Climate action is indeed action; compassionate action, inspired by deep empathy with the ongoing and potential suffering caused by the climate crisis.

To speak about climate action and climate leadership, we must first acknowledge the delicate symbiosis in which we coexist, or as the late Buddhist monk Thich Nhat Hanh described, our ‘interbeing’ with nature (1).

The relationship between planetary health and patient health is intricate and dynamic, often resulting in unpredictable health outcomes and unintended consequences (2).

As healthcare professionals, moreover as humans, it is vital that we create opportunities to experience the awe of our connection with our magnificent planet, and the terror of our capacity for destruction. These emotions are important for catalysing climate action and inspiring effective leadership (3)

During art psychotherapy training, I attended an outdoor workshop, exploring a patch of land within the university campus. I remembered the poet John O’Donohue’s invitation to “take refuge in your senses, open up to all the small miracles you rushed through” (4).

I attuned my senses to a level often unknowable in my hurry from place to place. We can all relate to this automated hurry, but can you recall the last time you purposefully slowed down to observe the natural world?

In taking the decision to stop and notice, I made space to contemplate what was happening in that small patch of Earth.

I began to observe the dynamics of helping relationships mirrored in the seeds of the beech trees around me. As professionals, we might function as robust kernels, supporting our ‘seeds’ during vulnerable stages of development and healing. The abundance of kernels surrounding me echoed the countless people born every day, each with the need to receive care, often from professionals who must therefore practice and lead with care themselves. It is a nested system in which the environment of the kernel directly influences the seed.

I decided to paint what I had found (Figure 1). I wondered if I might be bored by seemingly plain twigs but the more I looked, the more I noticed their detail, depth, subtlety, character, and uniqueness. It became a very mindful experience, entering a microcosm of the world.

I curiously opened a kernel. Marvelling at the tiny seed, I suddenly realised that this destructive act would disrupt a natural process; forcing the kernel to open before the natural conditions arose. I felt a sense of responsibility, a reminder that all my actions, all our actions, however small, have tangible consequences.
I continued painting, capturing the enormous potential of that tiny seed (Figure 2). Splashes of water, previously suspended in clouds and oceans, interacted with pigment dyes, extracted from other natural sources. I thought about the tree that this seed could become, providing oxygen, shelter, and safety for thousands of beings during its lifetime.

In their proposal for a planetary health framework, MacNeill, McGain and Sherman (5) assert that achieving net zero healthcare emissions requires the prioritisation of health and wellbeing in society, while incentivising and promoting environmental stewardship. Furthermore, they highlight the first principle of the framework is to reduce demand for health services. When I mindfully connect with nature in the ways I have described, I remember my connection to the earth. I am somehow changed; I am gentler, more thoughtful, and inspired toward environmental stewardship. Moreover, spending time in nature, whether exercising, for leisure, or rest, I am investing in my own physical and mental health; for me it serves both a preventative and restorative function.

Hordyk and colleagues explored nature as a ‘holding environment’ while working with children (6). The author speaks of nature providing a “symbolic place of physical holding”, which speaks to my personal experience. If we can cultivate the sense of being held by the world, perhaps we might take more responsibility for our actions?

Do you, dear reader, feel held by the world?

It is important to note however, that while personal action is important, the decisions of leaders and policymakers are vital in the reduction of harm caused by healthcare practices, and other industries. Healthcare systems must continue to develop strategies to reduce the incidence and severity of disease, reducing the overall demand for care (5); for example, by focusing on the social determinants of health and improving health equity.

It is vital that politicians and leaders reflect on the environmental impact of policy decisions, but I wonder if they too busy in their own rushing and fighting? Leaders must learn to stop, notice, and act from wisdom gleaned from their direct experience of planetary symbiosis. For example, healthy rivers flow into oceans, lakes and streams to maintain ecosystems of rich biodiversity. In this way, healthy leadership has great influence on people and planet through the provision of guidance, resources and support, while inspiring team members in the co-production of thriving healthcare environments.

At a team level, leaders can inspire climate action by encouraging staff and patients to connect with the wonder that is the natural world. This could be through nature-based team workshops, reflective practice in nature, incentives to reduce carbon emissions (such as rewarding greener travel) and by working to create green environments within services.

At the micro-level, wherever possible, gardens, lovingly tended patches of land, or simply waiting rooms with plants, can serve to remind both professionals and patients of our interbeing with the world.

Our loss of connection with nature, adds to strain on our mental health. Systematic reviews report links between climate change and mental health (7,8) often described as ‘eco-anxiety’. The precise meaning of this term is ambiguous (9), since climate-related distress can encompass many emotions, including grief (10). Psychotherapy, in which I am now trained, can play a significant role in supporting people to explore, process and manage the full spectrum of emotional life through the provision of a therapeutic relationship. More specifically, art psychotherapists offer a relationship whereby people can give expression to their feelings through the process of artmaking and reflection. There is a growing evidence base for nature-based art psychotherapy practices, acknowledged in a forthcoming special edition of the International Journal of Art Therapy (11). In addition, a framework for intentional engagement with the climate crisis through creative arts therapies has been proposed (12). Art therapists are also primed to support the target of a Net Zero NHS through initiatives such as the Greener Allied Health Professional hub.

Nature-based arts therapies often take place outdoors, but natural materials and imagery can also be brought into the therapy room. On a personal level, I find that outdoor artmaking helps me to navigate my inner landscape. It can be as simple as a walk in my local park, being open to collect and work with whatever I might find. Bringing materials from the outside into my studio is an embodied act of mirroring, inviting the possibility of connection with the wisdom of nature, while dispelling the mistaken perception of myself as separate from the world.

The value of arts-based therapies is not limited to therapist/client relationships. By incorporating arts-therapists into multidisciplinary teams, professionals can enhance their emotional resilience, foster creative solutions, improve communication, build community, and effectively advocate, and indeed lead, for climate action. The integration of micro-level change in our individual practice and daily lives, combined with team, leadership and systems thinking is necessary to address the urgency of the crisis. The tiny seed contained within the beech mast held great wisdom and insight for me.

I wonder what insights await you, if you choose to take consultation from nature?

References

1. Hanh TN. The miracle of mindfulness: An introduction to the practice of meditation. Beacon Press; 1975.
2. Pongsiri MJ, Bickersteth S, Colón C, DeFries R, Dhaliwal M, Georgeson L, et al. Planetary health: from concept to decisive action. Lancet Planet Health. 2019;3(10):e402–e404. https://doi.org/10.1016/S2542-5196(19)30190-1
3. Brosch T. Affect and emotions as drivers of climate change perception and action: a review. Curr Opin Behav Sci. 2021;42:15–21. https://doi.org/10.1016/j.cobeha.2021.02.001
4. O’Donohue J. Benedictus: A book of blessings. Bantam Press; 2007.
5. MacNeill AJ, McGain F, Sherman JD. Planetary health care: a framework for sustainable health systems. Lancet Planet Health. 2021;5(2):e66–e68. https://doi.org/10.1016/S2542-5196(21)00005-X
6. Hordyk SR, Dulude M, Shem M. When nature nurtures children: nature as a containing and holding space. Child Geogr. 2015;13(5):571–588. https://doi.org/10.1080/14733285.2014.923814
7. Boluda-Verdú I, Senent-Valero M, Casas-Escolano M, Matijasevich A, Pastor-Valero M. Fear for the future: Eco-anxiety and health implications, a systematic review. J Environ Psychol. 2022;84:1-17. https://doi.org/10.1016/j.jenvp.2022.101904
8. Cosh SM, Ryan R, Fallander K, Robinson K, Tognela J, Tully PJ, et al. The relationship between climate change and mental health: a systematic review of the association between eco-anxiety, psychological distress, and symptoms of major affective disorders. BMC Psychiatry. 2024;24(1):833. https://doi.org/10.1186/s12888-024-06274-1
9. Coffey Y, Bhullar N, Durkin J, Islam MS, Usher K. Understanding eco-anxiety: A systematic scoping review of current literature and identified knowledge gaps. J Clim Change Health. 2021;3:1-6. https://doi.org/10.1016/j.joclim.2021.100047
10. Cunsolo A, Ellis NR. Ecological grief as a mental health response to climate change-related loss. Nat Clim Change. 2018;8:275–281. https://doi.org/10.1038/s41558-018-0092-2
11. Moula Z, Christopher G, Armstrong V, editors. Nature-Based Art Therapy [Special issue]. Int J Art Ther. 2025. Pending print publication, articles available at: https://www.tandfonline.com/action/showAxaArticles?journalCode=rart20
12. McLaughlin H, Seabrook D. The creative arts therapies and the climate crisis: Toward a framework for intentional engagement. Arts Psychother. 2025;92:102255. https://doi.org/10.1016/j.aip.2025.102255

Image references

Figure 1: Wrigley (2023), Mixed media composite image of paintings of twigs and beech masts          

Figure 2: Wrigley (2023) Mixed media composite image of paintings of beech masts and seeds (Wrigley, 2023)

Author

Gemma Wrigley (Trainee Art Psychotherapist)

Gemma will qualify as an Art Psychotherapist in March 2025, based in Manchester, UK. Gemma previously studied at Central Saint Martin’s College of Art & Design and has worked in NHS and voluntary sector mental health services since 2016. Gemma has a special interest in bridging Clinical and Arts-for-Health practices, working alongside people and planet, not only to reduce symptoms but to find meaning in life and to thrive.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.