The benefits of nature on health and wellbeing have become more widely understood in recent years, however the concept of social prescribing – where people can be referred to specific activities – takes the learning to another level.

In June 2021 a new handbook, ‘Nature on Prescription’, was launched to explain how social, and more specifically green prescribing can help people and to support organisations develop beneficial, safe and sustainable services.

Professor Ruth Garside, Associate Professor in Evidence Synthesis is a social science researcher based at the University’s European Centre for Environment and Human Health and has been involved in the launch of the handbook.

Ruth says: “When you think about health it isn’t created in hospitals and GP practices; it’s created through how we live our lives. This means that a lot of people who go to their GP may have a combination of practical, emotional, and social needs contributing to their feeling of ill health. So social prescribing is a way of trying to recognise that people may be better served by connecting with local community assets, and in the case of green prescribing connecting with nature, as an alternative to, or in addition to, being given drugs. The approach focuses on what matters to the individual not what is the matter with them, and the handbook was created to facilitate that empowerment and patient-centred personalised care.”

The handbook looks at how Nature on Prescription (NoP) can be used to support people’s mental health and makes evidence-based suggestions for how to develop and implement a high-quality scheme. It builds on the team’s existing research and involved external partners including the Wildfowl & Wetlands Trust (WWT). Ruth explains: “There’s been a huge investment in the NHS recently in trying to roll out social prescribing that’s included funding ‘link workers’ or ‘community connectors’ that health professionals can refer people to. The handbook is building on previous work that myself and my colleagues have been looking at and comes in parallel with a big NHS drive to think about patient needs which are not necessarily solved with pharmaceuticals or traditional clinical treatments, or not by these alone.”

Split into seven sections the handbook covers several topics including ‘considerations when using NoP’, ‘monitoring and evaluating NoP’, as well as ‘how and why it works’. The latter section focuses on how the programmes can positively impact someone’s health such as through developing a relationship with nature, physical activity, being with a group and more. It also offers advice to nature-based providers on these mechanisms.

Ruth says: “NoP can be used to meet a whole range of different needs such as social isolation, loneliness, or physical health issues such as weight, lack of physical activity or diabetes and looks at treatment in a holistic way. The organisations that try and activate a number of these different “mechanisms” in their activities are more likely to have success in improving people’s health and wellbeing.”

For instance, now, with funding from the government’s Green Recovery Challenge Fund, the WWT is using the handbook to develop on-site activities, alongside the co-production of an online mental health course with the Mental Health Foundation, focussing on nature.

The prevalence of the global COVID-19 pandemic meant for significant periods of time people’s ability to go outside was restricted and there was a growing awareness of the link between time spent in nature and mental and physical health.

Ruth explains: “It was fascinating to me as we’ve been working in this field to establish the importance of connection with nature for people, and then all of a sudden, everything was restricted and the one thing we were all allowed to do was to go outside for some exercise and spend time outside, preferably in nature. This was because it was known to be so, unequivocally good for our health and wellbeing. I think it crystallised a lot of people’s thinking and understanding about their basic needs and for half of us it was: we want to be in nature. It showed how important this sense of connection to the natural world really was.”

For the model to be successful Ruth says: “We need to evaluate what’s happening and think about how we can maximise the benefits and minimise the risks of NoP activities. Additionally, there needs to be a real recognition of how all the nature-based organisations can be properly resourced and supported to do what they do so well. There is also a risk that the most demand is put on the bit of the system that’s least able to cope with it because it’s under resourced.

“Equally it’s important that the activities are accessible for everyone. Traditionally, nature has often been more accessed by white, middle-class, middle-aged people and we need to try and make sure that everybody has an understanding of, and access to, the potential benefits of nature in a way that works for them. We need to avoid excluding people and exacerbating health inequalities and make strides to ensure that everybody feels like they’re welcome in those spaces.”