A qualitative study of the barriers to commissioning social and therapeutic horticulture in mental health care
Collaboration among organisations of the voluntary, community and social enterprise (VCSE) sector could have an important role to play in overcoming barriers to commissioning and referral to therapeutic horticulture, according to a UK study, Wood et al 2024, conducted in early 2023. Participants included individuals who would directly refer individual patients as well as regional commissioners for mental health. Findings from interviews with the nine participants suggested that many healthcare professionals and commissioners are not aware of therapeutic horticulture or its benefits for mental illness. Possibly reflecting this, they stated that therapeutic horticulture was not embedded within the NHS long-term plans, and that a focus on treatment rather than prevention further hindered commissioning of therapeutic horticulture services.
High quality studies could provide evidence for the benefits of therapeutic horticulture. However, some participants suggested that patient stories are often more illuminating than evidence, for example, for improvements in hospital discharge rates or cost savings to the NHS. Individual stories can be difficult to collect in healthcare settings, whereas therapeutic horticulture providers in the VCSE sector are well placed to capture and communicate the benefits of therapeutic horticulture at an individual level.
Participants also suggested that VCSE sector organisations could champion their services directly to the NHS to make medical professionals and commissioners more aware of the therapeutic horticulture services available within the community. This was felt to be important as commissioners do not typically receive training in therapeutic horticulture and are bombarded with a large volume of information. Helping commissioners appreciate how therapeutic horticulture services could align with NHS plans could lead to an understanding of the need for ongoing support and funding in the VCSE sector to provide such services.
Individual VCSE sector organisations typically work on a relatively small scale. Thus, according to Wood et al, critical for embedding therapeutic horticulture within NHS long-term plans is the role of network organisations, such as RGWN, that bring together the different therapeutic horticulture providers within a region. In this way, collaboration between the individual organisations would allow them as a whole to meet the large-scale commissioning requirements of the NHS. Collaboration can also facilitate applications for larger funding bids and could provide the sustained funding needed for the effective provision of therapeutic horticulture.
Some of these issues are now being addressed, as in the recent NHS 10-year plan and a report from the All Party Parliamentary Group for Outdoor Recreation and Access to Nature, Outdoors for All. For example, the latter states that green social prescribing should be mandated as a core component of NHS and public health strategies and should be funded accordingly to enable the expansion of green social prescribing. Provision of therapeutic horticulture is clearly recognised as part of the way ahead, and VCSE sector organisations and their collaboration will be important in delivering these services.
Wood et al 2024: A qualitative study of the barriers to commissioning social and therapeutic horticulture in mental health care. BMC Public Health 2024;24:1197
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https://link.springer.com/article/10.1186/s12889-024-18621-8