When Melissa Lem was a child, green spaces were an escape from the taunts of bullies in her Toronto neighborhood.
“It was in those green spaces—in my father's Chinese vegetable garden, in the park down the street, in the bushes and the trees on the edges of the school—that I felt most like myself and like I belonged,” she says.
Now as a family doctor, Lem is helping health practitioners and families lean into the mental, physical, and social healing effects of nature by writing “nature prescriptions” to get outside.
The concept of “nature deficit disorder”—the idea that a lack of access and time in green spaces can be harmful to kids’ health—has been around since 2005. That’s when Richard Louv, cofounder of Children and Nature Network, coined it in his book Last Child in the Woods.
Although Louv never intended nature deficit disorder to be a true medical diagnosis, it was an aha moment for health practitioners: If nature deficit was perceived as a disorder, perhaps a nature prescription would make a difference. Much like a prescription for antibiotics can heal an infection, a nature prescription for outside time could help alleviate symptoms of stress, anxiety, and other conditions that can improve by engaging with the outdoors.
Today, Lem is the director of Canada's national nature prescription program, PaRx, an initiative of the British Columbia Park Foundation, which helps connect more than 9,000 regulated health professionals with information and tools they can use to offer patients nature prescriptions. In the United States, over 1,500 registered health practitioners have issued more than 4,500 nature prescriptions through Park Rx America (PRA) since January 2019.
And though a nature prescription can be provided by a health professional, you don’t have to consult your doctor to get started on one. By keeping a few things in mind, families can design a prescriptive nature practice all their own. Here’s what you need to know.
What does a nature prescription look like?
Nature prescriptions aren’t a one-size-fits-all solution.
Just like a medical prescription, a nature prescription might vary according to your symptoms. Stacy Stryer, PRA’s associate medical director, says it can be prescribed on its own or alongside traditional pharmaceuticals.
For instance, a teen who suffers from mild anxiety might be prescribed an hour of screen-free hammock time once a week for two months, or 30-minute walks twice a day with a friend. Kids who take medicine for ADHD might be asked to do something more active, like play soccer in the park with a sibling for 30 minutes three times a week, or bike on local trails 20 minutes a day before and after school, with one hour of unstructured outdoor play on the weekends. And a child with a chronic illness that’s carefully managed—type 1 diabetes, for instance—might be prescribed dog walking near their home for 20 minutes at a time, five days a week.
The key, experts say, is that the prescription should be precise and authoritative, and allow for follow-up and adjustment over time. “A nature prescription is basically just like a prescription for a medicine,” Stryer says. “It's very specific.”
Lem acknowledges that not enough research has been done to rely only on nature dosing for specific conditions, and adds that it’s not meant to be a replacement for other medications—only as a supplement to support a holistic health-care approach.
“No one's saying that nature is going to replace everything that prescription medication does,” she says. “But I think it speaks to how powerful it can be as an adjunct to what we often prescribe.”
How to know if your family needs a nature prescription
Research is starting to show that spending more time outside—with or without a nature prescription—can improve a child’s focus; alleviate signs of stress, depression, and anxiety; decrease symptoms of ADHD; and—of course—prevent childhood obesity. In fact, Lem notes that just a 20-minute walk through a park can help improve mental well-being as well as concentration.
Given that spending more time in nature has no downsides, parents might want to consider a prescriptive approach from a health-care professional if they’re trying to address a specific medical ailment. Other parents might like the authority and accountability that a nature prescription offers, especially if kids will be more receptive to a doctor than, say, a parent’s nagging.
“It really formalizes it,” Lem says. “Evidence shows that when you write something down in prescription form, it increases a patient's motivation to do it.”
Working with your family physician is a good idea if you’re targeting a specific ailment, but Stryer says families should keep their doctor informed of any self-prescribed nature dosage.
“We want people to become familiar with the concept of a nature prescription and certainly write it for themselves,” Stryer says, adding that PRA offers a form to get people started. “But we recommend that everybody, even people who write their own prescriptions, work with their health-care provider to get the most out of their prescription and to make sure that people with chronic conditions are doing what is medically safe."
Writing your own nature prescription
Ready to build your own? Lem suggests starting with her standard recommendation that families spend at least two hours in nature each week for 20 minutes at a time. Here are a few other things to consider as you work out the best prescription for your family.
Decide what you want to accomplish. Is your goal less screen time? More together time? More physical activity? Ask kids for their input and work together to create a goal, which will help you know when your prescription is working. Plus, getting kids involved will give them a sense of autonomy over the experience.
Figure out a doable “dosage.” How often will you get outside? For how long? Which days of the week work for everyone? “Whether the prescription is for a person or family, it needs to be as specific as possible,” Stryer says. Pick a place that’s easy and safe to get to, and a time when everyone can go. And start small. A five-minute timed walk is better than nothing; you can always work to increase it each day.
Build in “peer review.” Once you’ve got a time and place set, get everyone involved in ideas for execution. The more fun the activity, the more likely you’ll stick to it. Jumping rope on the driveway, playing soccer in the park, or working in the garden can all be great ways to have fun outside.
Assess your progress. After you’ve “taken your medicine” for a few weeks, have a family meeting to discuss how it is going. Are you meeting your goals? Does anyone feel better? Paying attention to your successes will motivate you to continue. And if it isn’t working, you can fix that, too.
Adjust your “medicine.” Your nature prescription is really meant to lead to a lifelong change, not a temporary one. That means you’ll need to consider new goals and new prescriptions over time. “After a month or so, if the prescription isn’t working, then change the prescription and try again,” Stryer says. “It’s like an antibiotic for an ear infection. If the first one doesn’t work, try a different one.”