People with mental health conditions may not fully benefit from “green prescriptions”

Reviewed by Emily Henderson, B.Sc.Nov 6 2020

Spending time in nature is believed to benefit people's mental health. However, new research suggests that giving people with existing mental health conditions formal 'green prescriptions', may undermine some of the benefits.

An international research team led by the University of Exeter and published in the journal Scientific Reports, investigated whether contact with nature has the potential to help people with mental health issues, such as depression and anxiety, to manage their symptoms. They found that nature is associated with a number of benefits for these individuals, but only if they chose to visit these places themselves.

The research team collected data from more than 18,000 people in 18 different countries, as part of the EU Horizons 2020 funded BlueHealth project. A key aim was to understand why people feel motivated to spend time in nature, how often they visit, and how social pressure influences their emotional experiences during visits.

The findings suggest that whilst pressure to spend time outdoors can encourage visits, it can also undermine the potential emotional and wellbeing benefits of contact with nature.

Common mental health issues are the leading cause of disability worldwide, affecting approximately 17% of the world's population each year.

Although there is evidence that some people with these issues are using nature as part of their own symptom self-management, there was still much we didn't not know about how widespread this was, or whether more formal 'Green prescriptions' from medical professional to spend time in nature could aid management and potentially recovery.

The research team were surprised to find that people with depression were already visiting nature as frequently as people with no mental health issues, while people with anxiety were visiting significantly more often. On the whole, both groups also tended to feel happy and reported low anxiety during these visits.

However, the benefits of nature seem to be undermined when visits were not by choice. The more pressure people felt to visit nature by presumably well-meaning others, the less motivated people were and the more anxious they felt.

The research was led by Dr Michelle Tester-Jones, of the University of Exeter. She said: "These findings are consistent with wider research that suggests that urban natural environments provide spaces for people to relax and recover from stress.

However, they also demonstrate that healthcare practitioners and loved ones should be sensitive when recommending time in nature for people who have depression and anxiety. It could be helpful to encourage them to spend more time in places that people already enjoy visiting; so they feel comfortable and can make the most of the experience."

The authors believe their paper provides evidence that careful techniques to discuss accessing nature as a means of self- or supported-management for people with mental health issues need to be integrated into these programmes if they are to offer clients the best support.

Dr Mathew White, of the University of Exeter and University of Vienna, who co-ordinated the international research team, added:

We had no idea just how much people with depression and anxiety were already using natural settings to help alleviate symptoms and manage their conditions. Our results provide even greater clarity about the value of these places to communities around the world, but also remind us that nature is no silver bullet and needs to be carefully integrated with existing treatment options."

Dr Ann Ojala, a research team member from the Natural Resources Institute Finland (Luke) said: "The results encourage further research in clinical settings. We need more information on this delicate balance between the intrinsic motivation and sometimes necessary encouragement from outside, as well as how nature visits could be integrated to mental health treatment."

Co-author Dr Greg Bratman, of the University of Washington, said: "The results highlighted the importance of taking intrinsic motivation into account when it comes to the benefits of nature visits - and the relevance of integrating this consideration into effective green prescriptions".

Matilda van den Bosch, Assistant Professor at The University of British Columbia, said: "For green prescriptions, like with any intervention, it is important to avoid pressure to achieve compliance with the treatment. Nature cannot be forced on anyone, but must be provided at the individual's own pace and will."

The study's full title is "Experiences of nature for people with common mental health disorders: Results from an 18 country cross-sectional study", and is published in the journal Scientific Reports.