The challenge of mental ill health
Mental ill health is a widespread and escalating problem with one in three people over 16 in the UK experiencing the challenge within their lifetime. Covid-19 has intensified levels of mental ill health and associated health inequalities, which include a mortality gap of 15 to 20 years for those with a serious mental health diagnosis. Furthermore, the pandemic has not only emphasised the value of accessing greenspaces for wellbeing, but has also highlighted inequalities in access to green spaces.
The current mental health service model is under pressure and fighting to meet the needs of the population. As many as 40% of primary care appointments are related to mental health, and often people access their GP for what is primarily a social issue such as loneliness and isolation or financial problems.
Some evidence has suggested that increased mental illness is related to urban living, exposure to man-made environmental stressors and a lack of connection to nature.
The plan to meet the challenge
A number of countries have moved to a more social model of health which represents a shift away from the medical model to a holistic biopsychosocial focus. This has led to the growth in the use of social prescribing which is a way of enabling health professionals to refer patients to a range of local, non-clinical services. This model considers the patient in the context of community and environmental influences.
The British Environment Secretary, George Eustice, announced in July 2020 that a £4 million investment (bolstered to £5.77 million by partner organisations) would be used for cross-government projects. These projects are to take the form of social prescribing using nature to improve mental wellbeing, namely green social prescribing. Information about the test and trial sites is available on NHS England. These are directed at reducing pressure on the health and social care system by ‘preventing and tackling mental ill health through green social prescribing being embedded into communities’ aiming to:
- Improve mental health outcomes
- Reduce health inequalities
- Reduce demand on the health and social care system
- Develop best practices in making green social prescribing activities more resilient and accessible
This has established seven green social prescribing test and trial sites in England which look at how to increase people's connection to and use of our natural environment. Through referrals to ‘green activities’ (within the natural or semi-natural environment) and ‘blue’ (activities that take place on or near water). These projects and activities within communities aim to tackle mental ill health. These test and trial sites will aim to scale up green social prescribing in local places, understand system enablers and barriers and provide recommendations, next steps, and costs. The project development setup began in January 2021 and delivery will run until April 2023.
What is green social prescribing?
Social prescribing and community-based support is part of the NHS Long-Term Plan’s commitment to make personalised care business as usual across the health and care system. Social prescribing refers to the act of link workers guiding and supporting people. From having conversations about what matters to the patient the most to community initiatives that may promote their wellbeing, increase socialisation, and raise aspirations. This means that people will have choice and control over the way their care is planned and delivered and based on their individual needs, strengths, and assets.
Social prescribing will provide patients with an alternative to medical intervention, as link workers (and other trusted professionals in allied roles) are well placed to address the root cause of the personal difficulties.
Green social prescribing is the practice of linking people to engage in nature-based interventions and activities to improve their mental health. These occur mainly within the community, voluntary and social enterprise sector and includes both green and blue environments. The aim is to help people overcome the barriers they face to accessing green space and making the most of nature whilst safeguarding the natural environment.
How green social prescribing impacts wellbeing
Research shows that well-designed green prescriptions do work and can have a significant and positive impact on both mental and physical health. Green social prescribing should focus on creating quality moments within nature supporting the value of our emotional and psychological relationship with nature or nature connectedness as being important.
Research points to an emphasis on creating quality moments within the natural environment being responsible for mental health gains. Large scale research into green prescriptions that improve nature connectedness (closeness of our emotional relationship with nature) found improvements for promoting mental health with a greater impact on happiness and life satisfaction.
Evidence alludes to time and contact with nature being important for physical or general health improvements. Contact and time in minutes are important variables to consider and are more essential for physical and general health improvements. This may be through greater physical activity or outdoor social contacts.
This is where green space can act as an opportunistic setting for physical and activity and social contacts. Someone can spend time in nature but not necessarily be engaged in it. However, if someone is engaged in nature connectedness activities then they are usually spending time in the natural environment. Green social prescribing activities are required to be nuanced in order to fully support the relationship between nature and wellbeing.
What are some examples of green social activities?
Green social prescribing activities that are open and accessible occur in natural and semi-natural environments. Activities that help you to tune into nature and engage through simple activities emerge as being related to happiness, feeling that life is worthwhile, and lower rates of ill-being. These can range from
- local walking groups
- park runs
- active travel (cycling and walking) and other green exercise
- community gardening projects
- green gyms
- forest bathing
- care farming
- arts and cultural activities
Findings from research that outline specific routes to nature connectedness indicate that activities which emphasise contact, emotion, meaning, compassion, and beauty are pathways for increasing nature connectedness. These type of activities may include simply smelling wildflowers and noticing the blossoms of spring with awe and wonder. Nature connectedness influences the way in which we respond to time spent in nature. As such, green prescriptions should be carefully designed and need to consider both connection and time factors when aiming to improve mental and physical health together.
Activities that help you to tune into nature, for example, taking note of the good things in nature during an adapted natural walk can make significant improvements to mental health. This evidence supports the use of the Three Good Things in Nature approach for green social prescribing for improving mental wellbeing.
How can I access green social prescribed activities?
Social prescribing enables all local agencies to refer people to a Primary Care Link Worker who are social prescribers based in GP surgeries. Some Social Prescribing Link Workers are now also located at secondary health services, local authorities, or with anyone whose work brings them into contact with people. The pathway would include an initial visit to a GP who refers the individual to a social prescribing link worker where personal needs are assessed and prioritised, and then referral is made to community services via a direct or indirect route.
A link worker will work alongside people to get to know people’s strengths and assets and ultimately provide a non-judgemental service to support small changes that help improve quality of life, health, and wellbeing. This may include learning and skills acquisition, community employment support and activities such as green social prescribing, which develop and support a connection to the natural environment.
Who can use green social prescribing?
Green social prescribing can be accessed by any individual with mild to moderate mental health needs. Activities are embedded into communities and neighbourhoods for greater participation and accessibility.
Find out if your local NHS is participating in the roll out scheme
Overall green social prescribing can best be described as purposeful and engaging outdoor activities that are referred to in place of medical interventions. They help to remove some of the pressure from primary health care services. And they take place by tuning in to the natural environment, linking people together with the aim of improving and sustaining mental health through the connection to nature and wellbeing relationship.