Nature matters in mental health

In this blog post, authors Rosa Roberts and Tom Fisher explain the concept of nature-based practice, and discuss the growing body of evidence for its benefits to mental health.

Nature-based practice is an umbrella term that can include making small adjustments to bring nature into existing practice, as well as structured nature-based interventions such as allotment groups, mindful walking or other therapeutic activities within a natural setting (Sometimes offered through ‘Green Social Prescribing’).

There is a growing body of evidence relating to the mental health benefits of connectedness to the natural world.

Good for patients

Engaging with nature is linked to positive health benefits and general wellbeing across age ranges, cultures and social class^1,2, with those reporting lower wellbeing scores initially experiencing the greatest improvements³. Studies have shown that nature-based practices can lead to improvements in symptoms of depression, anxiety, addictions, emotional regulation and difficulties associated with autism ^3,4,5,6,7,8. Nature exposure has also been found to play an important role in child development, benefitting overall wellbeing, cognition and ADHD symptoms⁹.

A 2023 systematic review of 92 randomised controlled trials found significant reductions in depression and anxiety scores with nature-based interventions, as well as improvements in physical health measures such as lowered blood pressure¹⁰.

Nature-based interventions have also been shown to positively affect some of the more profound aspects of the human experience, such as meaning, purpose, belonging, self acceptance and sense of autonomy^{11, 12}. There is a wealth of evidence to show that a person’s connection to nature is key to the physical and mental health benefits of nature exposure^12,13,14, and that interventions which facilitate nature connection have the largest and most sustained positive impacts^15,16,17.

“Especially if you’re unwell - actually it’s really hard to leave the house - and so if you do manage to kind of get out of the house, then actually it does make you feel better, and I feel that you get that sense of perspective a little bit more, it’s easier to kind of … talk yourself down from a ledge if you’re outdoors.”^a

“I have been diagnosed with stress and anxiety, being involved at the allotment and the mindfulness course has been transforming. I cope much better with stress and anxiety, which has meant that my work performance has improved. Whereas before I found it stressful to have face-to-face interactions, now I feel much more comfortable”^b

Participants of nature-based interventions have reported enhancement in the therapeutic relationship and feeling empowered to take an active role in their own recovery¹⁸.

Good for the community

As well as individual health benefits, research shows that nature-based interventions can lead to improvements in social cohesion, social empowerment and social support, reducing feelings of loneliness and social isolation^19,20,21. Contact with nature may have advantages to low-income populations, giving the potential to reduce health inequalities²². The Royal College of Psychiatrists recognises this and states:

“There is clear evidence healthy environments and contact with nature are important for our mental health… equal access to nature must become a priority of the UK government, NHS and Mental Health Services.”²³

“I am very happy to be part of these sessions, it provides me good feeling about myself, coming to nature and involving these sessions at green space, it is so refreshing, It makes me feel better mentally, I feel so much relief every time, I come and involve this.

“This is important for my community who mostly live these local flats to come down and involve these sessions, it is so friendly, and we can sustain in long run. Coming to green space make me feel better and boost my mental wellbeing. Thanks for the Bristol Somali youth voice and green social prescribing project team for doing this and giving us this opportunity to involve.”^c

Good for staff

There are clear benefits to staff wellbeing of working in and with nature, which may help protect against burnout¹⁸. People with strong levels of nature connectedness feel happier and function better than those with lower levels. Increasing the nature connectedness of staff can improve employee wellbeing, with follow-on benefits for staff sickness, performance, and retention²⁴. Studies have shown limitations to employee’s exposure to nature contacts could impact levels of work related stress and stress-related behaviours²⁵.

“… being out of this building was really beneficial for us, it helped with burnout.”^d

“I always come back thinking I’m so glad I got out, you just feel refreshed … a different kind of fresher approach when you’re coming back to your work.”^d

“It restores us too!”^e

Good for the planet

There is evidence that nature-based interventions may be more cost effective than traditional models of care, as well as being a more sustainable and lower-carbon alternative^26,27. Nature-based interventions which lead to increased nature connectedness also lead to increases in pro-environmental and pro-conservation behaviours, which are vital in addressing the climate and environmental crisis^28,29,30.

International and governmental recognition

The integral links between nature and health have been recognised at both International and Governmental levels. The 2020 Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES) Report recognised that our mental and physical health is inextricably linked with the health of the natural world³¹. The UK Government 25 year plan includes multiple policies related to “Connecting people with the environment to improve health and wellbeing”, including “Considering how environmental therapies could be delivered through mental health services”³².

Theoretical frameworks for understanding the benefits of human-nature interactions:

Despite the evidence for the benefits of nature-based care, a 2023 Government report on the national state of Green Social Prescribing found that across the country the network of nature-based providers is patchy and diverse, often struggling to cater for those with more significant mental health needs. The report recommended several system changes, including better links into the health service³⁸. This report demonstrates that there is a clear role for mental health trusts in helping to deliver these services, both in collaborating with and providing training for nature-based providers to care for those with significant mental health difficulties, and also training and supporting staff to integrate nature-based care into their service, to provide these evidence-based interventions themselves.

“You’re both in nature together so you’re kind of barriers are down… it’s just like you’re two people out in nature rather than… therapist and this… person that needs help.”^d

Have a look at the podcasts and resources below for more ideas on how to integrate Nature into your own practice as a psychiatrist.

By Rosa Roberts and Tom Fisher

Quotes

1. Mother Nature Project (forest bathing sessions for mothers with postnatal difficulties and their babies¹⁸)
2. Mindfulness through nature connection programme
3. Bristol Somali Youth Voice – Green Social Prescribing Project
4. Bringing Nature into CAMHS^{24 -} 2022 study with CAMHS inpatient staff who had recently undergone nature-based facilitator training²⁴
5. Community Rehabilitation Team - Nature-based practice reflection group

References

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2. Bratman GN, Anderson CB, Berman MG, Cochran B, de Vries S, Flanders J, et al. Nature and mental health: An ecosystem service perspective. Sci Adv. 2019;5(7):0903. doi: 10.1126/sciadv.aax0903.
3. Rogerson M, Wood C, Pretty J, Schoenmakers P, Bloomfield D, Barton J. Regular Doses of Nature: The Efficacy of Green Exercise Interventions for Mental Wellbeing. Int J Environ Res Public Health. 2020 Feb 27;17(5):1526. doi: 10.3390/ijerph17051526. PMID: 32120892; PMCID: PMC7084199.
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