Debate: should NHS doctors hand out ‘nature prescriptions’?

Doctors on the Shetland Islands are due to start handing out ‘nature prescriptions’ to their chronically ill patients. The responses from the Spooniehacker team were mixed…
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A photo of a line of hikers on a green hillside with a blue sky

Emily Goss - she has long dark hair and red lipstick and is wearing a white T-shirtEmily of GrowEatGift: Yes, I’ve long wished the NHS was better at connecting body and mind

When I saw that the NHS were starting to offer ‘nature prescriptions’, I immediately shared the good news on Twitter. I’ve long been an advocate of nature for managing my conditions, and the idea that this might be taken seriously by doctors filled me with joy.

Research shows that spending time outdoors can help you relax. Forest bathing has recently been in the media, and there’s a wealth of research into its benefits. Even noting just three things in nature each day can be beneficial. There’s also evidence that soil has antidepressant qualities, thanks to friendly bacteria.

I also draw inspiration from nature, and there are many studies showing that spending time outdoors can boost your creativity. I find it great for reducing brain fog: and again, research suggests that nature can enhance attention restoration.

Of course, there’s a big difference between saying, ‘nature may help you’ and ‘this will cure you’. Having regular walks in nature can’t miraculously fix my twisted spine – and there are still plenty of days in the winter when exercise of any kind beyond bedbound pilates is beyond me. I’d hate it if people were blamed for their conditions because they hadn’t stopped to smell the roses. And there are some natural activities that could actively cause harm: if I was prescribed a long ramble, my body would object. But if nature prescriptions are tailored to the patient, I’m convinced they can help.

While some may see advice to connect with nature as patronising, I see the disconnect with nature as one of the major problems we are struggling with as a society

A walk along the canal certainly isn’t a cure-all but there have been many times when it’s made my pain more manageable. Nature has also helped me become more mindful, provided me with my five-a-day through foraging, and brought me joy.

While some may see advice to connect with nature as patronising, I see the disconnect with nature as one of the major problems we are struggling as a society. Of course most people know that it’s good to get outdoors, but a prescription gives it authority.

People may mean to get outdoors but the reality is that many people exist between office and home, without taking time to appreciate nature. Even the scrappy patch of communal lawn outside my flat is packed with wildflowers and bugs, with regular bird visitors – along with my neighbour’s cat – so the nature prescription doesn’t have to be something that’s too challenging. Instead, I see it as a reminder that we aren’t the only living things that need looking after. I get a self-esteem boost when I pick up plastic that could have harmed a duckling, or plant native wildflower seeds in scrubby ground. However, I’d never want to see people forced to litter-pick for their health!

The evidence that nature is a healer is clear, and a ‘prescription’ gives that authority

The sceptic in me suspects that nature prescriptions may be used to blame patients for their conditions: something I certainly don’t want to see happen. I also worry that they could be used to cut other services at a time when they’re already limited. However, if it can save money and free up funds for other interventions, that’s a different story.

We are only one part of nature and, for me, connecting with everything around me helps me feel more grounded – while helping wildlife. While some may see it as ‘woo’, the evidence that nature is a healer is clear.

I’ve long wished the NHS was better at connecting body and mind: having to see different people depending on which bit of the body is affected seems ridiculous as we are complex, and everything affects everything else. As such, I see the move towards nature prescriptions as a step in the right direction towards a more holistic approach to healthcare.

 

Photo of a non-binary person with short bleached blonde hair sitting on a concrete beach groyne wearing a tweed coat. They are looking towards the viewer's left and their tongue is stuck out. They are wearing sunglasses. The sea and blue sky are in the background.Aly Fixter: No, this story just reinforces harmful attitudes towards chronically ill people

I believe that the doctors who came up with these ‘nature prescriptions’ had their patients’ best interests at heart. And I definitely advocate getting into the natural world more as part of managing chronic illness. My own health only started to improve when I moved out of London to a small seaside town and made walking the few steps to the beach my daily goal, even if I could manage nothing else.

But… the thing is… I would never even have been so ill if I hadn’t been denied proper diagnosis and treatment for 15 years. My symptoms were so debilitating, I should never have been left with beach walks as my only treatment option. All my adult life, GPs have given me informal ‘prescriptions’ very much like the above, while refusing to take my symptoms seriously. So in my experience, it’s already a tendency among doctors to give patients lifestyle advice – instead of treatment.

Will patients who can’t access the countryside be given nature prescriptions for train tickets and mobility aids to ensure they can climb those hillsides? I guess not

The idea of the ‘nature cure’ is not new. I live in St Leonards-On-Sea, a town purpose-built nearly 200 years ago to encourage people to recover lost health with the aid of the bracing sea air. So while I’m sure some will benefit from being steered towards more nature walks – and I woudn’t deny anybody that – the presentation of this as something ground-breaking concerns me.

Definitely, offer complementary therapies in addition to competent first line healthcare. If that’s how ‘nature prescriptions’ will work, then great. Although, if they roll out UK-wide, will patients who can’t access the countryside due to location, disability and/or low income get nature prescriptions that include train tickets and mobility aids to ensure they can actually climb those hillsides? I guess not.

In any case, far too many of us in the UK are not being given the basic medical tests and treatment we are entitled to, and suffering unnecessarily as a result. I was diagnosed with Chronic Fatigue Syndrome after 12 years of illness, only to find out that in the UK this is believed to be caused mainly by deconditioning and ‘unhelpful illness behaviours’ (there is solid scientific evidence this is not the case). The blanket prescription for it is exercise and short-term psychological therapies. I was left with nothing but lifestyle advice with very little actual investigation into what was going on in my body.

We are well aware of the importance of diet, exercise, nature and all the other things we are constantly told will fix us

I eventually discovered – eight years later via a private cardiologist – that many of my symptoms were caused by an autonomic nervous system dysfunction called POTS. It’s treatable, and the cardiologist estimates it’s implicated in 30-40% of CFS cases. With proper management of this condition, I can now do more in a day than just stagger onto the beach and back. Yet the NICE guidelines on CFS specifically state that GPs should not carry out the test that would diagnose POTS. Why? Well, that’s a whole other debate. But it’s part of an approach that’s causing serious harm.

Our society loves to paint chronically ill people as not knowing how to take care of themselves – with the suggestion that if they did, they might not be unwell. In reality, the majority of us are working incredibly hard to manage our conditions – often with little support from the medical profession – and are well aware of the importance of diet, exercise, nature, and all the other things we are constantly told will fix us.

We don’t need ‘prescriptions’ for things we already have free access to. We need equal access to proper medical care – and we’re not all getting it. Let’s have some acknowledgement of that in the media and NHS’s press offices and then we can seriously discuss complementary therapies. Otherwise, I think a UK-wide rollout of something like this might just be another way for patients with diagnoses like CFS to be left to rot.

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