Atlas›Domain XV · Nature, philosophy, social & rites of passage›Guide 015
Guide XV-015

Green social prescribing through link workers

2020England
A 32 · L 57 · M 1120 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: the cross-government "Preventing and Tackling Mental Ill Health through Green Social Prescribing" programme in England (seven test-and-learn sites, sites announced December 2020, a two-year programme later extended), as NHS England, Defra and the national evaluation describe it, with practice detail from the National Academy for Social Prescribing (NASP) Green Social Prescribing Toolkit (revised edition, 2026) and the Thrive-led Green Social Prescribing Practitioner Guidance. [source: NHS England GSP page; gov.uk press release; Defra national evaluation final report, January 2024; NASP toolkit; GSP Practitioner Guidance]

What it is. Green social prescribing (GSP) is not a psychotherapy. It is a referral pathway inside social prescribing: a social prescribing link worker (SPLW) or another trusted professional has a "what matters to you" conversation with a person, agrees a simple personalised plan in the person's own words, and connects them to nature-based activities run mostly by community and voluntary organisations: walking groups, community gardening and food growing, conservation volunteering, green gyms, care farming, therapeutic horticulture, outdoor arts, and "blue" activities by canals, rivers, ponds and coast. [source: NHS England GSP page; NASP toolkit; workforce development framework]

Programme facts. £4 million was announced in July 2020; contributions from NHS England and NHS Improvement, Sport England and NASP brought the total to £5.77 million. Partners were DHSC, Defra, Natural England, NHS England and NHS Improvement, Public Health England, MHCLG, NASP and Sport England. The seven sites were Humber Coast and Vale; South Yorkshire and Bassetlaw; Nottingham and Nottinghamshire; Joined Up Care Derbyshire; Greater Manchester; Surrey Heartlands; and Bristol, North Somerset and South Gloucestershire. Aims: improve mental health outcomes, reduce health inequalities, reduce demand on health and social care, and make green activities more resilient and accessible, with a focus on communities hit hardest by Covid-19. The NASP toolkit dates the programme's establishment to October 2020 and says it was extended to April 2025; the national evaluation covered March/April 2021 to June 2023. [source: NHS England GSP page; gov.uk press release; NASP toolkit; final evaluation report]

How change is thought to happen. In the programme's own model, benefit comes from the whole journey: a person-centred conversation, active connection and support to attend, then the nature-based session itself, which is expected to build nature, social and occupational connection and reduce isolation. Step-down routes are meant to carry gains into everyday contact with nature. [source: NASP toolkit; GSP Practitioner Guidance] Evidence status in one line: the interim evaluation reported large rises in ONS4 wellbeing but compared different pre and post samples, based on "very limited post intervention data" that "should be viewed with caution"; the final report did not match individuals and had no control group. [source: GSP interim report summary 2023; final report 2024]

What the psychotherapist does. The therapist is usually a referrer and collaborator, not the provider: identifying when a client might benefit, preparing them, sharing information with consent, problem-solving access, debriefing participation inside therapy, coordinating around risk, and working with what nature means to the client. Some therapists also deliver outdoor talking therapy or a nature-based intervention; then dual-role, competence, confidentiality-outdoors and insurance issues apply. [synthesis] Related guides: V 155 (social prescribing), VIII 195 (arts on prescription), 022 (blue care, wild and open-water swimming) and X 196 (cold-water immersion), II 040 (behavioural activation).

2. Framework

The sources describe a pathway, not therapy phases. The stages below are assembled from the link worker framework and the GSP toolkit; the order is the toolkit's "whole GSP journey". [source: workforce development framework; NASP toolkit; Practitioner Guidance]

Stage 1. Identification and referral. Goal: get the person to a link worker or straight to a provider. Routes include GPs and other NHS staff, local authority services, pharmacies, housing, job centres, VCSE groups, community leaders and self-referral. In the evaluation, self-referral was the most common route into nature-based providers (30%), link workers made 27%, and fewer than 5% came through mental health services. Move on when the person agrees to a conversation or contacts a provider. [source: workforce development framework; interim summary]

Stage 2. "What matters to you" conversation and personalised plan. Goal: understand the person's priorities and agree a simple care and support plan, recorded in their own words. Format: one-to-one with the SPLW, typically 6–12 contacts over about three months, flexibly. Move on when a nature-based option fits what the person wants. [source: workforce development framework]

Stage 3. Matching. Goal: pick a pillar and a provider that suit the person's needs, interests and level of need. The toolkit's three pillars are nature in everyday life (self-led), nature-based community initiatives (structured, open access; most GSP referrals) and nature-based therapies (facilitated programmes for defined needs, often within a care plan), drawing on Bragg and Leck (2017) as cited in the toolkit. The Practitioner Guidance adds levels of mental health need (Level 0 no nature-based delivery; Levels 1–3 community provision of rising support; Level 4 usually clinical settings). Move on when the provider has the referral information and accepts it. [source: NASP toolkit; Practitioner Guidance]

Stage 4. Active connection and support to attend. Goal: get the person to the first session, which providers name as the biggest hurdle. Methods: welcome pack, pre-visit videos or pictures, taster visits, an introductory call, nature buddies, accompanying the person ("active link working"), warm handover. Move on when the person has attended. [source: interim summary; final report; NASP toolkit; Practitioner Guidance]

Stage 5. Participation in the nature-based activity. Goal: engagement with the activity and group. Duration depends on the provider; the sources give no standard length. The toolkit mentions, as a cost model only, a set number of free sessions followed by a means-tested contribution. [source: NASP toolkit] [uncertain: no standard programme length found]

Stage 6. Follow-up and review. Goal: check progress, adapt the plan, and manage changing needs. SPLWs review progress; for complex needs, providers and SPLWs keep regular contact and hold review meetings where other services are involved. [source: workforce development framework; Practitioner Guidance]

Stage 7. Step-down and move-on. Goal: avoid a "cliff edge" at the end of a programme, moving people from therapy-type provision to community groups and everyday nature, or back to the link worker. Criteria: end-of-access expectations set at the start; the person can keep going with less support. [source: Practitioner Guidance; NASP toolkit]

Where therapy fits. Therapy usually runs alongside stages 1–7. Sources give no therapy session counts for GSP. [synthesis]

3. Guiding principles

  • What matters to the person comes first. Start from the client's own priorities, not from a belief that nature is good for them. [source: workforce development framework; NHS England GSP page]
  • It is non-medical and not for acute illness. Do not use GSP as a stand-in for treatment of crisis or severe illness; the toolkit glossary states social prescribing does not aim to support acute mental illness. [source: NASP toolkit]
  • Match to level of need. Send a person only to a provider equipped for their level; directories should show this. [source: NASP toolkit; Practitioner Guidance]
  • Support, do not replace, clinical care. Nature-based practitioners do not diagnose or advise on medication; your treatment continues. [source: Practitioner Guidance]
  • Active connection beats signposting. A handed-over leaflet is rarely enough; plan the first attendance. [source: final report; interim summary]
  • Choice and voluntariness. The person picks; "medicalised" prescription language can put people off. [source: interim summary]
  • Reduce inequality, not widen it. Plan for poverty, transport, kit, language, culture, disability and childcare from the start. [source: final report; NASP toolkit]
  • Co-production and trusted gatekeepers. Communities may see nature and wellbeing differently; work with community-led and culturally specific offers. [source: NASP toolkit]
  • Proportionate safety. Providers hold written risk assessments and safeguarding policies; your part is to share relevant risk information with consent. [source: Practitioner Guidance]
  • Consent and information governance. Share only what the client agrees to and what the referral needs; Gillick competence for under-16s and the Mental Capacity Act 2005 for adults apply. [source: workforce development framework]
  • Keep relationships professional. Nature-based practitioners keep "therapeutic" not friendship relationships; you keep your own frame when roles overlap. [source: Practitioner Guidance; synthesis]
  • Plan the ending at the start. Set step-down expectations early to reduce dependency. [source: Practitioner Guidance]
  • Light-touch measurement. Use measures that are acceptable to the person; some found ONS4 triggering. [source: NASP toolkit]
  • Work as part of the system. Feedback loops between referrers and providers are often weak and depend on personal relationships; keep them alive. [source: final report; interim summary]
  • Respect link worker capacity. Link workers report rising caseloads and high-risk referrals; do not offload clinical risk onto them. [source: interim summary]

4. Intervention inventory

The programme sources describe pathway functions (conversation, matching, connection, follow-up, step-down) for link workers and providers, not therapist techniques. The 20 items below adapt those functions for a psychotherapist; where the therapist's procedure is not in the sources it is marked [synthesis].

4.1 Identifying when GSP fits

  • Purpose: Spot clients for whom a nature-based community activity could serve their goals: loneliness, low mood with lack of structure, recovery from illness, wish for meaningful activity or outdoor contact. [source: Practitioner Guidance Level 1–2 descriptions; workforce development framework]
  • Steps: (1) Listen for isolation, loss of routine, wish for purpose or wish to be outdoors. (2) Ask about past and current contact with nature, and what it meant. (3) Gauge level of need against the Level 1–3 descriptions (Level 3 needs providers working as an extended team with mental health services). (4) Rule out acute crisis first; GSP is not a crisis response. (5) Offer it as an option, not an instruction. [synthesis built on Practitioner Guidance levels]
  • Example language (illustrative): "You've said the weeks feel empty and you miss being outside. There are local groups, gardening, walking, conservation, that people join through a link worker. Is that something you'd want to hear more about?"
  • Watch for: The client hearing it as being moved on from therapy; current crisis or high risk (stabilise first); a client who agrees to please you. Working if: the client asks questions or names an activity that interests them.

4.2 Supporting the "what matters to you" conversation

  • Purpose: The SPLW starts from the person's priorities and records the plan in their own words; the therapist can help the client arrive ready to say what matters. [source: workforce development framework]
  • Steps: (1) Explain that the link worker will ask what matters to them, not what is wrong. (2) Spend part of a session helping the client name two or three things they care about (people, places, skills, routine, being useful). (3) Note practical constraints they may want to raise (money, travel, mobility, caring duties). (4) Suggest they bring a short list. [synthesis]
  • Example language (illustrative): "The link worker's first question is likely to be what matters to you. What would you want them to know first?"
  • Watch for: Clients who can only name problems; reframe toward what they would like more of. Working if the plan the client brings back uses their own words.

4.3 Making contact with the link worker or provider

  • Purpose: Get the client into the pathway by the route that suits them. [source: workforce development framework; interim summary]
  • Steps: (1) Find out how SPLWs are reached locally (often via the client's GP practice or primary care network; many schemes also take self-referral and community referral). (2) Decide with the client: self-referral, referral by you, or via the GP. (3) If waiting times for a link worker are long, consider direct contact with a provider that accepts self-referral, since a long wait can make a poor first experience. (4) Check local provider directories (Nottingham's "Big Green Book" is the toolkit's example). [source: interim summary; NASP toolkit; synthesis]
  • Example language (illustrative): "Would you rather contact them yourself, or would you like me to send a referral with your agreement?"
  • Watch for: Referral sitting unanswered; agree a date to check. Working if contact is made.

4.4 Writing the referral and sharing information with consent

  • Purpose: Give the provider what its referral criteria require and what keeps the client safe, and nothing more. [source: Practitioner Guidance; workforce development framework]
  • Steps: (1) Get the client's informed consent to what you will share and with whom; under-16s by Gillick competence and adults with capacity concerns under the Mental Capacity Act 2005. (2) Cover the items the Practitioner Guidance lists for referral forms: contact details; relevant health, social and behavioural information; identified risks; an agreed limit on contact attempts; contacts for other professionals involved. (3) Note anything affecting safe participation: allergies, medication side effects that matter for safety (for example drowsiness), social or behavioural barriers, capacity concerns. (4) Read it back to the client before sending. [source: Practitioner Guidance; workforce development framework]
  • Example language (illustrative): "I'd like to tell them that crowds can bring on panic, so they can plan a quieter start. Are you happy for me to say that, and is there anything you'd rather I left out?"
  • Watch for: Over-sharing therapy content; under-sharing risk the provider needs; confusing medication information with advice (providers do not advise on medication, and neither should the referral). Working if the provider confirms it can meet the person's needs.

4.5 Matching to pillar, level and provider

  • Purpose: Choose the right kind and intensity of provision. [source: NASP toolkit; Practitioner Guidance]
  • Steps: (1) Place the need: everyday nature (self-led), community initiative (structured, open access), or nature-based therapy (facilitated, for defined needs). (2) Check the provider's stated level of need, supervision ratio, group size and experience with presentations like your client's; the Practitioner Guidance asks providers to describe these. (3) For quality, ask about the Green Care Quality Mark, UK Association for Social and Therapeutic Horticulture standards, or a local trusted-provider scheme (the toolkit cites the Nottingham CVS scheme); the sector is not regulated. (4) Match interest: growing, walking, making, animals, water, quiet versus sociable. [source: NASP toolkit; Practitioner Guidance]
  • Example language (illustrative): "Some groups are mainly social, some have staff with mental health training and a set programme. From what you've said, which sounds more like what you need now?"
  • Watch for: A provider built for early intervention receiving a person with complex needs; the toolkit notes fewer providers specialise in complex needs, and Humber and North Yorkshire's cohort criteria reassure providers they will not be asked to work with people in crisis. Working if the match holds after the first few sessions.

4.6 Outdoor health and safety screening

  • Purpose: Anticipate physical and environmental risks qualitatively and route them to the provider's own risk assessment. [source: Practitioner Guidance; synthesis]
  • Steps: (1) Ask about allergies (pollen, stings, plants), mobility, balance, heat and cold tolerance, toilet needs, medication effects relevant to sun or exertion, and pain. (2) Raise ticks, sun, weather, uneven terrain and hydration in plain terms and tell the client providers cover these at induction. (3) Where physical activity is involved, route questions about safe levels to the client's GP or a qualified exercise professional; do not set exercise targets. (4) Ask the provider for its induction details (toilets, first aid kit and defibrillator, rest areas, PPE are listed in the Practitioner Guidance). [source: Practitioner Guidance; synthesis]
  • Example language (illustrative): "You mentioned your knees and the bee-sting allergy. Those are worth telling the group lead at the start; they plan around things like that."
  • Watch for: Clients minimising health limits to avoid being excluded. Working if the client has raised needs with the provider and adjustments are in place.

4.7 Blue activities: screening and routing

  • Purpose: The toolkit includes open-water swimming, surfing and waterside activity under GSP; these carry specific risks. [source: NASP toolkit]
  • Steps: (1) Ask whether the planned activity involves entering water or only being beside it. (2) Name cold-water shock, hypothermia and drowning as real risks, qualitatively. (3) Ask about heart conditions, epilepsy, pregnancy and medications, and route the client to their GP before any immersion. (4) Route to published safety guidance from the RNLI, the Outdoor Swimming Society, Swim England or national lifesaving bodies, and to a supervised provider. (5) Do not give temperatures, durations, acclimatisation or breath-hold advice. Cross-refer 022 and X 196. [synthesis] [uncertain: not verified]
  • Example language (illustrative): "Before trying the swimming group, it's worth a word with your GP about your heart medication, and going with an organised group that follows lifesaving guidance."
  • Watch for: Interest in cold exposure as self-punishment or as a mood "cure" replacing treatment; solo swimming. Working if the client chooses supervised, screened provision.

4.8 Problem-solving access barriers

  • Purpose: Poverty, transport, kit, language, fluctuating mental health and culture block access and may hit marginalised groups hardest. [source: final report; interim summary]
  • Steps: (1) Walk through the trip: route, bus, cost, time, childcare, clothing and footwear. (2) Ask the link worker about transport and kit support, which the evaluation names as enablers. (3) Check physical, sensory and cognitive access with the provider; ask for reasonable adjustments. (4) Ask about cost; the toolkit notes some providers charge after free sessions and that referrers sometimes limit themselves to free options. (5) Plan for bad mental-health days: can the client miss a session without losing the place? [source: final report; NASP toolkit; Practitioner Guidance; synthesis]
  • Example language (illustrative): "Let's picture next Tuesday. How do you get there, what do you wear, and what would stop you?"
  • Watch for: Shame about money or clothing; barriers left unspoken. Working if each named barrier has a plan.

4.9 Familiarisation before the first visit

  • Purpose: Reduce anticipatory anxiety. The Practitioner Guidance lists pictures, videos, online questions, taster visits or an introductory call; providers give a welcome pack with a named contact, what to bring, times and expected duration. [source: Practitioner Guidance; NASP toolkit]
  • Steps: (1) Ask the provider for its welcome pack and any walkthrough video. (2) Look at it with the client in session. (3) Name the contact person. (4) Suggest a taster visit or call before committing. [source: Practitioner Guidance; synthesis for in-session use]
  • Example language (illustrative): "Shall we look at the photos of the garden together and see what feels manageable?"
  • Watch for: Avoidance dressed as "not ready yet"; use graded steps. Working if the client can picture arriving.

4.10 Active link working and warm handover

  • Purpose: Being accompanied to the first session was an important enabler; providers said getting people to the first session was the biggest challenge. [source: final report; interim summary]
  • Steps: (1) Ask the link worker whether they or a volunteer can accompany the client the first time. (2) Where offered, use a staged handover like the Greater Manchester example in the toolkit: introduce the activity, a one-to-one chat with the delivery lead, a no-pressure site visit, then a new-starters group. (3) As therapist, decide whether accompanying is within your role; usually prefer the link worker or a buddy. [source: NASP toolkit; synthesis on therapist role]
  • Example language (illustrative): "The link worker can come with you the first time, or there's a volunteer who meets new people at the gate. Which would help more?"
  • Watch for: Drop-off between referral and joining. Working if the client attends and returns; providers report people generally keep coming once they have attended. [source: interim summary]

4.11 Referring to a nature buddy scheme

  • Purpose: Nature buddies are trained volunteers who support a person one-to-one or in a small group past barriers such as low confidence about going outside; support can be practical (reading a bus timetable) or fuller help to take part, short-term or ongoing. Some schemes link to social prescribers. NASP publishes a Nature Buddies Toolkit from a Natural England-led pilot. [source: NASP Nature Buddies page]
  • Steps: (1) Ask the link worker whether a local scheme exists. (2) Explain to the client what a buddy is and is not (a volunteer, not a therapist). (3) Agree with the client what the buddy may know. (4) Review the buddy relationship in therapy. [source: Nature Buddies page; synthesis]
  • Example language (illustrative): "A nature buddy is a volunteer who'd go along with you for the first few times. They're not there to talk about your problems unless you want to."
  • Watch for: Over-reliance on the buddy; boundary confusion. The page does not describe safeguarding or matching procedures [uncertain]; ask the scheme. Working if confidence grows and the client starts attending without the buddy.

4.12 Behavioural-activation framing and first-session plan

  • Purpose: Treat attendance as a valued activity to schedule and troubleshoot, linking GSP to activity-based work in therapy (II 040). [synthesis]
  • Steps: (1) Link the activity to the client's stated values. (2) Schedule the first attendance concretely (day, time, route, who). (3) Predict obstacles and plan responses. (4) Agree a small minimum (for example, arrive and say hello) as a success. (5) Review at the next session without judgement. No exercise targets; questions about physical exertion go to the GP or a qualified exercise professional. [synthesis]
  • Example language (illustrative): "What would count as a good enough first visit? Even turning up and leaving early counts."
  • Watch for: All-or-nothing goals; self-criticism after a missed session. Working if attendance happens and is discussed openly.

4.13 Debriefing participation in therapy

  • Purpose: Turn experience at the activity into therapeutic material: mood, social contact, competence, sensory experience, conflict. [synthesis]
  • Steps: (1) Ask open questions about what happened, what they noticed in body, mood and thoughts, and who they spoke to. (2) Note links to therapy goals. (3) Explore difficulties (a group member, feeling watched, not being good at it). (4) Decide together whether to continue, adjust or change provider. [synthesis]
  • Example language (illustrative): "Tell me about Thursday at the allotment. What stayed with you afterwards?"
  • Watch for: Therapy sessions becoming only reports on the activity; idealising the group. Working if the client draws connections without prompting.

4.14 Monitoring outcomes sensitively

  • Purpose: Track whether it helps, without the burden the toolkit warns about. Tools named in the sources: ONS4 (widely used; some participants found it triggering and it did not suit some communities), the Outcomes Star, the Warwick-Edinburgh Mental Wellbeing Scale, "feelings thermometers", and the Healthy Outdoors guide. [source: NASP toolkit; Practitioner Guidance; workforce development framework]
  • Steps: (1) Use your usual therapy measures; do not duplicate the provider's. (2) With consent, ask the provider or link worker what they collect. (3) Add a simple question at review: has the activity made any difference, and how. (4) Record non-attendance and dropout as information, not failure. Licensed tools: use under their own terms; items not reproduced here. [source: NASP toolkit; Practitioner Guidance; synthesis]
  • Example language (illustrative): "Since starting the group, what's changed, if anything? It's fine if the answer is nothing yet."
  • Watch for: Questionnaires spoiling the experience; mismatched cultural framing. Working if the client can name changes in their own words.

4.15 Coordinating with link worker and provider

  • Purpose: Feedback loops were often underdeveloped and relied on personal relationships; for complex needs, providers and SPLWs should keep regular contact and agree adjustments. [source: final report; Practitioner Guidance]
  • Steps: (1) Agree with the client at referral what updates you may share and receive. (2) Name one contact at each organisation. (3) For Level 3-type needs, set review points or join a multidisciplinary meeting. (4) Keep updates brief and need-to-know. [source: Practitioner Guidance; synthesis]
  • Example language (illustrative, to the provider with consent): "[Client] has asked me to let you know that early mornings are hard because of medication. Could a later start be possible?"
  • Watch for: Contacts lost when staff move on, which the interim report flags. Working if adjustments happen without the client chasing them.

4.16 Managing deterioration or risk during participation

  • Purpose: Providers respond to risk "in the moment", reassess dynamically, follow local safeguarding routes and liaise with SPLWs and other services; they have no crisis protocol in the guidance, so clinical risk stays with the clinical team. [source: Practitioner Guidance]
  • Steps: (1) Keep your own risk assessment and safety plan current; the activity does not change your duty. (2) With consent, agree in advance what the provider should do and whom to contact if the client is distressed on site. (3) If deterioration emerges, review with the client whether to pause, reduce or continue. (4) Do not ask link workers or volunteers to hold risk beyond their role; the interim report records link workers feeling unsafe with high-risk referrals. (5) Crisis resources: local crisis services, emergency services, Samaritans 116 123 (UK and Ireland). [source: Practitioner Guidance; interim summary; synthesis]
  • Example language (illustrative): "If you have a bad day at the group, what would you want the leader to do, and who should they call?"
  • Watch for: Withdrawal from the activity as an early sign of relapse; distress triggered by group or setting. Working if the plan is known to the client and the named contact.

4.17 Step-down and move-on planning

  • Purpose: Avoid a "cliff edge" when a programme ends; build nature, occupational and social connection that continues; move from therapy-type provision to community activity and everyday nature. [source: Practitioner Guidance; NASP toolkit]
  • Steps: (1) At the start, ask the provider how long access lasts. (2) Mid-way, explore what the client would continue alone or with a community group. (3) Before the end, identify the next step and a re-referral route to the link worker if needed. (4) Mark the ending in therapy. [source: Practitioner Guidance; synthesis]
  • Example language (illustrative): "The programme finishes in the spring. What parts would you want to keep going, and with whom?"
  • Watch for: Loss and grief at group endings; relapse after the end. Working if the client has a self-sustaining nature or social routine.

4.18 Working with the meaning of nature in the client's life

  • Purpose: The toolkit notes communities may conceptualise nature and wellbeing differently. Nature can carry memories of home, migration, loss, land, faith, safety or danger. [source: NASP toolkit; synthesis]
  • Steps: (1) Ask what outdoor places meant in childhood and now. (2) Ask about feeling safe or unwelcome in green space (racism, harassment, being the only one). (3) Explore cultural or spiritual meanings without imposing a frame. (4) If climate distress arises, explore it and, where wanted, refer to groups as their organisers describe them [uncertain: not verified]. [synthesis]
  • Example language (illustrative): "When you think of being outside, what places come to mind, and what do they bring up?"
  • Watch for: Assuming nature is soothing for everyone; past trauma tied to outdoor places. Working if the client's own meaning shapes the choice of activity.

4.19 Culturally specific and community-led routes

  • Purpose: Test-and-learn sites set up dedicated groups for ethnic minority communities, worked through trusted gatekeepers and community champions, offered childcare and single-gender sessions, translated materials and co-designed measures. [source: final report; NASP toolkit; interim summary]
  • Steps: (1) Ask the link worker about culturally specific or community-led offers. (2) Ask the client whether single-gender, faith-sensitive, language-specific or group-with-friends options matter. (3) Accept referral from community leaders and self-referral as equal routes. [source: NASP toolkit; synthesis]
  • Example language (illustrative): "Would you feel more comfortable in a women-only group, or one that runs in your language?"
  • Watch for: Token offers; mistrust of NHS-linked schemes. Working if the client feels the group is for people like them.

4.20 Delivering outdoor work yourself: dual roles and boundaries

  • Purpose: The evaluation lists outdoor talking therapies among activities; some therapists also train as nature-based practitioners. [source: final report; synthesis]
  • Steps: (1) Check competence and training for the activity (for example social and therapeutic horticulture training; Green Care Quality Mark standards), and that your professional indemnity insurance covers outdoor work and the activity. (2) Contract confidentiality outdoors: being seen, meeting acquaintances, what you will say if greeted, where you talk. (3) Agree weather and cancellation plans, travel and meeting points, toilet access, and what happens if the client becomes unwell. (4) Touch: discuss in advance; consent before and during; a right to stop; never sexual. (5) Hold a provider's written risk assessment and safeguarding policy as the Practitioner Guidance expects of providers, including lone-working arrangements. (6) If you also see the client in a community group, consider Standard 3.05 (multiple relationships) of the APA Ethics Code, https://www.apa.org/ethics/code, and decide whether the overlap risks impaired objectivity or exploitation. (7) Relationships professional, not friendships; no socialising beyond the setting. [source: Practitioner Guidance; NASP toolkit; synthesis for insurance, contracting and ethics]
  • Example language (illustrative): "If we meet someone you know on the path, I'll just say hello and walk on, and we can pause the conversation. Is that all right with you?"
  • Watch for: Blurred roles when the therapist is also the group leader; confidentiality in public spaces; physical risk in the group. Working if the client knows the frame and feels safe in it.

5. Handling problems

  • Client never reaches the first session. The sources name this as the biggest hurdle. Response: shrink the first step (taster, call, video), arrange accompaniment by the link worker or a nature buddy, plan the trip in session, and review without blame. [source: interim summary; final report; NASP toolkit; synthesis]
  • Long wait for a link worker. The interim report notes long waits can sour the first experience. Response: check whether the provider takes self-referral; keep the plan alive in therapy meanwhile. [source: interim summary; synthesis]
  • Drop-off after referral or early sessions. People drop out when not supported. Response: ask what changed (group, travel, mood, money); ask the provider about adjustments; consider a different pillar or provider; record it as information. [source: final report; Practitioner Guidance; synthesis]
  • "Prescription" feels medicalised or patronising. The interim report found medicalised language could undermine buy-in. Response: talk about options and interests, not prescriptions; let the client choose. [source: interim summary]
  • Client feels sent away from therapy. Response: say clearly that therapy continues; explain why you think the activity fits their own goals; invite disagreement. [synthesis]
  • Mismatch of need and provider. A person with complex or acute needs referred to a volunteer-run group. Response: pathways should set out how inappropriate referrals are handled; step back to a more supported option or clinical care, and tell the provider. [source: NASP toolkit; Practitioner Guidance]
  • Deterioration or disclosure of risk on site. Response: providers follow safeguarding routes and dynamic risk assessment; you hold the clinical plan. Agree contacts in advance; review the safety plan; pause participation if needed. Crisis: local crisis services, emergency services, Samaritans 116 123. [source: Practitioner Guidance; synthesis]
  • Measures feel intrusive or triggering. Response: keep therapy measures separate; use brief, acceptable questions; do not let data collection drive the work. [source: NASP toolkit; synthesis]
  • Group difficulties. Conflict, feeling judged, social anxiety in a group. Response: process in therapy; rehearse entering and leaving conversations; ask the provider about quieter tasks or smaller groups. [synthesis]
  • Physical limits, weather and seasons. Response: plan clothing and shelter, indoor or accessible options, and how to cancel; route health questions to the GP; no exercise targets. [synthesis]
  • Water-based activity worries. Response: GP screening first for heart conditions, epilepsy, pregnancy or relevant medicines; supervised provision only; route to RNLI, Outdoor Swimming Society or Swim England guidance; no temperature, duration or acclimatisation advice. See 022 and X 196. [synthesis]
  • Cost and access. Response: ask about free sessions, transport and kit support, and means-tested contributions; do not limit options to free ones without discussing. [source: NASP toolkit; final report]
  • Cultural or safety mismatch in green space. Response: explore experiences of exclusion or harassment; seek culturally specific, single-gender or community-led groups. [source: NASP toolkit; synthesis]
  • Dependency or cliff-edge endings. Response: plan step-down from the start, mark the ending, re-refer via the link worker if needed. [source: Practitioner Guidance]
  • Confidentiality leaks. Information shared with a group, or the client meets someone they know. Response: agree what each party knows at referral; rehearse what the client will say about themselves. [synthesis]
  • Link worker overloaded or unreachable. The interim report describes rising caseloads and personnel gaps. Response: keep requests brief and clear; do not pass on clinical risk; coordinate directly with the provider with consent if needed. [source: interim summary; synthesis]
  • Climate distress triggered by conservation work. Response: explore the feelings in therapy; balance action with rest; consider climate-distress groups as their organisers describe them [uncertain: not verified]. [synthesis]
  • Children and young people. Under-18s took part in the programme. Response: safeguarding first; consent and assent; Gillick competence for under-16s; check the provider's DBS and safeguarding arrangements; involve parents or carers as appropriate. [source: final report; workforce development framework; Practitioner Guidance]
  • Disordered eating in food-growing or cooking groups. Response: screen; refer to a registered dietitian or eating-disorder service; in the US the National Alliance for Eating Disorders. No diet advice. [synthesis]

Sources

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