can be awareness scenarios, where knowledge ignored by academia is valued, from sociology of emergencies (Santos, 2013).

During these years, we have generated various learning services for the community. Students from different areas of environmental, social, and health knowledge, among others, from various universities, have collaborated with practices and research related to agroecology, bioconstruction, and organizational diagnosis. These instances have enriched the project, allowing an exchange of knowledge, while progress is being made in its strengthening. And a crucial learning activity for the project is the self-styled “Training Circle” (CdF- Círculo de Formación), where ONG Rebrota opens as a professional practice opportunity for fifth-year students of the Occupational Therapy career with the aim that interns learn about the eco-social paradigm and expand their radius of action in the future exercise of the profession. During their time at the CdF, the colleagues in training are linked to various communities and organizations, facilitating mental health services, horticultural therapy, and community strengthening.

Innovation

The problem is that we are repetitive when we must be creative.

David Bohm

Innovation, not always technological, and the incorporation of new technologies are key in the development of projects.

One of the main objectives of “Cerro Comestible” is to make peasant technologies available to the community, implementing a therapeutic and community garden in a public health device, open 3 times a week, where knowledge and experiences are shared to strengthen this type of regenerative agriculture. Each of the mentioned project areas has been implemented with agroecological principles and techniques and abandoned spaces and structures have been recovered with environmentally friendly construction techniques (bioconstruction), mainly using mud, taking advantage of the abundant clay available in the space. In the exchange and transfer of this type of knowledge to the communities, bringing peasant technologies to urban spaces, we believe that new ways of creating community and creating local projects can be found, broadening the perspective from a transdisciplinary approach. Based on this, the weekly activities are open to the community, allowing the confluence of a diversity of experiential and academic knowledge. Precisely the opening to this knowledge facilitates the self-organization of theoretical or practical instances so that constructive solutions that are friendly to the environment and at low cost are proposed.

Communication

A project that does not communicate... does not exist.

Salvador Simó

Every project must have a good communication policy. This should be focused on the general, professional, and scientific communities.

We currently use Instagram (@rebrotacl) and Facebook (@rebrotachile) as the main source of dissemination, where we interact with the community, share activities, and expanded information on our actions. In addition, we hold workshops and talks to publicize this project nationally and internationally.

We have also participated in presentations at Seminars and Congresses to share the experience of the “Cerro Comestible” from the analysis of different perspectives, such as the first Day of Community Rehabilitation of Maule, the Second Chilean Colloquium of Socio-ecology in Concepción, the Second Meeting of the Human Occupation Model in Valparaíso and the first Latin American Meeting on the right to madness in Santiago de Chile, in each one, the eco-social perspective was exposed as a methodology that offers the possibility of transforming the territories practically.

The main communication platform is Cerro Comestible, where we have opened a meeting and socialization space between cultivation areas. It is there where the instructions for each day are delivered, spaces are designed, decisions are made, knowledge and food are shared, and we tell each other our successes and mistakes. In this place, hidden between the hills, not only does the communion of ideas and foundations between professions and life experiences take place, but it is also a zone of reflection, active listening, and containment for those who seek comfort for mental and emotional suffering.

Investigation action

It is necessary to combine the cycles of reflection with those of action, such as the movements of the systole and diastole of the human being.

Emmanuel Mounier

In the project, we interspersed the cycles of reflection with action. Research allows us to create knowledge and ensure that our actions are on the right track, working from an intervention based on scientific evidence, having current knowledge of interventions and experiences with proven efficacy and methodological bases like ours, to systematize our work and receive feedback from those who participate in these research and dissemination spaces. In addition, to generate peer-reviewed endorsements that demonstrate that the health benefits, through the human-nature relationship, are applicable.

A hermeneutic paradigm based on our ability to understand complex human phenomena is privileged, through listening; and critical, based on our ability to improve social reality and the belief in the dignity of the human being. For this reason, we prioritize Participatory Action Research strategies, planning our actions for recovery and maintenance of work areas based on what has been observed in previous efforts. The continuous evaluation and organization of the information collected, both on the therapeutic processes and the planting, cultivation, and behavior of the place during our socio-ecological protection and restoration actions, is decisive for the project to be sustainable and scale up.

Scalability and replicability

Lots of little people, in little places, doing little things, can change the world.

Eduardo Galeano

Projects must be scalable and replicable. Scalability calls for each project to have the capacity to grow and take on new challenges, but always within sustainability parameters, and replicability is understood as the versatility to adapt to different environments with relevant cultural adaptations and relevant contextualization.

The “Cerro comestible” project began with the idea of recovering the greenhouse as a space for therapeutic use, transforming it into a community and educational garden, and unintentionally, into a model center. Currently, it is visited by people and organizations, where Rebrota provides support to those who seek to promote the creation of eco-social projects. The last objective that we have set ourselves is to co-create the first Therapeutic Park at the national level, located in a public health facility and in the heart of the city, where people can visit and learn about peasant technologies, while they find health in a space of contemplation in contact with nature.

Discussion

In this context highlighted by the serious climatic crisis that `endangers the survival of the ecosystems and Huamndiad, it is vital to develop a transformative praxis of the territories and their communities from an occupational ecology. This supposes a moment of awareness and reflection about the anthropogenic impact on Nature and the environmental crisis to which it has led us and that must be followed by determined action, through human occupation, for the restoration of the damage caused and promote sustainability.

Eco-social Occupational Therapy develops praxis that improves health and promotes the well-being of individuals, groups, and/or communities, generating a positive impact on socio-ecosystems from the co-construction of healthier, more inclusive, sustainable communities (Algado, 2012) and is close to the postulates of Social Occupational Therapy (Barros et al., 2002; Esquerdo et al., 2015) as the field of reflection and intervention, sociologically defined from the attention to social groups in processes breaking social support networks.

The praxis from Eco-social Occupational Therapy can be a contribution to a new approach to mental health, transcending from a model marked by psychiatric hegemony, with a curative approach to health, to a model based on the capacities of people, in which community resources and natural contexts. The objective is to help people in the construction of a life project full of meaning (Guzman & Algado, 2014), through the development of significant occupations, defined as that crossroads between needs, potential, and spirituality of the person (Algado & Burgman, 2006). Precisely the development of spirituality is what refers us to the dimensions of meaning and connection with oneself, others, and Everything.

The development of occupations in nature, such as horticulture, has value, not only in therapeutic but also in social and labor inclusion, especially for people with few opportunities to participate in society, considering universal human rights. Likewise, this type of community activity in natural environments can promote equal opportunities for people with disabilities, ensuring what is agreed upon in the United Nations International Convention on the Rights of People with Disabilities.

The Eco-social Entrepreneurship Model can be a tool, as a guide of aspects to consider or a list of possibilities for projects, inviting us to focus our gaze on the environment, decentralizing being as an objective, understanding that the reciprocity of this action human occupation is born and that the person is one of the elements to take care of the entire ecosystem that we call nature. It provides therapists with a culturally safe model, referring to its adaptability to the cultural context in which it can be implemented, being respectful of the history and traditions of each territory where it is used, being accessible and replicable, allowing us to participate as a discipline of conservation and protection of socio-ecosystems, being an opportunity to enjoy the available resources.

The development of actions of Horticultural Therapy and Eco-social Occupational Therapy opens up an alternative understanding of the health/disease process from the perspective of those who live and experience mental illness, supporting what is alluded to by the Collective Health Model.

The dialogue of Eco-social Occupational Therapy and the Science of Occupation from Occupational Ecology with disciplines such as Socio-ecology enriches us as a profession and allows the course of our actions to have an impact on the health, social participation, occupational justice, and sustainability. of the planet.

• 1
  Horticultural therapy: an active process that occurs within an established treatment plan, consisting of the performance of horticultural or gardening activities, facilitated by a qualified horticultural therapist, to achieve specific and documented treatment goals.
• How to cite: Mansilla, O. Q., Ojeda, C. P., Neira, P., & Algado, S. S. (2023). Occupational therapy from an ecosocial perspective of mental health. Cadernos Brasileiros de Terapia Ocupacional, 31, e3365. https://doi.org/10.1590/2526-8910.ctoRE257533652
• Funding Source Partial funding (Fondo Nacional de Discapacidad - FONAPI, Servicio Nacional de Discapacidad SENADIS).

Referencias

• Abel, N., Cumming, D. H., & Anderies, J. M. (2006). Collapse and reorganization in social-ecological systems: questions, some ideas, and policy implications. Ecology and Society, 11(1), 17.
• Albrecht, G. (2010). Solastalgia and the creation of new ways of living. In S. E. Pilgrim & J. Pretty (Eds.), Nature and culture: rebuilding lost connections (pp. 207-234). Londres: Earthscan.
• Alfred, G. T. (2009). Colonialism and state dependency. International Journal of Indigenous Health, 5(2), 42-60.
• Algado, S. S. (2012). Terapia ocupacional eco-social: hacia una ecología ocupacional. Cadernos de Terapia Ocupacional da UFSCar, 20(1), 7-16. http://dx.doi.org/10.4322/cto.2012.001
  » http://dx.doi.org/10.4322/cto.2012.001
• Algado, S. S. (2023). Occupational ecology: an emerging field for occupational science. Jorunal of Occupational Science. In press.
• Algado, S. S., & Burgman, I. (2006). Intervención mediante terapia ocupacional con niños supervivientes de conflicto bélico. In F. Kronenberg, S. S. Simó & N. Pollard (Eds.), Terapia ocupacional sin fronteras: aprendiendo del espíritu de supervivientes (pp. 246-261). Madrid: Editorial Médica Panamericana.
• Algado, S. S., & Oller, J. (2013). Terapia ocupacional y emprendedoria social: un diálogo necesario. TOG (A Coruña), 10(17), 1-19. Recuperado el 27 de noviembre de 2022, de http://dialnet.unirioja.es/descarga/articulo/4509196.pdf
  » http://dialnet.unirioja.es/descarga/articulo/4509196.pdf
• Algado, S. S., & Townsend, E. A. (2015). Eco-social occupational therapy. British Journal of Occupational Therapy, 78(3), 182-186. http://dx.doi.org/10.1177/0308022614561239
  » http://dx.doi.org/10.1177/0308022614561239
• Algado, S. S., Ginesta P. X., & Eugenio, V. J. S. (2014). Aprendizaje servicio universitario: creando empleo a partir de la emprendeduría social. Historia y Comunicación Social,18(Spe), 627-638. https://doi.org/10.5209/rev_HICS.2013.v18.44265
  » https://doi.org/10.5209/rev_HICS.2013.v18.44265
• Almeida-Filho, N. (2006). Complejidad y transdisciplinariedad en el campo de la salud colectiva: evaluación de conceptos y aplicaciones. Salud Colectiva, 2(2), 123-146.
• Anderson, C. B., Pizarro, P. J. C., Fontana, E. R. J., Sapoznikow, A., Pauchard, A., Barbosa, O., & Valenzuela, A. E. J. (2015). ¿ Estamos avanzando hacía una socio-ecología? Reflexiones sobre la integración de las dimensiones” humanas” en la ecología en el sur de América. Ecología Austral, 25(3), 263-272.
• Barros, D. D., Ghirardi, M. I. G., & Lopes, R. E. (2002). Terapia ocupacional social. Revista de Terapia Ocupacional da Universidade de São Paulo, 13(3), 95-103. http://dx.doi.org/10.11606/issn.2238-6149.v13i3p95-103
  » http://dx.doi.org/10.11606/issn.2238-6149.v13i3p95-103
• Boff, L. (2001). Espiritualidade: um caminho de transformação Rio de Janeiro: Sextante.
• Cernea, M. (1997). The risks and reconstruction model for resettling displaced populations. World Development, 25(10), 1569-1587. http://dx.doi.org/10.1016/S0305-750X(97)00054-5
  » http://dx.doi.org/10.1016/S0305-750X(97)00054-5
• Cortés, R. P. (2018). La Agenda 2030 y sus Objetivos de Desarrollo Sostenible. Revista de Derecho Ambiental, 6(10), 99-121.
• Crutzen, P. J. (2002). The “anthropocene”. Journal de Physique IV Proceedings, 12(10), 1-5. http://dx.doi.org/10.1051/jp4:20020447
  » http://dx.doi.org/10.1051/jp4:20020447
• Cruz-Velandia, I., Ruiz, S. G., Rodríguez-Prieto, I., Rojas-Cárdenas, A., & Chaves-Ortiz, V. (2015). Configuración política de la categoría discapacidad en Colombia: relación Estado y ciudadanía. Revista de la Facultad de Medicina, 63(3), 25-32. http://dx.doi.org/10.15446/revfacmed.v63n3sup.49350
  » http://dx.doi.org/10.15446/revfacmed.v63n3sup.49350
• Doran, G. T. (1981). There’s a S.M.A.R.T. way to write management’s goals and objectives. Management Review, 70(11), 35-36.
• Dussel, E. (2006). Ética de la liberación en la sociedad de la globalización y la exclusión Madrid: Editorial Trotta.
• Esquerdo, L. R., Malfitano, A. P., Silva, C. R., & Borba, P. (2015). Historia, conceptos y propuestas en la terapia ocupacional social de Brasil. Revista Chilena de Terapia Ocupacional, 15(1), 73-84. http://dx.doi.org/10.5354/0719-5346.2015.37132
  » http://dx.doi.org/10.5354/0719-5346.2015.37132
• Folke, C., Pritchard Junior, L., Berkes, F., Colding, J., & Svedin, U. (2007). The problem of fit between ecosystems and institutions: ten years later. Ecology and Society, 12(1), 30.
• Freire, P. (2005). Pedagogía del oprimido Ciudad de México: Siglo XXI.
• Guzman, S., & Algado, S. (2014). Construyendo proyectos de vida con personas supervivientes de enfermedad mental. TOG (A Coruña), 11(19), 1-25.
• Jonas, H. (1995). El principio de responsabilidad: ensayo de una ética para la civilización tecnológica Barcelona: Herder Editorial.
• Jonas, H. (2001). Más cerca del perverso fin y otros diálogos y ensayos Madrid: Los Libros de la Catarata.
• Kaplan, R., & Kaplan, S. (1989). The experience of nature: apsychological perspective New York: Cambridge University Press.
• Kates, R., Clark, W. C., Corell, R., Hall, J. M., Jaeger, C. C., Lowe, I., McCarthy, J. J., Schellnhuber, H. J., Bolin, B., Dickson, N. M., Faucheux, S., Gallopin, G. C., Grübler, A., Huntley, B., Jäger, J., Jodha, N. S., Kasperson, R. E., Mabogunje, A., Matson, P., Mooney, H., Moore, B., O’Riordan, T., & Svedin, U. (2001). Sustainability science. Science, 292(5517), 641-642.
• Latouche, S. (2009). Petit tractat del decreixement serè València: tres i Quatre/Institut del Territori. Documents d’Analisi Geografica, 58(1), 201-203.
• Martínez-Hernáez, A., & Correa-Urquiza, M. (2017). Un saber menos dado: nuevos posicionamientos en el campo de la salud mental colectiva. Salud Colectiva, 13(2), 267-278. http://dx.doi.org/10.18294/sc.2017.1168
  » http://dx.doi.org/10.18294/sc.2017.1168
• Medina, J. I. G. V. (2011). Una definición estructural de capital social. Revista Hispana para el Análisis de Redes Sociales, 20, 132-160.
• Menéndez, E. (1994). La enfermedad y la curación. ¿Qué es medicina tradicional? Alteridades, 4(7), 71-83.
• Nisbet, E. K., Zelenski, J. M., & Murphy, S. A. (2009). The nature relatedness scale: linking individuals’ connection with nature to environmental concern and behavior. Environment and Behavior, 41(5), 715-740. http://dx.doi.org/10.1177/0013916508318748
  » http://dx.doi.org/10.1177/0013916508318748
• Olmos-Martínez, E., & Ortega-Rubio, A. (2020) Socioecology. In A. Ortega-Rubio (Ed.), Socio-ecological studies in natural protected areas: linking community development and conservation in Mexico (pp. 3-18). Cham: Springer.
• Organización Mundial de la Salud - OMS. (2013). Plan de acción sobre salud mental 2013-2020 Ginebra: Organización Mundial de la Salud.
• Rendueles, G. (2006). Viejos y nuevos locos Madrid: Círculo de Bellas Artes.
• Santos, B. D. S. (2013). El milenio huérfano: ensayos para una nueva cultura política Madrid: Editorial Trotta.
• Sarli, R., Gonzalez, S. I., & Ayres, N. (2015). Análisis FODA: una herramienta necesaria. Revista de la Facultad de Odontologia, 9(1), 17-20.
• Sundquist, K., Frank, G., & Sundquist, J. (2004). Urbanisation and incidence of psychosis and depression: follow-up study of 4.4 million women and men in Sweden. The Journal of Mental Science, 184(4), 293-298. http://dx.doi.org/10.1192/bjp.184.4.293
  » http://dx.doi.org/10.1192/bjp.184.4.293
• Velandia, I. C. (2005). La salud colectiva y la inclusión social de las personas con discapacidad. Revista Investigación y Educación en Enfermería, 23(1), 92-101.
• Wilson, E. O. (1984). Biophilia Cambridge: Harvard University Press.

Edited by

Section editor

Prof. Dr. Daniela Testa

Publication Dates

• Publication in this collection
  10 Feb 2023
• Date of issue
  2023

History

• Received
  03 July 2022
• Reviewed
  11 July 2022
• Reviewed
  10 Oct 2022
• Accepted
  27 Nov 2022