Green Social Prescribing (GSP) is a key component of the personalized care approach (NHS 2019) and the Government invested in the ‘preventing and tackling mental ill health through green social prescribing’ programme (April 2021-March 2023), which involved seven ‘test and learn’ sites in England to explore the role that nature-based interventions can play in improving the nation’s mental health. The Department for Health and Social Care commissioned two pieces of research related to the GSP programme:
This research explored perceptions of green social prescribing amongst patients, potential users, and clinicians.
It found that most GSP services are reaching only a few of those people who could benefit: “It is relatively uncommon for patients to have been prescribed a nature-based activity: only 7% of individuals had received such a referral.”
However, of those referred, around four fifths (78%) participated in the activity that they were referred to.
This research sought to understand the capacity of green activity providers to support wider delivery, beyond the test and learn sites.The report found that GSP services are widely used by people with mild to moderate mental health needs, with capacity gaps identified in relation to service users with more complex or moderate to severe mental health needs, leading to equity challenges.
The research found that for green activity providers “performance capacity is undermined by reliance on a short-term, competitive and precarious funding model. Personal capacity (knowledge, skills and confidence) is variable but often not sufficient to accommodate service users with complex health needs. Workload capacity appears to be low, on average, with low numbers of paid and volunteer staff impacting on service delivery”.
The report concluded that:
Many providers have the capacity to support more service users. There are also often many more green activity providers operating in an area than are currently being referred to by link workers.
There are capacity issues that undermine the ability of link workers and green activities to provide meaningful support to service users with mental health needs, particularly those with more severe or complex needs. There is a worrying pattern of link workers and green activity providers receiving patients with complex mental and physical health conditions that they are not equipped to work with.
There is a pressing need for a more sustainable funding model for GSP, with a need to move away from short-term competitive funding that drives inefficiencies and uncertainty in the provision and incentivises new and different green and nature-based activities at the expense of continuity. Many green activity providers are reliant on grants to fund their activities and to establish themselves and grow over time.
There is currently not enough awareness among many GPs, link workers, and service users of the benefits of engaging with green and nature-based activities.
The report concluded that to enhance GSP delivery capacity, the focus on local provision must be accompanied by system-wide change.
GSP provision has had to focus on ‘low to no cost’ provision. It is our understanding that STH providers are often unable to afford to accept GSP referrals due to the higher costs of engaging an STH practitioner with the appropriate skills and training. Consequently, STH provision is currently underrepresented in both GSP practice and in the research and evaluation of GSP programmes. That the research highlights a lack of capacity amongst green activity providers to accommodate service users with complex health needs should not be taken to mean that such capacity does not exist within the wider sector.
The evidence strongly points to the role that STH can make in providing services appropriate to people with more complex mental and physical health conditions which would strengthen the GSP offer and mitigate the risk of inappropriate referrals. The identified need for a more sustainable funding model for GSP is critical to unlocking the potential that exists in the sector and enabling the STH provision to be made available to people with more complex or moderate to severe mental health needs, and thus improving health equalities.
