A collaborative project has been underway for the past three years, looking into the potential benefits of prescribing nature-based activities for patients living in isolation with mild-to-moderate anxiety or depression. Undertaken by Leeds Beckett University, the University of Essex and The Wildlife Trusts, several practices across the country took up the initiative to great success.

Rebecca Gilroy spoke to Dr Amir Khan, a Bradford GP whose practice participated in the study, on the benefits of green prescribing to both patients and practice.

Problem and solution

Mental ill-health is prevalent across the UK despite differences of locality – however, in more deprived areas it is at its highest level. When combined with social isolation, patients are more likely to use health services more frequently, taking up valuable GP that might be better used had preventative strategies been in place.

Social prescribing has been found to improve health outcomes in other initiatives, but the use of green spaces made this project unique. Participants were prescribed two hours of activity in a green space a week, and then referred to their nearest Wildlife Trust. They could then choose how they spent those two hours, whether walking independently or in group activities.

‘We were looking at the effects of wild space, or any kind of outdoor green space, on people’s health – specifically their mental health. We took people who had a mild-to-moderate mental health conditions, be that anxiety or depression, and exposed them to a minimum of two hours of outdoor space a week. They could just be doing normal things like going for a walk, spending time with others outdoors or be doing activities in The Wildlife Trust’s reserves,’ says Dr Khan.

‘They can either do individual activities where they just have access to the reserve and they can do whatever they want, or they can do the organised activities. This could be things like weeding, planting bulbs, planting trees and saplings, tidying up the reserve and mowing the lawn. All very social activities.

‘We know that social isolation plays a big part in their anxiety or low mood and we were hoping to target that. These activities are available every day and at various times, so they were really accessible for everyone and you could bring your children along as well, it’s family friendly.’

Benefits

An analysis of the initiative showed that there was a social return on investment (SROI) value of £6.88 for every £1 invested for people who took part in specialised programmes designed to improve mental, physical and social wellbeing. A SROI value of £8.50 for every £1 invested was found in those who took part in a nature conservation volunteering programme used to tackle physical inactivity or loneliness.

The authors of the report concluded that their findings strengthen the argument that green prescribing should be standard for all GPs and NHS mental health services.

‘We were looking at the patients’ overall response to it and it was really positive. It showed that a minimum of two hours a week had a real positive effect on their mental health and reduced the number of consultations that they needed with their GP over the next six weeks,’ says Dr Khan.

Additionally, says Dr Khan, patient feedback was very positive – patients described feeling engaged with the activities, which then improved their mental health.

‘We’ve had really good patient feedback, which is very important. They have really engaged with it, first of all, a couple of them dropped out after the first interaction but we expected that with the nature of the illnesses that they have – but the ones that stuck with it showed a considerable improvement,’ explains Dr Khan.

‘Those of them that were considering medication said that after six weeks of doing The Wildlife Trusts work, they were not considering medication at that point and they would like to continue [with green prescribing], which they are continuing beyond the study.’

Patients varied in their conditions as well as in age, however, Dr Khan found that it was the more elderly patients whose health improved the most.

‘When we looked at patients, we looked at mild-to-moderate depression, with or without antidepressants, and we didn’t mind that they were on medication or not. We looked at elderly people who are still mobile who may be suffering from isolation so we tried to target them as well. They tended to go for the group activities, but one or two did choose to use the reserve for their own activities for walks and exposure. That was our biggest group in terms of best response.’

Future plans

Alongside the obvious benefits to patient health and to individual practices, the project also actively promotes awareness of the environment and community conservation.

‘Raising environmental awareness is also key, and that’s what the Wildlife Trust want to do. If you can have tangible benefits of being outdoors with nature, you’re more inclined to protect it. If you can prove that it’s helping the NHS, then the Government and larger bodies will be more inclined to protect those spaces as well,’ says Dr Khan.

‘I think being at the forefront of something like this is really important to me as a partner in the practice because it does show innovative thinking, it does show environmental awareness which I think is really on point at the moment and really important.

‘If we have a practice like ours, which is a large inner city practice that isn’t associated with green spaces, but using green spaces is an example to set to others [who might] not thinking about it yet, that could now be thinking about it should we go forward. It’s achievable. We’re in the middle of Bradford, which is not the greenest city, not the first city you’d think about when you’re prescribing green space. So if we can do it, any practice can do it.’