Copyright: Natural England/Robin Chittenden

We all know that spending time in nature is good for our minds and our bodies. There is now a plethora of research on the links between natural environments and human health (Defra recently published an evidence statement providing a broad overview of the of research). However, are we putting this knowledge into practice? A recent report commissioned by Natural England aims to provide a better understanding of nature-based interventions within social prescribing.

What is social prescribing and what are nature-based interventions?

Social prescribing (or community referral) describes a mechanism to engage patients with non-medical support services within the community. It includes a range of prescribed interventions and activities from online Cognitive Behavioural Therapy courses, community art groups and befriending clubs, right through to “green gyms” and “exercise on prescription” schemes.

Generally, we can distinguish two types of nature-based interventions: nature-based health promotion and green care. Nature-based health promotion includes services that provide opportunities for people to engage with nature in their communities, for example through food growing, community gardening or conservation volunteering. These services are often aimed at the general population and used for ill-health prevention by promoting health lifestyles. Participants usually self-refer, though people from disadvantaged groups are often encouraged by health or social care professionals.
In contrast, green care services are aimed at individuals with a defined health need. These services offer structured therapy, rehabilitation or care using “green” contexts such as conservation or horticultural projects or care farms. The contact with nature is provided within a coherent and deliberate strategy to generate health, social and education benefits. Specific interventions are planned for a particular participant.

To better understand green care prescribing and to identify best practices, the researchers conducted an evidence review, interviewing practitioners working in social prescribing as well as reviewing literature. They also held a demonstration event that brought together health and social care professionals and providers of nature-based care services in the Leeds area.

Green care offers huge potential

The report finds that green care offers great potential to help particularly those patients with a history of mental health problems, with two or more long-term health conditions, with conditions that are complex, untreatable or poorly understood, patients who don’t benefit from clinical medicine and drug treatment as well as people who frequently visit their GP.

The benefits of nature-based intervention include

  • Potential cost savings – pilots estimated a social return on investment ranging from £1.41 to £3.38 for every £1 invested.
  • Better outcomes for health and social care services – there is often a continuum of provision; the service providers offer volunteering opportunities after green care interventions come to an end and thus help participants to make long-term changes.
  • Improvements in mental health and well-being.
  • More effective use of GP time

A long way away from the mainstream

However, we are still a long way from social prescribing being a regular treatment option. While 90% of GPs believe patients would benefit from such intervention, only 16% said they regularly use it.

In addition, green care options are usually only offered to patients who express an interest in being outside. This can partly be explained by a lack of projects locally (most providers offer nature-based health promotion rather than green care), a lack of awareness of the projects that do exist, and/ or a limited understanding of the benefits they can provide. While there is now evidence to support these interventions, it often doesn’t live up to the “gold standard” of medical research, randomized controlled trials. There are also practical challenges, for example, agreeing appropriate referral routes and standards for provision. Nature based interventions are not particularly regulated: there are no specific inclusion criteria or accreditation requirements for service providers.

The successful pilots leading the way for green care have established effective primary care referral systems; GP are informed about green care services and provided with a non-medical referral option to enable patients to easily access health resources outside the NHS. Health and social care professionals as well as service providers in the third sector have a shared understanding of what social prescribing is, how it can be used and who benefits from it. They formed good partnerships and established joined ownership across organisations with very different organisational cultures. It is ensured that interventions are safe and of high quality, and service providers are financially supported in providing them.

There is still a lot to be done before “green prescription” enters the mainstream but the report is encouraging and provides guidance to those who want to make this happen.

You can download the full report Good practice in social prescribing for mental health: the role of nature-based interventions (NECR228) on the Natural England website.