Members of the OHBP participated in the cross-stakeholder, interdisciplinary workshop organised by Julze Alejandre (Glasgow Caledonian University), to prioritise and co-develop strategies for Scotland’s first blue-green prescribing programme for primary mental healthcare. Aligned with the implementation of Scotland’s Realistic Medicine and Value Based Health and Care, as well as NHS Scotland’s Climate Emergency and Sustainability Strategy, the Blue-Green Prescribing Research Team at Glasgow Caledonian University is designing a mental healthcare programme that aims to reduce pharmaceutical pollution in Scotland through the use of blue social prescriptions (i.e. social prescribing water-based activities such as swimming, kayaking, etc.) and/or eco-directed prescribing of pharmaceuticals (i.e. prescription of pharmaceuticals with less environmental impact). Blue-Green Prescribing could also help reduce prescribing costs and waiting lists for mental health service by making locally available water-based social prescribing interventions accessible to a wider group of service users.
Scotland is abundant in natural water environments or ‘blue spaces’, which help promote mental health and wellbeing. However, these blue spaces are at risk from pharmaceutical pollution such as antidepressant residues, which may be in part due to unsustainable prescribing practices, overprescribing, and improper disposal of unused medicines. Using planetary health, behaviour change, and system thinking lenses embedded in an implementation science framework, this research investigates the development of a Blue-Green Prescribing Programme for primary mental healthcare in Scotland with strong consideration of Scotland’s health and environmental contexts.
Stakeholders involved in the workshop included representatives from 35+ Scottish and UK-wide organisations for heath improvement, pharmacy services, delivery of nature-based social prescribing, patient experience integration, environmental management, water quality improvement, and environmental science and research. The workshop was underpinned by participatory approaches and guided by three robust and systematic research techniques: double diamond co-creation, Q-methodology and logic model design. Two break-out group activities were undertaken:
- Prioritising programme strategies using Q-methodology: where participants were prioritised and discussed 25 strategies, which were informed by the initial development of a guideline of Scotland’s blue-green prescribing programme from previous formative studies on knowledge creation, contextualisation and adaptation.
- Co-creating a Logic Model: where participants were allocated 5 strategies to work on and populated a Logic Tree with activities as part of the strategy, immediate and long-term outcomes, resources to implement the strategy and activities, sources of resources, and circumstances to facilitate or prevent the strategies. Logic models are powerful demonstration of how interventions (could) work, and this was deployed to establish the relationships of vital inputs, activities, outputs and outcomes to implement the strategies for Scotland’s Blue-Green prescribing programme.
Two workshops (online) will follow on from the in-person workshop, where the initial draft of the Blue-Green prescribing programme guidelines will be presented and refined, and the programme strategies will be evaluated in terms of acceptability, appropriateness, and feasibility in the Scottish context.
The workshop was part of the wider Blue-Green Prescribing Research and PhD programme at Glasgow Caledonian University, funded by the Scottish Government’s Hydro Nation Scholars Programme.