Take two hikes and call me in the morning

Dr. Melissa Lem has long been prescribing doses of nature to improve her patients' mental and physical health. Now, she's helped design Canada’s first large-scale nature prescription program, allowing health-care practitioners to formally prescribe time outdoors.

December 7th 2020
Dr. Melissa Lem is a B.C. physician who prescribes doses of nature to her patients. Photo submitted by Melissa Lem

Canada’s first large-scale nature prescription program just launched in British Columbia, empowering health-care practitioners to formally prescribe time outdoors for the physical and mental health of patients.

Dr. Melissa Lem is a family physician in Vancouver who has embraced the mounting evidence linking time spent in nature to health. She has been informally advising natural outings to her patients for more than a decade.

Now, at long last, she is able to prescribe the measure formally, which has been shown to improve the odds patients will take the order seriously. Doctors won’t yet be paid for dispensing these prescriptions, so for now, their power is in their accessibility and persuasiveness.

Lem’s first prescription for nature, some 10 years ago, was to a young man struggling with ADHD at the University of Toronto. Now she prescribes it for a growing suite of conditions.

“We’ve broadened the kinds of patients we can, in an evidence-based way, prescribe nature to,” she said, listing mental, heart, lung and immune health in particular. Side-effects may include greater longevity, increased energy, improved pain management and the bettering of mood, among many other benefits.

Dr. Melissa Lem indulging in some of her own medicine outdoors at Mt. Baker. Photo submitted by Patricia Lem

Lem has been developing this nature prescription program for two years now in her volunteer role with the BC Parks Foundation, the charitable arm of B.C.’s provincial park network. As temperatures drop, COVID-19 lockdowns persist and Canadians prepare themselves for the loneliest winter in a century, she decided it was time to launch the initiative to address the mental health of British Columbians.

“Over the summer,” she recalls, “when the wildfire smoke from the United States drifted up here, I really saw the number of phone calls and patient appointments — for anxiety, for stress, for depression — skyrocket. It was incredible, actually. When that nature outlet was taken away from people (by the smoke), that’s when stress really rose.”

Prescriptions for nature became available through this program at the end of last month, and their availability will improve as more health-care practitioners sign up for the prescription packages, which include fact sheets, relevant literature and a unique provider code. This can be done on the program’s website.

In the coming months, Lem intends to expand the program to other provinces and territories, forging partnerships between health-care and parks organizations and sharing the resources she has spent years collecting. Until then, she said health-care providers outside B.C. can sign up in advance and will get their prescription packages when the program reaches them.

Each province will have to structure theirs differently, she said. Residents of B.C. have exceptional access to natural spaces compared to those living in other parts of Canada because its provincial park network has no entry fees. Nature prescriptions elsewhere will likely incorporate free park access, in theory from partnering parks, and perhaps some form of public transit assistance, potentially from participating municipalities, removing as many barriers to the fulfilment of these prescriptions as possible.

“Outside is one of the safest places to be right now,” said Lem, referencing the exceptional ventilation atop Stawamus Chief Mountain, for example, as well as its social-distancing potential.

There are breathtaking views and plenty of fresh air on top of Stawamus Chief's second peak near Squamish, B.C. Photo submitted by Melissa Lem

Partnering organizations in her program’s launch include BC Family Doctors, Nurse Practitioners of BC, the Canadian Association of Nurses for the Environment and, of course, the BC Parks Foundation. It only takes two hours a week, said Lem, for at least 30 minutes per outing, to make a measurable difference in someone’s mental health.

“I see nature as an essential health service for all Canadians and I think bringing together parks organizations and health-care organizations to create initiatives like this is incredibly important,” she said.

I see nature as an essential health service for all Canadians.

Dr. Lem is far from the only health-care practitioner to prescribe nature for patients. Small pilot programs have been gaining ground across the country, like those promoting well-being among low-income residents of Wasaga Beach, Ont.; managing post-traumatic stress disorder (PTSD) among veterans of the Canadian Armed Forces on P.E.I.; and bolstering the general health of Newfoundlanders with a partnership between Western Health, a provincial public health authority, and nearby Gros Morne National Park.

The health benefits of time spent in nature have been the subject of intense study in recent years, and have proven to be broad. The largest meta-analysis of its kind, including data from 143 studies internationally and published in the journal Environmental Research in 2018, concluded that increased green space exposure was associated with decreased cortisol (stress) levels, heart rate, diastolic blood pressure, HDL cholesterol, risk of pre-term birth, Type 2 diabetes and all-cause and cardiovascular mortality, and increased incidence of good self-reported health.

To get the benefits of nature, you don't need to be in old-growth forest.

And new studies continue to reinforce past results. Lem references a study published in the journal Science Advances in October in which the playgrounds of 36 Finnish daycare children were transformed from being primarily gravel-based to primarily nature-based (forest floor, sod, planters for growing annuals and peat blocks for climbing and digging).

After 28 days in this wilder setting, the children's skin and gut microbiota became more robust and diverse, while markers of immune health and anti-inflammatory function surged. Getting results like this for health-care practitioners in B.C., said Lem, is a major goal of her program.

“To get the benefits of nature, you don’t need to be in old-growth forest far away from other people or on the side of a mountain. There is research showing that what matters is that you feel you’ve had a meaningful experience with nature,” said Lem, suggesting everything from backyard gardens to urban green space.

“I think there’s a lot of power in your health-care professional recommending nature to you,” she said. “Nature and health are having a major moment right now. I think nature prescriptions are what Canadian health care needs to heal and emerge from COVID-19 with resilience.”

Dr. Melissa Lem out on a hike practising what she often prescribes for her patients — time outdoors. Photo submitted by Melissa Lem

Zack Metcalfe is a freelance journalist, columnist and author based in the Maritimes.

Amen to this! Kids need to get out in nature too. Check out the supports offered by HCTF Education here in BC: https://www.hctfeducation.ca

Very many years ago I made a trail through the forest from parking lot B to the physics building at SFU. This short forest walk, maybe one minute, every morning did wonders for my state of mind.