Health Economics-Informed Social Return on Investment (SROI) Analysis of a Nature-Based Social Prescribing Craft and Horticulture Programme for Mental Health and Well-Being

Holly Whiteley, Mary Lynch, Ned Hartfiel (), Andrew Cuthbert, William Beharrell and Rhiannon Tudor Edwards
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Holly Whiteley: Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor LL57 2PZ, UK
Mary Lynch: Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland
Ned Hartfiel: Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor LL57 2PZ, UK
Andrew Cuthbert: School of Medicine, Cardiff University, Cardiff CF14 4EP, UK
William Beharrell: The Fathom Trust, Llanfellte Farm, Bwlch LD3 7JL, UK
Rhiannon Tudor Edwards: Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor LL57 2PZ, UK

IJERPH, 2025, vol. 22, issue 8, 1-24

Abstract: Demand for mental health support has exerted unprecedented pressure on statutory services. Innovative solutions such as Green or Nature-Based Social Prescribing (NBSP) programmes may help address unmet need, improve access to personalised treatment, and support the sustainable delivery of primary services within a prevention model of population health. We piloted an innovative health economics-informed Social Return on Investment (SROI) analysis and forecast of a ‘Making Well’ therapeutic craft and horticulture programme for mental health between October 2021 and March 2022. Quantitative and qualitative outcome data were collected from participants with mild-to-moderate mental health conditions at baseline and nine-weeks follow-up using a range of validated measures, including the Short Warwick–Edinburgh Mental Well-being Scale, ICEpop CAPability measure for Adults (ICECAP-A), General Self-Efficacy Scale (GSES), and a bespoke Client Service Receipt Inventory (CSRI). The acceptability and feasibility of these measures were explored. Results indicate that the Making Well programme generated well-being-related social value in the range of British Pound Sterling (GBP) GBP 3.30 to GBP 4.70 for every GBP 1 invested. Our initial pilot forecast suggests that the programme has the potential to generate GBP 5.40 to GBP 7.70 for every GBP 1 invested as the programme is developed and delivered over a 12-month period. Despite the small sample size and lack of a control group, our results contribute to the evidence-base for the effectiveness and social return on investment of NBSP as a therapeutic intervention for improving health and well-being and provides an example of the use of health economic well-being outcome measures such as ICECAP-A and CSRIs in social value analysis. Combining SROI evaluation and forecast methodologies with validated quantitative outcome measures used in the field of health economics can provide valuable social cost–benefit evidence to decision-makers.

Keywords: health economics; social return on investment (SROI); social cost–benefit; social value; nature based; social prescribing; green craft; horticulture; nature-based interventions (NBIs); mental health; well-being; prevention; forecast (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2025
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