The final report, and research briefing, for the Defra funded Therapeutic Nature: Nature-based social prescribing for diagnosed mental health conditions in the UK project has been published. The 12 month project aimed to identify what works in the use of nature-based therapeutic interventions for people with an identifiable mental illness.

Background

The Therapeutic Nature project was led by Dr Ruth Garside and was a collaboration between researchers at ECEHH, University of Exeter, PenCLAHRC, University of Plymouth and Exeter, NHS Born in Bradford and eftec. The report is aimed primarily at governmental (national and local) departments or bodies with responsibility for, or an interest in the development and use of NBSP. It may also be relevant to those organisations and individuals involved in the development and delivery of NBSP. The report informed the development of the Government’s Green Social Prescribing Test and Learn Pilots. Ruth, Becca and Kerryn are now contributing to the evaluation of the pilots.

There were four strands of work:

Work Stream 1: a detailed review and mapping exercise of the current provision of nature-based therapeutic interventions to support people with a mental illness in four areas of England: Devon, Newcastle, Bradford and West Yorkshire.

Work Stream 2: review of the current evidence base and update of existing reviews with the aim of understanding what works, for whom, in what circumstances.

Work Stream 3: gathering insights from service commissioners, mental health service professionals, primary health care services, environmental voluntary organisations, community-based providers and other intermediaries in the four locations.

Work Stream 4: bringing together insights from the mapping, evidence review and qualitative work using established methods of evidence synthesis and produce detailed conceptual frameworks, descriptive texts and illustrative case cases.

Key findings

• There is a significant amount of nature-based activities offered by mental health and environmental NGOs, social enterprises, community interest companies (CICs), local councils, NHS trusts, and private therapists. However, there is wide variability of the nature and scope of these offers, within and between districts. Often projects are collaborative between multiple organizations. Referral bodies include primary care, mental health services, social care and educational institutions, people may also self-refer.
• Many social prescribing activities are targeted at adults experiencing social isolation, loneliness and anxiety with complex needs. While some nature-based social prescribing (NBSP) activities are designed as therapeutic, and others promote resilience, or provide enjoyable experiences, others are rather unspecific about which participants they are targeting. Some activities include therapeutic aspects such as formal counselling or therapy, other intervention components, such as skills learning or creative activities, may also be used.
• Current capacity within the system is challenging to understand. There is poor coordination of demand and supply at a national or local level.
• Most NBSP offers are short term (~12 weeks), supported by project funding from bodies such as Big Lottery. There was some evidence of commissioned models, these tend to be pilots. There is a reliance on 3^rd party funders whose goals sometimes align with national level priorities of the health system (e.g. the focus on better mental health) but not necessarily with local needs.
• There are positive perceptions towards NBSP activities offered through social prescribing across the system, however this is not universal.
• The mechanisms through which information is shared on individual NBSP specifics with the referral body is often patchy, ad hoc and, in some cases, insufficient to allow the link worker to make informed decisions about referrals. Stakeholders struggle to maintain sufficient information. In the referral system this information deficit relates to the availability and specifics of NBSP activities, in the delivery system this information deficit relates to health and care system needs, engagement routes, and evidence standards.
• There is little robust quantitative research evidence for the effectiveness of nature-based social prescribing, however, we found some evidence that nature-based activities can positively impact on depression, anxiety, mood and feelings of hope. Higher quality qualitative evidence revealed how the activities are experienced and perceived to benefit.
• We identified a number of key elements which need to be in place for NBSP to be effective: coordination of NBSP within wider systems of health; where NBSP is additional and complementary to other services; if appropriate and informed referrals are made; where there is adequate information sharing between stakeholders; there is clarity in the aims and process of the NBSP; where NBSP activities are evidence based and theoretically driven; and provider organisations have adequate skills and capacity to design and deliver suitable NBSP offer.

We produced logic models to describe how the systems work…

…and why they might not be working

Recommendations

We identified a number of key recommendations for further developing and NBSP, these include: 1) advocacy for NBSP across systems; 2) identifying mechanisms to facilitate coordination of supply and demand in NBSP at a strategic level; 3) enhancing knowledge sharing, peer support and advocacy through a network and one-stop shop for nature-based social prescribing; 4) enhancing capacity of local coordinating bodies; 5) improving the funding system; 6) supporting the development of skills in nature-based social prescribing; 7) enhancing the usability of information on nature-based social prescribing; and 8) improving understanding of what works, how and for whom.

The Therapeutic Nature: Nature-based social prescribing for diagnosed mental health conditions in the UK report and briefing are published by Defra (Defra Project Code BE0155) and are available from the Department’s Science and Research Projects Database at http://randd.defra.gov.uk. Whilst the research was commissioned and funded by Defra, the views expressed reflect the research findings and the authors’ interpretation; they do not necessarily reflect Defra policy.

Garside R, Orr N, Short R, Lovell R, Husk K, McEachon R, Rashid R, Dickie I. (2021). Therapeutic Nature: Nature-based social prescribing for diagnosed mental health conditions in the UK: Final Report for Defra. Department for Environment, Food & Rural Affairs. Available at: http://randd.defra.gov.uk/Default.aspx?Menu=Menu&Module=More&Location=None&ProjectID=20263