The NHS Forest vision is for patients and healthcare professionals to have access to adequate green space in or near their site. There are many of reasons access to the outside should be championed, but the relationship between mental health and nature is one of the most compelling. Here’s a rundown of all the most current research on the importance getting outside for our wellbeing. Whether that be through walking through the local park on your break or taking your patients outside.   

We recently shared a blog about how green social prescribing can offer a structured way to harness the benefits of the outdoors on our health. Recent case studies of nature-based solutions in a Cornish woodland and tree planting for occupational therapy at Langdon Hospital also give some tangible examples of NHS trusts running nature-based solutions outdoors. It seems intuitive that being in nature can be restorative, but what current research backs this up?  

A National Trust report found that 71% of participants infrequently or never watched clouds and 79% either infrequently or never smelled wildflowers (Hunt 2020). 

A Japanese study, which looked at the psychological benefits of walking through forest areas, analysed data from 585 young adult participants after a 15-minute walk in either an urban setting or in a forest. Results showed that compared to walking in an urban setting, the participants walking in a forest experienced less anxiety, hostility, fatigue, confusion, and depressive symptoms and more vigour (Song et al., 2018). Phytoncides are released by trees, especially coniferous trees, i.e. pine trees, cedar, and spruce. These trees are especially good at releasing volatile organic compounds (VOCs). These have been found to boost the immune system, lower stress hormones, and reduce inflammation. They also improve wellbeing and mental health by reducing stress, promoting a positive emotional state, and eliciting feelings of wellbeing (Mei et al; 2021). 

Unfortunately, we don’t all have a forest next to our workplaces, but even just getting outside in the sunlight is good for your mind and body. Sunlight stimulates vitamin D synthesis which is essential for keeping bones, teeth, and muscles healthy. It also synchronises our circadian rhythm which is fundamental to good sleep (Smolensky et al. 2015).  

Interestingly, indoor environments can sometimes harbour higher levels of air pollutants than the outdoors. Regular breaks can counteract the decrease in functional ability (Vehviläinen et al., 2016). Put simply, taking regular breaks outside can help the mind work better. Interacting with nature can make our minds sharper. Research has indicated that even simple and brief interactions with nature can produce marked increases in cognitive control (Berman et al.,2008). Addressing indoor air quality concerns is particularly critical for vulnerable populations in healthcare settings. Care homes, for instance, often grapple with high levels of indoor pollutants and suboptimal ventilation, exacerbating health risks for residents (Air Quality Expert group, 2022).  

Noticing the good things about urban nature has strong clinical potential as a wellbeing intervention and social prescription. (McEwan et al., 2019). Nature connectedness has wider knock-on benefits to society. A meta-analysis shows that connecting people with nature may be a promising avenue for promoting action to protect the environment and prevent harm to nature (Mackay and Schmitt 2019).  

A 2017 Wildlife Trusts study of 2,000 British adults found that 70% of respondents reported that they had “lost touch with nature”.

Yet, despite these potential benefits, many of us find ourselves disconnected from the natural world. A significant portion of adults feel estranged from nature, with implications for their ability to pass on ecological knowledge to future generations (Hunt, 2020). Fortunately, initiatives like our ranger programme in hospitals aim to bridge this gap, facilitating meaningful interactions between people and nature.  

Increased nature connectedness is important because it brings sustained and clinically significant benefits to mental health. It doesn’t matter what our starting point is. In fact, the greatest benefits are to those with the lowest starting levels of nature connectedness. (McEwan et al., 2019).

Outdoor walks in urban green spaces can lead to a reduction in clinical depression of more than 30% compared with indoor activities (Frühauf et al., 2016). This may be because whole body outdoor experiences are more engaging to our senses. We are multisensory beings and patterns in nature contrast with the linear structure of buildings in urban environments. Patterns in nature are known as fractals. These are structures in which patterns occur multiple times at different scales. You may see similar patterns in a trees shape as you do in its branches and leaves. Humans enjoy fractal designs as they increase our desire for engagement and complexity at the same time as decreasing tension (Robles et al. 2021).   

When engaging with nature, non-visual sensory pathways benefit us through sound, smell, touch and taste. Natural sounds decrease self-reported anxiety and agitation. It terms of preference, sounds of water, wind and animals are preferred over anthropogenic sounds such as traffic, industrial and recreational noise (Franco et al. 2017).  

So, let’s celebrate the relationship between mental health and nature and spend a few minutes outside using as many senses as possible. Connect with the natural environment around you and notice how spring is here and the plants around you are budding with potential energy for this year.  Remember that even the subtlest appreciations of nature can have profound impacts on our wellbeing.  

References used:  

Air Quality Expert group (DEFRA) (2022). Indoor Air Quality. [online] doi: D.O.I 10.5281/zenodo.6523605. 

Berman, M.G., Jonides, J. and Kaplan, S. (2008). The Cognitive Benefits of Interacting With Nature. Psychological Science, 19(12), pp.1207–1212. doi: 

Franco, L.S., Shanahan, D.F. and Fuller, R.A. (2017). A Review of the Benefits of Nature Experiences: More Than Meets the Eye. International Journal of Environmental Research and Public Health, [online] 14(8), p.864. doi: 

Frühauf, A., Niedermeier, M., Elliott, L.R., Ledochowski, L., Marksteiner, J. and Kopp, M. (2016). Acute effects of outdoor physical activity on affect and psychological well-being in depressed patients – A preliminary study. Mental Health and Physical Activity, 10, pp.4–9. doi: 

Hunt, A. (2020). Noticing Nature The first report in the Everyone Needs Nature series #EveryoneNeedsNature. [online] National Trust . Available at: University of Derby. 

Mackay, C.M.L. and Schmitt, M.T. (2019). Do people who feel connected to nature do more to protect it? A meta-analysis. Journal of Environmental Psychology, [online] 65, p.101323. doi: 

McEwan, K., Richardson, M., Sheffield, D., Ferguson, F.J. and Brindley, P. (2019). A Smartphone App for Improving Mental Health through Connecting with Urban Nature. International Journal of Environmental Research and Public Health, 16(18), p.3373. doi: 

Mei, P., Malik, V., Harper, R.W. and Jiménez, J.M. (2021). Air pollution, human health and the benefits of trees: a biomolecular and physiologic perspective. Arboricultural Journal, 43(1), pp.19–40. doi: 

Park, B.J., Tsunetsugu, Y., Kasetani, T., Kagawa, T. and Miyazaki, Y. (2009). The physiological effects of Shinrin-yoku (taking in the forest atmosphere or forest bathing): evidence from field experiments in 24 forests across Japan. Environmental Health and Preventive Medicine, 15(1), pp.18–26. doi: 

Robles, K.E., Roberts, M., Viengkham, C., Smith, J.H., Rowland, C., Moslehi, S., Stadlober, S., Lesjak, A., Lesjak, M., Taylor, R.P., Spehar, B. and Sereno, M.E. (2021). Aesthetics and Psychological Effects of Fractal Based Design. Frontiers in Psychology, 12. doi: 

Smolensky, M.H., Sackett-Lundeen, L.L. and Portaluppi, F. (2015). Nocturnal light pollution and underexposure to daytime sunlight: Complementary mechanisms of circadian disruption and related diseases. Chronobiology International, 32(8), pp.1029–1048. doi: 

Song, C., Ikei, H., Park, B.-J., Lee, J., Kagawa, T. and Miyazaki, Y. (2018). Psychological Benefits of Walking through Forest Areas. International Journal of Environmental Research and Public Health, [online] 15(12), p.2804. doi: 

Vehviläinen, T., Lindholm, H., Rintamäki, H., Pääkkönen, R., Hirvonen, A., Niemi, O. and Vinha, J. (2016). High indoor CO2concentrations in an office environment increases the transcutaneous CO2level and sleepiness during cognitive work. Journal of Occupational and Environmental Hygiene, 13(1), pp.19–29. doi: 

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