The impact of nature-based interventions on the wellbeing of vulnerable adults.

Following years of austerity, slow economic growth and continued strain from the wake of the Covid-19 pandemic, there remain major challenges facing the National Health Service (NHS) in the UK. There are declines in levels of wellbeing and increasing numbers of people unable to work due to mental ill-health (MIH). There has been increasing interest in the integration of Social Prescribing (SP) to access non-clinical support services and support cost reduction of repeat prescriptions and GP visits. Studies have attempted to understand and quantify the benefits of a variety of non-clinical options, including Nature-Based Interventions (NBIs). There are key areas of uncertainty around NBIs including standardisation of practice, long-term outcomes and the mechanisms for how nature exposure and interaction translates into wellbeing improvements. This research addresses some of these areas of uncertainty by providing evidence of the wellbeing and nature connection (NC) benefits of participating in woodland-based mixed-type NBIs, and identifying the potential underpinning mechanisms for wellbeing changes. Such areas of uncertainty negatively impact the overall perception and optimal use of NBIs, and the implementation of and referral to NBIs. Therefore, work to decrease areas of uncertainty will assist in achieving a clearer understanding of the benefits of NBIs and how they can best be utilised by providers, healthcare professionals and the general public. This research utilised a sequential mixed-method design with both quantitative and qualitative approaches. This research recruited vulnerable adults referred to a NBI provider, including those who participated in a NBI and those who were placed on the waiting list for a NBI. Study 1 quantitively assessed the wellbeing and NC of vulnerable adults (n=100) via standardised questionnaires. These were administered both before and after participating in a 12-week NBI or a 12-week waiting list control group (WLCG). Study 2 involved face-to-face semi-structured interviews conducted with 10 NBI participants. Interviews explored mechanisms underpinning NBI wellbeing changes reported in Study 1. Participants of the NBIs (NBIG), but not the WLCG, reported significant improvements in wellbeing (p<.001) and NC (p<.001). Six themes were identified through thematic analysis, which mapped over to the suggested mechanisms underpinning wellbeing changes: (1) Social interaction, (2) Interaction with natural environment, (3) Physical activity, (4) Behavioural gains, (5) Self-esteem, confidence and emotional experience, and (6) Empowerment. Mechanisms were classified as external (1-3) and internal (4-6), with a conceptualisation of the potential process of the mechanisms. For most NBI participants, their accumulated experience from the NBI led to feelings of having taken control of their life; a sense of owning their improvements and achievements, and self-belief in their capacity to continue these into the future. Together, these two studies provide an indication of NBI outcomes and mechanisms underpinning a successful NBI. The findings should assist in reassuring referrers on the impacts of NBIs and provide a deeper explanation of the outcomes participants may expect. Overall, the findings indicate that structured NBI programmes could be beneficial in supporting mental health treatment and recovery of vulnerable adults, representing important implications for both public health policy and practice. The research supports the integration of NBIs within healthcare referral pathways as an adjunct to conventional mental health care approaches. This has potential to reduce demand on overstretched NHS services, enhance recovery and self-efficacy among vulnerable adults, and contribute to a more sustainable, preventative model of community mental health provision.