Social prescribing, a wellbeing activity which the public can self-refer to or be signposted to by health professionals, has been considered a suitable alternative to prescribing medication for the last 30 years but is now progressing even further into green social prescribing thanks to the research undertaken by Dr Kirsten McEwan, Associate Professor in Health and Wellbeing. Green social prescribing is a way to improve wellbeing, physical health and social connection, by engaging people with nature-based interventions, such as therapeutic gardening or conservation volunteering.
Dr McEwan has been researching green social prescribing for a number of years, and more specifically looks at Forest Bathing. Forest Bathing is originally from Japan, where it is a green social prescription. Forest bathing is a slow, mindful, sensory walk in a natural environment, where walkers are encouraged to appreciate their surroundings. The benefits from Forest Bathing have been associated with both mental wellbeing and physiological factors. It has been so effective in helping the Japanese population that there are over 65 certified centres, and it is used regularly as an alternative medication by Japanese healthcare providers. However, in the UK there has only been one other study besides Dr McEwan’s into the benefits of it.
Dr McEwan’s study with The Forest Bathing Institute, used wellbeing surveys and measured heart rate variability before and after the walk. Heart rate variability tells us how well-balanced our nervous system is; the higher the heart rate variability (HRV) the more balance there is between our fight and flight system and our rest and digest system which results in feeling calmer and having better cardiovascular health. This study found similar results to Japanese studies, with significant improvements in cardiovascular health (HRV), anxiety, and uniquely measured and found improvements in rumination and social connection (McEwan et al., 2021) and has since resulted in Surrey Council using Forest Bathing as a social prescription and becoming a Government ‘test and learn’ site for green social prescribing.
Dr McEwan says: "It has been rewarding to see the results of our research project so quickly put into action by Surrey Council. Through the test and learn funds, around 90 adults in Surrey with mental health difficulties or learning disabilities have so far benefitted from Forest bathing with The Forest Bathing Institute and have shown significant improvements in mental and physical health, including a 42% reduction in anxiety and a 34% increase in mobility."
A lack of forests
Despite Japan’s overwhelming success with Forest Bathing, the UK is at a disadvantage when it comes to rolling it out across the whole country. Ancient woodlands have been suggested to be more effective for Forest Bathing, and in collaboration with Sheffield University, Dr McEwan found that ancient woodland held more immune-boosting volatile organic compounds compared with an urban garden (Walker et al, 2023). However, unlike Japan, which has 67% tree cover with 19% ancient woodland, only 13.2% of the UK’s landscape is covered by forest, and of that, only 2% is ancient woodland. Ancient woodland is, therefore, less accessible, so, adapting the research and the learning, Dr McEwan and mindfulness author Vanessa Potter introduced ParkBathe.
While initially sparked by the UK’s lack of forest, ParkBathe was also a response to Covid-19 lockdowns. The Covid-19 lockdowns saw many people confined to back gardens or local parks and with concerns around mental health due to isolation. With funding from the Big Lottery, ParkBathe offered free one-hour walks in urban parks and enabled more people to access the benefits of Forest Bathing. Inspired by the success of ParkRun in attracting those who would not normally run, ParkBathe aimed to provide a gateway to attract ‘sceptics’ who would not normally consider Forest bathing or be too busy to engage in a traditional 2-3 hour Forest bathing walk. Indeed, walkers who were initially sceptical reduced in their scepticism and showed the greatest improvements in wellbeing. Whilst one busy walker commented, ‘The pace of life in London is so fast, it’s often ‘next next next!’ and you don’t get to take anything in. I’m going to slow down more and appreciate my surroundings because it’s good for me’
The findings from ParkBathe are promising, for example, reducing anxiety by 40%, and are beginning to encourage social prescribers to refer people.
One walker commented, ‘It’s now nearly eight hours since I ParkBathed and I’m still feeling so relaxed. My mind isn’t full of “stuff” and I don’t feel any anxiety - something I’ve been plagued with for nearly a year now.’
The research and studies have also attracted the attention of Good Parks London, who, recently used Parkbathe as a case study of good practice. Good Parks London have found a reluctance for females to use parks due to safety concern of being out alone. Group walk initiatives such as ParkBathe offer an opportunity to spend time in parks in the safety of a group, and therefore not miss out on the wellbeing benefits available.
Making ParkBathe accessible to wider groups
For younger people, a silent walk is far less engaging than an adult may find it. Dr McEwan, in collaboration with those who work with young people in nature, adapted the walk so that it became a blend of sensory and Forest School activities. Significant improvements were seen in anxiety, rumination and especially nature connection.
One young person commented: "I feel much happier. I’ve had a lot of stress this week…exams coming up, but I’m not even thinking about that now, I’ve got chronic fatigue so my fight/flight is all over the place, next time I’ll spend more time in the woods."
There is demand for Forest bathing guides to adapt their walks to meet the needs of groups who find physical access to nature difficult due to low energy or impaired mobility. For example, in collaboration with three Forest bathing guides with lived experience of Long Covid, Dr McEwan researched the benefits of online Forest bathing for adults with Long Covid. There were significant reductions in anxiety, symptom severity and most striking an 81% increase in social connection.
One person with Long Covid commented: "It’s just magical. I feel the best I have felt this whole month. I’m bedridden and when we do the session it feels like a massive release from all the issues I’m dealing with. It makes an impact to how I cope with things the week after. It really is adding to my toolbox to cope with chronic illness".
Dr McEwan more recently collaborated with EcoWisdom in Canada, who offer online Forest bathing on prescription for adults living with a disability. Results show significant improvements in symptom severity, social connection, and rumination which last up to one month later.
One person who is bedridden commented: "You can lay on the bed and you don't have to get to the river or the forest. You can imagine it and picture it in your mind, which is really powerful"
List of active collaborators:
- Gary Evans (firstname.lastname@example.org), The Forest bathing institute, Surrey
- Olga Terbenina (email@example.com), The Forest bathing institute, Surrey
- Vanessa Potter, ParkBathe (firstname.lastname@example.org)
- Yasuhiro Kotera (email@example.com), University of Nottingham
- Jamie Bird (firstname.lastname@example.org), University of Derby
- Mark Faghy (email@example.com), University of Derby
- Jessica Eve Jackson (firstname.lastname@example.org), University of Derby
- Harriet Collett (email@example.com), Kindred Soil
- Jeannie Nairn, WoodlandBreathing (firstname.lastname@example.org)
- Caroline Cook (email@example.com), WellWithNature
- Heather Walker (firstname.lastname@example.org), University of Sheffield
- Kari Krogh, EcoWisdom (email@example.com), Canada