Blue Prescribing Project

This project is an innovative wetland-based health programme, designed to enhance people’s connection with nature and improve their wellbeing.

Introduction

The Blue Prescribing Project is a wetland health programme specifically designed, in consultation with participants, to promote a range of mental and physical health benefits through facilitated wetland nature engagement.

The project is similar to the growing health practice of social prescribing, which enables health care professionals to refer people to local, non-clinical services to improve health and wellbeing and make better use of community resources.

Social prescribing is a key component of the NHS’s Universal Personalised Care, an approach that moves away from asking ‘what is the matter with you?’ but towards ‘what matters to you?'

WWT are working with local health care providers, The Mental Health Foundation, The University of Exeter and participants to design nature-based health programmes that are delivered over several weeks and that enable people to be active, take notice of wildlife and connect with other people in wetland settings, all to help people improve their mental health.

Our Blue Prescribing aims to improve health by harnessing the link between people and nature, a link that is now well established1. Spending time in nature can reduce psychological stress, fatigue, anxiety and depression; it can also reduce social isolation and increase physical activity. We will be combining the amazing wildlife and visitor experiences offered by WWT centres to create a unique health resource.

The problem

A quarter of people in Britain experience mental health problems each year2 and 40% of all GP appointments are about mental health3.

However, mainstream NHS services are constrained by capacity and limited options, to the point that 70-75% of people with a diagnosable mental health problem receive no treatment at all4. These problems add up, the full economic and social cost of mental health is £105 billion a year in England5.

These statistics relate to before the Covid-19 pandemic, a health crisis that is profoundly exacerbating these issues. More than two-thirds of adults in the UK (69%) reported worries about the effects COVID-19 is having on their lives6. The pandemic has highlighted the further need for alternative mental health treatment options as well as a need for outdoor programmes that allow physical distancing. While some elements are in place to facilitate this - for example the NHS has invested in 1000 ‘link workers’ to connect people to community services – currently there are insufficient community services to meet the rising demand. The Blue Prescribing Project aims to help rectify this.

Access to blue and green space is associated with better health outcomes but is unequal in the UK. Although exercising outdoors during the pandemic has provided respite for some, those experiencing mental health problems, and those most at risk, faced greater barriers to accessing nature. They are more likely to live in urban areas with fewer natural spaces and less likely to have the means to travel to those spaces. The Blue Prescribing Project aims to enable greater access to those that need it as part of the project.

Access to nature – and wetlands – is very unequal in the UK, with few wetlands easily accessible.

What we have done so far

We conducted pilots with individuals diagnosed with anxiety or depression at the WWT Slimbridge centre. Participants took part in a two-hour session per week for six consecutive weeks, in which they went bird-watching, tried bird feeding, had a canoe safari, estuary walk and picnic. Participants self-completed questionnaires before and after the programme and we invited them to take part in a focus group at the end.

Participants said that the wetland site provided a sense of escape from everyday environments, helping them relax and feel less stressed. As a result our findings showed significant improvements in mental health across a range of indicators, including mental wellbeing, anxiety, stress and emotional wellbeing.

On average, mental wellbeing improved from ‘below average’ to ‘average’ by national norms. Participants and healthcare professionals also reported improved physical health and reduced social isolation.

What we are going to do

2021 and 2022 will see wider rollout of the project at WWT Steart Marshes (funded by the government's Green Recovery Challenge Fund) and at WWT London Wetland Centre (funded by Simply Health). With the Mental Health Foundation we will co-create activities that build and progress participant’s health, knowledge and confidence in wetland nature. We will facilitate peer-support networks where people can share experiences with others in similar life situations, enhancing social inclusion and resilience. Overall, we aim to equip participants with the tools to continue exploring nature and improve the way they look after their long-term mental health.

With the Mental Health Foundation we will also begin the development of an online nature-based, mental health self-management course. With the University of Exeter our PhD studentship will work with us to help understand how we can make the programme work for all parties: the participants, WWT, other environmental NGOs and the health sector. We will also help the University develop their guidance on Nature Prescriptions.

We will roll out the nature prescribing service in London and Somerset so more people can benefit.

The UK’s health problems are complex and so nature engagement for health is no magic bullet, but many organisations and the Government are realising that encouraging and improving access to good quality nature has a role to play in preventing and treating mental health issues. This also reduces the financial burden on the health service and creates a deeper connection between people and nature.

An outstanding question is how organised nature access can be better recognised by and integrated with traditional healthcare. The Blue Prescribing Project will help make this case through creating networks, collaborating widely and gathering evidence. Along with health improvements, the project also aims to help change public attitudes so that nature is recognised as essential to health and more people adopt environmentally friendly behaviours and support conservation.

Key achievements and outputs

  • 2019 – WWT Slimbridge pilot is conducted and the research is published
  • 2019 – Partnership with Mental Health Foundation begins
  • 2020 – The Blue Prescribing Project PhD with the University of Exeter begins
  • 2020 – The Blue Prescribing Project team work with the University of Exeter’s Nature On Prescription project to trial new nature prescribing guidance.
  • 2021 – The Blue Prescribing Project at WWT Steart Marshes begins
  • 2021 – Development of an online nature-based, mental health self-management course begins
  • 2021 – The Blue Prescribing Project at WWT London Wetland Centre begins

Our science and the feedback from participants on our Slimbridge programme tells us that Blue Prescriptions work, that they are cost effective and that the participant’s love them and want more.

Our programmes at Steart Marshes and WWT London Wetland Centre in 2021/22 will enable us to better understand how these types of health programmes can be delivered more effectively and how to sustain them over time.

Dr Jonathan Reeves, Principal Research Officer (Health & Wellbeing), WWT