Green social prescribing is the practice of supporting people to engage in nature-based interventions and activities to improve their mental and physical health. Social prescribing link workers (and other trusted professionals in allied roles) connect people to community groups and agencies for practical and emotional support, based on a ‘what matters to you’ conversation.
Green social prescribing includes both what is known as green and blue activities. These could include local walking schemes, community gardening projects, conservation volunteering, green gyms, open water swimming or arts and cultural activities which take place outdoors. These activities may be ‘prescribed’ by link workers (and other trusted professionals) alongside other forms of support, for example, referrals to support for housing or finances – based on the needs and circumstances of each individual.
Evidence on green social prescribing
There is a strong and growing evidence that nature based social prescribing plays and important role in improving mental and physical health and reducing loneliness.
The National Academy for Social Prescribing’s briefings and visual guides give a clear overview of existing evidence. They point to the success of social prescribing initiatives, and they identify where we need to do more research.
The nature briefing helps set out what the evidence currently tells us about nature and health and wellbeing. It summarises the key findings from a rapid evidence review and delivered by the National Academy for Social Prescribing’s academic collaborative.
Cross government Green Social Prescribing Programme
The £5.77 million cross government Green Social Prescribing Programme was a two-year programme which launched in April 2021. The programme built on the government’s commitment to transform mental health services and increase social prescribing and personalised care, set out in the NHS Long Term Plan. It also helped deliver the government’s 25 year environment plan to support more people, from all backgrounds, to engage with and spend time in green and blue spaces in their everyday lives.
The programme set out to test how to embed green social prescribing in mental health pathways and across integrated care systems to improve mental health and tackle health inequalities. It provided valuable learning to help health and care systems, providers and local communities develop green social prescribing in order to:
- improve mental health outcomes
- reduce health inequalities
- reduce demand on the health and social care system
- develop best practice in making green social activities more resilient and accessible
- demonstrate how to spread and scale green social prescribing across integrated care systems
The Green Social Prescribing Programme included:
- Support for 7 test and learn integrated care systems (ICSs) to tackle and prevent mental ill-health, including financial resource, national programme support and a programme wide community of practice.
- Expressions of interest were invited from ICSs experiencing the impact of COVID-19 and health inequalities as well as mental health need.
- Department of Health and Social Care commission of two pieces of research which were published in March 2022:
- A national evaluation project managed by the Department for Environment, Food and Rural Affairs to assess how to spread and scale green social prescribing to inform policy and practice. The final report is due to be published in 2023/24.
The programme was supported by the Treasury Shared Outcomes Fund with additional funds from NHS England, Sport England and the National Academy for Social Prescribing (NASP). It was project managed by the Department for Environment, Food and Rural Affairs with support of national partners the Department of Health and Social Care, the Department for Levelling Up, Housing and Communities, Natural England, Sport England and NASP. The test and learn site delivery was project managed by NHS England.
Test and learn sites
The seven test and learn sites tested the ways in which connecting people with nature can improve mental ill-health and explored and brought together opportunities for communities to get involved in their natural environment. The successful sites were announced at the end of 2020 and commenced the two year project in 2021:
- Humber and North Yorkshire Integrated Care System
- South Yorkshire and Bassetlaw Integrated Care System
- Nottingham and Nottinghamshire Integrated Care System
- Joined Up Care Derbyshire Integrated Care System
- Greater Manchester Health and Social Care Partnership
- Surrey Heartlands Health and Care Partnership
- Healthier Together Bristol, North Somerset and South Gloucestershire Integrated Care System
The sites are in areas that were disproportionately affected by COVID-19 and contain communities disadvantaged by health inequalities. This includes people living in deprived areas, people with mental health conditions and/or people from specific ethnic minority communities.
Results and findings
- Over 8,500 people have been referred to a green social prescribing activity during the programme from April 2021 to March 2023.
- Interim evaluation findings showed positive improvements in mental health and wellbeing and strong engagement in communities experiencing high levels of social inequalities that affect health and wellbeing. The final evaluation report will be published later in 2023.
- 85% uptake of green social prescriptions when offered.
- Green networks have been established in all test and learn sites.
- Integrated workforce development has increased trust and understanding. between delivery partners and healthcare providers, leading to more referrals to suitable green activities.
- Green social prescribing is represented in policy and strategy at a national and local level across different government sectors.
- Green social prescribing continues to be delivered in all seven of the test and learn sites, demonstrating a lasting impact of the programme.
Test and learn site video case studies
- Nottingham and Nottinghamshire: People’s journey to green social prescribing: partnership working between the link workers and green providers in the ICS project with contributions and perspectives of staff, green providers, the voluntary sector and people who have lived experience of mental ill-health.
- Nottingham and Nottinghamshire: partnership working between the link workers and green providers with contributions and perspectives of the green providers, mental health service, and people who have lived experience of mental ill-health.
- Derby and Derbyshire: partnership working between Erewash Primary Care Network and green providers with different professional prospectives including sharing its approach to setting the programme up, the challenges for providers, and overcoming the barriers for and with participants.
- Derby and Derbyshire: contribution and perspective of staff, green providers and someone who has lived experience of mental ill-health and has benefited from nature-based support.
- Greater Manchester: partnership working between the link workers and green providers with contributions and perspectives of the Greater Manchester Partnership, green providers, social prescribing link worker lead, and people who have lived experience of mental ill-health and have benefited from nature based support.
- South Yorkshire and Bassetlaw – mental health: the importance of co-design and how the approach informed the project with contribution and perspective of staff, green providers, social prescribing link worker lead, and people who have lived experience of mental ill-health.
- South Yorkshire and Bassetlaw – co-design: the importance of co-design and how the approach informed the project with contribution and perspective of staff, green providers, Sheffield Hallam University evaluation lead, social prescribing link worker lead, and people who have lived experience of mental ill-health. The film has particular focus on engagement with the local ethnic minority community, people with experience of mental ill health, young people and people who live in the most deprived neighbourhoods and communities in the area.
- Humber and North Yorkshire: hear from volunteers, the provider, a social prescribing link worker and a person with experience of mental ill health in York who has benefitted from green space and interacting with other people.
- Bristol, North Somerset and South Gloucestershire: hear from a provider offering Nordic walking, the benefits, connections made and those involved in reaching into South Asian, Caribbean, African communities. We also hear about the challenges and how some of these have been overcome with instructors who are ethnically representative of the communities they serve.
- Surrey Heartlands: how the project has supported people who are socially isolated and unemployed helping them back into employment, training, education and ultimately enabling them to be part of a community again.
Green social prescribing toolkit
The learning from the programme has been captured in a Green social prescribing toolkit designed to help communities, organisations and health professionals who are looking to set up green social prescribing programmes that connect with local health systems.
The toolkit includes details of the project, including:
- information about specific projects involved in the pilot
- templates and guidelines for getting started and best practice
- links to evaluation and research
- links to other useful resources.
Whilst this toolkit focusses on green social prescribing, the framework could be adapted for other activity types including arts, heritage and physical activity.
In addition to the two pieces of research commissioned as part of the Green Social Prescribing Programme, the Department of Health and Social Care also commissioned and funded four clinical research studies testing the effectiveness of green social prescribing on mental health outcomes. These studies have been commissioned by the National Institute of Health Research and if found to be feasible, there are plans for full-scale studies.
- A development and feasibility study for a randomised control trial of nature-based social prescribing for mental health.
- A nature-based intervention to improve mental health: efficacy of an angling intervention for military veterans with post-traumatic stress disorder.
- Outdoor swimming as a nature-based social prescribing intervention for depression: a feasibility randomised control trial.
- A short-term evaluability assessment looking at what works for whom in what contexts for ethnic minority groups
Natural England evidence summaries, published in November 2022:
- Links between natural environments and mental health (EIN065)
- Links between natural environments and physical health (EIN066)
- How the natural environment can support children and young people (EIN067)
- Connection to nature (EIN068)
- Methodology for natural England evidence information notes EIN065, EIN066, EIN067 and EIN068 (EIN069)