Developing a nature-on-prescription intervention for people with common mental health conditions

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Post by James Fullam, Nature on Prescription Research Fellow

I only went out for a walk and finally concluded to stay out till sundown, for going out, I found, was really going in. John Muir (Naturalist and Founder of US National Parks)

Thanks to the pioneering work of conservation groups, GPs, and academic researchers, there is a growing number of individuals with experience in the delivery of nature-on-prescription interventions in the UK. The recently launched nature-on-prescription project at the European Centre for Environment and Human Health aims to explore and leverage this experience in order to understand how and why nature-on-prescription works. We are specifically interested in nature-on-prescription for common mental health conditions, including, stress, depression and anxiety.

We plan to bring together relevant stakeholders, including groups providing nature based activities, primary care practitioners and patients, to meet and discuss their experiences with nature-on-prescription to-date, both as a wider collective and in individual focus groups.  In tandem with this we will undertake a realist review of the existing literature, seeking to understand how these interventions work, why they work, for whom do they work, and in what circumstances. Together, this review of research evidence, and the experiences of practitioners and patients, will feed into the production of an Intervention Manual. This will be a freely available resource for nature intervention providers to use as a roadmap for designing and planning future nature-on-prescription interventions. Our focus will be on the development of group-based interventions, as we believe the natural environment offers a setting which encourages shared goals, and accessing feelings of community and empowerment, that are known to benefit mental health.

This is an opportune time to bring together stakeholders in social prescribing of nature-based activities. From Cornwall to Shetland conservation groups and GPs are partnering to “prescribe nature”. The government has committed funding to develop social prescribing, and the recently published 25 Year Environment Plan makes significant reference to connecting people with nature for improving health. Natural England has published a report on the role of nature-based-interventions for mental health, and relevant non-governmental stakeholder groups including the RSAs Food, Farming and Countryside Commission are advocating further investment in green care. However, it is also a critical time for the development of nature-on-prescription . There remain many unknowns concerning the specific mechanisms and effects of nature on human health and wellbeing, and the existing evidence for the effectiveness of these types of intervention is limited.

The reality is that without robust evidence of effectiveness, commissioners are likely to remain reluctant to fund nature-on-prescription interventions; the necessary infrastructure for sustainable development will not materialise.

Intuition, culture and art tell us much about the restorative potential of nature, and what high quality evidence we have is tantalising. In the context of individuals suffering from common mental health conditions, nature-on-prescription may offer a novel and effective treatment option. There are of course allied benefits, including restoration and improvement of natural environments, and the opening of new revenue streams for intervention providers. This project intends to help realise these benefits and answer the most pressing questions about nature-on–prescription in the context of modern healthcare. With this project we plan to strengthen the evidence base and provide foundation work for future development of nature-on-prescription interventions.

If you are interesting in taking part in the study or would like to know more please contact James Fullam (Project Research Fellow) j.a.fullam@exeter.ac.uk.

The Nature on Prescription project is an MRC funded research project at the European Centre for Environment and Human Health. The project will be led from the Centre’s headquarters in Truro and will be supported by colleagues at Exeter University’s Penryn and St. Lukes’ campuses, and Peninsula Medical School, University of Plymouth.

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