The Cost Effectiveness of Ecotherapy as a Healthcare Intervention, Separating the Wood from the Trees

Abstract

Internationally, shifts to more urbanised populations, and resultant reductions in engagements with nature, have been a contributing factor to the mental health crisis facing many developed and developing countries. While the COVID-19 pandemic reinforced recent trends in many countries to give access to green spaces more weight in political decision making, nature-based activities as a form of intervention for those with mental health problems constitute a very small part of patient pathways of care. Nature-based interventions, such as ecotherapy, are increasingly used as therapeutic solutions for people with common mental health problems. However, there is little data about the potential costs and benefits of ecotherapy, making it difficult to offer robust assessments of its cost-effectiveness. This paper explores the capacity for ecotherapy to be cost-effective as a healthcare intervention. Using a pragmatic scoping review of the literature to understand where the potential costs and health benefit lie, we applied value of information methodology to identify what research is needed to inform future cost-effectiveness assessments. We show that there is the potential for ecotherapy for people with mild to moderate common mental health problems to be cost-effective but significant further research is required. Furthermore, nature-based interventions such as ecotherapy also confer potential social and wider returns on investment, strengthening the case for further research to better inform robust commissioning.

Social Return on Investment of Nature-Based Activities for Adults with Mental Wellbeing Challenges

“…The body of evidence regarding the physical and mental benefits of NBIs is steadily expanding, but research on their cost-effectiveness is limited. A recent scoping review found that there is potential for NBIs to be cost-effective for people with mild-to-moderate com-mon mental health problems, but more research is needed, such as a randomized controlled trial with sufficient statistical power and follow-up, to confirm these findings [22].…”

“…While the existing evidence on the cost-effectiveness of NBIs for treating mental health challenges is currently insufficient for the National Institute of Health and Care Excellence (NICE) to conduct a meaningful assessment and provide clinical guidance, SROI analysis is increasingly being used to estimate the wider benefits of NBIs [22].…”

Health education via “empowerment” digital marketing of consumer products and services: Promoting therapeutic benefits of self-care for depression and chronic pain

“…Such a gap in public knowledge creates an opportunity for yoga studios and companies manufacturing and promoting yoga apparel to create “empowerment” marketing and digital ads that offer relevant and evidence-based information ( Figure 1B ). Since nature therapies such as eco-therapy and forest bathing gain more recognition for their clinical effects ( 92 , 93 ), advertising health benefits of connection with nature can be a part of health promotion campaigns ( 94 ). It is noteworthy that “positive-gain” message framing has been shown to be more effective in promoting health-related behaviors ( 95 , 96 ).…”

Green spaces for mental disorders

“…Currently, the evidence base is not clear about the optimum duration of exposure for maximum health gain or whether individuals with particular mental disorders may respond better. Furthermore, while evidence suggests that green social prescriptions are likely to be cost-effective for individuals with mild to moderate mental illness [46]; further research is required to demonstrate the magnitude of these benefits and the potential social and wider returns on investment. It is also reported that while mental health clinicians perceive nature-based interventions to provide a range of health benefits for individuals with mental illness including improved mood, wellbeing, and social connections; there are concerns over barriers to use of services, such as individuals’ mental health symptoms, lack of motivation and geographical accessibility [47,48].…”