Promoting Therapeutic Horticulture as Community Healthcare
Imagine, for a moment, a healthcare strategy that invites those seeking mental healthcare services into a conversation on how to improve their quality of life. The conversation would focus on “How would you describe your lifestyle?” and “What activities bring you joy?”, instead of “What’s wrong with you?” or “What are your symptoms?” This peculiar approach would consider the individual’s social connections and the health of the environment they live in. Of course, this form of healthcare would be accessible, affordable, and effective for everyone.
Sounds too good to be true, doesn’t it? Well, this peculiar mental healthcare strategy is called social prescribing, and it is gaining ground in several US cities. Healthcare providers striving to meet the growing need for mental healthcare services, are turning to “prescribing” non-clinical therapeutic interventions provided by community care partners. The prescriptions focus on social connections and could include art therapy, animal assisted therapy and nature-based therapies like horticultural therapy.
The State of the Nations’ Mental Health
We hear it often enough; the state of the nation’s mental health is a cause for concern. There has been little to no improvement nationally in our mental health since those early, desperate days of the coronavirus pandemic. From a public health perspective, the pandemic was not the cause of our failing state of mental health, but it did bring an existing issue into sharper focus.
According to Mental Health America, in 2024 there was just one mental healthcare provider for every 340 Americans who are actively seeking services. It is unlikely that this shortage will improve any time soon, which only worsens another concerning issue, provider burnout. The intention of using community-based care providers is not to replace pharmaceuticals or mental health counseling, but rather to provide support for those traditional care models. Community based care providers could become a powerful tool to reduce the burden on our healthcare system and at the same time address the inequities in healthcare that are so prevalent in the US today.
What is Social Perscribing?
Social prescribing is a health care concept developed in the UK and adopted by the National Health Service (NHS) as a key component for creating personalized care and support plans for clients. Working in conjunction with a medical practice, an NHS “link worker” will find non-clinical activities and resources available within the client’s community. Social prescription activities are focused on the clients’ personal interests like art, dance, nature or meaningful service. Social determinants of health are considered when choosing an activity best suited for the client. This is due to the influence of the home and work environment on human health. Once the individual begins to spend time in an environment where they are supported and have purpose, they become empowered to improve their own quality of life.
Social Prescribing USA is an organization dedicated to promoting social prescribing initiatives across the nation. Their website offers access to research, education, networking and resources for the layperson and professionals alike. At present there are social prescribing programs from Boston to Los Angeles, mostly occurring in urban areas. The activities offered range from dance classes for clients with Parkinson’s disease, performing arts outings for children and families to nature walks for older adults aging in place. One such social prescribing hub is Art Pharmacy based in Atlanta, GA which collaborates with community care providers in Massachusetts, Connecticut, New York, and California.
Within the next five years, Social Prescribing USA endeavors to create grants supporting pilot projects, educate medical and allied health students and create a trustworthy informative presence on social media. Another ambitious goal is to research, write and publish official policy positions on the role of social prescribing within the US healthcare system by 2030. For those interested in social prescribing, this organization serves as a great resource.
Instead of just addressing “What’s the matter with you?” social prescribing addresses “What matters to you?”
~Julia Hotz, The Connection Cure
Easing the Burden
Last year the National Institute of Health reported a burnout rate of 57.4% for healthcare professionals across the US. A lack of resources was a major contributing factor. This echoes the 2024 Mental Health America report. In short, mental healthcare providers in the US are unable to serve all who seek services, and this burden is now stressing other sectors of the healthcare system and society at large.
Since 1992, social prescriptions have been used successfully in the UK. A recent study of nine regions across England that utilize social prescribing found a 42% reduction in physician visits and a 24% reduction in emergency room visits. The benefits do not stop there. A 2023 review found for every £1 ($1.33 US) invested in social prescribing, there is an economic return of £2.14 to £8.56 ($2.84-11.36 US). Charlotte Osborn-Forde, Chief Executive of the National Academy of Social Prescribing states, “Many things that affect our health and well-being cannot be tackled by medicine and doctors alone. It is not only good for patients, but it is good for the health system too. Because it helps people to stay healthier for longer, it can mean people visit their GPs less often and are less likely to be admitted to hospital.”
Nature Based Social Prescribing
If ever there was a good fit for nature-based social prescribing, the profession of horticultural therapy might well be it. Specifically, nature-based social prescribing, known as green social prescribing in the UK, is focused on improving physical and mental well-being through purposeful nature interventions. Therapeutic horticulture (TH) interventions are well suited to group-based sessions which build community and can be conducted year-round providing both active and passive participation. Therapeutic horticulture will skillfully offer an opportunity for nature connectedness, enliven all five senses, reduce stress, and promote ecological stewardship.
Those seeking mental healthcare services via a TH social prescription do not need a green thumb to participate. Practitioners are trained to support all abilities and cultures through modification of interventions. For the older adult aging-in-place who is struggling with isolation and loneliness, they will develop a sense of community and much needed companionship. Elementary school students with behavior management issues will practice coping skills and build a sense of pride. Incarcerated young adults will learn valuable vocational skills that could offer new opportunities. The LGBTQ+ individual will discover an inclusive and welcoming environment to express themselves without judgement or bias.
Eco-Anxiety Social Prescribing
Fear and anxiety surrounding climate change is widespread and can quickly become debilitating. Finding ways to manage eco-anxiety is paramount to improving our mental health. TH has a unique role in this endeavor. Through therapeutic intervention a participant strengthens their own resiliency. Ecological stewardship develops through interventions with a nature connection. In other words, participants in TH social prescribing sessions do something good for themselves and at the same time, do something good for the planet. No other therapeutic practice is so adept at providing both in a single session.
Our antiquated healthcare system is in dire need of repair and renewal. Social prescribing is a practical solution to the lack of resources and inequities surrounding the shortage of mental healthcare providers. Nature-based social prescribing might just be the agent needed to bring horticultural therapy to the frontline of this struggle. It may not be prudent to wait for our privatized healthcare system to embrace social prescribing. HT/TH practitioners can move forward with providing much needed social prescribing through self-referrals. Many corporations are now using wellness reimbursement programs, and several states are introducing “wellness wallet” programs. Both programs provide funding for community-based care. Equipped with this knowledge, how could a social prescribing therapeutic horticulture program support your community?
