Between November 2025 and March 2026, the Forest4Youth project brought together practitioners, advocates and experts from Belgium, France, Germany, Ireland and Luxembourg to explore how time in forests can support young people receiving psychiatric care. Through 44 interviews and focus groups, this Patient and Public Involvement process focused on listening closely to experience and translating it into something practical.
What participants described was not a single intervention, but a journey. It begins before entering the forest, moves through a moment of arrival, and unfolds into an experience that can shift how a young person relates to themselves, to others and to the world. Forest-based care is not simply about taking therapy outdoors. It is a carefully supported approach that creates the conditions for something more human to unfold.
Key developments
A practical guide co-designed through lived and professional experience
Participants shaped and co-designed a concise, field-ready guide that can be used by multidisciplinary teams. The emphasis is on clarity and usability. It sets out essential elements such as preparation, safety planning and communication, while avoiding rigid instruction. Much of what makes these sessions work remains in the background. Careful preparation, coordination and trust allow the visible moments to emerge without being forced.
Seeing the forest as an active partner
Across all countries, participants described the forest as more than a setting. It makes offers. Its sensory richness, changing seasons and scale invite curiosity and reflection. Young people often respond to these qualities without prompting. These moments cannot be planned in advance and this is precisely where their value lies. This is not simply time spent outdoors. It is an approach that allows meaningful, unplanned experiences to emerge.
Balancing preparation and freedom
The idea of planned spontaneity sits at the heart of the approach. Careful preparation supports young people to engage safely and with confidence. This includes building trust, setting expectations and establishing simple rituals that frame the experience. Many described a delicate moment at the point of entering the forest, where hesitation can give way to openness when the right support is in place. When this happens, young people can begin to let go of pressure and connect more freely.
Opening access through immersive virtual nature
Participants also explored how immersive virtual nature can support those who are not yet ready to enter a forest setting. It can provide an initial step for young people experiencing high levels of anxiety or restriction within inpatient care. There was strong agreement that this should act as a bridge, supporting access to real environments as soon as it is safe and appropriate to do so.
Voices from the project
Next steps
The focus now turns to testing and refining the practical guide across different settings. Project partners will pilot the approach within clinical teams and gather feedback on how it works in everyday practice. Training will support staff who may be less familiar with forest environments, helping them feel confident in delivering sessions that are both safe and responsive.
Further work will also explore how immersive virtual nature can be integrated in a way that supports progression toward real outdoor experiences. Continued engagement with practitioners, young people and families will remain central as the work develops.
Impact and relevance
Forest4Youth is contributing to a shift in how we understand care for young people in psychiatric settings. The findings highlight that recovery is not only about reducing symptoms. It is also about relationships, identity and the opportunity to experience oneself differently.
Time in the forest can create a space where roles soften. In these moments, the usual hierarchy between adult and young person becomes less pronounced, allowing relationships to feel more equal and more real. Young people can begin to move beyond the identity of patient and experience themselves in terms of capability and possibility.
The project also shows the value of bringing together different forms of knowledge. Mental health professionals, forest guides and public contributors each contribute essential perspectives. Through this process, they have shaped and co-designed an approach grounded in both evidence and lived experience.
What this PPI process has made clear is that forest-based care is not a set of activities. It is an approach built on preparation, trust and openness to what might happen. When these elements are in place, the forest becomes more than a setting. It becomes a place where change can begin.
