The Vineyard Project: a therapeutic landscape for young people experiencing mental ill-health
The Vineyard Project cultivates the vineyard as a therapeutic landscape for youth experiencing mental ill-health, involved in a one-to-one interaction with vine-growers and peer agronomy students in vine care activities. With the involvement of arts, humanities and enological high schools, the project aims to develop an innovative program for youth, based on peer-training, aimed at competitive employment (an essential part of citizenship) and rooted in locally constructed therapeutic landscapes.
Local
Italy
Province of Cuneo (Piedmont Region)
Mainly rural
It refers to other types of transformations (soft investment)
No
No
Yes
As a representative of an organization, in partnership with other organisations
Name of the organisation(s): Eclectica+ Research and Training Type of organisation: Non-profit organisation First name of representative: Eleonora Last name of representative: Rossero Gender: Female Nationality: Italy Function: Researcher (Sociologist) Address (country of permanent residence for individuals or address of the organisation)<br/>Street and number: Via Silvio Pellico 1 Town: Torino Postal code: 10125 Country: Italy Direct Tel:+39 346 983 9522 E-mail:rossero@eclecticapiu.it Website:https://eclectica.it/homepage-inglese/
Name of the organisation(s): Mental Health Department, Local Health Authority (Azienda Sanitaria Locale CN1) Type of organisation: Public authority (European/national/regional/local) First name of representative: Andrea Last name of representative: Barbieri Gender: Male Nationality: Italy Function: MD Psychiatrist in charge of Cuneo and Dronero day centres (Mental Health Department) Address (country of permanent residence for individuals or address of the organisation)<br/>Street and number: Corso Francia 10 Town: Cuneo Postal code: 12100 Country: Italy Direct Tel:+39 339 806 7702 E-mail:andrea.barbieri@aslcn1.it Website:https://www.aslcn1.it/
The Vineyard Project stems from preliminary reflections on the cultural and symbolic value of the viticultural landscape, suggesting the vineyard as a possible therapeutic landscape for youth experiencing heterogeneous forms of mental distress and vulnerability.
Moving beyond green-care initiatives that conceive contact with nature as intrinsically beneficial, the project aims to explore: i) the processes of constructing therapeutic landscapes; ii) the elements that contribute to subjective experiences of wellbeing; iii) the role that youth mental health services can play in the cultivation of enabling places.
A pilot started in 2022, followed by an ethnographic, immersive research suitable to study landscape and the relationship with space and its materiality. The pilot involved the training of 12 people aged 18-25 in a 1:1 interaction with professional winegrowers, to perform manual grape harvest and other vine care activities. Results underlined a number of therapeutic features (see Research report) and emphasised the role of training activities in the process of recovery.
These findings guided the design of the following phases (ongoing), confirming one-to-one practical training as an element that facilitates interaction, moderates its emotional intensity, normalises silence and allows non-verbal communication. A peer-training program has been developed with students of the local high school of Enology. The notion of “peer” is here understood in a double perspective: objective (same-age people who share interpretative and communicative registers), and subjective (participants’ feeling of being equal, despite their non-traditional biographical trajectories, altered by the onset of a disorder).
The final aim is the development of a rehabilitation program for youth, based on peer-led training, aimed at competitive employment (an essential part of citizenship), and rooted in locally constructed therapeutic landscapes.
Therapeutic landscape
Peer-led activities
Formation-based rehabilitation
Youth mental health
Viticultural practice and training
Drawing on previous research, the Vineyard Project understands the relation between vine-growers and the vines a relationship of care, driven not only by productive interests: the recipients of care, in fact, are not only the vines as living beings vulnerable to disease and harmful environmental conditions, but also the other inhabitants of the vineyard (animals and plants), the soil, the water and, more generally, the biodiversity that characterises these landscapes. We discussed in a recent publication (see the Gastronomica article attached) how modern winemakers referring to “natural agriculture” invoke the profound knowledge their ancestors had of their vines. The particular attention paid to the vineyard is an endeavour to attune to something other than human. Traditional manual operations are much telling about the intimate relationship between the vine and the winemaker.
On this basis, the pilot was hosted in the wine-making area of Langhe (Italy), specifically by a renowned winery that over the last twenty years has adopted environmentally sustainable farming methods, obtaining the organic certification in 2015.
The repetition of ancient gestures, typical of biological and biodynamic agriculture (its magical-ritual practices) can be seen as a cultural form of resistance to a depersonalized, atemporal and managerial activity, to a standardized practice that sacrifices every subjective manifestation on the Procrustean bed in the name of a scientific, utopian “dream of control”, overshadowing the maieutic abilities of the winegrower in the dialogue with their vines.
In the design and implementation of the pilot and its following phases, we considered the peculiar context of biological winemaking – particularly sensitive to the safeguard of (bio)diversity – the perfect setting to host an initiative for vulnerable young people, where attention, care, ability to listen and to attune to the (human or non-human) other, are cultivated and valued.
The project is hosted in the 50th UNESCO site of Langhe-Roero and Monferrato (Italy), a place known for the aesthetic qualities of its landscapes, the architectural and historical diversity of its built environment and the cultural relevance of winemaking art.
The initiative draws on the concept of “therapeutic landscape of the mind”, a psychic space structured around the emotional and sensorial contents of the lived experience in a physical environment (in this case, the vineyard). Moving from the results of a pilot phase, the project examines how place can engender social and emotional resources for young people experiencing mental ill-health.
The aesthetic qualities of the natural environment and the vine care activities that people taking part in the project have experienced showed immediate beneficial effects in terms of wellbeing, derived from moments of immersion and contemplation, increased sensitivity to external stimuli and, in parallel, to inner movements.
This experience-based initiative supports the exploration of new territories of the self, experimenting new contexts and relations with strangers (a social activity mediated by a one-to-one organization of work, that facilitates interaction, decreases the emotional intensity, normalises silence and therefore makes sociality accessible to people with relational difficulties).
Experiencing unprecedented “ways of being” have an impact on previous structures of thought and action. This means that the therapeutic properties of a place are not only beneficial here-and-now; rather, they intervene at a deeper level on self-representations, engendering feelings of pride (related to the successful participation in the project), satisfaction and increased self-confidence. In this sense, therapeutic landscapes can have real transformative effects which extend to other times and places in the person’s life, catalysing deeper changes and intervening on biographical trajectories.
Inclusion is intended in this project as the engendering of emotional and social resources through the cultivation of a therapeutic landscape, made accessible to a marginalised group: youth experiencing mental health issues.
One-to-one interaction in vineyard activities was successful in making participants feel accepted irrespective of their relational difficulties. By focusing on a practical task (grape harvest), social norms concerning behaviour were relaxed, normalising silence and allowing physical proximity to be sustained without discomfort. Repeated one-to-one interaction represented a means of gradual approach to the wider group: day after day, the increasing familiarity gave way to jokes and friendly comments between workers and participants. The mediating entity that normalises interaction by finalising it to a practical task (the red box where bunches are deposited) represents a resource that can be exported to other contexts, an expedient facilitating group interaction (a typical obstacle to sociality).
Imperfection as an admissible characteristic and diversity as a value turned out to be constitutive features of the vineyard: vine-growers explained how diversity characterises their team (e.g., nationality, age) and work environment. It derives the need to embrace and adapt to the characteristics of each workmate, vine specimen, degree of grape ripeness and atmospheric condition. Along the project activities, it was observed the establishment of continuous, sometimes implicit, parallels between the human and the vine world: “They (the vines) are like us, they are all different”, a vine-grower observed.
The phase following the pilot, that will foster professional training prior to employment, is consistent with evidence showing that persons participating in competitive employment meeting their vocational needs are more likely than people in sheltered work programs to feel included in their communities and to report a high quality of life.
Involvement has been fostered on multiple levels at all stages of the initiative: 1) Participants of the pilot stage have been involved in the design of the following phases, providing feedbacks and insights of their experience and suggestions to engage other young people in the initiative from their perspective; 2) High schools involved in the pilot had the opportunity to express the need to engage students in activities concerning youth mental health: to this extent, an unplanned series of seminars have been co-designed and conducted by mental health professionals, using participatory methods to maximise youth’s engagement; 3) After the pilot, peer-led educational activities have been co-designed with the School of Enology that will host them, benefitting also from the institute’s previous experience with vulnerable people (i.e. a project with people detained in the local prison). These multiple forms of engagement of different subjects enrich the initiative and inspires its evolution according to the needs and aspirations of those who will directly benefit from its implementation.
The impact of the initiative concerns the civil society as well. The project and pilot’s results have been disseminated through health authority’s press releases, articles in the media and the production of a video (https://www.youtube.com/watch?v=reyJCRHykcA), with the aim of increasing awareness on youth mental health and the innovative interventions that are being designed. Citizenship will further be involved in the final event and auction, where the whole project will be narrated through its participants’ voices and its material outputs (artistic productions, labels, writings) will be shared.
The initiative also has a de-stigmatisation scope, pursued in particular in the field of employment: it means to attempt overcoming public stigma about mental illness that may undermine an employer’s willingness to hire a person with a psychiatric diagnosis.
The pilot of the project involved several actors and institutions. First of all, the project stemmed from the collaboration between different services of the Mental Health Department of the local health authority (ASL CN1), specifically community services: Mental health centres (diagnosis and treatment), Day centres (rehabilitation), specialistic services (Centre for eating disorders). Services focused on the youngest services users, involved by individual psychiatrists and other professionals to evaluate the appropriateness, motivation, and concrete modalities of inclusion in the initiative.
The project involved the third sector, in particular: a social cooperative (Società Cooperativa Sociale Proposta 80), and a social enterprise specialised in applied health research (Eclectica+ Research and Training). The social cooperative provided human resources (health professionals and volunteers) as well as material resources (a van used to travel to the vineyards with the group). The social enterprise conducted qualitative research, carrying out participant observation in the vineyard and individual interviews with participants. Results of the study have been useful to design the project following the pilot and are attached to this application (Research report).
The project involved three educational institutions: Arts and Humanities high schools (Alba), and the School of Enology (Alba). Arts high school was crucial for the third phase of the project (see the Methodology section); Humanities high school inspired the organizers to develop and conduct a laboratory with students dedicated to adolescents’ mental health; the School of Enology was fundamental in the co-design of the formative activities developed for the second edition of the project.
The project received the patronage of the Association “The Vineyard Landscape of Piedmont: Langhe, Roero and Monferrato” (UNESCO site) the Municipality of Alba.
The project involved professionals from different disciplines since the very beginning. The therapeutic and rehabilitative scope, proposed by the psychiatrist in charge of the project, was further developed with the support of psychologists, social workers, nurses and health professionals working in the different services of the Mental Health Department.
The project was enriched by the collaboration of sociologists working as qualified researchers in the field of health. The design of the project developed through a continuous exchange between the field of psychiatry and that of health sociology, as the heterogeneous literature that forms the basis of the project’s theoretical framework shows (see Research report). The theoretical background was extended by contributions from the psychological field, as well as from the tradition of health geography that was fundamental in the conceptualisation of the “therapeutic landscape”.
The multidisciplinary nature of the initiative was evident in the vineyard activities as well: together with participants there were psychiatric nurses, occupational therapists, a sociologist (ethnographer) and a health worker specialised in eating disorders. The co-presence of the different professionals on the field represented the occasion for a continuous dialogue between disciplines, as well as between theory and practice, project’s goals and concrete needs of the participants. Preliminary results during the analysis of the pilot study were regularly discussed in multi-professional teams, to integrate analytical tools and perspectives in the iterative process of analysis and design of the following phases.
An essential knowledge field was represented by biological vine growers who worked together with the group, transmitting substantive knowledge to the participants and a different perspective on the initiative. This inspired reflections on stigmatization and the relation with the wider community outside of mental health services.
The innovative character is evident when the initiative is compared to mainstream rehabilitation activities concerning training and employment. These are critical domains of functioning as well as an essential part of citizenship, and therefore an important target of recovery-oriented programs for people with psychiatric disabilities.
Contrary to usual sheltered work programs, the program is hosted in a real-world setting where participants work side-by-side with experienced vine-growers. The ultimate goal was developing an evidence-based rehabilitation program specific for the target population (youth with mental ill-health) aimed at competitive employment. Pilot findings identified features that address the target population’s specific needs: on-site practical training provided in a 1:1 interaction with professionals, supplemented by educational resources available in the community (e.g. local School of Enology); covering of all the vineyard activities throughout the year; growth of expertise on an individual as well as on a group level, to foster the building of a cohesive team that can compete on the labour market and that provides participants with a sense of membership and identity; opportunity for new participants to join the team, acknowledging their peers as experts who can in turn pass on their knowledge; continual assessment of the needs of participants and qualitative inquiry of their perspective, to provide ongoing adjustment of the program.
The dimension of peer training intended in its external and internal meaning (see section on Inclusion) is innovative in the specific area of learning and training: it goes beyond traditional understandings of “peer” as an objective status that fosters credibility easing the transmission of knowledge, integrating the subjective perspective of the fragile and vulnerable learner, and therefore emphasizing the inclusive potential of educational activities.
The process and outputs of the initiative could be easily transferred and adapted in several ways.
First of all, the project can be scaled locally, expanding the number of participants, schools and producers involved, reaching new beneficiaries.
The project could be replicated in other places, within or outside of Italy, becoming a rehabilitation tool aimed at competitive employment of young mental health service users.
Lastly, the project could be adapted to different contexts in the agricultural field, being potentially applied in settings that do not practice viticulture but other kind of activities. Indeed, the very objective of the project is to provide indications to explore and cultivate therapeutic landscapes that are locally available and that may prove beneficial for the target population.
The research investigating the pilot and the following developments will be useful also to the extent of outlining a rehabilitative, formation-based tool, accompanied with guidelines and practical indications for implementation. The model, evidence-based and rooted in scientific literature from different – medical and non-medical – disciplines, will guarantee a sufficient level of generality that allows for the adaptation to different contexts.
Besides the core model, additional guidelines will be provided with respect to the target group considered, namely young mental health service users. The model can be further expanded to cover formative activities in other areas (e.g. adult psychiatry; addiction disorders).
The pilot entailed four phases: 1) Participants were involved in manual grape harvest with experienced vine-growers. The aim was to explore the vineyard as a therapeutic landscape by virtue of its capacity to imprint itself in the experience of youth and to engender social and emotional resources; 2) In-depth interviews were conducted with participants, enabling them to narrate their experience and describe the inner landscape that took shape in the vineyard; 3) Stories collected through audio-recorded interviews were transferred as audio tracks to the Arts high school’s students, asked to create – through interpretation and empathy – labels and other artistic productions; 4) An open event (June 2023) will recount the pilot to the community and include a fundraising auction of bottles labelled with students’ works.
A distinguishing element of the project is the peer-led activities characterising the different phases. In the pilot, the efficacy of this approach was particularly evident between the 2nd and the 3rd phase. Through narration and its discursive and intrinsically relational nature, the subjective experience of participants became a story passed on to other youth (students). The latter were very present in the inner landscape of participants: during interviews, participants constantly referred to their invisible interlocutors, sometimes addressing them directly, at other times confiding to the interviewer that they had done their best to enable their peers to understand their experience. This appeared to make them feel useful to their peers and to the overall opportunity of the project to progress.
These promising results guided the project’s team to include peer activities in the following phases of the project, both in the formative phase in the School of Enology, and in the development of a digital application to present the qualified team on the competitive job market (involving the Informatics high school).
The initiative addresses the need to develop innovative programs for vulnerable young people. The WHO defines adolescence (10-19 years) and youth (20-25 years) as critical biographical transitions, having long-term consequences in terms of physical, mental and sexual health. Young people represent a particularly vulnerable group: the literature shows that 50% of mental disorders first emerge under the age of 15, while 75% see an onset by the age of 25. Anxiety, depression, eating disorders, alcohol and other substance abuse and gambling have been growing steadily among younger people in recent years. The outcomes of the Covid-19 pandemic have contributed to a further deterioration of their mental health. The social and economic consequences of the distress affecting youth concerns the entire community and requires timely and targeted interventions to address the phenomenon.
Despite the intrinsic social value of protecting youth health, mental health services on the international scene are designed to respond mainly to the acute and chronic needs of the adult population, neglecting the specificities and needs of young people. Children and adolescents mental health services are often undersized, underfunded and poorly integrated with those for adults. As a consequence, this group is characterised by less access to medical care, poor compliance, and delayed referral.
The epidemiological data on the mental health of the 10–25-year-old population and the inadequacy found in traditional services denote the need to develop innovative interventions capable of reducing the cultural and economic barriers to accessing services, promoting inclusiveness, de-stigmatisation and community involvement. The development of a place-based intervention aimed in particular at vulnerable young people – such as The Vineyard Project – will hopefully inspire the design of initiatives in the field of mental health and the involvement of stakeholders outside the healthcare context.
The pilot is in its 3rd phase (Arts school’s students have received audio-tracks in December 2022 and are currently working on the labels and artistic productions), while the final event is being organized for June 2023.
In the meantime, analysis of the empirical material gathered in the 1st and 2nd phases has been analysed, and a research report has been written (please find it attached). The results are promising with respect to the impact the pilot had on participants. Two contributions on this project have been submitted and accepted by the 31st European Congress of Psychiatry, a prestigious conference that will take place in Paris (25-28 March 2023). The first one will present the findings of the pilot study, highlighting the therapeutic and rehabilitative value of formative activities in a “real world” setting; the second will describe the next steps of the project and gather valuable feedbacks from experts in the field of mental health.
Pilot’s findings point to the need to implement more extensive rehabilitation programmes, based on formative activities supporting inclusion and competitive employment. To reach this goal, agreements between the Mental Health Department and the School of Enology (Alba) have been signed, after the co-design of a program involving young mental health service users and peer students of the school. The latter will train the former about the different activities concerning the vineyard (e.g., pruning, harvesting) in a 1:1 interaction that proved successful in the pilot (both to increase social skills and to provide access to the broader group for vulnerable people). Training will take place between Spring and Autumn 2023.
The final step (Autumn 2023) will involve students of the Informatics high school, that will interpret the young team needs and develop a digital application through which wine producers can find and hire them for one or more seasons, strengthened by the certified training received in the School of Enology.
This initiative contributes to the development of new competences in non-formal education settings (youth work and peer-training activities) in that it is focused on a sustainable approach to vine care and viticultural practice, respectful of bio- and human- diversity. The project engages young people (both mental health service users and students of several high schools), reaching a relevant number of recipients and potentially stimulating them in the reflection on sustainability. Moreover, the pilot is hosted in the 50th UNESCO site of Langhe-Roero and Monferrato, a context that is currently investing to address climate change, installing sensors to monitor air and soil parameters in the area and eventually inaugurating a permanent observatory on these topics. The site is also active in the involvement of local communities on environmental issues, particularly youth: a call to action for 20-35-years-old has been launched in 2022 to constitute a think tank on UN Sustainable Development Goals (https://rb.gy/lyqb97).
