Sustainable Compassionate Community Farm for People with Serious Mental Illness

Running Head: SUSTAINABLE COMPASSIONATE COMMUNITY FARM 1

Sustainable Compassionate Community Farm for People with Serious Mental Illnesses

By Alicia Shelley, AManda Elderkin, Lee Reinertson, Paige Abrams, Summer Eckenroad Clay, Nikki Curtin, Megan Hofer, Skye Hamik, Jacqueline Vickerman, Chris Zimmerman, Shauna

Fassino, Jamie Hanks, Shasta Myers, Jaclyn Bauman, Kristine Kohlmann, Carly Smith, Katherine Desmond, Paula Dittmann, Marika Schipper, Gyuhwa Lee, Kevin Herrera, Jamie

Lawson, Elsemina Stuart, and Rebecca Hildebrant

Sonoma State University

2SUSTAINABLE COMPASSIONATE COMMUNITY FARM

Abstract

A class of nursing students created the foundation to implement a Sustainable

Compassionate Community Farm for people with serious mental illness that have not succeeded

in available community programs in Northern California. Looking at the components of daily

structure, therapeutic horticulture, talk therapy and journaling, co-occurring (dual) diagnosis,

medications, alternative therapies, environmental sustainability, animal therapy and farming,

technology and apps, we explore many aspects of evidence based and holistic care for this

underserved population. We integrated our access to Sonoma State University Departments and

clubs for possible avenues of collaboration.


The idea of creating a sustainable and compassionate community farm for people with

serious mental illnesses was introduced to our class the first week of our Psychiatric Mental

Health course with Deborah Kindy, PhD, RN. She provided the opportunity to explore the

creation of a west coast United States version of these farm projects that exist in northern Europe

and on the east coast of the United States. We split into groups to develop sections of researched

ideas and to bring those ideas together. It is an honor to participate as students in something that

has the potential to grow into a living agent for change in the lives of those living with serious

mental illnesses.

Daily Structure: Therapeutics, Recreation, and Work

Learning to live with a mental illness brings many changes and obstacles into patients’

lives. This can be particularly difficult in the beginning stages of rehabilitation due to the

immense amount of change and growth necessary to become a functioning member of the

community. Establishing new routines and daily patterns allows patients to structure their day

and leave minimal opportunities to veer off the course of recovery. Routines help to create

positive habits that can serve patients in the long run by helping to maintain sobriety, retain a

job, and create a healthier and balanced life. Routine incorporates a rhythm into life, which can

then become habit. Human bodies are created to function at their optimal capacity when

sleeping, eating and exercise patterns are performed on a consistent schedule. Due to the

inundation of stimuli, our mind has infinite amounts of information to process. Therefore, the

brain depends on habit to help it regulate common daily processes. Reinforcing a rhythmic

process can allow the brain to heal.

In mental illnesses such as Schizophrenia and Bipolar Disorder, thought processes and

daily tasks are often scattered and considerably disorganized. Adding a daily routine for patients

4SUSTAINABLE COMPASSIONATE COMMUNITY FARM with diagnoses such as these may help them to manage their symptoms and relieve stressors.

Studies have shown that daily structure is essential in the rehabilitation of patients with varying

mental illnesses. Multiple therapies have been dedicated to helping individuals with mental

illness identify and maintain daily routines. Founded by Ellen Frank and her colleagues at the

Western Psychiatric Institute & Clinic at the University of Pittsburgh, the Interpersonal and

Social Rhythm Therapy (IPSRT) is predicated on the foundation that people with illnesses such

as bipolar disorder have a disruption in their sleep and circadian rhythms, which may in part

produce some of their symptoms. When Interpersonal and Social Rhythm Therapy is used in

combination with psychiatric medications, research has shown that patients can advance in their

targeted lifestyle routines, reduce both manic and depressive symptoms, and increase frequency

of maintaining a consistent, regular mood (Tartakovsky, 2015).

The daily structure of Sustainable Compassion Community Farms (SCCF) should

above all promote social and physical functionality. Giving members of the community tasks and

jobs that require time outside and physical movement promotes recovery from mental illness.

This concept is not entirely new. When psychiatric services were entirely institutionalized, work

in the garden was a common practice. (Iancu 2014) This kind of compassionate sanctuary for

those suffering from serious mental illness is a culmination of many practices that are already

being implemented in mental health care settings.

In Green Care Farms in the Netherlands, daily activities include farm related tasks such

as feeding animals, working in the stable, or cultivating fruit and vegetables. Members also

perform household activities such as preparing dinner, gardening, and dish washing. The Gould

Farm, found in Monterey, Massachusetts, was the first farm to implement this program. This

schedule is a great model on an ideal routine that should be implemented into the care farm

5SUSTAINABLE COMPASSIONATE COMMUNITY FARM setting. Their daily structure is as follows; otherexamplesofdailystructurewillbeoutlined

inothersections.

7:30 am Breakfast 8:00 am Morning meeting 9:00 am Work program 11:00 am Wellness and group activities 12:00pm Lunch 1:00pm Work program 4:00pm Tea Time 6:00pm Dinner

7:00pm Recreation and relaxation

Work that participants can partake in includes collecting eggs, milking cows, clearing

trails, or harvesting produce. Those with mental illness, especially during times in which they are

low functioning, often feel “useless”, and are unable to care even for themselves. Those who are

unemployed often enter a cyclical mindset in which they believe that because they are

unemployed, they are useless. This concept has been understood to be a form of “self-stigma.”

Self-stigma leads to lower levels of self-esteem and self-efficacy, thereby decreasing the

individual's ability to take positive steps toward recovery. (Corrigan et al 2006, p. 875-884) The

conceptualization of oneself as “useless” further prevents patients from reaching out into the

community and looking for work, and the cycle continues. By creating environments on the farm

that mirrors the socio-structural aspects of general society, the participants can feel empowered

and grow to become autonomous, independent individuals, thereby countering effects of self-

stigma. Furthermore, in the community farm setting, there will be significantly less

discrimination based on participants’ mental illness due to the nature of the setting. Members can

find commonalities and validation from peers and the staff, thereby facilitating recovery by

highlighting the positive effects of social support. The work performed by participants should be

individualized to promote the highest functioning level the person can work at, without

6SUSTAINABLE COMPASSIONATE COMMUNITY FARM overwhelming them and leading them into more distress. On Ballicherry Farm in Ross-shire,

Scotland, members are first working part time, and are given small projects to work on, and

gradually participate in more as their confidence grows. (Care Farming UK) The farm setting

easily accommodates this style of employment, as there are plenty of beneficial small activities

members can take part in at the beginning, such as washing the dishes, or even something as

simple as painting something to decorate the building with.

The morning meeting and group activities provide opportunities for social interaction.

Integrating at least two separate times for social interaction is a crucial component for facilitating

the development of a cohesive community. At least one of these time slots could be used for the

group to separate into therapeutic groups, based on categories such as symptom management, or

by disorder. This would further promote the ease at which members of the farm feel empowered

by their work. In the “real world” setting, those with mental illness feel unable to connect to

those around them, especially their colleagues. They feel as if their colleagues can’t understand

their disorder, or might be judging them for what they can and cannot do. By allowing members

of the farm to participate in therapy together, a sense of understanding and trust can form around

group members. Furthermore, it will encourage participants to seek out resources once they

return to society, when they see how much it helped them in their time spent on the care farm.

Recreation and relaxation time allows for time for reflection. An interesting aspect that

could be implemented into recreation time that would be beneficial would be art therapy. Art

therapy has been shown to have many positive therapeutic benefits among the mentally ill

community. This may be especially beneficial for particularly traumatized individuals who enter

the community, and are unable to function at a working level yet. Art therapy has been shown to

be therapeutic for those who have difficulty communicating (Carozza, 2016) Furthermore, the

7SUSTAINABLE COMPASSIONATE COMMUNITY FARM peaceful and aesthetically pleasing aspect of the farm might be inspiring. This concept will also

be explored further in following sections.

Therapeutic Horticulture: Combining Therapeutics, Recreation, and Work

The implementation of a community garden is an effective way to combine all aspects of

therapeutics, recreation, and work, all of which provide daily structure. A community garden

could be utilized in the Work Program at 9:00am/1:00 pm, Wellness and Group Activities at

11:00am, and Recreation and Relaxation at 7:00pm. The tending of gardens has been proven to

strengthen communities and encourage interpersonal bonding. This highly beneficial central

activity for the members of the Sustainable Compassionate Community Farm (SCCF) will teach

socialization and how to work with one another. Gardening has also been proven to be highly

therapeutic in relieving anxiety, depression, and symptoms of dementia/Alzheimer’s. Allowing

patient’s to be in the fresh air while performing a physical task provides a source of exercise,

which is proven to reduce the severity of both anxiety and depression, and the time outdoors

supports healthy circadian rhythms. In addition, residents would be cultivating and learning

healthy habits by growing fresh and organic produce. These habits will then become part of the

patient’s lives once they leave the SCCF. Once the fruits and vegetables are fully grown,

residents would participate in harvesting the crops in work groups. The produce could then be

used in one of two ways: 1) Fresh fruits and vegetables would be used to prepare healthy meals

on site for the residents to consume. 2) The produce could be sold at local farmer’s markets to

make a profit in order to contribute back to the SCCF and fund the garden itself. Selling the

produce at a local farmer’s market would allow residents an opportunity to work at the

community’s booth as well as socialize with members of the public. This provides vocational

teaching and support as well as incorporating socialization skills and opportunity for community

8SUSTAINABLE COMPASSIONATE COMMUNITY FARM outreach. Therapeutic horticulture can be used as a form of work, but it is often seen as

recreation for many people. Incorporating a rewards system for hours spent tending to and

maintaining the garden may reinforce this recreational aspect. It is often very rewarding for

people to watch fruits and vegetables grow as a result of their hard work and time. I believe it is

important to not look at the idea of community gardening from just one angle (such as just

growing nutritious food), it should be approached in a multifaceted manner in order fully

encompass all of the possible benefits of the program. Therapeutic horticulture/community

gardening is a highly rewarding form of therapy, recreation, and work combined into one

program. It promotes a healthy body, spirit, and mind!

For children and adolescents who suffer from mental illness, nature-based horticulture

can improve their boundaries, impulse control, management of emotions, focus and attention,

mastery and self-control. Children with bipolar disorder, ADHD, anxiety, depression can gain

respect for nature, manual work, individuals, and the community. Some of the activities that help

children and adolescents with mental illness are growing plants, harvesting vegetables, and

preparing meals by using produce out of the garden, bee keeping, maple syrup production, and

small machinery operation.

(http://residential.greenchimneys.org/treatment/clinical-services/, 2016).

Therapeutic farm community is especially useful for people with mental illness,

dementia, and substance abuse because horticulture-focused activities, such as horticultural

therapy, therapeutic horticulture, healing gardens, or healing landscapes, provide time and space

for recovery and ability to work at one’s own pace. This notion of providing time and space can

help decrease the feeling of depression and anxiety (Loue, 2014). Therapeutic farm communities

9SUSTAINABLE COMPASSIONATE COMMUNITY FARM also create opportunities to engage in meaningful work, develop new relationships, and gain new

knowledge.

The American Horticulture Therapy Association states that, “to improve mental health,

for people with acute or persistent mental health problems, regular involvement in gardening or

community food-growing projects can provide a variety of benefits.” (Deveraux et al., 2014).

Some of these benefits include an ability to contribute to improved social interactions and

community cohesion (Deveraux et al., 2014). It is also found to reduce the occurrence of

episodes of stress, and the severity of stress and associated depression as well as reliance on

medication, self-harming behavior, and visits to psychiatric services (Deveraux et al., 2014).

Other benefits include improving alertness, cognitive abilities, and social skills. (Deveraux et al.,

2014). For those with a co-occurring diagnosis therapeutic horticulture provides productive

manual activity and beneficial social interaction for people tackling drug and alcohol dependency

(Deveraux et al., 2014). In addition, it increases overall levels of physical activity and fitness to

contribute to healthy weight management which is often difficult while on certain psychiatric

medications.

Gardening Matters is a Twin Cities, MN based independent community gardening

advocacy group who has compiled research and evidence from multiple studies. According to

their website horticulture therapy can significantly impact mental health and wellbeing. The

research shows that exposure to green space reduces stress and increases a sense of wellness and

belonging (Bremer, Jenkins, & Kanter, 2003). Another study says, “A ten percent increase in

nearby green space was found to decrease a person’s health complaints in an amount equivalent

to a five-year reduction in that person’s age” (Sherer, 2006). In Brentwood California, the Vets

Garden employs 35 patients, many of whom have not been able to hold down a job since the

10SUSTAINABLE COMPASSIONATE COMMUNITY FARM Vietnam War. Since the garden program started, inpatient stays have been significantly reduced

and the gardeners have been making progress at faster rates and are better able to “participate

more fully in the world and move on to jobs outside the hospital”. Employment opportunities

such as gardening and landscaping throughout the city have become available to Vet gardeners

and mental health program participants have even gone back to school. (Cambell, 1999).

The American Community Gardening Association (ACGA) has local chapters that could

be accessed by the SCCF as a resource and for participation in setting up the gardens and

maintaining them. “The association recognizes that community gardening improves people’s

quality of life by providing a catalyst for community development, stimulating social interaction,

encouraging self-reliance, producing nutritious food, reducing food budgets, conserving

resources, and creating opportunities for recreation, exercise, therapy, and education” (ACGA,

2014). Local gardens ran by the ACGA as a testament to their success include:

• Harvest For the Hungry Garden (1717 Yulupa Ave., Santa Rosa, CA 95405)

• Friends of Julliard Community Garden (200 Santa Rosa Ave., Santa Rosa, CA 95401

United States)

Talk Therapy and Journaling

Journaling combined with talk therapy creates a relationship allowing nurse/therapist to

work together on problems or difficulties at hand (Thomas, 2012). When talk therapy is

expanded to more than just a one-on-one session, everyone involved benefits and the patients

feel as if they are not being “treated” (Mackler, 2013). Journaling is a way to summarize what

has been learned or discussed during talk therapy sessions. Journaling is not only therapeutic, it

is a great way to reflect or process an experience. If practiced habitually journaling “becomes a

natural part of analysis and synthesis” (Waldo, 2009). Psychosis is a problem involving

11SUSTAINABLE COMPASSIONATE COMMUNITY FARM relationships which can only be nurtured through talk therapy, group therapy, and therapeutic

interactions (Mackler, 2013). Dependent upon diagnosis and individual preference clients may

choose what therapy to attend, although some sessions may be mandated.

A place north of Finland works with people struggling with psychosis disorders through

an alternative to medication known as Open Dialogue (Mackler, 2013). They define Open

Dialogue as “[weaving] together interviews with psychiatrists, psychologists, nurses, and

journalists to create both a powerful vision of medication-free recovery and a hard-hitting

critique of traditional psychiatry” (Mackler, 2013). These Open Dialogue groups work as a non-

secretive, non-hierarchical conversation where clients and therapists speak openly and honestly.

Therapists work in teams and are able to bounce ideas off one another in front of clients

(Mackler, 2013).

Example of a Daily Schedule Possible activity list to incorporate with other daily activities:

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Morning Self-time and Journal

Small group

Self-time and Journal

Small group

Self-time and Journal

Small group

Afternoon Tea time reflection

Tea time reflection

Drama Therapy

Tea time reflection

Evening -Group session -Weekly Goal planning

Poetry Writing

Drop in Process Group

Drop in Process Group

Friday Night Social

Self-time and journal. Wake up and journal thoughts from prior day or anything on one’s mind.

Time to read a newspaper, or a group can be “writers” where they design a newspaper (Waldo,

2009) If clients would like one on one therapy, can be arranged in place of self-time and journal

12SUSTAINABLE COMPASSIONATE COMMUNITY FARM 1-3+ days a week. Confidentiality of one’s journal is at the discretion of the client and they may

choose to share with the care team, combine with one-on-one sessions, or keep private.

Tea time. More natural group discussion (different group than MWF small group) These groups

may be self-chosen groups. They might sit at round tables and have tea/coffee/snacks and cards

at table for things to discuss. These groupings are not designed to be diagnosis related (Waldo,

2009).

Small group. More structure and embracing the Open Dialogue concept. Conversation is

resident driven, and mediated by trained professionals such as, a licensed clinical social worker,

a therapist, psychologist, or advanced practice nurse (Mackler, 2013) (Thomas, 2012).

Group session. SCCF as a whole has an overall debriefing, including news, updates, and new

member introductions (Gould farm) (Waldo, 2009).

Weekly goal planning. This is a part of Group Session, that may include residents writing down

personal goals for the week based on coping skills, positive thinking, and helpful classes or jobs

they plan to attend the week, etc.

Drop in process group. Hour long sessions for anyone who wants to check in and discuss freely

about what is on their minds. Residents may listen to input from others or just express how their

week is going. This can be led by graduate students during an assigned rotation to fulfill clinical

hours. The leaders can compose a structure to loosely follow that facilitates group discussion and

focuses on a daily goal.

Drama therapy. Peer led group activities involving stretching, creative storytelling, role

playing, etc. This concept will be explored more in the Medications and Alternatives section.

Poetry writing. Weekly poetry writing, discussion, and practice of performances. These can be

shared with others or kept private.

13SUSTAINABLE COMPASSIONATE COMMUNITY FARM Friday night social. Friday Night Social is open to anyone who may come and perform/read

their poetry/art pieces/comedy pieces or any other social activity. May include outside

entertainment or guest speakers.

Sonoma State University resources that can contribute in this area include the Psychology

Department who can recruit students to be student mentors, participate in group therapy sessions,

and help create programs and groups for farm members to participate in. Graduate students can

work as interns in their field of study in order to gain experience and complete hours needed

towards their practicum. Counseling and Psychological Services (CAPS) would be able to

encourage students with mental illness to come participate on the SCCF. They could also have

counselors or psychiatrists from Sonoma State come to the SCCF to lead therapy sessions on-

site. Students Offering Support Club (SOS Club) can assist therapy groups, talk with residents,

and participate in social events for the SCCF community. They could also teach SSU students

about how to contribute to the SCCF and highlight opportunities for potential jobs on-site.

Lastly, The Hutchins Department could recruit students who want to be teachers, possibly with

an interest in teaching those with mental illness, to help organize group activities for learning,

such as art, music, and storytelling.

Through a stepped progression, symptoms improve, real-life skills are learned, and a

sense of worth and hope is recovered that allows the individual to build the strength and

confidence to move towards greater independence and recovery (Gould Farm).

The mission is about individualized healing and recovery and is accomplished through

taking carefully implemented healing steps in which positive, healthy feelings emerge,

motivation builds, and a sense of purpose develops. The personal needs of each individual are

14SUSTAINABLE COMPASSIONATE COMMUNITY FARM met and the farm’s beautiful and soothing landscapes aid in the healing process (Hundred Acre

Homestead, 2011).

Co-Occurring (Dual) Diagnosis

Our program is unique in that it is designed to treat both substance abuse and mental

health disorders concurrently, with staff cross-trained in both areas. According to the National

Institute on Drug Abuse, “More than half of individuals who suffer from drug addiction also

have a diagnosable mental illness, other than the addiction issue itself” (NIDA, n.d.). We are

committed to the principles of dual recovery using evidence-based practices. When these

practices are used in a dedicated and therapeutic environment recovery from both disorders is not

only possible, but highly successful.

Addiction is caused by a multitude of factors ranging from a genetic predisposition, to

chemical dependency to environmental influences (NIDA, n.d.). Ultimately, it leads to isolation

from ourselves, society and from the ones we love dearly. Our program is based on the belief

that connection is the key to a successful sobriety. We incorporate this notion, that in order to

beat addiction successfully it is imperative to rediscover the purpose in our lives and to reconnect

and revive the bonds with society. It is our mission to create a hopeful, encouraging environment

so our clients can empower themselves and mend the connections they have lost.

“Regardless of the presenting dependency, the main features of addiction are obsession

and compulsion, focused around an object or behavior which, it is believed, will somehow bring

transformation of the person's inner world” (Ward, 2010).

*When individuals articulate the experiences of transformation they seek via these

objects and behaviors they answer (Ward, 2010):

➢ Self-acceptance ➢ Self-forgetting


➢ Wanting wholeness ➢ Transcendence of the everyday ➢ Love ➢ Feeling expanded ➢ Feeling complete ➢ Feeling good ➢ Confidence ➢ Security

The treatment environment should provide the “optimum conditions for these positive

qualities to grow and flourish in the treatment cycle.” By “consciously fostering these conditions

for change… the environment will organically lead patients towards a way of being in the world

that is not dependent on drugs and alcohol, but based instead on purpose, value, and meaning”

(Ward, 2010).

On the farm, residents should be given tasks and jobs to instill inner-purpose and self-

worth. More importantly, residents should spend time reflecting and appreciating the meaning of

that work on a personal level. Ultimately, the environment is maintained by the patient--with the

direction and support of facilitators--and gives rise to a more self-actualized human being, who

channels his or her innermost desires (listed above*) by contributing to a balanced society.

The ‘therapeutic community’ that we hope to develop will minimize harm and prevent

relapse. This model, “follows the rationale that one should actively engage patients where they

are in the addictive cycle, and attempt to minimize the impact of their addiction by education,

support, and engaging them with local statutory services” (Ward, 2010).

The relapse prevention model is, “loosely based on cognitive behavior therapy (CBT)

principles. This model defines a set of cognitive and behavioral approaches that can prevent or

limit relapse episodes, including skills training, changing negative thoughts, and lifestyle

16SUSTAINABLE COMPASSIONATE COMMUNITY FARM balancing” (Ward, 2010). An expanded description of CBT is available in the section: Cognitive

Behavioral Therapy.

It is our goal that this treatment center will be the premier “local statutory service” for

those travailing a co-occurring diagnosis—offering education and support that fosters healing

and lifelong learning based on individual needs. Intrinsically, the program will deliver the

‘lifestyle balance’ that is operative in recovery from both addiction and mental illness,

concurrently.

We understand that different therapies work for different people. This is why we offer

several treatment options, with an emphasis on CBT, to help clients gain new insights and tools

needed to sustain recovery long term. Cognitive behavioral therapy (CBT) is a therapeutic

modality that teaches the client how to replace self-destructive thoughts and behaviors with

positive, productive ones. CBT has been used successfully in the treatment of both mental illness

and substance abuse.

According to Romana, “cognitive-behavioral therapy is an action-oriented form of

psychosocial therapy that assumes that maladaptive or faulty thinking patterns cause maladaptive

behavior and ‘negative’ emotions.” Patients with dual diagnosis benefitted from receiving

therapy for their mental illness as well as treatment for their addiction concurrently. Cognitive

milieu therapy (CMT) has been shown to lead to a decrease in substance abuse and use. In a

study where 102 patients in Denmark in a supportive inpatient treatment facility for substance

abuse and mental illness, 65% of patients were reported to have no substance abuse and 9% had

decreased substance abuse after the therapy was completed (Lykke, 2010). Patients also reported

a decrease in symptoms of their mental illness. Medication management is also helpful in

combination with CBT and has been shown to be more effective than CBT alone (Brooks, 2003).

17SUSTAINABLE COMPASSIONATE COMMUNITY FARM Supplemental Approaches:

12-step programs. 12 step programs are very common for addiction recovery treatments.

Studies have shown for alcoholism, the 12 step program is successful in decreasing alcohol use,

but patients had worsening physical health and increased psychiatric hospitalization. Patients

showed less alcohol use and greater life satisfaction with both the 12 step program and CBT, but

CBT alone showed increase in marijuana usage. 12 step programs are also spiritually based,

which does not work as well with all patients (Brooks, 2003).

Motivational Interviewing (MI). Motivational interviewing is a client-centered treatment

philosophy that approaches the therapist-client relationship as a collaboration. Taking a non-

judgmental, accepting attitude, the therapist works with the client to address thoughts and

behavior.

Dialectical Behavior Therapy (DBT). Originally developed to treat severely suicidal patients,

DBT has also been applied successfully to the treatment of addiction, personality disorders,

depression and other disorders. DBT teaches clients how to deal with painful emotions through

practices that involve mindfulness and acceptance.

Intensive case management. Case management services are an important part of dual diagnosis

treatment. A case manager follows the client from the assessment stage through rehab and

beyond to ensure quality of care, provide continuity after rehab, and advocates for the client if

necessary.

Trauma resolution therapies. Past trauma is at the root of many co-occurring conditions.

Adults who have experienced childhood abuse, sexual assault, military combat, natural disasters

or other devastating incidents may be psychologically and emotionally scarred by these

18SUSTAINABLE COMPASSIONATE COMMUNITY FARM experiences. Dual diagnosis therapy offers treatment modalities that target trauma, including eye

movement desensitization and reprocessing (EMDR), and grief/loss therapy.

Holistic therapies. People who suffer from undiagnosed anxiety or depression often use drugs

and alcohol to control stress. Holistic therapies can help these individuals manage their stress and

cope with the emotional triggers that lead to substance abuse. These alternative modalities

include hypnotherapy, biofeedback, massage, yoga, guided meditation, exercise therapy and

more.

For many of our clients the first step in treatment will begin here--on our SCCF--where

detox, assessments, and stabilization for mental health issues will occur. These clients may need

clinically appropriate medications to ease withdrawal symptoms.

Graduates of the residential program will be fully equipped with the skills and tools

needed to address future challenges; however, recovery is an ongoing process. Aftercare

planning will begin on day one and ongoing support will continue after completion. The first

year out of treatment is the most critical and studies show that relapse rates can be as high as

85% (Moos, 2006). Therefore, we are dedicated in supporting and fostering growth within our

clients. Suitable and formally-trained staff members will be available to remediate the life

challenges faced by postgraduate clients, and intervene as necessary (i.e. inviting a recent

graduate to continue to volunteer at the SCCF’s garden in order to cultivate connection.) This is

also implemented in our ‘bridge program’ where clients are encouraged to attend weekly

aftercare support groups here on the SCCF. Families are encouraged to come, learn, and support.

Additionally, personalized follow-up continues with a case manager for one year post

graduation.


An integrated approach is generally accepted to be the most promising treatment strategy

for co-occurring addiction and mental illness (Rachbeisel,1999). In the case of dual-diagnosis,’

mental illness and addiction exist side-by-side. As providers of care, we understand that the two

disorders ‘live together’ and should be managed accordingly. By implementing the strategies we

have outlined, our program simply embraces the akin connection between our thoughts and the

actions they elicit.

Medications and Alternatives to Medications

Typical treatment of mental illness involves medications. There are a wide variety of

medications used for different types of mental disorders. This section will take you through an

overview of some of the different kinds of medication treatments. This table will help to break

down the overview while you are reading it.

Medications

Type Uses Common Drug Names

Antidepressants: SSRIs Depression, Anxiety Fluoxetine, Sertraline,

Citalopram, Paroxetine

Mood Stabilizers Bipolar Lithium

Anticonvulsants Bipolar Valproate, Lamotrigine Carbamazepine

Anxiolytics: Benzodiazepines Anxiety Diazepam, Alprazolam,

Clonazepam, Lorazepam

Antipsychotics: 1st Generation/Typical Schizophrenia, Mania Haloperidol

Antipsychotics: 2nd Generation/Atypical Schizophrenia, Mania Risperidone, Clozapine,

Quetiapine


Antipsychotics: 3rd Generation Schizophrenia, Mania Aripiprazole (Abilify)

As stated in their name, antidepressants are used to treat depression; there are many

different categories, but they all focus on increasing levels of serotonin and norepinephrine,

neurotransmitters involved with mood. The poster child for antidepressants are SSRI’s or

selective serotonin reuptake inhibitors (Halter, 2014). These inhibit the reuptake of serotonin in

the synapses and allows for more serotonin to be used. Mood stabilizers and anticonvulsants are

used to help with the mood swings associated with bipolar disorder. The mood stabilizer lithium

is thought to work by stabilizing the electrical activity in the brain by interacting with sodium

and potassium at the cell membrane. The anticonvulsants valproate, carbamazepine and

lamotrigine work by reducing the firing rate of high frequency neurons in the brain (Halter,

2014). Antipsychotics are used to help treat the symptoms involved with schizophrenia and other

manic disorders. The first generation antipsychotics, or typical antipsychotics, treat the positive

symptoms of schizophrenia by blocking dopamine receptors to reduce dopamine transmission.

The over activity of the neurotransmitter dopamine in the mesolimbic system is thought to be

responsible for some of the symptoms of schizophrenia. The other antagonistic effects of these

medications cause a lot of undesired side effects and extrapyramidal side effects (EPS). Second

generation, or atypical antipsychotics, are used to treat the positive and negative side effects of

schizophrenia. They have fewer side effects and are used more widely now. They include

clozapine, risperidone, and quetiapine. The only third generation drug on the market is

aripiprazole (Abilify); it is a dopamine system stabilizer and has very few side effects (Halter,

2014). Anxiolytics are used to help with anxiety. Benzodiazepines are currently the most widely

used; they promote GABA activity, which is the neurotransmitter that produces calming effects.

21SUSTAINABLE COMPASSIONATE COMMUNITY FARM Some antidepressants are also used to help with anxiety type disorders (Halter, 2014). All of

these medications have been used on humans and are FDA approved. They are found in

textbooks, medication books, government sources, and online sources. They have all gone

through studies and trials to prove effectiveness (Halter, 2014).

Medication therapy will need to be implemented and integrated into care on a variety of

levels. First, a psychiatrist must be employed by the SCCF and take up residence there. This will

help with the therapeutic milieu of the SCCF and allow for ease of medication prescription and

follow through. Patients need assistance 24 hours a day and their issues do not simply stop at

5pm and start back up at 8am when the normal work day takes place. By having a psychiatrist

living on the SCCF it will allow for assistance around the clock for all patients and will enhance

their ability to be treated effectively.

Nurses will also need be employed and living at the SCCF to administer medications on

a daily basis and evaluate patients throughout every step of the medication process. Medication

therapy for patients with mental illness can have serious complications and need to be under

constant evaluation. The psychiatrist cannot do all of this by himself and needs the help of

professionally trained nursing staff to step in. Compliance with medications can always be an

issue given that many patients don’t like their side effects and feel that not taking them is better

than taking them. Nurses will be on staff around the clock to monitor all patients for potential

side effects and ensure that clients are compliant with their medication regimen. Having nurses

will allow for more eyes on every patient and better compliance with medications.

A room must be designated as the medication room. It needs to be locked and only nurses

and doctors are allowed access. By having a room just for medication storage and retrieval that is

locked it will prevent patients from utilizing their medicals in negative ways such as possibly

22SUSTAINABLE COMPASSIONATE COMMUNITY FARM overdosing. The nurses will prepare all the patients medications in this room and then bring them

to the patients in their rooms or wherever they may be. This creates more of a home feel rather

than a hospital feel by having them all come to the medication room for their therapy. This room

will be stocked by pharmaceutical companies with single dose medications. These companies

will have scheduled delivery dates and times on a weekly basis. This room will be essential to

enhance the safety of medication therapy.

Dance movement therapy is the psychotherapeutic treatment that uses dance and body

movements to enhance one's emotional, cognitive, physical and social prosperity. It is based on

the idea that the human body, mind, and soul are all integrated into one. The American Dance

Therapy Association trains dance therapist to go out in the community and hold these classes.

Dance therapy is very helpful in managing symptoms associated with mental illness, such

reducing anxiety, stress, and improving mental status (ADTA, 2015).

A case study was performed on a young lady who suffered from severe anxiety and

PTSD from being abused as a child and later in her marriage. She was sent to dance movement

therapy classes for 40 minutes twice a week over a two-month span. She took the Profile of

Mood States test and Somatic Inkblot Series-II test before and after each session to see her mood

and personality changes. By the end of her two months her both scores were dramatically

increased indicating improvement (Dasgupta, 2013).

This therapy could easily be implemented at the SCCF by seeking out a licensed dance

movement therapist thought the ADTA website finder [http://www.adta.org/Find_a_DMT] and

having them come a couple times a week to hold classes for all the individuals at the farm. It

could easily be integrated as a weekly activity in the client's schedule of events. To reduce the

cost it may be possible to have an intern therapist come in as a volunteer to teach the classes.

23SUSTAINABLE COMPASSIONATE COMMUNITY FARM Another great way to find a therapist is through the California Institute of Integral Studies in San

Francisco. This college focuses on a more holistic approach and trains students in a multitude of

areas including Somatic Psychology. They could place Marriage and Family Therapist Interns

(MFTI) to come to the SCCF and teach classes as a part of their practicum hours toward

licensure (CIIS, 2016).

Art therapy is currently used in many settings including the mental health profession. Art

therapy is facilitated by a certified art therapist who focuses on encouraging the clients to explore

their feelings, express emotions, resolve emotional conflicts, promote self-awareness, deal with

maladaptive behaviors and addictions, develop social skills, orient to reality, reduce anxiety, and

increase self-esteem. The overall goal is to restore patients functioning and self-esteem by

working through each symptom of one's mental illness (AATA, 2013).

A meta-analysis was performed on 35 studies that have been conducted on art therapy in

order to determine whether it is an effective therapy for many different illness and disease

processes. Overall the studies showed that art therapy does help with the symptoms related to

mental illness. Some of those include less fatigue, avoidance, anxiety, symptoms of depression

and PTSD, overall mood improvement, fewer incidences of seclusions, reduced stress, and

improved social engagement (Slayton et al., 2010).

This therapy requires a licensed therapist of the American Art Therapy Association

(AATA). One can be located through this webpage [http://www.find-a-

therapist.com/directory?cat=artther]. Once a therapist is found, have them come to the SCCF a

few times a week to hold classes for the clients. This can be integrated into the client's weekly

schedule. The therapist could also be hired on by the farm and live on the farm to offer more of

their services. An employee already fluent with art could become a certified therapist through

24SUSTAINABLE COMPASSIONATE COMMUNITY FARM AATA; go to [http://arttherapy.org/aata-aboutus/] for more information. The California Institute

of Integral Studies also has an expressive arts therapy major; as discussed above in the Dance

Therapy section MFTI students or new grads may be interested in working with the residents at

the SCCF.

“Animal-assisted therapy (AAT) is defined as the use of human-animal bond through

strategically chosen, goal directed animal-assisted interventions in which the animal is an

integral component of the clinical treatment” (Perry et al, 2012). AAT utilizes domestic pets and

farm animals to facilitate the recovery process. The primary goal of ATT is to improve patient

symptoms through a variety of modalities including; increasing participation in therapeutic

activities, developing self-expression and enhancing the patient-therapist relationship.

“AAT is establishing itself as an empirically based primary and adjunct treatment option

for a wide range of psychological disorders” (Perry et al, 2012). Studies indicate that AAT can

reduce the physiological and psychological symptoms associated with mental illness. A study

involving 230 hospitalized patients with psychiatric illness, which participated in AAT,

demonstrated a reduction in anxiety, using the State-Trait Anxiety Inventory when compared to

traditional treatments (Parshall, 2003). Another study comprised of 69 dual diagnosed

individuals, residing in a psychiatric facility, exhibited increased participation and socialization

during animal facilitated group therapy (Parshall, 2003). This study highlights a meaningful

advantage of AAT, the ability “to attract voluntary patients who normatively exhibit isolative

tendencies” (Perry et al, 2012). AAT has also been beneficial in reducing depression, blood

pressure and aggression.

AAT can be efficiently incorporated into traditional therapeutic treatments due to its

versatility and cost effectiveness. However, there are several key elements to consider prior to

25SUSTAINABLE COMPASSIONATE COMMUNITY FARM implementing AAT. The facility will need to determine the types of animals to integrate into the

treatment plan. While canines are traditionally used; the Delta Society has identified other

appropriate animals including: guinea pigs, horses, goats, pigs and chickens (Morrison, 2007).

In addition to providing therapeutic interventions incorporating farm animals would promote

sustainability. More specifically, chickens would supply the facility with fresh organic eggs.

Another facet of introducing AAT is determining the method of training involved in preparing

the animals to work and establishing safety protocols to ensure proper care of the animals. The

Delta Society is an excellent source of information regarding this topic. Additionally, the facility

will need to properly train staff and/or require an Animal-assisted therapy certificate for staff

conducting therapy sessions. More will be discussed later in the Animal Work Farm section

below.

Nutritional education and support groups play an integral role in addressing symptoms

related to poor health management and mental illness. The primary goals of support groups are

to provide education, create natural support networks and identify appropriate community

resources.

Individuals with mental illness are at high risk of developing additional health

complications due to inadequate dietary intake and side effects of medication. “A systematic

review of 31 heterogeneous studies concluded that people with schizophrenia often have poor

diet characterized by a high intake of saturated fats in conjunction with low consumption of fruit

and fiber, as well as low intake of polyunsaturated and monounsaturated fatty acids” (Journal of

Community Nursing, 2015). Research suggests that individuals with mental illness would

benefit from nutritional assessment and subsequent support therapy to combat health

complications. A study of 139 individuals with comorbid mental and medical illnesses enrolled

26SUSTAINABLE COMPASSIONATE COMMUNITY FARM in a Chronic Disease Self-Management Program “demonstrated improvements in health

indicators and health behaviors” after 6 months of attending educational workshops (Lorig et al,

2014).

The facility can develop educational programs aimed at improving dietary

comprehension, addressing symptoms of poor health management and increasing access to

healthy, nutrient rich food. The Ceres Community Project serving Sonoma and Marin County is

an invaluable resource for constructing and implementing nutritional programs. Their

philosophy is based on promoting health through nutrition; their Healing Foods Class instructor

could aid in creating specialized meal plans based on the needs of the individual. Furthermore,

students from the Bauman College Nutrition Consultant Training Program here in Sonoma

County could conduct health management workshops and cooking demonstrations utilizing

seasonal fruits and vegetables grown on the property.

Acupuncture is a component of traditional Chinese medicine involving specialized

needles inserted into the body at specific acupuncture points to restore and maintain balance

(Cady et al, 2015). “Acupuncture treatments can provide relief from a variety of symptoms

including; chronic fatigue, depression, grief, anxiety, insomnia, nightmares, irritability and panic

attacks” (Golden, 2012). In addition, acupuncture therapy can be utilized to combat the adverse

effects of mental health medications; therefore, increasing treatment adherence. In a study

comprised of 29 men and women taking either a selective serotonin reuptake inhibitor (SSRI) or

a selective noradrenaline reuptake inhibitor (SSNI), noted a decrease in sexual dysfunction after

undergoing 12 weeks of acupuncture treatments (Khamba et al, 2013).

Furthermore, research highlights that acupuncture can be highly effective, particularly in

conjunction with traditional biomedical treatments. A study involving 151 men and women with

27SUSTAINABLE COMPASSIONATE COMMUNITY FARM major depressive disorder reported a decrease in depression severity, using the Hamilton

Depression Rating Scale, after receiving 12 acupuncture sessions over the course of 8 weeks

(Wu, 2012).

Acupuncture treatments would be given by a California Licensed Acupuncturist and

require access to an onsite, private room. The acupuncturist(s) would provide treatments based

on the needs of the individual, complete facility approved documentation and attend

interdisciplinary team meetings to determine the efficacy of treatment.

Natural supplements can be used in the treatment of mental illness. Folic Acid, also

known as vitamin B, is found in green leafy vegetables, citrus fruits, beans, and fortified breads

and cereals. Folic acid is used for depression and when combined with an antidepressant it can

encourage symptom relief. The daily recommended dose is 400 mcg. SAMe is a substance made

naturally in the body that increases production of neurotransmitters that regulate mood and can

be used for depression. The supplement can increase effectiveness of SSRIs and SNRIs when

used together or work as well as tricyclic antidepressants on its own. A warning is that it can

trigger mania in patients with bipolar disorders. The recommended dose is 400 to 1,600 mg per

day. Ginkgo Biloba is an herbal supplement from the leaves of ginkgo tree and is used for sexual

problems related to antidepressants and Alzheimer’s disease. Ginkgo biloba slows cognitive

decline and is similar to taking a cholinesterase inhibitor. It can take between 8 weeks to a year

to see results. The recommended daily dose of ginkgo biloba is 120-240 mg per day. Ginkgo

research had four credible double-blind studies and a meta-analysis of forty controlled trials of

treatment for mild dementia. In 26 studies, the group receiving ginkgo did significantly better in

treatment for “cerebral insufficiency” than the control group. St. John’s Wort is an herbal

supplement from an extract of the plant Hypericum perforatum that helps with depression. The

28SUSTAINABLE COMPASSIONATE COMMUNITY FARM adult daily dosage is 900-1,800mg in 24 hours. A warning with this supplement is serotonin

syndrome if taken with an antidepressant and can also reduce effectiveness of many other drugs.

St. John’s wort in a recent meta-analysis of 23 double-blind trials involving 1757 showed

depression improvement in all groups (NAMHPAC).

A few more supplements that are beneficial to mental illness treatment are Valerian,

Omega-3 fatty acid, and melatonin. Valerian is an herb that comes from the root of Valeriana

Officinalis pink flowers used for anxiety and sleep problems. It is an option that doesn’t cause as

many memory and thinking complications as benzodiazepines. It can also improve sleep in

children with ADHD. The recommended adult dosage is 450-600 mg daily. Omega-3 fatty acid

is a naturally found in cold-water fish such as salmon. There are also fish oil capsules to obtain

the fatty acid if fish cannot be eaten. It is used for bipolar depression and major depression.

Omega-3 can increase the effectiveness of antidepressants but for patients with bipolar disorder

it can help treat depression yet may trigger mania so it is important to take with mood stabilizers.

It is recommended to consume fish two times per week and a daily 1-2 g supplement containing

EPA and DHA. EPA and DHA stand for eicosapentaenoic acid and docosahexaenoic acid and

are highly unsaturated fats in omega-3 fats of cold water fish. DHA is a building block of tissue

in the brain and retina of the eye. EPA and DHA also convert into prostaglandins that help

regulate cell activity and cardiovascular function (Hoffman, 2013). Melatonin helps with sleep

problems and regulation of circadian rhythms in the body. The recommended dosage is 0.25-0.3

mg per day. Newer studies are finding that melatonin is beneficial for more than just a sleep aid.

Melatonin helps with heartburn and GERD, migraines, cardiovascular prevention, diabetes

prevention, macular degeneration, and alleviate tinnitus. A few case studies have been completed

on the different benefits of melatonin. In one study, 351 people with heartburn were either given

29SUSTAINABLE COMPASSIONATE COMMUNITY FARM Prilosec or 6mg melatonin and those taking melatonin had total resolution of heartburn after 40

days and only 66% on Prilosec had total relief (Whitaker, 2014).

A garden can be grown on the property with all the plants and trees necessary to create

many of the above natural supplements, particularly the herbal supplements. While the residents

participate in the SCCF’s therapeutic horticulture program they will be helping to create

ingredients that contribute to the SCCF’s herbal apothecary. For the supplements that can’t grow

in a garden such as the omega-3 fatty acids residents could possibly fish if there is water near the

property or maybe contract with local fisherman to bring fish to the farm 2 times per week. Other

supplements such as SAMe and Melatonin can be offered as alternatives from psychiatrists. The

California School of Herbal Studies has classes on herbal education and is from the local area.

The SCCF could possibly connect with the school to offer classes on the SCCF for patients to

learn about the seasons of harvesting, drying, and basics of herbalism. The website for this

school is [http://www.cshs.com/].

Electroconvulsive Therapy, previously known as electroshock therapy, is a procedure

performed under general anesthesia and with muscle relaxants, during which small electric

currents are passed through the brain to induce a tonic-clonic seizure. It lasts about 40 seconds

and is thought to reverse symptoms of mental illness by making changes in the patient's brain

chemistry (ECT Mayo Clinic, 2015). ECT is given once every 2-5 days for a total of 6-12

sessions (ECT UCSF, 2008). ECT is used most commonly to treat depression and severe

depression.

A case study was done on adolescents who received ECT for treatment resistant

depression. 13 adolescents who had ECT for treatment at a Canadian tertiary care psychiatric

hospital over a 5-year interval had their charts reviewed. Out of the 13 adolescents aged 15-18 10

30SUSTAINABLE COMPASSIONATE COMMUNITY FARM had reliable improvement after a mean of 14 sessions. 3 experienced full recovery. The

conclusion of the case study is that significant improvement was observed for the adolescents

who received ECT for treatment resistant depression. ECT is an option for depression in selected

patients (Journal of ECT, 2015).

ECT is an option for treatment of mental illness which can be offered on the farm. After

the treatment the patients would be easily observable. General anesthesia is used to relax the

patient and provide comfort before use of electrical current. This might be costly for the SCCF

and need licensed physicians to perform but may be well worth it. The clinical staff will need to

have training in application. The benefit of providing this on the SCCF is the ability of a

continued follow up after the treatment for side effects and progression.

Sonoma State University Departments

We would need to collaborate with career services at Sonoma State in order to get

approval to post job applications on the SSU student job website. We would like to mostly

recruit students to apply for the jobs. Positions would include farmers, cooks, animal caretakers,

cleaning crew, maintenance team, and activities coordinators. For example, a Sonoma State

student can become hired as a part-time stable cleaner, and they would help maintain cleanliness

and order in the barns and in the animal stables.

We would like to create pamphlets that would provide information about the farm for the

students to access on campus. These pamphlets would inform the students about what the farm

does, why it exists, and how they can get involved. We can put the pamphlets in different

educational departments or in high-trafficking areas on campus, such as the Student Center or in

Lobos, for students to see and take.

Flyers can be created and posted around the campus and in campus residential areas. We

31SUSTAINABLE COMPASSIONATE COMMUNITY FARM can also create a Facebook page that students can join to obtain information about the farm and

events. Participating in “tabling” on campus could help us spread awareness about the farm to

students as well.

Sustainability

When designing an innovative and caring homestead, sustainability is not only cost-

effective, it also causes less harm to the environment and supports a community by providing

essential resources and opportunity to work on the land in a therapeutic framework. Some

sustainable perspectives we examine are compositing, solar power, rainwater and greywater

harvesting, and a permaculture community garden, which we expand upon below. We also

include farm animals like chickens, ducks, cows, goats and bees that are separate from therapy

animals.

Composting is a mixture of decayed or decaying organic matter used to fertilize soil.

Composting, which includes worm bins, is an excellent way to dispose of organic material

generated in the kitchen and leftover from meals. Starting compost piles involves three basic

ingredients, browns, greens and water. Browns include dead leaves, branches, and twigs that

provide carbon to compost. Greens include grass clippings, vegetable waste, fruit scraps, and

coffee grounds, which provide nitrogen to compost. Water is important for compost

development, providing moisture to help to break down the organic material.

When constructing a compost pile, an ideal placement would be a dry, shaded location

near a water source that can keep the pile moist. There should be equal amounts of browns and

greens and the layers should be alternating based on differentiating particle sizes. To start the

pile shred the browns and greens into small pieces and moisten them as they are added to the pile

then cover the top with a tarp to help retain moisture. Compost piles can take up to 2 years to be

32SUSTAINABLE COMPASSIONATE COMMUNITY FARM complete, but usually require a shorter amount of time. Once complete the contents can be added

to the on-site garden to fertilize and support growth (US Environmental Protection Agency,

2015).

The residents can be participants in both the creation and the maintenance of the compost

pile(s). For the creation they can assist in the sorting and layering of the materials outdoors and

making sure that it remains adequately moist. Inside signs special compost bins can be set up

with images of what is compostable for the residents to sort food into. Once the compost pile is

established residents can also participate in the maintenance of the pile and bringing the enriched

product to the on-site garden. The bulk the work would be done by staff and residents, and the

only real financial cost would be the startup costs of building the pile, and the cost of water to

maintain it. If using water harvesting, this water cost would be significantly reduced.

Let’s harness benefits of the sun! Solar energy technologies provide resources for

generating clean and sustainable electricity. For the farm, we recommend the use of use smaller

scale solar PV systems (use both direct and scattered sunlight to create electricity and uses 10 kw

or less), which can be designed to meet any electrical requirement. A typical solar electric

system consists of solar cells, modules or panels (which consist of solar cells), arrays (which

consist of modules), and balance-of-system parts, which depends on whether the system is a

stand-alone system, connected to the electric grid, or a hybrid system. Balance-of-system

equipment can include: mounting racks and hardware for the panels, wiring for electrical

connections, power conditioning equipment, such as an inverter, batteries for electricity storage

(optional), and stand-by gasoline electric generator (U.S. Department of Energy, 2013 ).

For higher energy savings, incorporating solar infrastructure like passive solar design and solar

water heating should also be considered in the design of the farm.

33SUSTAINABLE COMPASSIONATE COMMUNITY FARM Passive solar collects heat from the sun through south-facing windows and retains it in

materials that store heat, known as thermal mass. In designing the building this way, the solar

energy from the panels can be directed towards electricity. Before designing a sustainable

housing project, it is important to remember cost-effective strategies for reducing heating and

cooling bills - it is recommended to have a home energy assessment to help determine

improvements and energy efficient. To find an Energy Auditor in the North Bay, visit

http://www.resnet.us/directory/search.

Solar water heating system includes pumps that circulate household water through

collectors, a well-insulated storage tank, and a backup system (U.S. Department of Energy,

2013). The purpose of the heater is to generate hot water for indoor usage. On average, if one

installs a solar water heater, the water heating bills should drop 50%–80% (U.S. Department of

Energy, 2013 ).

In turning to solar energy strategies and means of harvesting, energy costs would be

reduced. Initially implementing solar energy may be pricey, yet would be cost effective long

term. An option would be to apply to grants for these renewable energy projects. Having

residents and team participate in documenting data and offering educational programs about the

advantages of environmental impact on reusable power.

There are two parts to our water conservation plans, a rainwater harvesting system and a

greywater system. The initial work for these projects involves installing water conservation

structures. For rainwater harvesting this includes outfitting the building roofs to capture run-of in

the gutters and drain it into rain barrels, underground cisterns or storage tanks. This stored water

can then be used to irrigate the gardens or further filtered and used to water the animals.

Capturing this excess water can additionally reduce the volume and peak flows of storm water

34SUSTAINABLE COMPASSIONATE COMMUNITY FARM entering the sewer, thereby reducing flooding and combined sewer overflows.

The second part of water harvesting involves greywater harvesting. This is the process of

using water from the bathroom sink, shower, tub, and washing machine to help grow the plants

in the gardens. The water contains some soap but is clean enough to water plants. This process

can result in a significant decrease in potable water use and flow to the sewer system. One of the

pioneer rainwater programs is the Laundry-to-Landscape Graywater Program (SFWater.org).

The residents and staff will be able to participate in the harvesting of both the rainwater

and the greywater. With the rainwater harvesting it will involve emptying of any rain barrels into

either a larger containment system or to either the on-site garden or the compost pile as needed.

With the greywater system, all people on site will contribute to the creation of it as they go about

their daily activities using water. They can also use this water for the on-site garden and the

compost pile as needed. There is an excellent local resource, Blue Barrel Rainwater Catchment

System (https://www.bluebarrelsystems.com/), which has equipment needed for a set-up.

Permaculture is a practical design philosophy guided by its own set of ethics and aimed at

creating sustainable living environments to meet human needs while minimizing our carbon

footprint (Lebo, 2013). Permaculture is simply a combination of “permanent” and “culture.” This

eco-efficient design system of maximizing beneficial relationships can be applied to any human

environment including landscapes, buildings and even institutions. Permaculture draws on three

main sources of information and inspiration: natural systems, traditional farming, and

appropriate technology (Sustainable Living on a Small Farm the Permaculture Way).

Natural systems such as mature forests or mangrove swamps are highly efficient and

productive while producing no waste. Permaculture replaces natural ecosystem elements (i.e.,

plants and animals) with those that produce a yield for humans, while emulating their beneficial,

35SUSTAINABLE COMPASSIONATE COMMUNITY FARM symbiotic and interdependent relationships, as well as creating a cultivated ecology of “useful”

plants and animals.

Like natural ecosystems, traditional farming systems are bio-diverse with elements

working harmoniously together. The waste output of one element, like duck manure is captured

by the system as an input to another, for example to feed fish. Environment and lifestyle

sustainability...

The best of appropriate technology is utilized to enhance system eco-efficiency and yield.

Such technology includes water-harvesting earthworks, solar and wind power, composting

toilets, solar greenhouses, energy efficient housing, and solar food cooking and drying.

http://www.small-farm-permaculture-and-sustainable-living.com/

Residents and team workers will be able to participate in the day to day activities of

maintaining a functioning garden. This is also a great platform to involve the community, such a

volunteers or students for the JC or SSU. One team member should be contracted with the

particular job description of managing the garden/farm.

The Environmental Science department can help with growing crops, harvesting crops,

planning of which crops to grow per season, and teaching farming techniques.

Students interested in the field of horticulture can facilitate programs that would maintain

gardens with various plants along with education about plant management and care. Some of

these gardens can be used for food (which would open up more job or volunteer opportunities for

those interested in cooking).

The EOP (Educational Opportunity Program) Club and The International Student

Volunteers Club has members who can contribute through working in the gardens or

volunteering with daily activities/events.

36SUSTAINABLE COMPASSIONATE COMMUNITY FARM Students for Sustainability Club and The Association of Environmental Professions Club

can help maintain the farm’s processes for disposing wastes, recycling, and using our crops in

the most beneficial way. Their focus would be to improve the farm’s “footprint” on the land and

make sure that we are operating in the most environmentally-friendly way.

The Biology Department can recruit biology students to do studies and possible

experiments on crops in order to benefit growth, harvesting, and sustainability.

Other potential groups that could come to the farm could be sororities and fraternities in

order to do philanthropic events. These Greek organizations are required to do philanthropy in

the community, and the farm would be a perfect place for these students to host an event or

participate in activities with the farm members.

Animals

At the farm there will be many animals ranging from chickens to horses. As Rebecca

Johnson, a nurse who heads the Research Center for Human/ Animal Interaction at the

University of Missouri College of Veterinary Medicine points out, “studies have been focusing

on the fact that interacting with animals can increase people's level of oxytocin. Oxytocin helps

us feel happy and trusting.” (Rovner 2012) This shows that interactions with animals can in fact

be therapeutic and help people with mental disorders. This interaction can help reduce anxiety

and lower blood pressure as well as help improve the mood of the client.

We also plan to incorporate chicken, ducks, cows, goats and bees into the sustainable

farm. The chickens and ducks will provide eggs for direct consumption as wells as cooking

purposes. The cows and goats will be used for milk and cheese, and the manure will be added to

enrich the compost project. The residents and staff will be able to participate not just in the care

of the animals, but also in the collection of the eggs, milk and honey as well as the cooking of

37SUSTAINABLE COMPASSIONATE COMMUNITY FARM these products. Staff and residents will also be able to collect and transport the manure as part of

the composting pile.

Allowing patients to interact with and care for farm animals (with varying amounts of

supervision relative to the patient’s cognitive abilities), creates a sense of responsibility and bond

formation with the animals providing an “increased coping ability and self-esteem through

routines that include feeding, milking, and caring for other living creatures” (Berget 2008).

Collecting eggs and milking cows would demonstrate that caring for another being often has

beneficial results. Physical rewards could consist of items like eggs and milk, emotional rewards

would be demonstrated through bond formation. “Horses have many characteristics which lend

them to being effective agents of change, including honesty, awareness, and ability with

nonverbal communication” (Eagala 2013). Patients could participate in feeding, grooming,

ground exercises, and potentially even riding.

The benefits of Animal Assisted Therapy for psychiatric patients are significant. Using

farm animals as therapeutic agents in the context of Green care (a concept that involves the use

of farm animals, plants, gardens, or the landscape in recreational or work-related interventions

for different target groups of clients in cooperation with health authorities), results showed that

there was an increase in self-efficacy and coping ability through the use of AAT with farm

animals for psychiatric patients with long lasting psychiatric problems (Berget 2008).

The Equestrian Club and the People for Animals Club at Sonoma State can maintain

stables and provide care for horses. They could also aid in the training of horses or other animals

(dogs, for example) for the animal therapy program. Biology students with an interest in zoology

can facilitate and contribute to animal therapy and animal care.

We plan to incorporate chicken, ducks, cows, goats and bees into the sustainable farm. The

38SUSTAINABLE COMPASSIONATE COMMUNITY FARM chickens and ducks will provide eggs for direct consumption as wells as cooking purposes. The

cows and goats will be used for milk and cheese, and the manure will be added to enrich the

compost project. The residents and staff will be able to participate not just in the care of the

animals, but also in the collection of the eggs, milk and honey as well as the cooking of these

products. Staff and residents will also be able to collect and transport the manure as part of the

composting pile.

“Green Chimneys” is an organization that focuses on helping children and adolescents

who suffer mental illness through farming. This organization provides the advantages of

participating in purposeful, supervised gardening activities that enhance self-esteem, alleviate

depression, improve motor skills, provide opportunities in problem solving, encourage work

adjustment, and teach marketable horticultural and business skills. Moreover, through the use of

AAT (animal assisted therapy), Green Chimneys focuses on mentally ill children and adolescents

to help and improve trust, communications, confidence, boundaries, impulse control,

management of emotions, focus and attention, and self-control.

Technology and Apps

Applications for electronic devices, or ‘apps’ have become readily available to the

mainstream audience and this could be useful to incorporate for clients to help them navigate

their lives a little easier and healthier. For example, CareZone makes it simpler to take care of

yourself, an aging parent, and other family members that need medical management help. It is a

great way to use modern technology to help with medication and total health management to stay

healthy without the stress. It is user friendly for all ages including features that don’t require any

typing (Care Zone Incorporated, 2016). Additionally, created by athenahealth service, Epocrates

is available on mobile devices and online. It can be used by clinicians, nurses, and patients. It is

39SUSTAINABLE COMPASSIONATE COMMUNITY FARM geared towards the health care professional as a tool to manage medications but, some features

are available to patients for them to look up their medications and self-educate. (Epocrates,

2016). The final practical app is a very popular one called FitBit. FitBit requires the purchase of

a wearable wristband that functions as a watch and as a data recorder. As the user performs

activities of daily living, depending on which FitBit device is purchased, data such as heart rate,

steps climbed, quality of sleep, calories burned, exercise performed, etc. are being transmitted to

FitBit servers. The user can then observe trends in his or her online account or app and can input

additional information such as weight, daily food and water consumed. The app allows users to

set fitness and weight loss goals and to connect with friends who also use FitBit to encourage

and inspire one another. The FitBit wearable bands can also be paired with the FitBit Aria Scale

to monitor BMI and body composition (fat mass versus lean mass). (Fitbit, Inc. 2016).

Next, we looked into several apps that help their users practice coping techniques and put

to use the skills they learn in therapy. These apps help their users manage symptoms from day to

day. The PTSD Coach app was created by the VA's National Center for PTSD in partnership

with the Department of Defense's National Center for Telehealth and Technology. It is a great,

FREE tool to use alongside professional treatment for PTSD and learn about the disease and how

to cope. It offers a variety of functions that can be used between therapy appointments with a

professional. Users can gain knowledge about PTSD; track their progress and do self

assessments; manage symptoms with help; and search for local resources and support groups

(US Department of Veterans Affairs, 2015). “Breathe2Relax is a portable stress management

tool which provides information on the effects of stress on the body. It gives instructions and

practice exercises to help users learn the stress management skill called diaphragmatic breathing”

(Flynn, 2013). It was created in cooperation with The National Center for Telehealth as a tool

40SUSTAINABLE COMPASSIONATE COMMUNITY FARM that can be used as a stand-alone or alongside clinical care for anxiety and stress (Flynn, 2013).

Ginger.io is an app to help manage symptoms of depression, anxiety, and schizophrenia before a

crisis arises. It was created based on extensive MIT research to utilize many complex algorithms

to monitor people’s mobile device behaviors which have been shown to change with their mental

health status. Some of the great features include daily mental health assessments (“surveys” or

“check-ins”); cognitive behavioral exercises; a calm down kit which contains resources such as

relaxing guided meditation, videos of cute/funny animals; encouragement to participate in

healthy coping activities such as walking; a notes tab for user to journal; health tips that are user

specific; and coaches available during certain hours to provide assistance for people with various

conditions (most commonly anxiety and depression). (Ginger.io, Inc. 2016).

Then we found some unique apps all in categories of their own. First, the app called Big

White Wall (BWW) is a “safe online community of people who are anxious, down, or not coping

and who support and help each other by sharing what’s troubling them, guided by trained

professionals” (BigWhiteWall Ltd., 2014). BWW offers a variety of services to its users like

blogs, forums, self assessments, education, professional help, and connections with other people

facing similar problems. It is like Facebook for the worried and struggling (BigWhiteWall Ltd.,

2014). Next is an app called Charity Miles. This app allows users to earn money for charities,

with every activity performed donations are made to more than 30 charities. At the end of the

2016 challenge term, each charity partner will receive $530,000. For patients living in a

therapeutic community looking to contribute to a cause outside themselves, starting up this app,

sticking it in a pocket as activities are performed throughout the day can help ensure they know

their work is meaningful and is contributing not only to their own community but to the world.

(Charity Miles, 2016). Finally we found an app made by the National Association for Mental

41SUSTAINABLE COMPASSIONATE COMMUNITY FARM Illness (NAMI) called NAMI AIR. NAMI AIR is an app that allows users to improve well-being

through seeking out support or to be able to support others through its use. (NAMI, 2015).

Below is a chart that lists the pros and cons we found in each App. We hope you’ve found

this information fun and informative and are maybe considering getting an app or two for

yourself!

Name of App Target User Beneficial Features The Downside

CareZone (Care Zone Incorporated, 2016)

Patients with multiple health conditions and medications.

• Auto populates dosages, name, etc when user uploads a photo of their medication bottle

• Medication taking and refill reminders and printable schedule

• Tracks adherence and allows for journalling to track symptoms and progress

• Calendar to track appointments

• Stores important health information (eg insurance details)

• Helpful tips and information about condition and relevant health topics

• User can choose to share select information with doctors and family members but can revoke this permission at any time

• Free

• Only Compatible with Apple products

• Requires a device with a camera

• Medication IDs may not always be accurate so user must still be knowledgeable about current medications


Breathe2Relax (Flynn, 2013)

Patients with anxiety and high levels of stress Everyone and anyone!

• Can be used supplementary to psychiatric medical treatment

• User personalizes their settings to fit their needs

• Clear instructions and visual demonstrations on how to do the exercises

• Tracks stress levels and effectiveness of each exercise

• Provides education about the effects of stress on the body

• Tips and tricks to stay healthy

• Only compatible with Apple products

• Limited to one domain of stress relief techniques

• May appear overly simplistic making the user skeptical of its effectiveness

PTSD Coach (US Department of Veterans Affairs, 2015)

Veterans Patients with PTSD

• Compatible with Apple products, Androids, and desktops

• Designed by Veterans who have PTSD

• Provides easily digestible information about PTSD

• Self-assessments to make the user more aware of their symptoms and progress

• User can rate the different tools to find the most effective for them

• Complaints that the latest update has complications with storing data

• Requires the latest Apple or Android software updates

• Talking and music only runs in the App if the screen is lit up


• User can integrate contacts, photos, and music into the program

• Instant help at their fingertips wherever they go

Big White Wall Patients with anxiety and stress

• There is great healing that comes from connecting with people facing the same battles as you

• It is HIPAA compliant with confidentiality and is as anonymous as the user wishes it to be

• Connects individuals with each other, with support groups, and with resources and professionals

• There is a professional available online 24/7

• Taps into creativity by offering creative ways to share feelings and moods (eg creating banners)

• Offers tests and self assessments to check progress and stay involved

• Main connection is to the UK

• Depending on health benefits there may be a subscription fee (Veterans get it for free)

• Can require a significant amount of time, may become hindering

FitBit (FitBit, Inc. 2016)

Patients • Multiple models to choose from to suit unique personal needs/lifestyles

• Water resistant (would probably survive a shower, definitely ok to wash the dog or do dishes,

• Not waterproof - it cannot track activities such as swimming.

• Can cause skin breakdown if not cared for properly (i.e. cleaned regularly)

• No longer allows


etc) • Use of visual charts

to track health/activity trends over time

• Ability to set goals and earn “badges” for achieving goals

• Tracks activity throughout day with little to no need to interaction with device

• Can connect with friends and participate in activity goal games/friendly competitions

• Silent vibration on wrist when selected personalized goals are met for the day

• Could potentially be used in physician appointments to login and allow physician to note patient’s quality of sleep (number of times restless or awake throughout the night, compare activity levels before and after starting a new medication, etc).

custom tracking: manual entry of blood pressure, blood glucose, body measurements, etc.

• Requires a purchase. Depending on Fitbit model chosen, cost can range from $60-$250.

• Could potentially be used in physician appointments to login to Fitbit “Dashboard” and allow physician to note patient’s quality of sleep (number of times restless or awake throughout the night, compare activity levels before and after starting a new medication, etc).

Epocrates (Epocrates, 2016)

Clinicians, Nurses, Patients

• Drug information • Interaction check

between as many as 30 medications at a time

• Pill ID • Secure text

messaging among

• $174.99 per year for full services for clinicians

• May be too in-depth for patient use. Drug-guide, interaction checker, and pill ID might be only useful


providers (requires additional free app download)

• calculator • medication tables • Full services geared

towards clinicians only include: (comes with a fee) -Guidelines for evidence-based, patient-specific guidelines that are condensed for convenience with links to the full information; -Information about alternative medicine, such as herbals and other commonly used supplements; includes reported uses, dosing, caution, adverse reactions, etc. -In-depth information about labs: results, costs, prep, and collection guidelines

parts of this app for patients

• Requires patient to be able to read and comprehend in English

Charity Miles (Charity Miles, 2016)

Patients & Workers on Farm

• Free app • Provides motivation

to exercise or to do work

• One method of participating in a cause outside of oneself

• Functions while walking, running, or biking

• Users get to pick which charity to support

• The money earned goes to an external charity, not to the farm itself.

• Requires a mobile device and pocket

• Requires activation of phone’s geolocation services (the app will ask for permission for that when first logging in)

• Does not work for indoor biking (as


• Walkers and runners earn 25 cents per mile

• Bikers earn 10 cents per mile

with a stationary bike in a gym)

Ginger.io (Ginger.io, Inc. 2016)

Patients with anxiety or depression (may also be useful for schizophrenia)

Mental health assessments (“surveys” or “check-ins”)

• Free (currently) • Therapeutic exercises

teach cognitive behavioral tools to change negative patterns of thinking

• “Calm Down Kit” guides to quick resources for easing anxiety (videos, tips, hotlines, etc)

• Notes: app users have a space to journal

• Health tips are provided based on the condition the user has

• Coaches: available as much or as little as the user needs; coaches are paired with users whose condition they specialize in

• requires input of personal data

• app is updating and will be requiring a paid subscription later in the 2016 year.

• Coaches are not licensed clinical therapists. The coaches are simply trained professionals who have experience supporting people with depression and anxiety.

• Coaches are not online 24/7; coach responds to inquiries daily within his or her set online times (usually 3-6 hours per day)

NAMI AIR (NAMI, 2016)

Patients, Caregivers, Patients’ Families

• Free • users can share

problems and seek support anonymously

• can be an educational tool and support for family members of loved ones with mental illness as well - address family needs for

• The app is built for iOS7 and iOS8

• It has the potential to turn into a negative spiral: reading other people’s problems or comparing “war stories”


understanding and support, not just patient’s

Conclusion

It is our hope that this exploration of all the necessary, and many of the possible, aspects of

creating a safe, secure and revolutionary place of healing for those suffering with serious mental illness

will serve those that continue to work for its realization. Whether the next step be technology, alternative

treatments, sustainable gardening, animal therapy, or traditional approaches to mental health, we know

that the range of evidence based treatments for mental illness are many and always increasing. As future

nurses we hope that RNs are remembered as important caregivers in the lives of the future residents of the

Sustainable Compassionate Community Farm in Northern California. We know that this residential

resource is imperative to our community’s mental health and to increasing the standard of care

worldwide.

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Sustainable Compassionate Community Farm for People with Serious Mental Illness

Healthcare

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