Exploring the Use of Sea Swimming as an Intervention With Young People With Mental Health Challenges: A Qualitative Descriptive Study

ABSTRACT

There is emerging evidence that sea swimming can have a positive impact on the mental health of adults. Less is known about how this intervention can impact young people's mental health. The aim of this study was to explore young service users and staff's perspectives on sea swimming in the child and adolescent mental health services. Fourteen participants were interviewed (eight young people and six staff members). Data were analysed using reflexive thematic analysis and five themes were identified. A preference for sea swimming was demonstrated by young people in comparison to other therapies. Young people reported an enhanced (and sustained) sense of well‐being after sea swimming. They were able to relate the act of entering cold water to their recovery journey, acknowledging the importance of leaving their comfort zone. A sense of social cohesion was also described. Staff members acknowledged the risks of open sea swimming but highlighted the importance of positive risk taking, given the benefits of this novel intervention. Owing to the positive impact sea swimming can have on the physical and psychological health of young people, there is potential for this novel intervention to be used more frequently within the services.

1. Introduction

Children and adolescents are susceptible to developing mental health challenges, with approximately one‐third of young people experiencing some degree of psychological distress (Cannon et al. 2013; World Health Organization 2021) and 13% experiencing emotional or mental distress (Healy et al. 2019). Without appropriate intervention, this prevalence is likely to increase as these individuals transition into their twenties. Depression among young people is not only widespread, but also persistent and disabling, often associated with low academic achievement, school absenteeism, substance misuse, violence, self‐harm and suicidal ideation (Finning et al. 2019). The COVID‐19 pandemic significantly impacted the mental health of young people, intensifying pre‐existing issues and creating new challenges. Lockdowns, school closures and social distancing measures disrupted the daily lives and routines of children and adolescents, leading to increased feelings of isolation, anxiety and depression (Pustake et al. 2022).

There are a number of evidence‐based ways that the child and adolescent mental health services (CAMHS) support and work with young people and their families or carers, including psychoeducation, developing parenting skills, promoting communication between the child/adolescent and their family, all of which can positively impact familial or carer relationships (Benton, Boyd, and Njoroge 2021; Finsterwald and Spiel 2012). Chen et al. (2020) emphasises the significance of giving CAMHS users transferable and usable skills so they can transition back to community care as easily as possible. It is therefore paramount that healthcare staff identify age‐appropriate ways of enhancing the mental health of this population group.

2. Background

The act of immersing oneself in the ocean, sea swimming or dipping, can offer a multisensory experience, triggering physiological responses within the body. Amidst the cold and the ebb and flow of tide and waves emerge feelings of not only invigoration but also calm, an intrinsic connection between humanity and the natural world (Bozalek, Shefer, and Romano 2024). Immersion in water evokes a profound sense of connection with a force far greater than oneself. This experience facilitates a shift in perspective, allowing individuals to perceive themselves as part of something bigger (Bozalek, Shefer, and Romano 2024). As Denton and Aranda (2020) suggest, this awareness diminishes the illusion of control over the material world, fostering a recognition of broader influences at play. By disengaging from the distractions of modern life and engaging fully with the body, one can transcend the confines of the mind and simply exist within the natural world.

Although not a novel concept, the COVID‐19 pandemic precipitated a significant increase in sea swimming as individuals sought alternative means of physical activity and mental health support amid widespread restrictions and lockdowns (Christie and Elliott 2024). With the closure of indoor recreational amenities and gyms, the natural environment became a significant resource for sustaining physical fitness and psychological well‐being. Sea swimming, in particular, gained popularity due to its accessibility to those living near coastal areas, low cost and requiring little to no equipment (Trylińska‐Tekielska et al. 2022).

There are several reasons why someone might start sea swimming, including taking on the challenge, the desire to connect with nature and the motivation to enhance one's well‐being (Massey et al. 2022). Overbury, Conroy, and Marks (2023) found that sea swimming has the potential to improve well‐being and mood, and reduce feelings of anger, fatigue, depression and anxiety. Yankouskaya et al. (2023) identified a significant relationship between cold water swimming, whether in plunge pools or the sea, and increased feelings of energy, awareness and confidence, along with decreased feelings of dread and anxiety in adults. Moreover, it has been suggested that sea swimming can be a ‘suppressor of suicidal ideation’ (Christie and Elliott 2024, p. 24), in particular during COVID‐19 lockdowns, with the sea offering a place of comfort and ‘akin to a natural health service’ (Christie and Elliott 2024, p. 24).

Stress reduction theory (Ulrich et al. 1991) suggests that natural environments inherently elicit a stress reduction response, especially in areas free from noise, air pollution and crowds. Denton and Aranda (2020) expand on this, commenting that blue spaces, such as those used for sea swimming and cold water immersion, foster a profound sense of connection and belonging. This includes connections to the swimming location, to other swimmers and to the broader community. They assert that immersion in the sea facilitates synchronising one's movements with the water, enhancing the feeling of being connected to the natural environment. In addition, focusing on aspects of sea swimming, such as the cold water and blue spaces can transform a person by taking them out of their minds and into their bodies (Britton and Foley 2021). Sea swimming could also enable a swimmer to be more resilient and gain more confidence in their skills to overcome challenges, including their mental health. It offers coping mechanisms for many of life's difficulties (Burlingham et al. 2022).

According to Stevens et al. (2021), swimming in the sea with others can have a positive direct effect on adults who struggle with depression. As a result of engaging in a group, participants' personal activity levels improved, while feelings of loneliness and isolation and depression symptoms reduced. From partaking in swimming groups, participants reported that they developed a greater understanding of water safety and strategies for managing the cold, describing feelings of being alive, energetic and elated, to feeling calm and relaxed. These feelings lasted different lengths for each individual participant from hours to days. The participants described both improved mental and physical health, including improved confidence and increased motivation, with some even going as far as reporting the intervention as life changing which gave them a new sense of purpose and new connections. Participants also reported improvements in physical health, including reduced joint pain and improved sleep patterns. Many adult swimmers express pride in their achievements and note increased confidence and enjoyment in being in the water (Burlingham et al. 2022).

Research on the use of sea swimming with younger populations who experience mental health challenges is more limited. In a study by Gardiner et al. (2022) involving four young people with low‐level anxiety and mood‐related difficulties, a 15% improvement in emotional well‐being following a sea swimming intervention was reported. The authors suggest that further research is needed with regard to the potential of sea swimming as an intervention with this population.

Due to levels of restrictions during COVID‐19, many community CAMHS teams exchanged face‐to‐face therapeutic engagements for online service provision, although the option of in‐person support remained available. This remote delivery of therapeutic interventions enhanced feelings of security, offering young people ‘a sense of safety’, (Worsley et al. 2022); however, this was not applicable to CAMHS inpatient services, within which therapeutic activities are offered as part of service provision and are an important part of an admission. As such, one inpatient unit in Ireland suggested the use of sea swimming as an intervention. The availability of nearby oceanic amenities and a curiosity regarding therapeutic service provision provided the backdrop for exploration into the possibility of the use of sea swimming as a therapeutic intervention with CAMHS inpatient service users (hereafter referred to as ‘young people’). Given the call for further research around the use of sea swimming as an intervention with young people, this study aimed to explore young people and staff members' perspectives, using a qualitative approach.

3. Methods

3.1. Intervention Description

During the summer, swimming is offered to all young people once weekly, following a risk assessment by the MDT. This activity may also be offered on an individual basis for young people all year round, at their request. If a young person has been demonstrating very risky behaviour, for example, suicidal ideation with a plan or intent, a decision may be made by the team that the young person is not suitable for all group outings at that time. If a young person experiences health challenges, for example, low weight due to eating difficulties, they would agree with staff on a time frame for being in the water, and would float as opposed to swim, following a risk assessment by the team. Safety plans are agreed prior to every outing, and measures are taken to reduce the risk of ‘afterdrop’ such as warm water for feet, warm drinks and adequate clothing.

To accommodate a group of four or five young people, two to three staff (comprising various members of the MDT) attend sea swimming; all staff members demonstrate a strong swimming ability. The beach used for this intervention is safe, well known to staff, with no currents and has a shallow shelf, so there is no reason for the young person to go out of their depth; as such, young people are not excluded from attending sea swimming based on their swimming ability.

The actual swimming itself is part of a larger process, which includes the anticipation of getting ready; collecting towels, snacks and milk cartons full of warm water; choosing the music for the car journey; and chatting in the car along the way. The act of swimming itself generally takes 20 min; this is followed by the ritual of warming up, getting dressed, having snacks and getting a coffee. There have been no reports of any young person not enjoying being in the sea. Most of the young people who avail themselves of the service are female, and therefore, there has been a higher number of females attending sea swimming than males.

3.2. Design

This study was guided by a qualitative descriptive approach. Such an approach encourages the researcher to stay close to the data, reporting on participants' experiences and perceptions in their own words, thus facilitating an authentic account of the phenomenon under investigation (Doyle et al. 2020; Searby et al. 2022). The COREQ checklist guided this study (Tong, Sainsbury, and Craig 2007).

3.3. Data Collection

A purposive sampling approach was used. Posters advertising the study were placed in the CAMHS inpatient unit where sea swimming was facilitated. Posters were also displayed in prominent locations in outpatient environments (for the attention of young people who had engaged in sea swimming as inpatients). Data were collected through individual interviews, via Microsoft Teams, using a semi‐structured interview guide. Two experienced mental health nursing researchers (who did not attend sea swimming and were university employees unaffiliated with the impatient unit) conducted the interviews (JG and MOM). Once transcripts were checked against the audio for accuracy, the original recordings were deleted. Interviews lasted 23 min on average. Field notes were recorded.

3.4. Data Analysis

Reflexive thematic analysis was used to analyse data (Braun and Clarke 2021). Analysis was facilitated by NVivo 14 (QSR International Pty Ltd. 2023).

Data from young people and staff were analysed separately. To enhance immersion in the data, transcripts were read repeatedly. Transcripts were coded by JG. The relationship between codes was reviewed by MOM, leading to the generation of initial themes. These themes were presented to AT, which were debated and refined. In line with the qualitative descriptive approach and Braun and Clarke 2021), interpretations are supported using direct quotations from participants.

The principles outlined by Lincoln and Guba (1985) were followed to maintain rigour. We maintained credibility by ensuring data analysis was a collaborative process, involving regular meetings and reflexive conversations (Ahn and Shin 2023). Dependability was ensured by maintaining an audit trail, in addition to transparent reporting of data collection and analysis (Peart, Kerr, and Searby 2023). Transferability is achieved through reporting participant characteristics and the provision of quotes from a wide range of participants (Goodwin et al. 2022; Lincoln and Guba 1985).

3.5. Ethics

Ethical approval was granted by the Clinical Research Ethics Committee of the Cork Teaching Hospitals, approval number: ECM 4 (p) 20/06/2023.

4. Results

Nine young people initially agreed to take part in the study; however, one participant became uncomfortable during an interview, which was suspended early. Consequently, data from eight young people were included (see Table 1). Six staff members were interviewed (see Table 2).

TABLE 1.

Demographics (young people).

	Number (n)
Gender
Male	1
Female	7
Age
14	2
15	2
16	2
17	1
18	1
Race/ethnicity
White Irish	8

TABLE 2.

Demographics (staff members).

	Number (n)
Gender
Male	2
Female	4
Race/ethnicity
White Irish	4
Any other White background	2
Discipline
Psychiatric nurse	5
Occupational therapy	1
Years working in mental health services
0–5	1
6–10	3
11–20	2

Four themes were identified from young people's data, and four themes were identified from staff data. There was crossover between themes across the two groups—these related to the benefits of sea swimming, enhanced social connections and a preference for sea swimming when compared to other therapies; these data are thus presented together as: ‘More at Peace: The Mental Health Benefits of Sea Swimming’, ‘Something We Could Do Together: Enhanced Social Connections’ and ‘They Actually Seek to Avoid Them: Sea Swimming Compared to Other Therapies’. ‘I am Brave: Accepting the Challenge’ was a theme identified unique to young people's data, while ‘We Do a Lot of Positive Risk Taking Anyway: Acknowledging Risk’ was a theme identified as unique to the staff member data (see Figure 1). Pseudonyms are used throughout to preserve anonymity.

FIGURE 1.

Thematic map.

4.1. ‘More at Peace’: The Mental Health Benefits of Sea Swimming

Young people described an initial feeling of scepticism when introduced to the concept of sea swimming as an intervention. They reported a lack of interest in outdoor activities, in addition to doubt about how sea swimming could benefit their mental health:

I didn't really see how it could, like, benefit, your mental health (Becca, young person [YP])

However, for many, the benefits of sea swimming became immediately obvious as soon as they engaged with it. Participants spoke about the fun they experienced while in the water and the sense of freedom they felt:

If you wanted to go for fun, you could go pier jumping. Or, if you wanted to actually swim, you could go for distances, and there's endless amount of things you could do. (Freya, YP)

The ‘feel good factor’ achieved through sea swimming was described by several participants. This related to the act of being in the water but also extended to the excitement of getting prepared to go to the beach and the prospect of a post‐swim warm drink. Participants reported feeling ‘more energised’ on the days that they engaged in sea swimming:

Like, we'd be chatting all the way down the car, listening to music, and we'd have a picnic after. And then we might stop for coffee (Hailey, YP)

You always feel really good and refreshed after it, and you feel energetic. (Eva, YP)

In addition to feeling energised, participants spoke about the sense of calm that sea swimming invoked. Several young people reported experiencing negative emotions and anxiety prior to swimming in the sea. However, once they entered the water, they commented that these worries ‘drifted away’ replaced with a sense of calm:

The best part about it was just kind of being there and experiencing it and […] feeling, like, a bit, more at peace. (Daisy, YP)

Young people attributed these changes in their thoughts and feelings to the impact of cold water. It was felt that the initial system shock of feeling the cold prompted the body to enter ‘survival mode’ shifting the focus away from anxious thoughts and promoting a feeling of ‘being in the present moment’:

I suppose like biologically it goes into like […] I don't even know how to explain it but… like, when you're so cold your brain, like, all it focuses on is, like, just surviving. So, like, you know, you're not thinking of other stuff, like, your head just stops and you're just focusing on being in the moment. (Becca, YP)

The changes described by young people were also observed by staff members. They noticed that young people who had been ruminating on past events or expressed concerns about the future were far calmer following engaging in sea swimming:

Afterwards in the car going back, you can see they're just… everybody's kind of more zen. You know, they're an awful lot more relaxed than they would have been on the way down. (Elisa, staff member [SM])

All of these benefits were enhanced by having time away from the inpatient unit and being out in the open air. For both young people and staff members, being at the beach and engaging in sea swimming helped to ‘break up the day’ and was associated with a sense of ‘normality’:

Just being out in the sea, like it's, it's nice. It's nice to be out there. It's something different like than the hospital. (Andrew, YP)

I suppose just how normal it was, you know, it was just good to see the kids in the environment that wasn't the clinical setting – just outside enjoying themselves and… being kids, really. (Christopher, SM)

The benefits of sea swimming were not limited to the event itself, with participants reporting a sustained improvement in their well‐being. They continued to feel a sense of calm and were more productive through the rest of the day:

You feel just as happy coming out from it as you are even better coming out, you know. With most dopamine rushes like a sugar rush, you'd have a crash afterwards. But with the ocean you feel even better coming out. You know, if you're having a bad day and you go for a swim, it could cheer up your day […]. It inevitably, it helps your mental health. (Freya, YP)

Staff members concurred with the sustained benefits to well‐being. They gave several examples of young people who, upon admission, were disengaged, low in mood and demonstrated a reluctance to attend the ward activities. However, engaging in sea swimming promoted a positive shift in their recovery, which became more obvious over time:

To see this girl, how she was, I mean, her affect, her arousal, her interest, her whole being was so different. Her body language was so different, and you could almost feel it. You know, it's kind of a core regulation thing. It was really invigorating. It was just great, like, it really was inspiring to see how the cold could change you. (Flora, SM)

4.2. ‘I am Brave’: Accepting the Challenge

Despite an initial reluctance to enter the cold water, young people spoke about the importance of leaving one's comfort zone, accepting the challenge presented to them, and ‘pushing through’:

When you do go, even though you didn't want to, you never, ever regret it. You have to push through, and you know, if you don't do it now, when will you ever do it? (Gabrielle, YP)

In doing so, participants realised that they were stronger than they thought they were and that they could accomplish difficult tasks. There was a recognition that, although life can sometimes be overwhelming and fraught with seemingly insurmountable challenges, it is always worth accepting the challenge:

I am brave […] I can do hard things. It's like, ‘I've done this’, you know, this is another hard thing. But remember that time when I got into the freezing cold ocean? Like, I did that, and I was OK. I got out the side of it, obviously, so it really sets up your mindset. (Becca, YP)

Having accepted and overcome the challenge of facing the cold water, participants took pride in their sense of accomplishment. Moreover, they were able to apply this revelation to other aspects of their life, including their mental health recovery journey. They began to realise that, in spite of the mental health challenges they faced, progress and recovery were possible:

Afterwards as well that feeling of like accomplishment and, like, you know, almost, like, being proud of yourself, even though it seems like something that's very, like, little, very small. But it's, you know, when you're in that kind of that state of mind, like, something like that is, feels like a big thing to accomplish. (Daisy, YP)

4.3. ‘Something We Could Do Together’: Enhanced Social Connections

Participants spoke about the benefits of sea swimming as a collective social experience. They emphasised the importance of peer support while being in the water and the sense of safety that this fostered for each individual:

It was something we could do together. (Becca, YP)

There's that sense of safety when you're with the crowd, because if something goes wrong, there's other people there. (Freya, YP)

It was reported that the group process was also more motivating. Participants felt that, if sea swimming were conducted solo, it would be unlikely that they would brace the cold water, thereby losing out on all the benefits. However, when at the beach, young people would encourage each other to push that bit further:

It was nice having, like, other people to do it with because you can kind of encourage them and they can encourage you. (Daisy, YP)

Attending sea swimming as a group activity was also described as being ‘more fun’. Participants spoke about how they would play games in the water, challenge each other to submerge themselves completely in the water and adopt a carefree approach to the activity that proved to be enjoyable:

I'd say groups would be better because it's more… you'd have more craic [Irish colloquial term for fun] out in the water. (Andrew, YP)

Staff members also observed the impact that the social elements of sea swimming had on young people. However, they also commented on the enhanced young person–staff member dynamic. Sea swimming was viewed as a shared experience between young people and staff, something that brought everyone together on a common level. Owing to the absence of uniforms and everyone being similarly attired in their swimming gear, it was felt that power dynamics were reduced:

I wouldn't be in my uniform, so we genuinely looked just like anybody else on the beach. That was nice as well ‐ it put us all on like a really equal footing. (Dorothy, SM)

That's, you know, not only just between the young people themselves and the staff: everyone connects together and that's benefited by everyone jumping in the sea together as well as from having a laugh together. (Alan, SM)

Indeed, one staff member described the sea swimming activities as a ‘family trip out’ further emphasising the erosion of power dynamics and the collective social element:

It was like nearly […] a family trip out, you know, as a collective. And just building that relationship with young people outside of something clinical. (Christopher, SM)

4.4. ‘They Actually Seek to Avoid Them’: Sea Swimming Compared to Other Therapies

Young people drew a distinction between other therapies and sea swimming. They cited a preference for sea swimming over all other forms of therapies, including talk therapies and other outings (on the unit, young people participate in a variety of outings, including attending playgrounds, wildlife and animal rescue parks, woods, greenways, cinema, shops, wildlife parks, print studios and cafes):

Usually for me, the other therapies don't really help (Cathy, YP)

Several young people spoke about their experiences with talking therapies. There was a sense of discomfort about voicing one's thoughts and feelings in a 1:1 situation, and agitation about the formality of sitting still in a room speaking to a health professional. Sea swimming, on the other hand, was perceived much more favourably, with no concerns about formality or feeling uncomfortable:

It's not just like sitting in a in a like a therapy session or something. It's like you're just in the water and you kind of forget about everything else. (Hailey, YP)

Such sentiments were echoed by staff members. They observed that young people have a tendency to actively avoid talking therapies, particularly on a 1:1 level. It was suggested that expressing one's feelings verbally can be challenging for young people. Instead, activities such as sea swimming, where change is immediately felt, were considered superior:

Young people don't want those intense 1:1 talking therapies and interaction; they actually seek to avoid them. (Elisa, SM)

It would be lovely if people can talk about their feelings, but sometimes people are not at that place for whatever reason. […] It could be language can be interpreted in lots of different ways. So, to connect through the body like that hierarchy of., you know, just connected with the body first and feeling regulated. (Flora, SM)

It was not just talk therapies that were considered less preferable to sea swimming—issues with other outings were also expressed. With these outings, participants described feeling disengaged or being present in body only.

I think, because with the other activities you can go, but you don't really have to mentally go, I would just kind of zonk out, kind of, like, just, you know, not really be active or present. (Gabrielle, YP)

Staff believed that the lack of structure involved in sea swimming was a boon. It was noted that, with all other therapies, the events were planned in advance and flexibility was not always possible. Staff members felt that this rigorous structure might not suit all young people and that such activities could feel repetitious. Sea swimming, on the other hand, was perceived as far less repetitious and less structured:

‘I think maybe some found that they got a bit repetitive and, I don't know, like, if you weren't interested in art or baking, these kind of things, just not what everyone's interested in. So, I think that going to the beach was a lot more fun for them and just a nice change and not repetitive’ (Bella, SM)

While other group activities offered on the ward, such as baking and art therapy, were perceived as enjoyable, their benefits were not always obvious. However, there was an immediate sense of accomplishment associated with sea swimming which was maintained over time:

I've done art therapy, and we do a baking group and, you know, there's that sense of accomplishment, but it's not the same as the swimming […] – there's no physical activity with baking or in art, and you don't get that same sense of achievement. (Freya, YP)

4.5. ‘We Do a Lot of Positive Risk Taking Anyway’: Acknowledging Risk

Staff members acknowledged the potential risks of sea swimming. They noted that the mental health services are traditionally risk averse and that it was important to be realistic about some of the dangers associated with taking young people to the beach:

I suppose at the end of the day, there is risks associated with: we are going to a beach. We are going to open water, you know. (Christopher, SM)

However, staff members commented that the services were becoming less risk averse and beginning to engage in positive risk taking. Owing to a change in this culture, it was felt that opportunities are now opening up to offer more person‐centred therapies to young people, including sea swimming:

We do a lot of positive risk taking anyway in CAMHS and things have that culture as changed. (Elisa, SM)

The importance of conducting risk assessments was expressed; indeed, staff reported that they were always assessing risk, acknowledging the potential for issues to escalate quickly. Despite this, among all staff members, there was a sense that bringing young people sea swimming was a very safe activity:

I'm trying to remember if I had any kind of anxieties, trepidations around things like safety concerns. I don't think I did, to be honest. (Alan, SM)

Indeed, the only risk cited by staff was the risk of seeing sea swimming not be offered to young people as an intervention in the future. Staff emphasised the importance of continuing to adopt a positive risk‐taking approach within CAMHS and that more staff members need to take ownership of the sea swimming activities:

We're always a little bit cautious that somebody is going to pull the plug. I don't know that like you know we we're always super careful, but we just we value it so much as intervention. (Flora, SM)

5. Discussion

The aim of this study was to explore young service users and staff's perspectives on sea swimming in CAMHS. Young people emphasised the sense of both fun and peace they experienced while sea swimming. They also gained insights into their ability and their bravery in overcoming obstacles such as the cold or a lack of motivation to begin. Participants were able to take these learnings and use them to make changes in other parts of their life that might aid their recovery. These are novel findings in this setting. This altering sense of self/identity has been noted in adult populations in the context of sea swimming (Denton and Aranda 2020; Pritchard et al. 2020), as has its positive impact on adult depression and anxiety (Denton and Aranda 2020; Garrett et al. 2019; Van Tulleken et al. 2018). This study reveals that such benefits also extend to younger people experiencing mental health challenges. Moreover, recent research has highlighted the importance young people experiencing mental health challenges place in ‘having fun’ when engaging in creative interventions such as dramatherapy (Keiller et al. 2024) and music therapy (Klyve and Rolvsjord 2023). Indeed, Klyve and Rolvsjord (2023) comment that the experience of ‘fun’ is not just entertainment—fun is ‘something of existential importance and with great therapeutic potentials’ (p. 100). Comments from young people in the current study indicate that fun can also be experienced through sea swimming. Given the importance of this concept for this population group, sea swimming should be used to create a greater sense of fun and enjoyment during young people's mental health journeys.

In addition to these benefits, we found that sea swimming enhances peer‐to‐peer relationships; this is important given the positive impact that such relationships can have on people's mental health in general (Tang et al. 2022) and specifically on young people's mental health (Liu et al. 2024). For example, it has been noted that strong peer‐to‐peer relationships in young people can reduce symptoms of depression and anxiety (Liu et al. 2024). We also found that relationships between young people and staff members were strengthened through sea swimming. However, young people demonstrated less positive attitudes towards engaging with staff members in other therapies, a finding in concurrence with other research, where initial distrust, or reluctance to engage in therapy is displayed among young people (Stubbing and Gibson 2022; Tsamadou et al. 2021). It should be noted that there is a robust evidence base for the use of psychotherapy with youths who experience mental health challenges (Mishu et al. 2023; Tsamadou et al. 2021), so it is important to encourage this population to participate in such interventions. Moreover, there is evidence to support the importance placed by young people on forming meaningful connections with therapists in order for therapy to be effective (Stubbing and Gibson 2022). There may be potential to better engage young people in psychotherapy and foster more trusting relationships with staff members by first encouraging engagement in sea swimming. Further research in this area is warranted.

Sea swimming is often viewed as a risky activity; there is always the potential to drown if the conditions of the sea or swimmer are not fully considered (Foley 2017). Staff participants in this study articulated an awareness of the risks, not only of sea swimming but also the particularities of the young people, their vulnerabilities and needs. They also spoke of a changing culture within CAMHS whereby services were becoming less risk adverse and open to engaging in positive risk taking with young people. Clinical risk and its management are increasingly acknowledged as a fundamental consideration in CAMHS, influencing how clinicians and their managers think about their work (Aggett and Messent 2019). Policies and guidelines advocate that mental health practitioners use positive risk management (PRM) when working with service users. Although definitions vary, in general, PRM is the process of collaboratively ensuring the safety and well‐being of service users while promoting quality of life (Just, Tai, and Palmier‐Claus 2023). In the context of CAMHS, positive risk‐taking (PRT) is about supporting young people to engage in activities or decisions that challenge them, promote growth and help them develop coping strategies, while still managing and mitigating potential harm (Duell and Steinberg 2019). Assessment, planning and clear communication are central to positive risk taking or management, whereby practitioners work collaboratively with the young person and their family to identify areas where taking a calculated risk could lead to positive outcomes, such as increased independence or improved self‐esteem (Cantrell et al. 2024; Hannigan et al. 2015). This approach requires further investigation in the context of interventions that may complement established therapies or interventions when engaging with young people in CAMHS settings.

6. Limitations

This study has limitations. The intervention has been ongoing for a number of years, and while a substantial number of young people have taken part in sea swimming, only a minority agreed to be interviewed. Although it is well established that recruitment of mental health service users for research can be challenging (Eckerström et al. 2020; Walsh, Bradley, and Goodwin 2022), we acknowledge that our small sample size impacts transferability. A lack of ethnic and gender diversity can be viewed as a limitation within research (Goodwin et al. 2024), and this was the case with this study, given that all participants identified as White and most identified as female. We also acknowledge that self‐selection bias, where participants may have had personal reasons for volunteering for the study (Walsh, Bradley, and Goodwin 2022) is a potential limitation of this study.

7. Conclusion

Findings from this novel study emphasise the physical and psychological benefits for the young people, while raising important considerations for staff relating to types of therapeutic interventions, the centrality of relationships and the need to develop positive approaches towards risk‐taking and management. The benefit of sea swimming as a therapeutic activity within a safe and generative culture has been demonstrated in this study. Given some of the sampling limitations, further research is warranted to better understand who can benefit the most from sea swimming and if there are any contraindications. Further research is also required to establish the benefits on a larger scale and to examine the culture where shared decision‐making and relational approaches to risk complement the technical approach of risk assessment and management.

8. Relevance for Clinical Practice

Given the benefits described in the current study, it is recommended that novel approaches, including sea swimming, continue to be explored in mental health practice. Using such an intervention, there is the potential to enhance the mental health and well‐being of young people and strengthen both young person–staff and peer‐to‐peer relationships.

Author Contributions

Alice Taylor contributed to the introduction, applied for ethical approval and made critical revisions to the final manuscript. Maria O'Malley collected data, contributed to the discussion, wrote the conclusion and made critical revisions to the final manuscript. Rachael McCarthy contributed to the introduction and made critical revisions to the final manuscript. John Goodwin applied for ethical approval, collected data, wrote the methods, contributed to the discussion and made critical revisions to the final manuscript.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.