More than a decade ago, family physician Dr. Melissa Lem sat in her Toronto office and listened to a young patient talk about his struggles with attention deficit disorder.
Like her, he’d moved from small-town British Columbia to the city and felt overwhelmed by stress. She talked about conventional options with him – medication, sleep, exercise and therapy – and added a recommendation about what worked best for her: 20 minutes in nature every day.
“I thought he was going to roll his eyes,” she said.
The patient took her suggestion to heart but Dr. Lem wished she had something more formal to give him.
Today, she does. The BC Parks Foundation, working with Dr. Lem and a group of other health care providers, is launching Canada’s first formal nature-prescribing program.
Parkprescriptions.ca, launched last week and known as PaRx, is free for all licensed health care professionals in British Columbia, and will roll out across the country over the next year as partnerships with other parks organizations are announced.
PaRx is not linked to any health system and providers receive no reimbursement for the prescriptions.
Dr. Andrew Day, chief executive officer of the BC Parks Foundation, said the organization hopes to encourage people to spend time in nature by providing them with evidence about the health benefits and giving them details on green spaces nearby.
“We know that chronic disease and mental health have really taken their toll on Canadians, the health care system and budgets. Nature is a very cost-efficient way of improving physical and mental health,” Dr. Day said.
The BC Parks Foundation, the charitable partner of BC Parks, has been developing a program for nature prescriptions over several years but the launch was delayed by the pandemic. In that time, COVID-19 and the resulting restrictions on indoor gatherings drove more Canadians into the outdoors for recreation and mental health, Dr. Day added.
He said he hopes “that anyone who is going through a challenging time can be reminded that they are not alone, that they are part of something larger, that the gentle healing power of nature is there for everyone.”
PaRx is modelled on similar programs around the world, especially Parks Rx, a nature prescription program set up by the Golden Gate National Parks Conservancy in partnership with the National Park Service in the United States. In an analysis published earlier this year in the International Journal of Environmental Research and Public Health, low-income families increased their visits to parks after receiving a park prescription with information about where to find safe, accessible green spaces.
For the BC Parks program, licensed health care providers like physicians, physiotherapists and psychologists can register to receive a unique provider code, along with instructions for prescribing and tracking nature prescriptions. Patients can access information about the evidence supporting time in nature to treat specific conditions.
The PaRx initiative recommends patients spend two hours a week in nature and at least 20 minutes at a time, the minimum required before levels of the stress hormone cortisol drop significantly, according to a study published in Frontiers in Psychology.
The act of writing a prescription demonstrates to patients and providers that nature time can be as important as some medications, said Dr. Jane Thornton, a sports medicine physician and researcher at Western University who is not involved with PaRx.
“We can advise our patients, like our cancer patients, and say, ‘This works as well or better than some of the medications that I’m prescribing you. So I’m going to write this down as part of your treatment plan.’”
Dr. Lem, who is now based in Vancouver, said she wants nature time to be recognized as the fourth pillar of health, along with diet, exercise and sleep. The first three pillars have been established for decades, but people still struggle to change their lifestyle habits. They are, however, more likely to comply with written prescriptions rather than oral advice, studies show.
Time in nature has not been studied with the kind of rigour that drug therapies undergo, but the evidence is growing. Time outdoors increases resilience among people with cancer as they navigate their diagnosis and treatment. Nature helps reduce the number of rapid, repetitive thoughts in people who are stressed, and it helps people feel more connected to their communities. There are additional benefits for people who combine nature with physical activity.
Dr. Dallas Seitz, a geriatric psychiatrist at the University of Calgary, prescribes outdoor time for his patients, particularly those with dementia. The introduction of a formal nature-prescription program will be especially helpful to older Canadians, he said, many of whom are struggling with isolation.
“Most seniors spent a lot of time in nature when they were younger and those early memories tend to be spared in people with dementia,” he said. It’s easier for many older adults to find tranquility in the outdoors rather than learning new skills, which are often required for psychological therapies, he added.
Things like walking, going to gardens or sitting in nature are “simple, feasible, and potentially very impactful activities for them,” Dr. Seitz said.
Dr. Clark Svrcek and Dr. Doug Klein, family physicians in Calgary and Edmonton, have been enrolling patients in a study of nature prescribing over the last year. They recommend nature time for people with depression, anxiety, COVID-related mental health issues and stress.
They have not completed their study but believe formal prescribing helps patients make change. “[Nature prescribing] is a sort of formal endorsement that nature time is part of looking after yourself,” Dr. Klein said.
Dr. Lem, who is a member of the Canadian Association of Physicians for the Environment, hopes this initiative will encourage Canadians to become proactive in combating climate change as they connect to outdoor spaces.
“We’re in the COVID-19 crisis and the climate-change crisis, and we’re seeing the fallout to mental health from both of these,” she said.
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