Art as medicine: Doctors prescribe time in nature — and in galleries

Story by Julie Chadwick

It has long been known — at least informally — that getting out in nature can be just the thing to fix what ails you, whether that’s mental, emotional or physical.

But clinical research also backs this up, and shows that being in nature can significantly improve things like immune function and stress levels, while reducing the risk of lung infections and heart disease, among other things.

The Vancouver Parks Foundation took that concept to the next level, and in 2020 came up with the PaRx program, where healthcare providers can prescribe patients time  in nature as part of an overall health regimen.

“I just knew in my own personal life how great I felt when I went outside and I had a lot of personal experiences of times of challenge or things going in your life, where if I went outside and went for a hike, or sat in a forest, or sat by a river, I could feel things kind of drift away a bit,” Vancouver Parks Foundation CEO Andrew Day told Vancity Lookout. “I became interested in the evidence around the health benefits of going outside, and we then built it into our strategic plan as a core pillar of what we would do.”

Day co-founded PaRx with Jennie McCaffrey, the foundation’s vice president of health and education, and Dr. Melissa Lem, a clinical assistant professor at the University of British Columbia (UBC). The initiative has spread across the country to become a Canada-wide program.

It started as a small volunteer-run idea inspired both by a fledgling parks prescription program in the U.S. and the concept of Shinrin-yoku or Japanese forest bathing that emerged following the country’s mental health crisis in the late 1980s and early 1990s,  Day said.

“They had essentially made it part of health care, and had built little nature bathing places in different cities. And now they've institutionalized it. So that was all quite interesting,” Day explained. 

The group worked with medical students at UBC  to gather evidence, which then got the project an endorsement from family physicians in B.C. and other medical bodies. The project launched on a provincial level and then spread to every province in Canada.

“We didn't have any external funding, we relied on passionate medical professionals in each province to help organize and lead it,” Day said. Nationally, there are now approximately 20,000 regulated health professionals who have collectively issued more than 1.5 million nature prescriptions.

Putting its own twist on the idea, the Vancouver Art Gallery partnered with the Parks Foundation’s PaRx program to offer healthcare provider-prescribed visits to the gallery, including to its newest nature-inspired exhibit, That Green Ideal: Emily Carr and the Idea of Nature, which opened Feb. 5.

The show features more than 100 works that focus on renowned artist Emily Carr’s “evolving idea of nature” and draws from the gallery’s significant existing collection of Carr’s art, according to a gallery statement.

The science behind nature prescriptions builds on several core theories, Dr.  Lem explained. Essentially, being out in nature leads to a reduction in stress because busy urban environments tend to stress people out and tax our finite attention spans, whereas time in nature restores our brains. 

“It's a source of soft fascination that we don't have to continuously direct our attention to navigate around, and it just fills back up our attention bucket and reduces our irritability and fatigue,” she said. It also reduces our stress levels because humans evolved to want to be in biodiverse environments — it's rich sources of food, shelter and water signified benefits to our survival and longevity.

“Basically, after a stressful event, if you spend time in nature, the theory is that it just helps you recover faster, because that's where we're drawn to be,”  Dr. Lem said. 

Going outside into nature also typically involves the health benefits of movement and exercise in less-polluted areas, and the reduced stress levels function as a sort of “social lubricant,”  which leads to better social connections, Dr. Lem added.

“Last but not least, phytoncides are these volatile organic compounds that plants and trees release — if you think about a cedar forest, that smell — it essentially is something that these trees and plants release to repel fungi and viruses and insects,” Dr. Lem said. When humans breathe them in, research has documented a natural boost to the immune system and an increase in cells that fight off viruses and bacteria. The effects can last for days or even weeks after immersion in a forest environment.

Dr. Lem also recently joined the board of the World Forum on Forest Therapy, an international platform aimed at mainstreaming the practice of forest therapy across the world, and will head to Korea in May for its first board meeting to set the agenda of scaling up the practice internationally.

The idea of social prescriptions to things like an art gallery exhibit work in a similar way, says Paula Toledo, lead wellbeing consultant for the Vancouver Art Gallery. When the partnership launched last year on World Health Day it marked the first initiative that linked a nature prescription program directly to an art museum.

“There's a lot of crossover with respect to art, and the nature-based art that we have within Emily Carr's exhibition. There are studies and evidence that suggest that looking at images of nature can also be restorative and reduce mental fatigue,” she says, citing a British Medical Journal study that showed people who frequently engaged in receptive arts activities had a 31 per cent lower risk of dying, independent of other factors. “When we notice nature and notice how we feel, there are well-being benefits — feelings of moral elevation, gratitude and interconnectedness to all people and things.”

Toledo became interested in social prescriptions after her spouse died and she was left caring for a baby and a toddler alone at home. She ended up seeing a social care coordinator, who encouraged her to engage in movement, like yoga, and make music with others. 

Already a musician, she began playing, sharing and writing songs again, and though she didn’t think it would make much difference, it ended up being “transformational,” Toledo said.

“After engaging in the arts and movement, something kind of shifted in me. My body started to physically feel better. My mind started to feel more, kind of connected, like, energized to play with my children and enter their worlds of wonder,” she recalled. “That self-efficacy came back where I started to feel like, ‘Okay, I can change things for the better. I know I can do this.’”

Toledo was so inspired by the experience she ended up doing her master's in applied positive psychology at the University of Pennsylvania, where her final project was to envision building a well-being pathway for art-based museum prescriptions to buffer loneliness and enhance well-being and social connection.

Any registered healthcare provider that wants to issue prescriptions can sign up with the PaRx program to start giving these prescriptions to patients. 

The gallery has also implemented what it calls a “slow looking guide” to help take visitors on a mindfulness experience within the exhibit that is part of its Art of Wellbeing Lab pilot project, run by Toledo and Sirish Rao, the gallery’s interim co-CEO.

In addition to the PaRx partnership, the Art of Wellbeing lab has implemented an Art of Wellbeing for Seniors program that combines tours of the gallery with interactive, arts-based creative workshops.

The prescription for the gallery offers free entry for as long as the exhibit is open and includes one guest. That Green Ideal: Emily Carr and the Idea of Nature runs until Nov. 8.