It would be easy to miss the entrance to Pensford Field in a quietly affluent road in Kew, west London. But for many of the people who have found their way to this tree-shaded space in suburbia, it has been the first step towards dramatically improved mental health.
The site is the headquarters of a charity, Dose of Nature, founded in 2018 by psychologist Dr Alison Greenwood, which takes referrals from GPs for people experiencing a wide range of problems, from depression to addiction.
It aims to encourage a greater connection with nature, said Greenwood, and “inspire lifestyle changes that will have a significant and lasting impact on people’s mental health”.
With volunteer “nature guides” as the backbone of the service, it is relatively cheap to deliver, benefiting a cash-strapped NHS beset by long waiting lists for mental healthcare.
Greenwood said: “The cost effectiveness of our programme is an essential part of its success.”
Explaining the philosophy behind it, she said: “For millennia, across the globe, people have used nature to support their mental wellbeing in various different ways, across all cultures, across all generations.”
The “green social prescribing” movement, in which a GP may recommend a patient joins a walking group, for example, is one manifestation of this approach.
However, Greenwood believes her venture is rare in the UK, both because it is overseen by mental health professionals and because nature itself is the therapy — not simply a location in which to participate in activities.
People joining Dose of Nature’s programme are given an initial assessment lasting up to two hours by Greenwood or another psychologist. This is held outdoors, whatever the weather. “Getting wet, getting cold can be really good for the brain and body,” she adds.
Next, they are assigned their nature guide, who has undergone training to spot if a situation needs to be escalated, for example if someone is having suicidal thoughts.
Data collected by the charity has shown that it “consistently outperformed equivalent NHS interventions” such as cognitive behavioural therapy, Greenwood said.
The results were even more striking, she argued, since the patients include those considered by the NHS too severe or complex for a short-term course of CBT, and who would most likely have been referred for more costly hospital or community-based treatments.
The science underpinning the approach goes far beyond the simple recognition that being outdoors lifts the mood. Studies have shown that breathing in phytoncides — airborne chemicals that trees and plants give off to protect themselves from threats such as bacteria, insects and fungi — can boost the immune system.
Moreover, listening to nature’s sounds leads to “an instant switch from our sympathetic nervous system into our parasympathetic nervous system — so from our fight/flight, which most of us spend far too long in, into our rest/digest”, said Greenwood.
Dose of Nature’s work is inspired by the international “forest medicine” or “forest bathing” movement. One of its most influential proponents Qing Li, clinical professor at Nippon Medical School Hospital in Tokyo, said it had “no side effects, is free, and has the effect of preventing disease and promoting health, so it can be said to kill three birds with one stone”.
Other countries where the approach has been adopted included South Korea, Australia, Canada, parts of the US and Scandinavian countries, Greenwood added.
The charity receives some resources from local authorities and the NHS and raises the rest from donations, grants and fundraising. There is no fee for patients for its service. All of the GP surgeries in the neighbouring boroughs of Richmond and Kingston, and in north Guildford, now refer patients aged between 16 and 96.
Each Dose of Nature “prescription” costs between £400 and £500, which includes 10 weeks of one-to-one sessions and unlimited access to other nature-based activities, such as outdoor art classes and Qigong sessions.
In contrast, official NHS data from 2022, covering 47 providers, suggested CBT costs £1,350 for a 10 week course.
Greenwood said the charity’s work was demonstrably easing strain on the NHS, pointing to an independent study carried out for a local family doctors’ practice, which found a 40 per cent average reduction in GP contacts in the six months after a patient had worked with Dose of Nature, compared with the six months before.
“One of the reasons GPs have been receptive to what we offer is because we are psychologists, and we have worked in the NHS . . . so we do feel able to hold clinical responsibility for patients,” she added.
Last year, interim findings from a study by Kate Laffan and Christian Krekel, behavioural scientists at the London School of Economics, concluded that participants in the programme scored “substantially lower on both depression severity . . . and anxiety”.
They also scored substantially higher on both “life satisfaction . . . and sense of purpose in life” than a control group of people who were on the charity’s waiting list to start treatment.
Ruth Roadnight, who has been a volunteer at the centre for two and a half years, said: “It’s not a guided nature walk. I’m not a counsellor. And everything you tell me will be private.”
Elaine Lester, who was groomed by an abusive older man from her early teens and endured decades of poor mental health, said that open-air activities, including drawing and writing poetry, with Roadnight “unlocked” an “inner confidence . . . [and] self assuredness that I’ve never had before in my life”. At 55, she is finally the “best version” of herself, she said.
Another person for whom the programme has been transformative is Tom Krumins who was diagnosed with bipolar disorder almost 15 years ago.
Since completing the programme two years ago, Krumins said he had not “really experienced any . . . volatile manic episodes, and I feel like I’ve got a strong grasp on my depression”. He has now become a Dose of Nature guide himself.
Krumins added: “When your mind is so frantic, and you’re burdened by the past or dreading the future, if you can start to hear the birds sing, suddenly it can tune you into the present . . . It reframes your human experience, and it can calm you and ground you and give you some sort of clarity.”
