Health care professionals in Edinburgh have officially prescribed nature to their patients, alleviating illnesses from diabetes to depression and from arthritis to anxiety. Seventy-four percent of patients benefited from their Nature
Prescription, opening up the question—what can nature do for us, and what can we do for nature?
There has been much research on the connection between green spaces and mental well-being, as well as the
connection between time spent outdoors and improved physical health. In recognition of this, health care providers, policy makers and governments are increasingly promoting the benefits of time spent outdoors, though it is yet to be
formally integrated into the UK’s National Health Service…until now.
Health care professionals in Scotland are striving to make nature part of every GP’s toolkit, and who better to help do it than the RSPB, the UK’s largest nature conservation charity?
Together, the NHS and the RSPB are trialling ‘Nature Prescriptions’. The project was designed to support GPs and other medical practitioners in the formal prescription of nature, with the idea that their medical authority and
societal respect would encourage and permit patients to connect with nature in order to improve their health and wellbeing.
It is important to note that Nature Prescriptions are not a replacement for standard treatments, but complement them whilst giving the patient ownership of their own recovery and, in some cases, new interests.
‘We have never been more aware of how important nature is to our health and our wellbeing, with many of us turning to nature for support as we deal with the ongoing stresses of the COVID-19 pandemic.’—RSPB Scotland on Nature Prescriptions
One GP from East Craigs Medical Centre described the Nature Prescriptions as having ‘no side effects, and it is easily accessible and available’, whilst another GP emphasised how there is no waiting list for nature, the patient can start as
soon as they are ready.
Nature Prescriptions are more than just being outdoors, one practice nurse said ‘This is not just going for a walk, this is enjoying a walk’. The prescriptions aim to engage patients with their local wildlife and seasonal
changes, not just walking for the sake of it.
The provided materials encourage patients to connect with nature, ‘in particular, there is a focus on cultivating emotional connections, noticing with the senses, perhaps noticing beauty’, said Elaine Bradley, project manager of the Nature
A Nature Prescription is not just a conversation with your GP, it is a tangible, helpful guide to help patients engage with their local environment in a way that suits them. Each prescription consists of a leaflet and a calendar, the former
provides ideas for connecting with nature and links to local walking groups and volunteering opportunities, as well as local maps.
Such ideas include visiting a green space in your city that you’ve never visited or listening out for five curious natural sounds and then thinking about how your body responds as you listen.
The calendar takes this a step further, weaving mindful enquiry into seasonal changes. Each month suggests different natural phenomena to notice and enjoy; for example, in July one suggestion is to watch ducklings on your local pond and one
idea for August is to forage for blackberries.
But when did it all start? And how is it going? Nature Prescriptions first started on the Scottish Shetland Islands, the northernmost part of the UK, in 2017. The project was well received by patients and practitioners alike, leading to its
expansion to all ten Shetland practises in the following year. The pilot scheme generated a huge amount of anecdotal evidence and positive feedback, though no formal research was carried out.
This brings us to the most recent trial in Edinburgh, Scotland’s capital city. With the apparent success of the Shetland trials, the RSPB wanted to see if Nature Prescriptions could be delivered to an urban environment. After all, those
living in urban environments are more likely to suffer with anxiety disorders and have lives very separate from the natural world.
The Edinburgh Nature Prescriptions were a collaborative project from RSPB Scotland, the Edinburgh Health Foundation and the Lothians Health Foundation. Five Edinburgh GP surgeries took part in the study during the earlier stages of the
COVID-19 pandemic, from September 2020 to June 2021. Despite the obvious challenges of lockdown, 50 healthcare professionals prescribed nature to their patients, with over 355 Nature Prescriptions formally recorded.
Overall, nature was prescribed for 32 different health conditions. The majority of prescriptions (69%) were for mental health conditions—anxiety, postnatal depression, PTSD and schizophrenia among them. Some prescriptions were for physical
health conditions, such as diabetes, asthma, arthritis and eczema, to name a few.
Seventy-four percent of patients say they benefited from their Nature Prescription, one patient from the East Craigs Medical Centre said that ‘a prescription from a GP makes you feel more obliged and motivated’, having previously struggled
with motivating themselves to get outside.
Seventy percent of patients said they connected with nature either daily or a few times a week, with over 75% saying they found no difficulty in following their Nature Prescriptions, surely highlighting the effectiveness of this
nature-based, personal scheme.
Eighty-seven percent of patients thought it likely or very likely that they would continue with nature-based activities, which is great news as pro-nature activities are vital in the midst of habitat loss, pollution and climate change.
‘Seventy-four 74 per cent of patients say they benefited from their Nature Prescription.’
Younger patients were prescribed nature predominantly for their mental health, with increasing numbers of physical health conditions in older age groups.
Interestingly, 73% of the prescriptions were given to women, regardless of age. Elaine Bradley offered a range of reasons for this potential gender bias. One being that prescribers may think that women are more receptive to the idea of
Nature Prescriptions. It may also be due to the majority (70%) of prescribers being women themselves.
However, in Scotland, around 62% of GPs identify as female, meaning it is not particularly surprising that most of the nature prescribers were female. Elaine highlights that future research would help to lessen any potential gender bias if
we are to see more people benefitting from Nature Prescriptions.
What is to come?
So what does the future hold for Nature Prescriptions, where are they headed?
Karl Stevens, Head of Engagement, Fundraising and Communications at RSPB Scotland, says that the Edinburgh Trials are just the tip of the iceberg, as more questions and queries have stemmed from the project. For example, looking beyond just
the age and gender of patients would help understand how people from a range of backgrounds respond to Nature Prescriptions.
Looking at patients’ ethnicity, sexuality and income, as well as their access to green spaces, would help RSPB Scotland and the NHS to get a representative picture of community structure. This will bring understanding of how best to engage
with different groups of people.
The next step is to sustain the scheme in the current five Edinburgh clinics and expand it throughout the city, working on a longer time frame. ‘Ultimately’, says Karl, ‘we would love for this to be part of the toolkit of all healthcare
professionals in Scotland’.
‘We would love for this to be part of the toolkit of all healthcare professionals in Scotland’.
There are also plans to create a central resource, or Nature Prescriptions Hub, with access to tools, support and even training. With so much talk of what nature can do for us, perhaps it is easy to forget that we can do a lot for nature in
its hour of need.
In the last 50 years, 40 million birds have vanished from Britain, as we leave them fewer wild spaces in our disconnection from the natural world. A close connection with the natural world, the seasons and your local wildlife, forms a
relationship that benefits both you and the nature on your doorstep.
The RSPB have published a report on their findings from the
Edinburgh Nature Prescription Trials, as well as a webinar discussing it. There is still a long way to go before the natural world
is formally integrated into our National Health Service, but
these initial steps are crucial if we are to navigate the biodiversity crisis, alongside the physical and mental tolls of modern life.