Does being prescribed nature help our health?

Today we launched the findings of the Nature Prescriptions Edinburgh trial. Kirsty Nutt tells us more about the project, and what the findings of the trial tell us.

We are now more aware than any time in recent memory of the benefits of nature for our health and wellbeing. During the pandemic many of us have turned to nature for comfort, support or just a change of surroundings, taking enjoyment from watching and hearing birds and taking more notice of nature near us.

 This tallies with the mounting body of scientific evidence that exposure to nature has a range of health benefits. That we need this evidence to recognise the importance of nature to every one of us would shock (and I like to think appal) our ancestors who spent many thousands of years understanding they were part of nature rather than separate. But perhaps this will be a turning point where our growing disconnection from the natural world can be reversed and with that the current crisis that nature faces stopped.

 The link between nature and health benefits, along with the need for us to look after nature better than we are, is what inspired Nature Prescriptions.

 

It began with a kernel of truth – that we are part of nature and forgetting this is bad for our health – and an idea that it would make a lot of sense to work with medical professionals to help people connect with nature.    

 Nature Prescriptions started with one GP practice in Shetland in 2017 – it was believed to be the first initiative of its kind in the UK – and was so well received that it was rolled out to all ten GP practices in 2018. It involved providing information about the benefits of nature and suggesting a wide variety of activities that people could do to harness the benefits that nature can provide regardless of health condition, confidence or sociability. 

 

Click the image to read the activities!

 

The response from around the world – from independent filmmakers to students in France to the Danish Government and even as far away as Australia – was incredibly humbling and a little overwhelming at times. But it revealed that there was a huge appetite for this sort of initiative and making it available to everyone.

 Being an organisation that bases decisions on sound science, we wanted more than anecdotes to prove it worked and we wanted to investigate how this could be scaled up from the small numbers of practices, healthcare professionals and patients in Shetland to much larger numbers of people in very . In Shetland, nature is much more literally on your doorstep and many of the calendar activities took advantage of that from spotting the first sten-shakkers (wheatears) returning to Shetland after wintering south of the Sahara to finding a grottie-buckie (cowrie shell, which used to be used as currency). In a city, there are also many opportunities to connect with nature, but they aren’t always so obvious.

 

 Andy Hay

 So, with the support of Edinburgh and Lothians Health Foundation and five GP practices across the city, and activities including taking a stroll under the cherry tree blossom in the Meadows, listening for birds singing from the tops of tenements and looking for the strangest place a plant grows, we began an Edinburgh pilot.

 It was due to start in spring 2020 but was delayed due to the onset of the Covid-19 pandemic. However, it was restarted in November that year, despite ongoing pressures, as GPs were keen to begin with one saying

 “Nature Prescriptions is needed now more than ever”.

 

The prescription system was set up in the same way as in Shetland with GPs and other healthcare professionals using their medical knowledge to choose when a Nature Prescription was appropriate as part of a patient’s treatment.

 The prescription was again supported by a leaflet and calendar of local, seasonal activities that were all designed to help people connect with nature in a personal and meaningful way, with the addition of information about local greenspaces and groups people could consider if they weren’t confident to connect with nature alone.

 

 Louise Greenhorn 

 

But this time prescriptions were recorded, and we conducted questionnaires with those that would be prescribing at each of the five practices at the start and end of the pilot and also gathered feedback from patients who had received a prescription (anonymously) in order to analyse the impact and process of nature prescriptions.

 We are very excited to be able to share those results with you today as they offer evidence for the first time that prescribing nature is good for patients and healthcare professionals and has the potential to be expanded across Scotland.

 

Over the pilot, 335 patients across all age groups received a prescription and those prescriptions were given for 32 different conditions showing just how many people nature has the potential to help. Most prescriptions were given for mental health particularly anxiety and depression, but they were also given to help patients with obesity, diabetes and high blood pressure as well as insomnia and drug and alcohol dependency.

 “I think it’s natural that it would be really helpful for mental health problems, and I agree with that, but I handed a nature prescription for somebody who just had a heart attack. They had been in hospital, had treatment and they were slowly building up their activity levels, and they’re obviously a bit nervous, not as physically fit as they were, kind of anxious about the future, slightly breathless and, actually, a Nature Prescription gave them a little bit of a focus to their activities and gave them a reason for going out. While it was the exercise itself, it took them beyond that, so that in itself was a very positive experience for them. So, I would say it’s for anybody.” GP, St Triduanas Medical Practice

 

 Ben Andrew

Sixty-five patients provided detailed feedback. Nearly three quarters of them felt they had benefited from their prescription, with many continuing to connect with nature each week, and nearly everyone saying they would probably continue using their prescription.

The formal prescription was an important part of this as patients felt it gave them both the permission and motivation to engage with nature. Nature Prescriptions was also liked because it was drug-free and because people felt it was working.

 

One patient said: “Connecting with the present moment and creating a sense of calm. I feel better for being outdoors and enjoying what is around me – it’s had a positive impact on mood and anxiety/stress and physical health.”

 

And healthcare professionals have shown they value it by their actions too. At the start of the pilot, just 39% were talking to patients about nature-based activities and then mostly outdoor exercise with nature as a backdrop. By the end of the pilot, nearly 90% were actively prescribing nature with others saying they would in the coming year.

 

 

At the heart of Nature Prescriptions is the idea that as nature nurtures us, we will start to value and want to look after nature more and be inspired to take action to protect it. There is some evidence that this did happen for some patients even over the short duration of the pilot showing the potential Nature Prescriptions has to support the health of people and nature.  

 “I have volunteered to help at COP26. I plan to buy a litter picker.” Patient

 What’s really clear from the report is that Nature Prescriptions is an effective, low-cost health intervention that can support a wide range of physical and mental health conditions alongside other treatment options as well as benefitting the healthcare professionals themselves. And that it can work in rural and urban areas.

 The potential impact of this initiative to be expanded to provide these benefits to everyone in Scotland is huge. There are still questions to answer about how this could be best achieved, but that must be the ambition – to make nature part of every healthcare professional’s toolkit.

 “It is sad to hear that the pilot will be coming to an end, but hopefully it will prove to be something which will become part of our normal practice.” GP, Inchpark Surgery

 This would support individual wellbeing but by building (or more accurately rebuilding) a deep and meaningful connection with nature hopefully more people will want to help protect it too, helping stop and reverse the current nature and climate emergency.

 

Now is the time to start creating a better future where nature thrives in our cities and countryside, where everyone has access to connect with it and where we invest in nature’s recovery for its own sake and for ours. We must remember that we are part of nature.

 

I will give the final word to my favourite piece of patient feedback: 

“Thank you to whoever thought this up. It has opened up a new world for me.”

 

If you’d like to read the full report or look at the resources, they are available to download at rspb.org.uk/natureprescriptions

 Ben Andrew

Main image - A lady looks up at trees and reaches up to touch a leaf. It is autumn.  Ben Andrew