a Coalition for Fresh Air?
Massachusetts, a unique initiative is being considered:
One that affirms the essential connection between psychological
well being and the healing effects of nature. This effort
is named CFAR: The Coalition for Fresh Air Rights. We have
filed a bill in the State Legislature to make daily access
to fresh air and the outdoors a fundamental right.
At issue: The denial of fresh air and outdoor access to
patients in psychiatric facilities. Most psychiatric hospitals
are ‘locked’, and most have limited access to
the outdoors, some none at all. Outdoor access is mainly
governed by ‘privilege’ systems, and fresh air
is often restricted as a punitive measure for ‘bad’
Everyone, to some degree, agrees that fresh air is important.
But we think access to the outdoors is extremely important
to basic psychological well being. To deny it to people
who, by no fault of their own, are suffering acute emotional
and spiritual crises, only exacerbates their pain.
The push for greater equality and dignity for the ‘mentally
ill’ can arguably be said to be one of the last frontiers
of the Civil Rights movement. As ‘consumers’
(persons with mental health concerns), we are experiencing
a groundswell of empowerment and newfound respect, the logical
result of all great civil rights efforts.
Still, we start out at a loss in a society that seems to
have lost track of how to be well. Rampant abuses of power
by treators, tremendous media stigmatization, and a broken
health care system are challenges faced by us all.
For example, in this state, prison inmates are mandated
time outdoors, yet consumers are not. We seek to change
As a ‘consumer’ myself, I have experienced the
profound pain of mental illness. I’ve been lucky to
come from a supportive background. But I and countless others
have been victimized by a system that takes those in crisis
and locks them inside for very short stays (a week or so
on average - sometimes months in state facilities), in cold,
The isolation felt in this situation is compounded by staff
members who are frequently disdainful and seriously overworked,
and ‘privilege’ systems that treat people like
helpless children. Being indoors 24/7 only makes things
Despite the common refrain from insurers that “if
people are well enough to go outside, they are well enough
to go home”, staying inside distances people from
the outside world and stifles their preparedness for discharge.
There is no escape from the dismal settings and others’
I have been hospitalized 11 times in my life, and looking
back over the diaries I’ve kept, I see a pattern.
Going outside was something that I looked forward to –
it spiritually nourished me, even in the ‘dead’
of winter. Again, I was lucky – my hospitalizations
happened in places where outdoor access was allowed. I don’t
think I could handle staying in all day, breathing stale
The ‘privilege’ systems that exist in many places
punish patients for noncompliance with treatment plans or
disagreeing with staff. Privileges such as outdoor breaks
are therefore revoked.
An exhaustive survey of hospital policies at 72 hospitals
across the state has yielded mixed results. Some are very
supportive of the idea; and some have severely limited access.
Some administrators become indignant at the very idea of
providing outdoor access. In addition, some state hospitals
do not evaluate patients for 30-40 days for privileges,
keeping them inside for that duration.
How many of us just ‘don’t feel right’
if we don’t go outside each day? It’s a very
human condition. Scientific studies (many of them available
through ICE), have shown over and over that exposure to
nature directly correlates with lowered stress levels, decreased
frustration and violence, and an increase in overall well
being. In the 19th Century, the Quakers ran psychiatric
hospitals based on ‘moral treatment’: Patients
enjoyed fresh air, good food, and a remarkably tolerant
system where they were considered ‘brethren’.
But current trends in an increasingly restrictive and ‘managed’
healthcare system show we are moving backwards. People in
need of acute care are being kept in hospitals that are
more and more restrictive, for shorter lengths of time.
Emphasis is on ‘stabilization, not treatment’.
The units are basically holding areas where patients’
medications are monkeyed around with - far less emphasis
is placed on holistic types of treatment plans. This creates
a ‘revolving door’ situation, where consumers
become more and more reliant on medication, perceived as
the only approach.
The bill faces large obstacles, despite the fact that it
has been endorsed by organizations such as the National
Association of Social Workers, the National Alliance for
the Mentally Ill, 14 legislative co-sponsors, and hundreds
of fellow consumers and disability-rights activists and
The primary opponents to the bill are hospital industry
lobbyists. They argue that allowing access to fresh air
will cost large amounts of money, possibly leading to the
closure of units. Understaffing due to economic hardship
is a concern, as is safety. The hospitals worry that escaped
patients, some of whom are prone to dangerous behaviors,
threaten their own safety and that of the general public.
They fear public outrage and multimillion-dollar lawsuits.
But we believe progress can be made, and with some capital
expenditure and creative thinking, compromises can be reached.
A clause in the bill allows for the superintendent of a
facility, in limited cases, to revoke a person’s outdoor
access if that person is deemed too serious of a threat.
As Coordinator of CFAR, I feel extraordinarily lucky to
be able to spearhead a campaign that touches on a subject
that is important but often overlooked. When our bill was
heard in front of the Joint Legislative Committee on Mental
Health and Substance Abuse in July, the consumer turnout
was very impressive. Consumers and advocates alike testified
passionately about the importance of their connection with
nature. This was awe-inspiring and incredibly encouraging.
Thanks to groups like ICE, I now have the chance to ‘spread
the word’ on a national level. I hope this effort
will be a seed of enlightened thinking, and a movement toward
the true freedom nature offers.