Nature-based health interventions (NBIs) for the treatment of poor mental health are becoming increasingly common, yet evidence to support their effectiveness is lacking. We conduct a pilot study of a six-week intervention, aiming to engage individuals with wetland nature for the treatment of anxiety and/or depression. We employed a mixed methods design, using questionnaires, focus groups and semi-structured interviews to evaluate the intervention from the perspective of participants (n = 16) and healthcare professionals (n = 2). Results demonstrate significant improvements in mental health across a range of indicators, including mental wellbeing (Warwick and Edinburgh Mental Wellbeing Scale), anxiety (Generalised Anxiety Disorder-7), stress (Perceived Stress Scale) and emotional wellbeing (Positive and Negative Affect Schedule). Participants and healthcare professionals cited additional outcomes including improved physical health and reduced social isolation. The wetland site provided a sense of escape from participants’ everyday environments, facilitating relaxation and reductions in stress. Wetland staff knowledge of the natural world, transportation and group organisation also played a considerable role in the intervention’s success. These aspects should be considered in future and existing NBIs to maximise benefits to participants. We propose NBIs based in wetlands are an effective therapy option for individuals diagnosed with anxiety and/or depression.

Improved nature provision in urban environments offers great potential for achieving both biodiversity conservation and public health objectives. Yet there are few experimental studies that address links between specific natural environments and physiological and/or psychological changes that could contribute to the health and wellbeing co-benefits of urban nature. In addition, relative to green space, the salutogenic impact of aquatic environments are understudied. Here, we present a feasibility study examining the use of low-cost wearable technology to quantify the psychophysiological effects of short-term exposure to urban wetlands. The study took place at the WWT London Wetland Centre, which is characterized by its contrasting biodiverse wetland habitat and surrounding urban setting. Thirty-six healthy participants experienced counterbalanced exposures to an indoor space, a wetland, an urban site. We continuously recorded electroencephalographic (EEG) data and real-time physiological stress responses; with additional monitoring of post-exposure self-reported mood states. We found a significant effect of site on mean resting heart rate (HR), with increased HR in the urban setting, although this was only observed in participants with pre-existing high stress. We found no significant differences in other measures of physiological stress responses (heart rate variability and electrodermal activity). The EEG data showed modulation of high beta band activity only in the wetland setting, potentially related to changes in attention. However, the EEG findings were confounded by low quality signals and artifacts caused by movement and environmental interference. Assessments of self-reported mood states demonstrated an increase in positive feelings in the wetland setting. A pronounced decrease in negative feelings in the wetland setting was observed in stressed individuals only. Our results suggest that pre-existing stress levels may be an important modulator of the salutogenic effect of blue-green space. We provide partial support for the hypothesis that exposure to blue-green space promotes stress recovery and for the use of low-cost psychophysiological measurements to quantify the potential stress-reducing effects of blue–green space exposure in urban dwellers. Further technological refinement is required for this approach to become a viable tool to support evidence-based decision-making for public health and green/blue space provision.

Evidence on the health benefits of spending time in nature has highlighted the importance of provision of blue and green spaces where people live. The potential for health benefits offered by nature exposure, however, extends beyond health promotion to health treatment. Social prescribing links people with health or social care needs to community-based, non-clinical health and social care interventions to improve health and wellbeing. Nature-based social prescribing (NBSP) is a variant that uses the health-promoting benefits of activities carried out in natural environments, such as gardening and walking. Much current NBSP practice has been developed in the UK, and there is increasing global interest in its implementation. This requires interventions to be adapted for different contexts, considering the needs of populations and the structure of healthcare systems. This paper presents results from an expert group participatory workshop involving 29 practitioners, researchers, and policymakers from the UK and Germany's health and environmental sectors. Using the UK and Germany, two countries with different healthcare systems and in different developmental stages of NBSP practice, as case studies, we analysed opportunities, challenges, and facilitators for the development and implementation of NBSP. We identified five overarching themes for developing, implementing, and evaluating NBSP: Capacity Building; Accessibility and Acceptability; Networks and Collaborations; Standardised Implementation and Evaluation; and Sustainability. We also discuss key strengths, weaknesses, opportunities, and threats for each overarching theme to understand how they could be developed to support NBSP implementation. NBSP could offer significant public health benefits using available blue and green spaces. We offer guidance on how NBSP implementation, from wider policy support to the design and evaluation of individual programmes, could be adapted to different contexts. This research could help inform the development and evaluation of NBSP programmes to support planetary health from local and global scales.

The health benefits associated with spending time in natural environments have been highlighted during the COVID-19 pandemic. Lockdowns and restrictions to safeguard public health have exacerbated the pre-existing mental health crisis and rise of non-communicable diseases. Thus, the importance of nature as a health resource has been elevated, hastening calls for a better understanding of how health benefits might differ across user groups and nature provisions. In this regard, urban green spaces have become the greatest research focus; however, blue spaces, especially inland freshwater (e.g., wetlands), remain less studied. First-hand user experiences are also under-represented. This exploratory study examines the motivations and benefits of active wetland centre users in the UK, both during and after visits. Responses to three open-ended questions were collated online from 385 participants, and a qualitative content analysis was conducted based on an existing taxonomy from users of urban green spaces. The results showed strong motivations to visit due to the biodiversity at the site (mainly the birdlife), while less tangible nature (e.g., fresh air) and amenities were also important. In contrast to other studies on natural environments, physical activity was a less influential motivation. Salient derived effects included positive and intensely positive emotions, relaxation and mental restoration. After visits to wetland centres, feelings of vitality and satisfaction were the most prominent effects that emerged. For decision-makers looking to leverage inland blue spaces for public health benefit, our results highlight the broad range and relative prominence of the reasons for use and the associated perceived health benefits derived by users of UK wetland centres. They highlight how biodiversity, abiotic nature and good amenities are important qualities to consider when planning, managing and encouraging people to use natural environments for health benefit, qualities that may also provide important environmental co-benefits.