Introduction
The World Health Organization identifies the promotion of mental health as a public health priority, which needs to be addressed in local communities (WHO, 2021). The youngest and most vulnerable groups require particular attention, as well as new approaches able to reach them and effectively communicate with them.
In Italy, as in many other countries, community mental health services play a pivotal role, developing programmes that involve not only people experiencing mental ill health but also the wider population. Community-based services developed after the so-called ‘Basaglia Law’ in 1978, a pioneering reform that brought mental healthcare from institutional settings (asylums) to the contexts of everyday life. Taking into account the social determinants of health and mental health, community services provide recovery-oriented interventions that also address housing, employment, education and social inclusion.
It is well known that people living with a mental health condition are often socially excluded. This undermines basic human rights, exposing them to discrimination and stigmatisation. When the onset of a mental condition occurs during adolescence, as for many disorders (McGorry et al, 2022), it is likely to disrupt biographical paths: people often drop out of secondary education, with long-term negative consequences and difficulties in entering the job market. This, in turn, increases the risk of social isolation and lack of participation in community life, adding to disadvantage and marginalisation.
Providing mental healthcare in the community means not only avoiding institutionalisation but also acknowledging and valuing the resources (social, material, emotional, cultural, spiritual or cognitive ones) available in the community itself. In what follows, we describe an intervention – the Vineyard Project (in Cuneo, North-West Italy) – based on the cultural value of the wine-growing landscape and its potential to become a ‘therapeutic landscape’ (Barbieri and Rossero, 2024) for youth experiencing mental ill health.
The Vineyard Project: aims, development and results
Drawing on a multidisciplinary theoretical framework (psychiatry, psychology, sociology and geography), the project developed through two phases. First, a pilot intervention explored the therapeutic potential of the vineyard, meant as a safe, welcoming and non-judgemental space. In the vineyard, the human–vine encounter allowed a genuine experience of connection among participants. Viticultural practice represents a form of care, as it entails situated, experiential knowledge being carried out (Mol, 2008). In particular, it is an example of local care that requires observation, attention and responsiveness to the environment’s needs, as well as flexibility and adaption to uncertainty (Krzywoszynska, 2016). These features characterised the setting in which the pilot intervention took place. Findings showed multiple therapeutical elements: sustainable one-to-one interaction mediated by grape-harvesting activities; the experience of mirroring the harvesting partner; the sense of connection with other participants, who shared bodily and emotional experiences; and the development of an empathic disposition as they attuned to the instances of the vineyard and the winegrowers (Barbieri and Rossero, 2024).
A second phase of the project implied a prolonged practical-experiential training path, hosted in a local high school for agricultural sciences. Participants (eight mental health service users under the age of 25) and students worked together in pairs or small groups in the school’s vineyards in different seasons (January–September 2023), experiencing peer training (students guided participants in operating on the vines) and co-training (teachers supervised both students and participants).
I [researcher] observe that this is a context in which errors are permitted: students are supervised by Matteo and Fabrizio [teachers], to whom they often turn to ask questions about what to do with a specific vine. I often hear jokes, e.g.: ‘Professor, if I prune this plant well will I get a passing grade?’. Students and participants are effectively peers, legitimized to make mistakes and ask for help.… On several occasions, I observed students showing participants how to correctly trim or tie a shoot, accompanied with encouraging expressions.
The relationship between students and teachers, characterised by confidence and irony, played an important part in relaxing tensions and addressing individual difficulties. Conversations were mostly characterised by friendly tones, informal expressions and the use of the local dialect. This atmosphere made this unusual training environment a liveable one, as the continuous presence of participants showed (there were sporadic absences due to personal appointments or difficulties external to the project but no drop-outs). This stability led to the development of a sense of familiarity: from week to week, the group saw the consolidation of routines and habits, which made the activity progressively known and predictable, thus contributing to lowering anxieties and fears. Sharing increasingly familiar vocabularies and mental representations made communication more fluid and relaxed, lightened by explanations that gradually became unnecessary.
In this ever more familiar environment, participants distanced themselves from the role of guests (who tiptoe around the place for the first time), becoming regular visitors known to the local students. When someone was not present, they were missed by the rest of the group. Personal relationships developed between participants and students, who got to know each other as they worked together on the vines. Dialogues concerned information not only about the operations to be carried out but also about youth’s daily lives, their passions or hobbies, and their stories. Interaction, mediated and justified by working in pairs or small groups on the vines, allowed the establishment of relationships, self-expression and the acquisition of an identity recognised by others. From the point of view of mental health services, this qualifies the intervention as effective in supporting valuable socialising interactions in the recovery process. Moreover, the project neutralised participants’ self-devaluation, relational avoidance and expectations of failure (disconfirmed by the success in the relationship, as well as in the correct and increasingly precise execution of tasks in the vineyard), which usually isolate people and socially marginalise them.
Consistent with the pilot phase of the project, the topic of plant diversity emerged. In the school’s vineyards, there were ‘easier’ (more regular) plants and more difficult ones (that is, when it was not immediately clear how to prune them, which were the fruit-bearing shoot and the spur and so on). These differences needed to be explained, unveiling the embodied and tacit knowledge entailed in viticultural practice. Each vine required a specific, personalised intervention, which inspired a reflection on human diversity: the emerging, shared impression was that in the vineyard, ‘there was room for everyone’ and that cooperation and balance could be achieved only through attunement to and the adoption of a sensitive posture. The ‘peer’ dimension pursued by the project was acknowledged by the students too: in a conclusive, dedicated focus group, they discussed their perception of being ‘on the same level’, to the extent that both groups – participants and students – were in the vineyard to learn. The meaningfulness of this experience seems to have translated positively into the ‘inner landscapes’ of students, who claimed to have talked about it with other significant people (family and friends) outside of the school context.
Conclusions and future advancements
The Vineyard Project seems successful in reproducing a micro-social context located in the real world, namely in a natural (that is, not simulated) environment. This context enabled the training of social skills, such as negotiation (for example, of breaks and work rhythms with one’s partner in the vineyard), cooperation and active engagement in conversations. The sustainability of these social activities for people experiencing mental ill health and relational difficulties is due to the fact that they are inscribed in the practical viticultural activities.
Consistent with the theoretical framework of immersed ecological care (de la Bellacasa, 2017), the human–vineyard relationship was observed to unfold through attention-based modes of viticulture, entailing a sensorial as well as affective involvement of participants with the vines. Through these haptic engagements in care (de la Bellacasa, 2017: 197), participants learnt to attune to the plants’ world and its needs, assisted by the patient and caring guidance of both students and teachers. The relationships that students established with participants during the project nurtured an empathic disposition that contributed to reducing the perceived social distance between the two groups, contributing to destigmatising mental ill health.
These findings can hopefully inspire new initiatives in the field of mental health, involving stakeholders external to the healthcare context (for example, schools and subjects from the agricultural and productive world). Community-based interventions are necessary to promote social inclusion and participation, dimensions that are pivotal to social recovery (Mezzina et al, 2006). These aims are of particular relevance for the youngest population, who may also benefit from programmes that provide educational opportunities. We believe that the extension of this peer and co-training model in other contexts of the agri-food sector (culturally relevant for the geographical area where participants live) may be valuable, both for socialising purposes and for the development of professional skills to employ in the labour market.
The future of the Vineyard Project includes the exploration of job opportunities for the group of participants as such (for example, as a cooperative), enhancing the sense of belonging and group identity developed during the training experience. Consistent with the young age of participants, the development of a visual identity and the exploration of digital tools (for example, apps) to reach potential employers will be pursued by the multidisciplinary team through a co-design process that starts from participants’ experiences and expressive preferences (Stoyanov et al, 2021). Multi-actor co-design practices combine different forms of knowledge and expertise, responding more effectively to the challenges of the sector, including the agricultural one (Macken-Walsh, 2019). Co-planning will include experts who approach the development of visuals and digital tools from an empathetic understanding of the issue (that is, the social and professional inclusion of people with lived experience of mental ill health) and from the situated needs and values of the viticultural field (Kenny and Regan, 2021). In continuity with the attention-based nature of the peer-led training path, this attitude represents a form of care and therefore an innovative direction and primary goal of mental health service activity.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Acknowledgements
We thank the participants, ASL CN1 and the professionals who contributed to the project, and the students and teachers of IIS Umberto I.
Conflict of interest
The authors declare that there is no conflict of interest.
References
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