Prescribing nature: Research suggests the outdoors are good for your mental health
Dr. Melissa Lem says spending time outdoors can clear our minds, lower our stress
Originally published on Sept. 6, 2021.
For many teenagers, a driver's licence can mean freedom to visit the mall — but for Jon Cadang, it offered him a reprieve from the depression that consumed him for years.
One of his first stops? A creek near his home in Mississauga, Ont., abundant in fish that he was determined to catch.
It would take Cadang two weeks before he landed one, but it taught the forager and painter that nature could be a powerful treatment to what ails him.
"I realized that whole time, I stopped ruminating about my situation — all the bad things that were happening," said Cadang, now 25. "I realized that maybe being out here and putting myself towards a goal, even if that's just to catch fish, maybe that could help," he told Back to the Land host Duncan McCue.
"I liked what I saw. I felt at peace."
A growing body of research suggests that being outdoors can benefit mental health and boost memory, improve cardiovascular health and help us live longer. Additional studies find that nature lowers cortisol, the body's stress hormone.
With that research in hand, doctors in parts of Canada have signed on to provide what are known as "nature prescriptions" for those living with mental illnesses and physical health conditions such as heart disease and diabetes.
Last November, PaRx, an organization led by Dr. Melissa Lem, partnered with the B.C. Parks Foundation and health-care providers across British Columbia to offer patients nature prescriptions. Programs have also recently launched in Ontario and Saskatchewan.
"We leverage what we know about their health status, where they live, what they're interested in to kind of create a customized nature prescription that they can fill," Lem said. A standard prescription, she adds, is two hours of nature per week, at 20 minute or longer intervals.
Patients work one-on-one with a licensed health-care professional — a doctor, nurse or psychologist — to find the best solution for them. Nature prescriptions are often used in tandem with more traditional approaches to health care, and PaRx recommends that people first consult with a health-care provider if they have medical concerns.
Lem says her patients have responded positively to the idea. "I find that when I bring it up in the context of other lifestyle interventions — like healthy diet, like exercise and good-quality, adequate sleep — that they nod their heads like it's intuitive to them.
Outdoors offered peace, but challenges continued
Cadang says that while he now has a good relationship with his parents, it was their expectations that compounded his depression.
"They wanted me to excel at school, so I couldn't really go outside. I couldn't really go anywhere aside from school," he said.
The pressure wore on him, and his mind spiralled. He spent most of his time alone in his bedroom, ruminating about his situation.
At the height of his depression, Cadang says, he would spend 18 to 20 hours a day sleeping. At one point, he experienced suicidal thoughts. In 2018, Cadang was diagnosed with major depressive disorder.
"It seemed that no matter what I tried to do, I could never get anything right. I think the worst part was feeling that I really had no place in this world, and it felt like there was no escaping that," he said.
Casting a line and tackle brought Cadang solace that had a healing effect. But as a college student, he still struggled with his mental health — and eventually faced a crisis, requiring medication and therapy.
Still, his counsellor at the time encouraged him to continue using nature as a medicine.
"It was affirming to hear that being outside, going on these walks, incorporating that into my treatment plan felt like I was walking the right steps," Cadang said.
Stressed in the city
Lem has been advocating nature prescriptions for more than a decade. The family physician has a practice based in Vancouver, but she worked in rural British Columbia earlier in her career.
After that, she made a move to Toronto — a change that proved to her the benefits of the outdoors.
Her job in Toronto, working as an outpatient physician, was less stressful than her time in rural B.C., where she had to deal with emergencies and middle-of-the-night births. But in Toronto, she says she still struggled with the weight of her job.
"I was sitting in my apartment looking out at a tiny little square of sky with the CN Tower in the distance, hearing the streetcars rumble by and feeling incredibly stressed," she told McCue.
"I thought, why am I so stressed out? And then I realized it was probably because I didn't have as much access to nature."
Living among green spaces can also lead to a healthier life, according to Becca Lovell, a researcher at the University of Exeter medical school, based at its campus in Truro, England.
"The greener your living environment, probably the better it is for your health, in terms that it can ameliorate a number of environmental stresses — so noise, poor air quality, heat-island effect and so on," she said.
"What we're starting to do now is think [of] the so-what question — so how do we make environments healthier?" That could mean adding green spaces to certain areas, or encouraging better use of what's already there.
And while more research into the topic is needed, Lovell argues that what is known points toward generally positive outcomes.
Along with PaRx, Lem's work goes beyond jotting prescriptions on a notepad. She is also an advocate for improved access to high-quality green space as part of urban planning.
"A really important part of the work that we do is getting governments to realize that nature is an essential health service and to get them to enshrine policy into city building and city planning that makes sure that green spaces are accessible to everyone," she said.
Nature offers 'a lot of meaning'
Cadang continues to work on his mental health. He says he's also looking for ways to turn his love of the outdoors into a career, after transitioning from an interior design program to study fish and wildlife technology.
He's recently found success foraging for and selling wild mushrooms.
And after making peace with his parents, it's a hobby they now enjoy as a family.
"We've made it a tradition that we go foraging for fiddleheads every spring. Now we go to the same spot and we end up having a really nice meal afterwards," Cadang said.
"They're very accepting of what I do now because they see that it brings me a lot of meaning and joy in my life — and they certainly don't mind having a lot of food on the table when I come home."
Written by Jason Vermes. Produced by Zoe Tennant.
If you're experiencing suicidal thoughts or having a mental health crisis, help is available. For an emergency or crisis situation, call 911.
If you are thinking of suicide or know someone who is, help is available nationwide by calling the Canada Suicide Prevention Service toll-free at 1-833-456-4566, 24 hours a day, or texting 45645. (The text service is available from 4 p.m. to midnight Eastern time).
You can also text CONNECT to 686868 and get immediate support from a crisis responder through the Crisis Text Line, powered by Kids Help Phone.