OP53 Preventing and tackling mental ill health through green social prescribing: Findings from a national evaluation

Background Over the last decade, social prescribing has become a focus within United Kingdom (UK) healthcare policy. The increasing awareness of the potential impact of nature-based activities on health has led to the emergence of Green Social Prescribing (GSP), which involves referral to nature-based activities to improve health and wellbeing. The GSP project was part of a two-year £5.77 m cross-governmental initiative focussing on how systems can be developed to enable the use of nature-based settings and activities to promote wellbeing and improve mental health. The programme ran from October 2020 to April 2023 and provided funding to seven pilot Test and Learn (T&L) sites across England to scale and embed GSP. The national evaluation was commissioned to: 1). Understand the different systems, actors and processes in each T&L site and how these impact on access to, and potential mental health benefit from, GSP. 2). Understand system enablers and barriers to improving access to GSP, particularly for underserved communities. 3). Understand how GSP is targeted at particular groups, including underserved communities. 4). Improve understanding of how to successfully embed GSP within delivery and the wider social prescribing policy landscape. Methods The qualitative data presented here forms part of a wider multi component mixed methods evaluation. An initial programme theory (PT) derived from the literature guided the data collection. Qualitative data were collected through the deployment of embedded researchers (ERs) in each T&L site. During the evaluation period, ERs conducted over 100 interviews with stakeholders involved in the delivery of the programme across the 7 T&L sites. In addition, ERs undertook observations of key meetings and conducted documentary analysis of site developed service user ‘case studies’ and key site documents. An initial analytical framework was developed from the PT and refined according to the emerging themes. Thematic analysis was undertaken to test our theory assumptions. Results Several important challenges to programme implementation were identified from our analysis: 1) Embedding a system level understanding of GSP, 2) pressures within the wider social prescribing system, 3) strengthening referral pathways; and 4) long term investment and support for the voluntary and community sector. Conclusion GSP has clear potential benefits for health and wellbeing. However, challenges to implementation and embedding GSP within the existing infrastructure remain. Addressing these challenges requires a systems level approach and commitment to longer term investment to ensure that processes are given time to adapt and become established. Our findings will have relevance to other organisations wishing to implement social prescribing programmes at scale.