Are Green Social Prescriptions the future of mental health care?

I have always had a strong connection to nature. I've found it extremely beneficial to my own wellbeing. From spending time in the garden growing my own fruit and vegetables and watching the bees and butterflies to walking my dog through the deep countryside, I find it always calms my mind and I feel much happier afterwards.

My interest in this area piqued during my undergraduate degree. I had the opportunity to undertake a research assistant role, helping out on a project my supervisor was researching. I was heavily involved in the data collection process which involved me visiting various green social prescription sessions. I helped with the sessions and got to spend time with the people taking part in the interventions. I heard their stories of how much coming to the sessions helped them and how far they had come from starting out. I realised just how important nature was, and that much more research and awareness are needed. 

I am now undertaking my PhD in psychology. My research focuses on nature-based interventions for wellbeing. I'm exploring the experiences people have in nature, how these vary and how that in turn can impact connection to nature and wellbeing. Being outdoors provides many benefits for wellbeing – but how we engage and interact with nature impacts the benefits we gain. 

Nature-based interventions

Over recent years there has been a growing research body around the use of nature-based interventions and 'green social prescriptions' for mental health recovery. These interventions can be a lower cost alternative to mental health medications, as well as eliminating things such as the risks of possible side effects. Green social prescriptions and nature-based interventions include any interventions taking place in natural settings – anything from walking in nature to community gardening. Some unstructured interventions such as charity-based community gardens encourage people to come and go as they please for as long as they would like and take part in whatever activities they would like to. More structured interventions take place over a certain number of sessions or weeks and have set activities. 

The rise in these interventions is partly due to the growing body of research demonstrating the benefits of spending time in nature on our health and wellbeing. Research around time spent in nature and its impacts on wellbeing has provided evidence for a range of benefits including reduced loneliness, improved confidence, life satisfaction, physical health and decreases in depression to name a few (Liu et al., 2022; Richardson & McEwan, 2018). Results from the Adults' People and Nature Survey in England found that 91 per cent of adults surveyed agreed being outdoors was good for their mental health (Natural England, 2023). 

As I've said, though, how we are in nature matters. Stronger connection with nature and direct experiences have been shown to have greater positive benefits for wellbeing. That's where understanding participant experiences becomes vital.

Understanding the benefits – participant experiences

When looking at green social prescriptions it is important to consider the views of those taking part in the interventions and the benefits they encounter. Some of my recent research has focused on systematically reviewing the studies on nature-based interventions for the participants taking part in them. Whilst there is some research on this, most research focuses on the views of those who run the sessions, or the healthcare professionals involved. 

Although it is important to have the views of the professionals running the sessions, listening to participants' own viewpoints allows us to gain first-hand and in-depth understanding of how future interventions could be tailored to better support those taking part in them. We also get to understand why they come to the sessions and what impact it has on their lives, as well as the longer-term impacts from taking part. 

When looking at the views of participants taking part in the interventions many feel a range of wellbeing benefits including a sense of belonging, developing skills, developing their sense of self and identity, and stronger connection with nature and relaxation (Howarth et al., 2021; Jauk-Ajamie & Blackwood, 2022). All of these skills may prove useful to people in managing their mental health and wellbeing outside of the sessions.

Many activities in these interventions are new to the participants, allowing them to build skills, and get a sense of reward, achievement, confidence and growth. Throughout my research I have found participants discussing how they felt more productive and useful, feeling like they had a sense of purpose. For those learning new skills, it felt like having a job to do; they felt part of a team and valued as someone working alongside others. They often reported they didn't feel like they were a patient in therapy – they felt equal with those running the sessions. This can help build stronger relationships between those running the sessions and patients, allowing for people to feel empowered in their own care. 

There were also reports that it was that sense of belonging, and feeling part of a team, that was behind participants' belief they had experienced greater benefits in comparison with previous more standard interventions. Moving forward from more traditional therapy interventions, or at least incorporating elements of nature, could therefore allow for greater uptake and improved outcomes.  

Importantly, nature-based interventions have also been used to bridge the gap between inpatient care and everyday life at home. Participants feel more in control of their rehabilitation through activities such as gardening, and they develop coping strategies and skills to use once discharged. 

What can we do to improve access? 

One of the biggest problems we face at the minute is getting people to access nature-based interventions in the first place. The lack of knowledge in the general population around both social prescribing link workers as well as green social prescriptions means many we know would benefit are unable to access them, or don't even know they exist.

It's also the case that many providers of nature-based interventions are small charity groups and organisations. They can close at short notice due to lack of funding; developments of research and understanding can help to secure funding and help improve access to services. 

Alongside this, even with the growing evidence base for these kinds of interventions they are still underused. This is for many reasons, including the continued underfunding of mental health care services. Throughout my own time working in the NHS I have seen the lack of social prescribers available. Promisingly, Social Prescription falls under the NHS universal personalised care approach, which aims to benefit millions of people and provide individualised care and support. Let's hope this is some reassurance that social prescriptions are being taken more seriously.

In the meantime, if you are incorporating nature-based interventions into your care provision in Psychology, why not join the conversation by commenting on the tweet about this article from @psychmag, or emailing [email protected]? 

References

Howarth, M., Lawler, C., & da Silva, A. (2021). Creating a transformative space for change: A qualitative evaluation of the RHS Wellbeing Programme for people with long term conditions. Health & Place, 71, 102654.  

Jauk-Ajamie, D., & Blackwood, A. (2022). "I Grow Every Day, like Plants." An Evaluation of a Gardening Program for Women in a Residential Community Corrections Setting. Women & Criminal Justice, 1-24. 

Liu, H., Nong, H., Ren, H., & Liu, K. (2022). The effect of nature exposure, nature connectedness on mental well-being and ill-being in a general Chinese population. Landscape and Urban Planning, 222, 104397. 

Natural England, (2023). The People and Nature Surveys for England. Natural England and  Department for Environment, Food & Rural Affairs.

Richardson, M., & McEwan, K. (2018). 30 Days Wild and the Relationships Between Engagement With Nature's Beauty, Nature Connectedness and Well-Being. Frontiers in Psychology, 9. 1500.