Scaling nature-based programmes for adolescent mental health and wellbeing: Evidence- informed policy and research directions from England

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However, policy momentum has outpaced robust evidence to support equitable implementation, particularly for adolescents (Clarke et al., 2021 ), a period marked by rising anxiety and depression and declining nature connection (Price et al., 2022 ; Richardson et al., 2019 ; Solmi et al., 2022 ). Drawing on a rapid systematic literature review (Lorimer et al., 2025 ), interviews with 16 secondary educators, and a co-produced cost–benefit model developed (Hopkins van Mil, 2025 ), this paper proposes a tiered universal–targeted–intensive policy framework for evidence-led nature-based programmes’ implementation in English secondary schools, combining whole-school nature integration with enhanced and specialist-linked provision for students with greater mental health needs. Findings show that nature-based programmes demonstrated stronger benefits for adolescents with existing mental health needs (e.g., reduced anxiety and stress, improved self-esteem, resilience, and connectedness), while effects in general student populations were smaller and more variable (Loose et al., 2024 ; Natural England, 2024c ; Shrestha et al., 2025 ). Economic modelling suggested early, targeted investment may yield long-term returns through reduced demand on mental health services and improved educational outcomes. Six interlinked policy priorities emerged: whole-school integration, equity safeguards, professional capacity, adolescent-informed evaluation, green-estate standards, and cross-sector governance. policy nature mental health wellbeing schools education Figures Figure 1 Figure 2 Panel 1: Policy Highlights as roadmap for implementation Panel 1: Policy Highlights as roadmap for implementation These short-, medium-, and long-term action pathways are designed for England but can be adapted to other contexts integrating nature-based programmes into education and mental health and wellbeing policy. Implementation priorities Integration: School leaders align NbPs with whole-school MHWB approaches and Climate Action Plans, embedding activities within core curriculum and pastoral provision where feasible, rather than treating them as optional enrichment, with a blended universal‑plus‑targeted offer for pupils at greater risk (for example in flood‑ or heat‑exposed communities and those with higher MHWB need). Given growing evidence linking climate change and mental health risk, such integration is preventative, not an optional add-on (Lawrance et al., 2022; Newberry Le Vay et al., 2023) . Inspection alignment: Ofsted’s Education Inspection Framework, which places greater emphasis on pupil personal development and wellbeing (Ofsted, 2025) , could explicitly recognise nature-based work as evidence of behaviour, attendance, attitudes, and personal development. Co-design and equity assurance: Engage students, teachers, and families, supported by national guidance from DfE 1 and local authorities, ensuring equitable access and participation, with attention to underserved groups. Time and training: DfE and teacher-training providers should, where feasible, embed NbPs within existing ITT 2 , PGCE 3 , and CPD 4 content offers (e.g., science, geography PE), while schools protect flexibility in directed time so educators can build capacity to deliver and evaluate NbPs confidently. Interoperability: DfE, DEFRA 5 , DHSC 6 , and NHS 7 England work toward a shared core set of high-level definitions, outcome domains and minimum data items for NbPs, while allowing locally chosen and co-produced measures, so that innovative approaches can still be compared, evaluated and learned from across sectors. Cross-sector coordination : Central government (DfE, DEFRA, DHSC), local authorities, NHS partners set out high-level frameworks for roles and funding levers: local authorities and ICS 8 /NHS partners agree local arrangements with schools to join up existing MHSTs 9 , climate and NbPs initiatives, rather than creating new structures from scratch. Pathway for action Immediate (12–18 months): DfE, local authorities, NGOs, and NENP partners support schools to establish baseline data on MHWB and green estate, pilot evidence-informed programmes across diverse secondary settings, and co-develop developmentally appropriate and adolescent-informed measures with students and staff. Medium term (2–3 years): National and local agencies (e.g., DfE, local authorities’ education, children’s services and public health teams; ICS) build interoperable datasets, align education, sustainability and MHWB systems, while schools and teacher-education providers expand cross-sector training, evaluation capacity and curriculum integration. Long term (3–5 + years): Government departments formally embed NbPs within statutory guidance and curriculum frameworks (including careers guidance and relevant national curriculum subjects such as geography, science, citizenship and PE; Department for Education, 2025b) ), RSHE 10 , and the core enrichment entitlement, while schools institutionalise co-production and establish ongoing NbPs cycles with education, sustainability, and MHWB policy. Risks and safeguards Risks: Without thoughtful design and targeting, NbPs may disproportionally benefit already well served pupils and schools, missing those facing the greatest barriers and widening wellbeing or attainment gaps. Support for inclusive design, simple evaluation, and shared practice might mitigate for this risk (while allowing for local innovation and adaptation to context). Safeguards: Ensure participatory and evidence-informed design, rigorous data-driven evaluation, and continuous equity audits. 1 Introduction Children and young people (CYP) in England are facing rising mental health challenges and environmental decline. One in five children and young people aged 8–25 now experience a probable mental health disorder (NHS Digital, 2023 ). At the same time, 59% of young people age 16–25 globally report serious worries about climate change (Hickman et al., 2021 ). A growing body of research indicates that climate-related worry may contribute to distress for some children and young people, particularly in combination with other risk factors (Newberry Le Vay et al., 2023). The UK is one of the most nature-depleted countries in Europe (Taylor & Hochuli, 2017 ). Here we define “ Nature ” following The Children’s People and Nature Survey for England (2024) definition, encompassing everyday green and blue spaces such as gardens, parks, woods, and waterways (Natural England, 2024b ). Addressing these intersecting trends is therefore essential for developing effective and timely responses for this generation. Hence, policy professionals and other stakeholders are increasingly exploring nature-based programmes as a means to supporting mental health and wellbeing while simultaneously addressing environmental decline. Recent policy developments include the UK Department for Education’s (DfE) Sustainability and Climate Change strategy 2023 (Department for Education, 2023c ), the National Education Nature Park (NENP), and school gardening initiatives (Gush et al., 2023 ), which signal growing political commitment to embedding nature in education. Current evidence indicates that, in some contexts, nature contact and certain nature-based programmes have been associated with improvements in specific aspects of young people’s mental health and wellbeing, but overall findings are mixed and study quality is variable (Campbell et al., 2026 ; Lorimer et al., 2025 ; Twohig-Bennett & Jones, 2018 ). Although some initiatives explicitly aim to strengthen nature connection (Barthel et al., 2018 ), much of the child and adolescent literature still conceptualises nature primarily as exposure or engagement, rather than rigorously testing nature connection as a primary mechanism of change. As a result, the active pathways through which nature-based programmes might support mental health and wellbeing, including, but not limited to, changes in nature connection remain only partially specified and empirically under-tested (Loose et al., 2024 ; Tillmann et al., 2018 ). In view of this, nature-based programmes remain uncommon in UK secondary schools, and the evidence base for both universal and targeted school-based approaches remains limited and uneven (Chiumento et al., 2018 ). Taken together, these limitations pose a practical policy challenge: waiting for more definitive evidence may delay potentially beneficial interventions, while large-scale implementation without rigorous evaluation could lead to inefficiency or unintended harms. However, in the context of rising demand and constrained mental health and wellbeing provision in England, nature-based programmes represent a relatively low-risk approach, where risks relate mainly to opportunity costs and the potential for unintended harms from poorly designed or implemented programmes. They also offer the prospect of multiple co-benefits, including potential mental health and wellbeing gains, educational and socio-emotional benefits, and contributions to environmental stewardship and biodiversity where programmes involve conservation or habitat-enhancing activities (Bratman et al., 2019 ; Garip et al., 2021 ). Thus, while direct evidence that increasing nature connection causes improved mental health and wellbeing in young people remains limited, the combination of early positive findings, indication that many children value time in nature, relatively low cost, and environmental co-benefits creates a reasonable case for further implementation and rigorous evaluation (Natural England, 2024a ; Tillmann et al., 2018 ). A pragmatic approach is therefore to treat nature-based programmes as emerging but not yet fully evidenced approaches that warrant cautious piloting, rigorous evaluation, and iterative development within existing school educational, mental health and wellbeing systems. This paper proposes evidence-informed policy directions and research priorities for the integrated development and rigorous evaluation of nature-based programmes in secondary schools, with the aim of improving adolescent mental health and wellbeing while building the evidence base needed to scale effective provision. We first outline why adolescence and schools are critical for both mental health and wellbeing, and nature engagement, and why this moment presents a unique window for policy and research. 2 Why adolescence, why schools, why now? Three observations motivate our focus. First, mental health challenges intensify at the start of adolescence, with data suggesting a rise in anxiety and depression between ages 11–15 (Clarke et al., 2020 ; Solmi et al., 2022 ). Second, during this same period, subjective reports of nature connection measured using tools such as the Nature Connectedness Index (NCI) reach a lifetime low, a phenomenon termed the “teenage dip” (Olsson & Gericke, 2015 ; Price et al., 2022 ; Richardson et al., 2019 ). Third, studies suggest that ‘nature connectedness’ is linked both to positive mental health and wellbeing (MHWB) outcomes in adolescents and with greater pro-environmental attitudes and behaviours, suggesting that fostering this relationship may yield both psychological and ecological benefits (Lumber et al., 2017 ; Mann et al., 2022 ; Nisbet et al., 2008 ; Pirchio et al., 2021 ) Taken together, these observations support two related hypotheses: (1) Nature-based Programmes (NbPs) that maintain the human-nature relationship before and during early adolescence may buffer against MHWB decline; and (2) that adolescents who are encouraged to maintain this relationship will be more likely to develop pro-environmental behaviours, influenced by factors including green self-efficacy, biospheric values, and climate concerns (Balundė et al., 2019 ; Becht et al., 2024 ; Pereira & Forster, 2015 ; Qin et al., 2024 ; Turcotte-Tremblay et al., 2024 ). Such outcomes would also align with the DfE's green skills agenda (Department for Education, 2024 ). These hypotheses are particularly salient given that schools often provide the primary – for some students, the only – reliable access to nature, emphasising their pivotal role in equitable exposure. A recent review by Natural England identified England’s schools as the main source of access to nature for 28% of children, increasing to 43% for those with disabilities (Natural England, 2025 ). Children from low-income families, minority ethnic and refugee backgrounds, and those with disabilities face the greatest barriers to nature engagement outside school, making schools a critical setting for equitable provision (Waite et al., 2021 ). Beyond access, schools provide stable institutional settings for multi-year programmes and longitudinal evaluation of student outcomes; though realising this potential requires additional capacity and resources (Comber et al., 2008 ; Price et al., 2022 ; Rigolon et al., 2021 ). Emerging evidence links NbPs to improved attendance, though effects are modest and require rigorous evaluation (MacNaughton et al., 2017 ; Price, 2013 ; Rice, 2023 ; Ruiz-Gallardo et al., 2013 ). Schools’ dual roles in providing equitable nature access and delivering sustainability education position them uniquely to prepare young people for a rapidly changing environment and to address inequalities in nature engagement (Department for Education, 2025b ). However, translating this potential into effective and equitable practice is not straightforward. Four challenges account for this gap. First, evidence for universal school-based programmes is mixed. Outcomes appear sensitive to programme quality, facilitator confidence, contextual fit, and implementation fidelity, rather than nature exposure alone (Richardson et al., 2021 ; Sprague et al., 2020 ). Poorly designed or delivered universal approaches may even produce unintended harms (Foulkes et al., 2026 ; MacGregor et al., 2024 ), a risk that is unevenly distributed given substantial variation in green space access and resources between state and private school settings. In contrast, targeted interventions for adolescents with existing anxiety or depression demonstrate more consistent symptom reduction, which is particularly relevant given the impacts of climate change on MH (Overbey et al., 2023 ; Rian & Coll, 2021 ). Second, inconsistent definitions and metrics hinder implementation and evaluation. Constructs such as ‘ nature connectedness , ‘nature relatedness ,’ and ‘ nature exposure’ capture different dimensions (emotional connection to nature (feeling good in nature), ecological understanding (knowing about nature), and environmental values (caring about protecting nature), yet are used interchangeably. This matters theoretically as well as methodologically, because cognitive recognition of nature’s value and emotional closeness to nature may not align for all individuals, and their respective links with adolescent wellbeing and pro‑environmental behaviour are not yet well characterised. Most scales are developed either for children or for adults and fail to address important adolescent motivational and social dynamics (Greenwood & Gatersleben, 2016 ; Neurohr et al., 2023 ). This is particularly important as adolescents may perceive NbPs as inappropriate for their age group (Hopkins van Mil, 2025 ). Clarity about targeted outcomes is essential for effective design and evaluation (Pereira & Forster, 2015 ). Third, practical barriers to implementing NbPs in schools divide into (i) contextual factors, such as weather, health limitations, academic pressures, and safety perceptions, and (ii) operational constraints, including limited teacher training, inadequate facilities, and sustainability challenges (Price et al., 2022 ). Finally, the school green estate requires attention as a MHWB and nature relationship determinant (McCormick, 2017 ). Socioeconomic and spatial inequities mean that under-resourced communities are more likely to have smaller, lower-quality green spaces, potentially limited biodiversity, reduced maintenance budgets, safety concerns such as vandalism and environmental hazards in addition to outdoor spaces that might not reflect the cultural identities and practices of the communities they serve (Baró et al., 2021 ; Zhang et al., 2020 ). Together these gaps argue for a cautious yet pro-active stance: NbPs should not be treated as a simple or stand-alone solution, yet their demonstrated benefits for targeted groups justify equity-focused pilot-to-evaluation pathways that can generate transferable evidence for wider and scalable adoption. Building on a rapid scoping review (Lorimer et al., 2025 ), stakeholder interviews (Hopkins van Mil, 2025 ), and an economic modelling exercise (Tsiachristas et al., 2025 ), we therefore present a tiered policy pathway that prioritises co-production with young people and educators, as the primary mechanism for ensuring programmes are developmentally appropriate, equitably delivered, and safeguarded against ineffectiveness and unintended harm. 3 Methodological Approach Design and Rationale Guided by the questions of what kinds of nature-based programmes are currently used in UK secondary schools, what forms they take, and what outcomes they report for adolescent mental health and wellbeing, this study used a mixed-methods approach, with evidence gathered through: A rapid systematic scoping review of peer-reviewed and grey literature on NbPs and adolescent mental health and wellbeing (2014–2024; (Lorimer et al., 2025 ), Semi-structured interviews with 16 educators from state and independent secondary schools in England (Letendre, 2025 ); A deliberative policy action (DPA) workshop with 30 cross-sector participants (DfE, Natural England, educators, and youth advisors (including the trained NeurOx YPAG); that co-developed a cost–benefit modelling framework (Hopkins van Mil, 2025 ). Four practice-led school examples (Bassett et al., 2026 ; Cappleman et al., 2026 ; Kelly et al., 2026 ; Ladbrook et al., 2026 ) This research project was co-produced with educators, policy professionals, and youth partners, spanning three University divisions (Medical Sciences, Social Sciences, and Gardens, Libraries and Museums). The approach builds on principles of transdisciplinary co-production designed to accelerate policy-relevant evidence generation (Chambers et al., 2022 ). Terminology For this study, nature-based programmes (NbPs) for mental health and wellbeing (MHWB) were defined broadly as structured workshops, interventions, or programmes that (i) involve learning about or through nature and/or (ii) draw on nature’s contributions to wellbeing, skills development, or alternative pedagogies. This definition encompassed both outdoor learning of standard curriculum subjects (e.g., maths, science, history; Tanaji et al., 2026 ) where nature serves as a learning context, and explicitly therapeutic or wellbeing-oriented activities. This broad definition is consistent with recent syntheses on NbPs (e.g., (Coventry et al., 2021 ; Harris et al., 2025 ; Mann et al., 2022 ). Analysis and Synthesis Data from the educator interviews and the DPA workshop were analysed thematically using grounded theory and an implementation-science lens to identify barriers, facilitators, and system levers for NbPs delivery. Evidence from all sources was then integrated to develop the sequenced policy pathway and six consolidated policy directions presented in this paper. The approach followed principles of evidential pluralism, recognising that robust policy synthesis draws on both qualitative and quantitative insights. 4 Results Evidence of Impact: Scoping Review Overall, our scoping review suggests that school-based NbPs are associated with improvements in MHWB, particularly reductions in anxiety and stress, and gains in self-esteem, resilience, prosocial behaviour, school connectedness, and nature connectedness (Lorimer et al., 2025 ). Academic outcomes were less consistent, with modest improvements reported in science engagement and arithmetic, but limited evidence of broader attainment gains (ibid). NbPs also show stronger and more consistent MHWB benefits for adolescents with existing mental health needs, while impacts in general student populations are smaller and more variable (Loose et al., 2024 ; Natural England, 2024c ; Shrestha et al., 2025 ). However, study quality was moderate, constrained by small samples, limited controls, and heterogeneous outcome measures, indicating a developing but methodologically uneven evidence base. Implementation Dynamics: Teacher Interviews and Stakeholder Workshop Our research highlighted that NbPs implementation operates across interlinked individual and institutional domains (Hopkins van Mil, 2025 ; Letendre, 2025 ). At the individual level, student need, staff confidence, and perceived behavioural risk shaped delivery. At the institutional level, curriculum pressures, inspection frameworks, risk management cultures, and DfE policy priorities acted as structural moderators. Provider type further mediated these dynamics. External providers were more likely to encounter funding and integration barriers but benefited from specialist expertise, whereas internally delivered programmes were more embedded within school culture but constrained by staff capacity and competing priorities. In addition, within the DPA workshop, stakeholders described fragmented nature-based provision and difficulty identifying partners, given limited school capacity for outreach (Hopkins van Mil, 2025 ). Economic Case: Economic Modelling Analysis Our economic cost-benefit model incorporated both positive developmental trajectories and counterfactual scenarios where mental health needs remain unmet (Fig. 1 ). This benefit-led, J-shaped cost–benefit model illustrated how early (Fig. 2 ), targeted investments in NbPs (particularly for students with existing MHWB needs), may generate disproportionate long-term returns through avoided service use, improved educational engagement, and enhanced life course outcomes. Taken together, the framework provides policymakers with a structured approach to assessing NbPs not solely as enrichment activities, but as preventative public health infrastructure within the urban school system. 5 Policy directions – ‘what’ and ‘why’ Our synthesis of the evidence and stakeholder insights identifies six interlinked Policy Directions (PD) for implementing NbPs in secondary schools: (1) whole-school integration through a tiered universal-targeted-intensive model; (2) equity safeguards; (3) professional development; (4) developmentally appropriate and adolescent-informed metrics; (5) improved green estates; and (6) cross-sector collaboration. Each PD targets a critical barrier or enabler for NbPs delivery aligning with and extending the DfE’s Sustainability and Climate Change Strategy (SCC; 2023) as well as the new data Evaluation Strategy (2025), which positions robust evaluation as central to delivering the government’s Opportunity Mission (Department for Education, 2025a ). These PDs are strategic principles rather than implementation blueprints, outlining what needs to happen and why, grounded in current evidence and stakeholder insights. Our evidence synthesis showed that NbPs can deliver outcomes across three interconnected domains: (1) mental health and wellbeing related outcomes (e.g., reduced anxiety and climate-related distress, improved mood and resilience); (2) educational outcomes (e.g., attendance, behaviour, engagement, attainment); and (3) environmental outcomes (e.g., nature relatedness, pro-environmental behaviour, biodiversity). The PDs outlined below are designed to support the delivery of each of these outcomes. Policy Direction 1 – Integrate nature-based programmes within whole-school MHWB systems Despite adolescence being a pivotal stage for both MHWB and nature connectedness, these areas remain largely separate in research, policy, and practice, the DfE's SCC Strategy (Department for Education, 2023a ), for example, does not explicitly link nature engagement to existing infrastructures such as Mental Health Support Teams (MHSTs). While no established causal link yet exists between nature connection and adolescent MHWB, modest positive findings, low cost, and environmental co-benefits create a pragmatic case for cautious integration, provided poorly designed approaches do not burden overstretched staff or dilute existing provision. Evidence shows a tiered pattern of benefit. Targeted and therapeutic NbPs for adolescents with existing anxiety or depression show consistent reductions in symptoms (Overbey et al., 2023 ; Pirchio et al., 2021 ; Rian & Coll, 2021 ). Universal school-based programmes, by contrast, yield smaller or mixed effects, with outcomes shaped more by implementation quality and contextual fit than by exposure alone (Loose et al., 2024 ; Richardson et al., 2021 ; Shrestha et al., 2025 ; Sprague et al., 2020 ). This supports a proportionate approach: targeting with intensive support where need is greatest, alongside universal programmes for prevention. This points to integration within England's existing three-tier school MHWB model: universal prevention, targeted support for emerging difficulties, and intensive therapeutic provision via MHSTs and community services. Standardised, developmentally appropriate and adolescent-informed metrics are essential to monitor outcomes (see PD4). Monitoring should operate across the same three tiers used within school MHWB systems: universal indicators (e.g. nature connectedness, MHWB, attendance, behaviour), targeted indicators for students receiving additional support (e.g. changes in anxiety or emotional regulation), and therapeutic outcomes for adolescents engaged in intensive interventions through MHSTs or community services. This would require interoperable datasets linking DfE, MHST, NENP, and school platforms. Attendance and behaviour are early warning indicators for mental health difficulties with links to attainment and direct impact on educational equity (Dräger et al., 2024 ; Kearney et al., 2023 ; van Poortvliet, 2025 ). Positioning MHWB as an explicit DfE evaluation outcome aligns NbPs with NHS prevention priorities and enables co-benefit assessment across, health, education, and environment. Recommendation 1 Integrate NbPs within whole-school MHWB systems through a tiered universal–targeted–intensive model aligned with existing mental health infrastructure, supported by standardised developmentally appropriate and adolescent-informed measures and shared data infrastructure and environmental datasets (e.g. DEFRA’s Access to Nature Statistics 2025) . Policy Direction 2 – Embed equity safeguards and ensure inclusive access Access to NbPs benefits is unequal where socio-economic deprived and ethnically minoritised communities consistently face poorer green-space quality, inadequate maintenance, increased safety concerns, and environments whose design, management norms and cultural narratives my reflect white ethnicities and marginalise other cultural practices and meanings (Baró et al., 2021 ; Comber et al., 2008 ; Rigolon et al., 2021 ; Snaith & Odedun, 2023 ). Students with disabilities face additional physical accessibility barriers, while students experiencing multiple, intersecting disadvantages face compounded exclusion. Without explicit equity safeguards, school-based NbPs risk reproducing or amplifying these disparities (Baró et al., 2021 ; Harvey et al., 2025 ). Our stakeholder consultations highlighted additional potential barriers specifically for adolescents, such as stigma around nature activities in secondary schools (e.g., perceptions that they are “uncool”). Similarly, qualitative research indicates that urban adolescents might associate nature with fear, danger, dirt, disgust, and discomfort and feeling isolated (Lekies et al., 2015 ; Zamora et al., 2021 ). To resolve this, students suggested integrating nature into academic routines, for example through green study spaces during exam periods and through youth-led design of outdoor areas. Such approaches align with practitioner-led urban design guidance (e.g., Make Space for Girls, 2023) which highlights the importance of youth- (gender-)informed public spaces design. and evidence of strong peer influences on pro-environmental behaviour (Collado et al., 2017 ). These innovations demonstrate the value of both developmentally appropriate and adolescent-informed programme design and positioning young people as co-creators, consistent with child-rights principles (Angelöw & Psouni, 2025 ). Equity requires both redistribution and recognition: under-resourced schools need additional resources and approaches that respect diverse cultural relationships with nature. While current monitoring of school-level green provision and NbPs outcomes remain underreported and uneven, existing socio-economic and spatial indicators (e.g., free school meal eligibility, area-level deprivation indices, urban density with limited green access, etc.) might provide pragmatic starting points for target support. Building on this, all schools, and particularly those serving under-resourced students, are likely to require: Co-design by schools and delivery support addressing cultural and safety barriers. Partnerships with local parks, community gardens, or nature organisations to overcome on-site constraints. Priority funding for NbPs development and staff training. Recommendation 2 : Prioritise schools serving disadvantaged students for additional NbPs funding, staff training, and local green partnerships. Support co-design with students, families, and communities. Where feasible, use existing disaggregated administrative and survey data (e.g., socio-economic status, ethnicity, SEND, gender, and available national nature engagement indicators (i.e., Children’s People and Nature Survey for England (Natural England, 2025 )) to review uptake and distribution of support, to ensure benefits reach those facing the greatest barriers. Policy Direction 3 – Strengthening professional capacity for sustained evidence-led nature-based practice The growing recognition of NbPs within DfE and Department for Environment, Food, and Rural Affairs (DEFRA) policies, including the NENP, Children and Nature Programme, and the government-confirmed General Certificate of Secondary Education (GCSE) in Natural History, creates additional demands for educator capacity. Integration within continuing professional development (CPD) is therefore vital, supported by specialist leadership roles and cross-subject learning pathways (for example, geography, science, and English) that embed NbPs in mainstream curricula and deliver more formalised, interdisciplinary outcomes (Dillon & Dickie, 2012 ). Educators consistently report limited time, confidence, pedagogical support for delivering NbPs, particularly outside traditional classrooms. This finding is consistent across literature and our educator interviews and stakeholder workshops (O’Malley & Pierce, 2022 ; Rushton & Walshe, 2025 ; Walker et al., 2021 ). Even where school leadership is supportive, crowded and outcome-driven curricula restrict opportunities to integrate NbPs into the timetable (Letendre, 2025 ). These pressures are reinforced by school accountability systems that prioritise measurable educational outcomes (attendance, examination results), while wellbeing and nature connectedness outcomes remain largely unrecognised and difficult to assess through standardised measures. Evidence indicates that NbPs have dual benefits by also supporting teacher wellbeing, retention, and environmental literacy, generating multiplier effects as educators model pro-environmental behaviour and integrate sustainability across subjects (Crespo-Martín et al., 2025 ). Stakeholders emphasised the importance of moving beyond staff retention to fostering conditions that sustain wellbeing and purposeful work. Teachers called for NbPs to be recognised alongside core subjects in school planning and evaluation, while also valuing creative flexibility within clearly defined parameters (Hopkins van Mil, 2025 ). Recommendation 3 Establish national Initial Teacher Training (ITT) and continuing professional development (CPD) frameworks for NbPs to support MHWB including specialist leadership roles (e.g., Senior Mental Health Leads, Sustainability Leads, PSHE Leads, SENCO/SENDCOs) and protected curriculum time – prioritising schools serving disadvantaged students. Enable educator-led practitioner research through partnership with communities, education, health, environmental, and local-government actors. Ring-fence targeted funding, aligned with existing MHWB, Pupil Premium, and sustainability streams, to support implementation and robust evaluation. Policy Direction 4 – Build developmentally appropriate and adolescent-informed and interoperable evaluation frameworks The DfE's 2025 Evaluation Strategy details robust, proportionate evaluation for the government’s Opportunity Mission delivery and building an evidence base that supports better life chances, protection, high standard education, training and care (Department for Education, 2025a ). Within this, mission-led approach initiatives such as the NENP have primarily focused on biodiversity, nature access and general wellbeing outcomes, with adolescent mental health not yet consistently specified as a formal outcome domain (Cottrill et al., 2025 ). However, designing future NbPs evaluations to more explicitly include adolescent MHWB outcomes would strengthen coherence with NHS prevention priorities (e.g., MHST in schools mentioned in PD1; NHS England, 2019 , updated 2025) and enable a more integrated evaluation of the cross-sector value of NbPs for health, education, and environment. Current evidence for NbPs’ effectiveness is mixed and methodologically limited (Lorimer et al., 2025 ). Studies report small to moderate effects that are context-dependent with weak causal design, inconsistent definitions, and short follow-up periods inhibiting effective evaluation and generalisation (Bratman et al., 2019 ; Loose et al., 2024 ; Tillmann et al., 2018 ). Yet mixed findings might reflect insensitive tools and brief observation windows rather than the absence of real effects. Furthermore, existing tools to assess nature connection are designed for children or adults and miss developmental and social dynamics specific to adolescence (Greenwood & Gatersleben, 2016 ; Neurohr et al., 2023 ). This highlights the need for developmental sensitivity in validated developmentally appropriate and adolescent-informed measures. Fragmentation across education, health, and environment sectors further hinders progress, because datasets use incompatible definitions, reporting cycles, and privacy protocols, preventing linkage between student MHWB, school performance, and environmental indicators such as biodiversity (Davis et al., 2025 ; Montana, 2023). Recommendation 4 Establish cross-sector, developmentally appropriate and adolescent-informed evaluation frameworks that explicitly include adolescent MHWB outcomes, harmonise data standards across NENP, MHST, and school datasets, and commission longitudinal studies to support equitable scale-up. Policy Direction 5 – Establish evidence-informed green-estate standards for MHWB and learning The DfE's SCC Strategy (2023) frames the MHWB and learning benefits of nature contact primarily as co-benefits of climate and biodiversity action rather than core objectives of school estate design. While green infrastructure requirements exist (Department for Education, 2023b ), they do not explicitly prioritise MHWB and learning outcomes, nor sufficiently differentiate between new builds and spatially constraint existing, particularly in urban and underserved areas. Yet, evidence shows that nature contact supports wellbeing and learning through multiple exposure pathways: indirect (views of greenery), incidental (routine contact on school grounds), and intentional (structured outdoor or therapeutic activities) (Cox, Shanahan, Hudson, Plummer, et al., 2017 ; Lomax et al., 2024 ; Ulrich & Parsons, 1992 ; Vakalis et al., 2020 ). Even modest nature exposure such as improved classroom views or small-scale greening like trees, shaded seating, and container gardens may yield measurable MHWB and environmental benefits, including heat buffering, cleaner air, noise reduction, and flood mitigation (Diaz et al., 2018 ; Yamashita et al., 2021 ). Given the wide variation in estate capacity, a proportionate, tiered approach is needed. However, design must be risk-aware and context-sensitive. Poorly designed green space interventions can pose risks such as allergies, animal nuisance, or bullying in unsupervised spaces in schools (Veibiakkim et al., 2025 ). Nevertheless, nature-positive NbPs that enhance habitat quality and ecological connectivity yield reciprocal benefits: healthier ecosystems support more reliable, higher-quality experiences and sustained wellbeing outcomes (Moore et al., 2025 ; Robinson & Barrable, 2023 ). Recommendation 5 Integrate student MHWB and learning outcomes as core objectives of school estate standards alongside sustainability targets. For new builds and major redevelopments, embed comprehensive green-infrastructure benchmarks. For existing schools, adopt a proportionate, tiered approach matched to spatial and resource capacity. Implement transparent, long-term monitoring of MHWB, learning, and ecosystem outcomes across all settings. Sta Policy Direction 6 – Develop coordinated cross-sector NbPs delivery and leadership Schools uniquely reach nearly all young people during a critical developmental window (unavailable to other sectors). In addition, evidence from our workshops and interviews shows that NbPs achieve the strongest outcomes when schools partner with local authorities, health services, and environmental organisations (Hopkins van Mil, 2025 ). This aligns with the DfE’s SCC Strategy (2023) which commits to a systems-based approach across multiple action areas. Research further indicates that nature connectedness, rather than nature knowledge alone, is the stronger predictor of pro-environmental behaviour (Whitburn et al., 2020 ). Together, this evidence reinforces the need for cross-sector partnerships that both connect schools with external organisations and prioritise activities that foster direct relationships with nature across both curricular and enrichment pathways. Thus, age-appropriately designed NbPs, whether delivered through national platforms like the NENP, local partnerships with parks and environmental organisations, or school-led initiatives, can simultaneously: Advance educational outcomes through curriculum integration (including climate and biodiversity learning), attendance, and engagement (Ardoin et al., 2020 ); Promote mental health and wellbeing by addressing climate-related distress and strengthening social relationships (Chawla et al., 2014 ; Newberry Le Vay et al., 2023); Build skills relevant to the green economy through enhanced self-efficacy, leadership, and competence (Campbell et al., 2026 ; Lovell, 2019 ); Strengthen ecological connectivity by contributing to corridors that defragment urban green space (Hyseni et al., 2021 ; WHO, 2017 ); Mitigate environmental pressures such as air and noise pollution, heat stress, and flooding (Blanuša et al., 2025 ); and Foster environmental stewardship by strengthening sense of place and long-term care for nature (Ardoin et al., 2020 ; Gush et al., 2023 ). Realising these benefits requires coordination across fragmented sectorial systems as currently NbPs operate through disconnected channels such as DfE sustainability initiatives, NHS mental health support (e.g., green social prescribing; Lyreskog et al., 2025 ), local authority environmental programmes, and third-sector providers limiting coherence and impact. Effective coordination requires shared leadership structures, funding mechanisms, common evaluation frameworks, and structured platforms for knowledge exchange. Recommendation 6 Establish cross-sector coordination mechanisms integrating NbPs across education, health, and environmental policy. Create shared accountability frameworks (for example, joint outcome frameworks and pooled or aligned funding agreements), clarify leadership responsibilities across sectors, and develop formal knowledge exchange infrastructure to support scaling through national platforms (including ONS, NENP, and related systems). 6 Implementation pathway – ‘when’ and ‘how’ ‘Quick wins’: Immediate actions (12–18 months) leveraging established evidence and existing capacity Immediate actions focus on integrating NbPs into existing teacher capacity and whole-school MHWB and sustainability infrastructure. Integrating with schools’ Climate Action Plans and sustainability leads could yield co-benefits as interventions that mitigate for flood, heat, and air pollution may also affect MHWB (Newberry Le Vay et al., 2023). (PD1) Current participation in programmes such as the NENP reflects schools that are already incorporating NbPs (~ 7,380 signed up schools as of July 2025; Cottrill et al., 2025 ). To extend equitable national access beyond these pioneer adopters, immediate focus should aim at identifying and removing barriers to initial implementation of NbPs, particularly for under-sourced schools. Priority actions include improving awareness of NbPs’ benefits, simplifying administrative steps, and offering easy-start support (e.g., through DfE grants; Cottrill et al., 2025 ). (PD2) At the same time, strengthening teachers’ professional capacity is essential for all schools, especially for those with limited resources, to ensure an effective and sustainable NbPs delivery (Hopkins van Mil, 2025 ). Teachers are pivotal implementers, and school leads can support teachers’ agency through protected time, and equitable access to CPD that embeds NbPs in existing curricula (e.g., science, geography, citizenship (Department for Education, 2025b ), and preparation for the Natural History GCSE). While school leads may express concern about introducing additional NbPs on school grounds, sustained delivery depends on leadership legitimacy for outdoor learning (Cottrill et al., 2025 ) and shared responsibility across subjects, supported by standardised metrics linking MHWB, education, and environmental outcomes. (PD3) Another priority is to establish robust baseline measurements for both MHWB and school green estate condition (including green-blue-characteristics and classroom views of green space, vegetation structure, biodiversity, etc. (Cox et al., 2019 ; Cox, Shanahan, Hudson, Fuller, et al., 2017 )). Existing initiatives, such as the NENP, provide existing frameworks to pilot data-linkage protocols between MHWB, attendance, estate indicators, and attainment, while large-scale platforms such as ECHILD demonstrate that secure cross‑sector linkage at national level is feasible (Department for Education, 2025a ). In the short term, piloting NbP‑relevant data‑linkage within these platforms can build readiness for future interoperability and longitudinal monitoring of NbPs’MHWB–learning co‑benefits. (PD4&5) As noted earlier in the results section (Implementation Dynamics), stakeholders described fragmented nature-based provision and difficulty identifying partners, given limited school capacity for outreach (Hopkins van Mil, 2025 ). To ‘de-fragment’ provision, clearer signposting of existing actors (e.g., DfE sustainability support for education, Climate Ambassadors, NHS green social prescribing, Local Nature Recovery Partnerships, etc.) could function as a practical short-term enabler. (PD6) System Building: Medium-term priorities (2–3 years) guided by early signals. Medium-term priorities should aim at strategic curriculum alignment and link NbPs to the curriculum via the GCSE Natural History qualification and related subjects such as Science and Geography (Cottrill et al., 2025 ). Coordination with national initiatives such as the NENP and DEFRA’s 25-Year Environment Plan will prevent duplication and maximise impact and extends biodiversity-focused programmes to include MHWB, educational, and behavioural outcomes. Within the next 2 to 3 years, DfE, DHSC, and DEFRA, in partnership with NHS England and academic experts, should convene a cross-sector working group aligned with the government’s mission-based agenda to: commission and validate developmentally appropriate measures of nature connectedness and adolescent wellbeing; establish interoperable data standards linking NENP, MHST, and school census datasets; and coordinate longitudinal studies in secondary schools to support equitable scale-up. A sustainable school–policy–research interface is required to enable collaborative research designs, shared data protocols, and regular knowledge exchange between educators, youth, researchers, and policymakers. Implementation should be guided by co-produced economic evaluation frameworks – developed through deliberative policy-action workshops or school research action groups – that prioritise social value, consider ‘nature’ as both outcome and stakeholder, context-specific efficacy, and long-term prevention (Hopkins van Mil, 2025 ; Reed et al., 2023 ). Multi-composite value assessment (including cost–benefit analysis, social return on investment, and multicriteria decision analysis) should inform decision-making. Equity must be embedded throughout system building. Shared data interpretation frameworks are needed across education, health, and environment sectors to identify underserved communities accurately and direct resources to areas of greatest need. Secondary-school-specific evidence pathways should explicitly address adolescent developmental mechanisms of change through robust research design and strengthened causal attribution. Given the wide variation in estate capacity, a proportionate, tiered approach is needed. High‑capacity sites (those with sufficient space, funding, and organisational capability) can reasonably be expected to meet comprehensive green‑estate standards, whereas constrained sites may focus on incremental greening (for example, container gardens, vertical planting and local partnerships), and severely constrained urban and/or under-resourced sites may prioritise low‑cost strategies such as maximising classroom sightlines to green spaces or sky, nature imagery, and regular off‑site use of local parks. A critical priority is harmonising MHWB, behavioural, and learning indicators with school-level environmental metrics, including biodiversity proxies derived from NENP habitat mapping (Marselle et al., 2021 ; Wang et al., 2024 ), to enable integrated evaluation across domains. Finally, we acknowledge that delivering NbPs at-scale will require medium-term structural investment, rather than continued reliance on existing school capacity or short-term funding streams. Therefore, a ring-fenced ‘Nature Premium,’ similar to the PE and Sport Premium, could provide schools with protected and sustained resources to embed NbPs within curriculum delivery, infrastructure development, and cross-sector partnerships. This proposal aligns with the ongoing UK-wide Nature Premium campaign (Forest School Association, 2022 ; Institute for Outdoor Learning, 2026 ; UK Parliament, 2020 ), which promotes a Nature Premium applicable across the full age range of statutory education, extending through secondary school and up to age 18. Transformational Change: Long-term vision (3–5 + years) Nature-based approaches to youth mental health and wellbeing represent a strategic opportunity to strengthen England’s leadership in integrating sustainability and wellbeing within education. While the UK aims to lead on education for sustainability and climate action by 2030 (Department for Education, 2023c ), realising the full potential of NbPs will require sustained commitment and major shifts in how educational systems conceptualise, resource, and deliver these interventions. This transformation requires embedding co-production with students, teachers, and families within NbPs governance and decision-making structures. Education has established mechanisms for student voice and participatory research in education, together with the health sector’s Patient and Public Involvement and Engagement (PPIE) frameworks, provide complementary models for ensuring that youth and educator experience informs all stages of programme design and evaluation (Staniszewska et al., 2018 ). Consistent with typologies of co-production in school health, programmes should integrate these perspectives into formal decision-making structures, strengthening contextual fit, accountability and sustainability by making those most affected active partners rather than passive recipients (Reed et al., 2021 ). This participatory approach should sit within a systems-aligned framework that integrates MHWB, education, climate, and equity priorities to enable coherent policy development and resource allocation across DfE, DEFRA, DHSC, and Ofsted. The ambitious goal is to integrate NbPs with MHWB and education strategies, moving beyond optional enrichment to core provision and from treating nature as extracurricular to recognising it as fundamental to education. A public health shift is also needed, one that reframes nature relatedness as a modifiable determinant of MHWB and pro-environmental behaviour (Lomax et al., 2024 ). As with physical activity, this should be embedded within whole-school wellbeing systems, coordinated through senior pastoral leadership (including mental health leads, SENCO/SENDCOs, or wellbeing coordinators where these roles exist). 7 Tiered Policy Pathway for action: synthesising policy directions and implementation stage The preceding sections outline both the strategic policy directions (what should change) and the implementation pathway (when and how change might occur). Table 1 synthesises these elements into a staged policy pathway that links immediate actions, medium-term system building, and longer-term transformation. This framework illustrates how NbP development can progress from early experimentation toward integrated, system-level implementation. Table 1 Tiered Policy Pathway for action. n PD1 – Whole-school MHWB integration; n PD2 – Equity safeguards; n PD3 – Professional capacity; n PD4 – Evaluation frameworks; n PD5 – Green estate standards; n PD6 – Cross-sector coordination; n Enabling conditions (cross-cutting across all PDs) . [1] CPD=Continuous professional development; 2 CBA=Cost-benefit analysis; 3 SROI=Social return on investment; 4 MDA=Multicriteria decision analysis; 5 ADR=Administrative data research UK; 6 ECHILD=Education and Child Health Insights from Linked Data - England. Quick wins: Immediate actions (12–18 months) using established evidence. System Building: Medium-term priorities (2–3 years) guided by early signals. Transformational Change: Long-term vision (3–5 + years) shaped by unknowns. PD1 – Whole-school MHWB integration Embed nature engagement in whole-school MHWB approach as the foundation for all subsequent actions. (low cost) Align school nature programmes with SRP /FS capital programmes, commercial programmes delivered through Risk Protection Arrangement (RPA), NENP and DEFRA’s 25 YEP to maximise impact and avoid duplication. Position England as a leader in evidence-based, nature-focused youth wellbeing. PD2 – Equity safeguards Use existing MHWB and cost–benefit evidence to prioritise initial NbP investments in disadvantaged and restricted settings. Promoting equity and preventing reinforcement of privilege through targeted NbPs investment using NE GI mapping and Accessible Natural Greenspace Standard (ANGsT) to prioritise areas of greenspace deficiency and deprivation. Make co-production with youth and educators standard in NbPs design and evaluation. PD3 – Professional capacity Clarify teacher/educator roles (link to CPD 1 ). (low cost) Implement targeted teacher and school leader training via continuing professional development (CPD) pathways. Embed NbPs within whole-school statutory wellbeing/education strategies, aligning with children’s rights to a clean, healthy and sustainable environment and environmental education (UN Articles 28, 29(1)). PD4 – Evaluation frameworks Standardise terminology for ‘nature’, ‘nature-relatedness’ measures, and nature-based programmes. (low cost) Validating measures of nature connectedness and adolescent wellbeing. Convene a cross-sector working group (DfE, DHSC, DEFRA, NHS) to validate adolescent-informed measures, coordinate longitudinal studies, and establish interoperable data standards. Establish cost–benefit evaluation infrastructure (CBA 2 , SROI 3 , MCDA 4 ), to assess NbPs value-for-money and inform scaling decisions. Institutionalise cross-sector data governance and longitudinal research frameworks to embed MHWB-environment-education indicators in national monitoring systems. PD5 – Green estate standards Set baseline MHWB through existing datasets such as Natural England’s CPANS and green estate metrics such as percentage of permeable ground /green surface /biodiversity proxies derived either from NE’s Green Infrastructure Framewor k combined with the NENP base mapping. Implement tiered green-estate standards aligned to spatial and resource capacity. Enhance NENP mapping through systematic minimal biodiversity metrics (e.g., pollinator count). Integrate NbPs into the curriculum, for example through the new GCSE Natural History or existing subjects (e.g., science, geography) Align NbPs appraisal with NE’s Environmental Benefits from Nature (ENCA) framework within FS/SRP capital planning. PD6 – Cross-sector coordination Policymakers should prioritise scaling interventions that have demonstrated positive cost–benefit ratios through rigorous economic evaluation. Create school–policy–research interfaces for knowledge exchange and data coordination. Develop an eco-biopsychosocial model or mixed-methods, transdisciplinary research infrastructure. Enabling conditions (cross-cutting across all PDs) Initiate linkage protocols between MHWB, attendance, green estate data, and attainment to build toward an integrated evidence infrastructure. (e.g., via ADR UK 5 ECHILD 6 ) Develop interoperable data infrastructure linking MHWB, educational, and environmental datasets. Build a systems framework linking MHWB, education, climate, and equity priorities across DfE, DEFRA, DHSC, Ofsted. 8 Policy and research implications Realising this vision requires cross-sector co-production with youth and educators, sustained educator support, and government-funded, mixed-methods transdisciplinary research infrastructure that bridges local evidence with scalable national indicators. Delivering effective nature-based policies requires interdisciplinary collaboration across education, health, and environmental systems, and professionals capable of translating policy into practice within school communities. Conceptual innovation is also important. This includes adopting integrated approaches that recognise the interwoven biological, psychological, and socio-cultural factors linking nature and health, recently referred to as an eco-biopsychosocial model and situating youth MHWB within broader environmental and social systems (Patel et al., 2023 ; Wilhelm et al., 2026 ). This is particularly relevant given that many young people face barriers to accessing formal mental health care due to long waiting times, stigma, and language barriers (Aguirre Velasco et al., 2020 ; MacLean et al., 2013 ). Schools therefore function as crucial enablers of accessible, equitable support, integrating MHWB (Fazel et al., 2023 ), learning, and environmental connection within a unified framework. NbPs must be embedded within core educational delivery, addressing curriculum, attendance, behaviour, and wellbeing, rather than treated as optional enrichment that risks excluding disadvantaged students. When effectively integrated, schools' unique position across social, educational, and environmental systems means that NbPs can deliver measurable co-benefits such as improved mood and anxiety (health), enhanced attendance and engagement (education), and strengthened, value-based nature connectedness supporting pro-environmental behaviour (environment). Our CBA model suggests wider economic gains, including improved workforce productivity through better mental wellbeing and reduced absenteeism (Tsiachristas et al., 2025 ). NbPs may also contribute to local and national economic resilience by stimulating demand for green skills, including horticulture, ecology, and landscape architecture, sectors where there is currently a recognised skills shortage (ibid). This is consistent with emerging evidence around the broader economic impacts of nature-based solutions that can create employment, stimulate local economic activity, and reduce pressure on public services while delivering broader ecosystem and community benefits (The Wildlife Trust, 2023 ; Wilkening et al., 2024 ). However, nature relatedness should be understood not merely as self‑reported affinity or aesthetic appreciation, but as a developing ethical relationship with more‑than‑human nature that shapes everyday choices and environmental responsibility, consistent with emerging frameworks and practices such as Ecological-Collective-Flourishing (E-Co-Flourishing) that link human and ecological wellbeing (Moore et al., 2025 ). Realising this potential requires alignment across research, policy, and practice to advance MHWB, educational, biodiversity, and equity goals. Table 1 outlines a tiered policy direction and research priorities pathway guiding from immediate foundational actions to long-term transformation and shows how evidence, data infrastructure, as well as co-production can be sequenced to build sustainable change. 9 Stakeholder roles and responsibilities This section addresses the question: Who does what? Table 2 outlines proposed roles for key actors in scaling NbPs across secondary schools, based on our evidence synthesis and stakeholder consultation. Effective NbPs delivery requires coordinated leadership across England’s education, health, and environment sectors. Table 2 Proposed roles for key actors in scaling nature-based programmes Potential System Actors Key role Department for Education (DfE) Embed NbPs in whole-school MHWB guidance, as an evidence‑informed, low‑risk approach, that reflects emerging (but still developing) evidence that structured access to nature and greenspace can support aspects of pupils’ mental health and wellbeing. Prioritise co-design (with youth and teachers) for equity, curriculum integration, interoperable standards, protected time and training (CPD/ITT), and cross-sector coordination to ensure inclusive, sustainable delivery of nature-based programmes. Set differentiated green-estate standards (new builds vs existing), and fund targeted estate upgrades. Department for Environment, Food & Rural Affairs (DEFRA) Habitat-target guidance and BNG/metric documentation used nationally ( https://www.gov.uk/government/publications/statutory-biodiversity-metric-tools-and-guides ) Department of Health & Social Care / NHS (incl. MHSTs) Integrate NbPs into school MHST pathways, co-fund indicated therapeutic programmes and align health metrics. Digital biodiversity data infrastructures (citizen science–based) Schools, pupils, and communities commonly use iNaturalist (and iRecord) to upload observations that are then shared into national repositories (NBN Atlas / GBIF) after verification (‘research-grade Citizen Science data’). Local authorities / school trusts Prioritise on-site green infrastructure upgrades and coordinated maintenance funding. Where feasible, broker Trust-level and community partnerships to enable shared access to green spaces for targeted use, recognising transport and timetable constraints in secondary settings. Natural History Museum (NHM), Natural England (NE) Biodiversity metrics ( https://data.nhm.ac.uk/dataset/bii-bte ; https://nbnatlas.org/ ) Royal Horticulture Society (RHS) Habitat enhancement guidance Schools /Senior leaders Protect curriculum time, appoint Nature leads (to incorporate within the role of the Sustainability lead (SL) or to team up with SL), implement CPD 1 and co-produce programmes with pupils. Universities /research partners Co-design developmentally appropriate and adolescent-informed measures, run pilots with robust evaluation (CBA 2 , SROI 3 , MCDA 4 ), and publish open datasets. Wildlife Trusts, environmental NGOs, programmes such as NENP Intermediary organisations provide technical support and engagement resources Schools contribute ecological observations to platforms such as ESRI, supporting environmental literacy and contributing to emerging citizen science datasets for local biodiversity monitoring. Continuous professional development. 2 Cost-benefit analysis. 3 Social return on investment. 4 Multicriteria decision analysis. Policy framework (England’s government) DfE should embed NbPs within existing MHWB guidance and curriculum frameworks; leveraging existing funding streams (e.g., NENP expansion rounds) to support implementation in under-resourced schools; and develop evidence-informed green-estate standards that prioritise MHWB and learning outcomes, which are differentiated for new builds and existing (constrained) estates. DEFRA and Natural England provide biodiversity guidance through platforms such as NENP, which has a broader environmental and educational remit; alignment with MHWB outcomes should complement rather than define this purpose; however, with opportunities to enhance methodological alignment between participation and ecological data quality. The DHSC and NHS partners can integrate NbPs within MHST pathways and align wellbeing metrics where appropriate. Local implementation Local authorities, academy /school trusts, or schools to coordinate place-based upgrades and broker community partnerships and strategically align NbPs with wider funding schemes (e.g., public health grants, climate and sustainability fundings, charitable or corporate partnerships) to maximise impact. School leaders integrate NbPs within existing curriculum and MHWB provision, appoint Nature leads (that can team up with the sustainability lead), and embed continuing professional development (ITT and CPD) through co-production with pupils. Research and evaluation partners Universities co-design developmentally appropriate and adolescent-informed measures, pilot evaluation frameworks (cost–benefit analysis, social return on investment, multi-criteria decision analysis), and publish open datasets. When aligned, these responsibilities would create the enabling architecture for equitable, evidence-led NbPs delivery. Table 2 identifies key system actors with relevant statutory, technical, or delivery roles in scaling NbPs. Inclusion does not imply formal partnership or endorsement but reflects their existing mandates, infrastructures, or capacities relevant to implementation. 10 Risks, safeguards, and success factors Success in scaling nature-based programmes depends on anticipating pitfalls and embedding safeguards throughout implementation while establishing conditions for sustained impact. Understanding the Risks The primary risk is that poorly implemented or inequitable NbPs waste resources, widen inequalities, and erode trust in evidence-based interventions and thus, potentially discrediting nature-based approaches more broadly (Forbes et al., 2025 ; Garside et al., 2020 ). Inequity may arise not only from unequal access to structured programmes, but also from reliance on incidental or passive exposure pathways (e.g., views of greenery or routine access to well-maintained grounds), which tend to be more prevalent in already well-resourced schools and neighbourhoods (Rigolon et al., 2021 ). Risks manifest differently across stakeholders. Policymakers risk promoting programmes failing to deliver promised outcomes. Educators risk inadequate preparation for effective delivery, increased strain on provider capacity (Garside et al., 2020 ). Individual risk to students (disservices) includes allergies, animal nuisance, bullying risks in outdoor spaces, maintenance costs requiring specialised knowledge, and safety concerns, all of which highlights that proximity to nature alone is insufficient without quality, cultural fit, and institutional support. Communities face dual risks: exclusion from beneficial programmes or interventions inadvertently reinforcing existing disadvantages. Researchers risk producing evidence that is methodologically limited, misinterpreted, or disconnected from practice needs, undermining credibility and impact. Table 3 summarises both contributions and potential disservices of nature in school settings, illustrating the need for transparent monitoring of benefits and harms. Table 3 Contributions and potential disservices of nature in school settings Pros - Contributions Cons - Disservices Benefits for SEN students Aesthetic concerns Bidirectional benefits for human and ecological health Allergies and pollen reactions Biodiversity Animal nuisance (insects, birds, rodents) Educational resource Bullying and interpersonal conflict risks in outdoor spaces Facilitates pro-social behaviour Dirt and cleanliness perceptions Habitat connectivity Green space perceived as age-inappropriate (mismatch between design and adolescent social identity and autonomy needs) Improves air quality Lack of maintenance during holidays Improves MHWB for students and staff Perceived maintenance and expertise requirements (although evidence from schemes such as Sheffield’s Grey to Green suggests long-term costs can be reduced when well designed; https://www.greytogreen.org.uk/ ) Mitigates flooding Safety concerns (real and perceived) Mitigates socio-economic disparities Provides food sources Provides sense of place and belonging Reduces noise pollution Reduces urban heat Supports biodiversity net gain Supports healthy soil and gut microbiome Mitigating these risks requires design and implementation safeguards, detailed below, embedding co-production and equity monitoring throughout programme lifecycles. This participatory approach must be paired with regular equity audits assessing accessibility beyond proximity (including green estate quality, safety, cultural fit), implementation fidelity across contexts, and both benefits and disservices (see Table 3 ). The forthcoming DfE Sustainability and Climate Change Strategy refresh offers an opportunity to embed these safeguards formally within national policy, aligning with statutory environmental (Climate Change Act 2008, Environment Act 2021) and wellbeing commitments (Education Act 1996, Health and Social Care Act 2012). Essential safeguards to mitigate risk Evidence from large-scale school mental health trials demonstrates that interventions designed without meaningful student and educator involvement can worsen outcomes for vulnerable young people (Montero-Marin et al., 2022 ). Consequently, embedding co-production throughout programme design, delivery, and evaluation functions as protective infrastructure, preventing three failure modes: misaligned priorities (e.g., our DPA workshops identified needs absent from literature such as 'green study spaces,' stigma mitigation strategies, bidirectional ecological concerns), developmental mismatch (adolescents rejecting child-oriented activities; educators prioritising time over training), and undetected harms (bullying, cultural exclusion, exposure-related anxiety). Here the education sector can draw on the medical sector's Patients and Publics Involvement and Engagement (PPIE) framework where NIHR embeds lived experience from priority-setting through evaluation, attributing youth and educators genuine decision-making authority, not tokenistic consultation (Singh et al., 2025 ). Critical success factors Sustainable scaling of nature-based programmes depends on three interrelated conditions: integrated data and research infrastructure linking environmental, educational, and wellbeing indicators; long-term policy commitments that recognise the interdependence of human and ecological health and extend beyond political cycles; and cross-sector literacy and intergenerational learning that enable educators, health professionals, policymakers, and young people to coordinate implementation. Together these conditions support evidence-based resource allocation, prevent programmes from remaining isolated pilots, and enable sustained, system-level change. 11 Limitations The synthesis prioritised breadth and stakeholder relevance over exhaustive inclusion of all available studies. Although the educator sample was small and geographically limited, triangulation across literature, practitioner insights, and policy deliberation strengthens validity. Future work should extend this analysis longitudinally and across educational phases to test the generalisability of findings. 12 Conclusion – Call to action Nature-based programmes should be integrated within whole-school mental health and wellbeing policy rather than treated as peripheral interventions. When integrated as a core component of whole-school mental health and wellbeing approaches, supported by teacher continuous professional development, and governed by interoperable data and equity safeguards, nature-based programmes can advance mental health and wellbeing, educational, and environmental outcomes simultaneously. Our synthesis makes three contributions: demonstrating the importance of adolescence-specific approaches during a critical developmental period when mental health problems emerge and nature connection declines; developing a staged policy pathway that connects immediate ‘quick wins’ with long-term systemic change; and illustrating how co-production research methods can align practice, policy, and research priorities. Based on our evidence synthesis and stakeholder consultation, six strategic priorities emerge: (1) integrating nature-based programmes within whole-school mental health and wellbeing systems; (2) embedding equity safeguards and ensuring inclusive access to nature-based programmes; (3) strengthening professional capacity for sustainable, evidence-led nature-based programmes delivery; (4) building interoperable and developmentally appropriate and adolescent-informed metrics and evaluation tools; (5) establishing minimum school green-estate standards that prioritise MHWB and learning outcomes; and (6) developing coordinated cross-sector governance for NbPs implementation at scale. Grounded in UN guidance on children's rights to healthy environments and environmental education (Articles 28, 29), our research also positions nature-based approaches as rights-based imperatives rather than optional enhancements. However, significant evidence gaps remain. English secondary schools are under-represented in research; methodological limitations constrain causal inference; and optimal implementation mechanisms require further development. The emerging evidence suggests nature-based programmes warrant serious investment as part of whole-school mental health and wellbeing provision (through a tiered universal-targeted intensive model), provided implementation includes rigorous evaluation, equity monitoring, and stakeholder co-production. Whether education systems can deliver this with sufficient quality and equity to address adolescent mental health needs at scale remains an open and urgent question. Abbreviation Abbreviation Definition ADR UK Administrative data research UK ANGSt Accessible Natural Greenspace Standard CBA Cost-benefit analysis CPANS Children and People and Nature Survey CPD Continuous professional development CYP Children and Young People DEFRA Department for Environment, Food, and Rural Affairs DfE Department for Education DHSC Department of Health and Social Care DPA Deliberate Policy Action ECHILD Education and Child Health Insights from Linked Data - England GI Green infrastructure ITT Initial teacher training MAT Multi-academy trusts MCDA Multicriteria decision analysis MHST Mental health support team MHWB Mental health and wellbeing NbPs Nature-based programmes NE Natural England NENP National Education Nature Park NGO Non-government organisation Ofsted The Office for Standards in Education, Children's Services and Skills (UK) PPIE Patients and Public Involvement and Engagement PSHE Personal, social, health and economic education RPA Risk protection arrangement SCC Sustainability and climate change strategy SENCO /SENDCO Special Educational Needs Coordinator / Special Educational Needs and Disabilities Coordinator SLT Senior leadership team SROI Social return on investment YPAG Young people advisory group Declarations Ethics approval and consent to participate This manuscript reports secondary analyses of data collected as part of a prior study. Ethical approval for the original study was granted by the Medical Sciences Interdivisional Research Ethics Committee (MS IDREC 688330). All relevant ethical procedures, including informed consent, were followed in the primary study. Consent for publication 'Not applicable' Availability of data and materials 'Not applicable' Competing interests The authors report there are no competing interests to declare. Funding This study is funded by grant from the Natural Environment Research Council (NERC) (grant number NE/W004976/1) as part of the Agile Initiative at the Oxford Martin School and in part by the National Institute for Health Care Research (NIHR) Oxford Health Biomedical Research Centre [NIHR203316] and the Wellcome Trust (grant no. 226785/Z/ 22/Z). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Authors' contributions JL, KW, and IS contributed to conceptualization. JL, KW, AT, SA, KP, RC, SM, and ML contributed to data curation. JL, KW, AT, SA, SM, and ML conducted formal analysis. KW and IS acquired funding. JL, KW, AT, SA, KP, RC, SM, ML, and IS contributed to investigation. JL, KW, AT, SA, SM, ML, and IS developed the methodology. JL, KW, and IS managed project administration. KW, AT, SA, and IS provided resources. JL, KW, AT, and IS provided supervision. JL, KW, AT, SA, KP, RC, SM, ML, and IS contributed to validation. KW, AT, and SA led visualization. KW wrote the original draft. All authors (JL, KW, AT, SA, KP, RC, SM, ML, and IS) contributed to review and editing. Acknowledgements We gratefully acknowledge colleagues at the Department for Education (DfE) for their valuable contributions to the development of this study. While the views expressed are those of the authors, their constructive collaboration and insights have helped shape the conceptual framing and policy relevance of this work. We would like to express our sincere gratitude to the project’s co-researchers, including all Patient and Public Involvement (PPI) contributors and the NeurOx YPAG whose invaluable insights and lived experiences and expertise have significantly shaped our research outputs and this paper. Authors' information (optional 'Not applicable' References Aguirre Velasco A, Cruz ISS, Billings J, Jimenez M, Rowe S. What are the barriers, facilitators and interventions targeting help-seeking behaviours for common mental health problems in adolescents? A systematic review. BMC Psychiatry. 2020;20(1):293. https://doi.org/10.1186/s12888-020-02659-0 . Angelöw A, Psouni E. Participatory Research With Children: From Child-Rights Based Principles to Practical Guidelines for Meaningful and Ethical Participation. Int J Qualitative Methods. 2025;24. https://doi.org/10.1177/16094069251315391 . Ardoin NM, Bowers AW, Gaillard E. (2020). Environmental education outcomes for conservation: A systematic review. Biological Conservation , 241 . https://doi.org/10.1016/j.biocon.2019.108224 Balundė A, Jovarauskaitė L, Poškus MS. Exploring the Relationship Between Connectedness With Nature, Environmental Identity, and Environmental Self-Identity: A Systematic Review and Meta-Analysis. SAGE Open. 2019;9(2). https://doi.org/10.1177/2158244019841925 . Baró F, Camacho DA, Del Pérez C, Triguero-Mas M, Anguelovski I. School greening: Right or privilege? Examining urban nature within and around primary schools through an equity lens. Landsc Urban Plann. 2021;208. https://doi.org/10.1016/j.landurbplan.2020.104019 . Barthel S, Belton S, Raymond CM, Giusti M. Fostering Children's Connection to Nature Through Authentic Situations: The Case of Saving Salamanders at School. Front Psychol. 2018;9:928. https://doi.org/10.3389/fpsyg.2018.00928 . Bassett S, Polgreen K, Wilhelm K. (2026). Schools using nature for education and wellbeing: Burford School . https://www.agile-initiative.ox.ac.uk/wp-content/uploads/2026/02/Burford-CS.pdf Becht A, Spitzer J, Grapsas S, van de Wetering J, Poorthuis A, Smeekes A, Thomaes S. Feeling anxious and being engaged in a warming world: climate anxiety and adolescents' pro-environmental behavior. J Child Psychol Psychiatry. 2024;65(10):1270–82. https://doi.org/10.1111/jcpp.14035 . Blanuša T, Sutcliffe C, Tanner R, Barker J, Woolley O, Naylor R. Implementation of green infrastructure in schools as a science and environmental learning tool – UK secondary school case study. Acta Hort. 2025;1429125–30. https://doi.org/10.17660/ActaHortic.2025.1429.14 . Bratman GN, Anderson CB, Berman MG, Cochran B, de Vries S, Flanders J, Folke C, Frumkin H, Gross JJ, Hartig T, Kahn PH Jr., Kuo M, Lawler JJ, Levin PS, Lindahl T, Meyer-Lindenberg A, Mitchell R, Ouyang Z, Roe J, Daily GC. Nature and mental health: An ecosystem service perspective. Sci Adv. 2019;5(7):eaax0903. https://doi.org/10.1126/sciadv.aax0903 . Campbell R, McGaw V, Reupert A. Systematic review and meta-analysis investigating nature-based interventions for adolescent mental health: Program characteristics and effectiveness. J Environ Psychol. 2026;110. https://doi.org/10.1016/j.jenvp.2026.102917 . Cappleman S, Polgreen K, Wilhelm K. (2026). Schools using nature for education and wellbeing: The Cherwell School . https://www.agile-initiative.ox.ac.uk/wp-content/uploads/2026/02/Cherwell-CS.pdf Chambers JM, Wyborn C, Klenk NL, Ryan M, Serban A, Bennett NJ, Brennan R, Charli-Joseph L, Fernández-Giménez ME, Galvin KA, Goldstein BE, Haller T, Hill R, Munera C, Nel JL, Österblom H, Reid RS, Riechers M, Spierenburg M, Rondeau R. Co-productive agility and four collaborative pathways to sustainability transformations. Glob Environ Change. 2022;72. https://doi.org/10.1016/j.gloenvcha.2021.102422 . Chawla L, Keena K, Pevec I, Stanley E. Green schoolyards as havens from stress and resources for resilience in childhood and adolescence [Article]. Health Place. 2014;28:1–13. https://doi.org/10.1016/j.healthplace.2014.03.001 . Chiumento A, Mukherjee I, Chandna J, Dutton C, Rahman A, Bristow K. A haven of green space: learning from a pilot pre-post evaluation of a school-based social and therapeutic horticulture intervention with children. BMC Public Health. 2018;18:836. https://doi.org/10.1186/s12889-018-5661-9 . Clarke A, Pote I, Sorgenfrei M. (2020). Adolescent mental health evidence brief 1: Prevalence of disorders. Early Intervention Foundation. https://www.eif.org.uk/report/adolescent-mental-health-evidence-brief-1-prevalence-of-disorders Clarke A, Sorgenfrei M, Mulcahy J, Davie P, Friedrich C, McBride T. (2021). A systematic review on the effectiveness of school-basedinterventions. Early Intervention Foundation. https://www.eif.org.uk/report/adolescent-mental-health-a-systematic-review-on-the-effectiveness-of-school-based-interventions Collado S, Staats H, Sancho P. Normative Influences on Adolescents’ Self-Reported Pro-Environmental Behaviors: The Role of Parents and Friends. Environ Behav. 2017;51(3):288–314. https://doi.org/10.1177/0013916517744591 . Comber A, Brunsdon C, Green E. Using a GIS-based network analysis to determine urban greenspace accessibility for different ethnic and religious groups. Landsc Urban Plann. 2008;86(1):103–14. https://doi.org/10.1016/j.landurbplan.2008.01.002 . Cottrill R, Robinson K, Clowes P, Corrigan S, Williams M, Gill V. (2025). National Education Nature Park - Process evaluation, research report . Coventry PA, Brown JE, Pervin J, Brabyn S, Pateman R, Breedvelt J, Gilbody S, Stancliffe R, McEachan R, White PL. Nature-based outdoor activities for mental and physical health: Systematic review and meta-analysis. SSM Popul Health. 2021;16:100934. https://doi.org/10.1016/j.ssmph.2021.100934 . Cox DTC, Bennie J, Casalegno S, Hudson HL, Anderson K, Gaston KJ. Skewed contributions of individual trees to indirect nature experiences. Landsc Urban Plann. 2019;185:28–34. https://doi.org/10.1016/j.landurbplan.2019.01.008 . Cox DTC, Shanahan DF, Hudson HL, Fuller RA, Anderson K, Hancock S, Gaston KJ. Doses of Nearby Nature Simultaneously Associated with Multiple Health Benefits. Int J Environ Res Public Health. 2017;14(2). https://doi.org/10.3390/ijerph14020172 . Cox DTC, Shanahan DF, Hudson HL, Plummer KE, Siriwardena GM, Fuller RA, Anderson K, Hancock S, Gaston KJ. Doses of Neighborhood Nature: The Benefits for Mental Health of Living with Nature. BioScience 67. 2017. https://doi.org/10.1093/biosci/biw173 . Crespo-Martín J, Corbacho‐Cuello I, Muñoz‐Losa A. Teacher Education as an Agent for Sustainability: Validation of an SDGs‐Focused Knowledge, Attitude, and Behavior Questionnaire for Pre‐Service Primary Teachers. Sustain Dev. 2025. https://doi.org/10.1002/sd.70084 . Davis Z, Jarvis I, Macaulay R, Johnson K, Williams N, Li J, Hahs A. A systematic review of the associations between biodiversity and children's mental health and wellbeing. Environ Res. 2025;266:120551. https://doi.org/10.1016/j.envres.2024.120551 . Department for Education. (2023a). Mental health support team school and college survey . Department for Education. (2023b). School output specification Technical annex 2J: sustainability . Department for Education. (2023c). Sustainability and climate change: a strategy for the education and children’s services systems . https://www.gov.uk/government/publications/sustainability-and-climate-change-strategy/sustainability-and-climate-change-a-strategy-for-the-education-and-childrens-services-systems Department for Education. (2024). DfE Sustainability and Climate Change Strategy: Evaluation Framework . https://assets.publishing.service.gov.uk/media/65b8fed74ec51d0014c9f16e/DfE_SCC_strategy_evaluation_framework_.pdf Department for Education. (2025a). Evaluation strategy 2025–2029 . Department for Education. (2025b). Government response to the curriculum and assessment review . Diaz S, Pascual U, Stenseke M, Martin-Lopez B, Watson RT, Molnar Z, Hill R, Chan KMA, Baste IA, Brauman KA, Polasky S, Church A, Lonsdale M, Larigauderie A, Leadley PW, van Oudenhoven, Plaat F, Schroter M, Lavorel S, Shirayama Y. Assessing nature's contributions to people. Science. 2018;359(6373):270–2. https://doi.org/10.1126/science.aap8826 . A. P. E., van der. Dillon J, Dickie I. (2012). Learning in the Natural Environment: Review of social and economic benefits and barriers (NECR092) . Dräger J, Klein M, Sosu E. The long-term consequences of early school absences for educational attainment and labour market outcomes. Br Edu Res J. 2024;50(4):1636–54. https://doi.org/10.1002/berj.3992 . Fazel M, Soneson E, Sellars E, Butler G, Stein A. Partnerships at the Interface of Education and Mental Health Services: The Utilisation and Acceptability of the Provision of Specialist Liaison and Teacher Skills Training. Int J Environ Res Public Health. 2023;20(5). https://doi.org/10.3390/ijerph20054066 . Forbes H, Wheeler B, Reeves J, Lovell R. How can funding for nature-based programmes impact health inequalities? A realist protocol. Syst Rev. 2025;14(1):204. https://doi.org/10.1186/s13643-025-02938-5 . Forest School Association. (2022). The Nature Premium campaign . https://forestschoolassociation.org/the-nature-premium-campaign/ Foulkes L, Holst G, C., Andrews JL. Potential harm from universal school-based mental health interventions: Candidate mechanisms and future directions. Curr Opin Psychol. 2026;67:102196. https://doi.org/10.1016/j.copsyc.2025.102196 . Garip G, Richardson M, Tinkler A, Glover S, Rees A. Development and implementation of evaluation resources for a green outdoor educational program [Article]. J Environ Educ. 2021;52(1):25–39. https://doi.org/10.1080/00958964.2020.1845588 . Garside R, Orr N, Short R, Lovell B, Husk K, McEachan R, Rashid R, Dickie I. (2020). Therapeutic Nature: Nature-based social prescribing for diagnosed mental health conditions in the UK . https://arc-swp.nihr.ac.uk/wp/wp-content/uploads/2021/06/15138_TherapeuticNature-Finalreport.pdf Greenwood A, Gatersleben B. Let's go outside! Environmental restoration amongst adolescents and the impact of friends and phones. J Environ Psychol. 2016;48:131–9. https://doi.org/10.1016/j.jenvp.2016.09.007 . Gush MB, Blanuša T, Chalmin-Pui LS, Griffiths A, Larsen EK, Prasad R, Redmile‐Gordon M, Sutcliffe C. Environmental horticulture for domestic and community gardens - An integrated and applied research approach. Plants People Planet. 2023;6(2):254–70. https://doi.org/10.1002/ppp3.10444 . Harris NM, Hartwell B, Thomas L, Grace M. How can nature connectedness and behaviours for learning be deliberately developed in children, adolescents and young adults? A systematic literature review. Child Adolesc Ment Health. 2025;30(2):168–85. https://doi.org/10.1111/camh.12774 . Harvey D, Jenkins S, Baker D, Hunt A. (2025). Different Journeys: Regional variations in English school residential visits and changes over time. The Council for Learning Outside the Classroom . Hazell J, Clarke E. (2024). Nurturing future leaders for nature: the example of the UK's National Education Nature Park. Philos Trans R Soc Lond B Biol Sci , 379 (1903), 20220330. https://doi.org/10.1098/rstb.2022.0330 Hickman C, Marks E, Pihkala P, Clayton S, Lewandowski RE, Mayall EE, Wray B, Mellor C, van Susteren L. Climate anxiety in children and young people and their beliefs about government responses to climate change: a global survey. Lancet Planet Health. 2021;5(12):e863–73. https://doi.org/10.1016/S2542-5196(21)00278-3 . Hopkins van Mil. (2025). Nature-based programmes for mental health and wellbeing in secondary schools Deliberative Policy Action (DPA) Workshop February 18th 2025 . Hyseni C, Heino J, Bini LM, Bjelke U, Johansson F. The importance of blue and green landscape connectivity for biodiversity in urban ponds. Basic Appl Ecol. 2021;57:129–45. https://doi.org/10.1016/j.baae.2021.10.004 . Institute for Outdoor Learning. (2026). Nature Premium . https://www.outdoor-learning.org/community/sector-specialist-groups/nature-premium.html Kearney CA, Dupont R, Fensken M, Gonzálvez C. (2023). School attendance problems and absenteeism as early warning signals: review and implications for health-based protocols and school-based practices. Frontiers in Education , 8 . https://doi.org/10.3389/feduc.2023.1253595 Kelly K, Polgreen K, Wilhelm K. (2026). Schools using nature for education and wellbeing: Mount Kelly School . https://www.agile-initiative.ox.ac.uk/wp-content/uploads/2026/02/Mount-Kelly-CS.pdf Ladbrook R, Polgreen K, Wilhelm K. (2026). Schools using nature for education and wellbeing: Wallingford School . https://www.agile-initiative.ox.ac.uk/wp-content/uploads/2026/02/Wallingford-CS.pdf Lawrance EL, Thompson R, Le Vay N, Page J, L., Jennings N. The Impact of Climate Change on Mental Health and Emotional Wellbeing: A Narrative Review of Current Evidence, and its Implications. Int Rev Psychiatry. 2022;34(5):443–98. https://doi.org/10.1080/09540261.2022.2128725 . Lekies KS, Yost G, Rode J. Urban youth׳s experiences of nature: Implications for outdoor adventure recreation. J Outdoor Recreation Tourism. 2015;9:1–10. https://doi.org/10.1016/j.jort.2015.03.002 . Letendre M. (2025). Barriers, Facilitators, and Moderators: Educator Perspectives on Implementation of Nature-based Programs for Mental Health and Well-being in UK Secondary Schools University of Oxford]. Oxford. https://ora.ox.ac.uk/objects/uuid:42f4f983-be19-484b-bcab-8b61f32924eb Lomax T, Butler J, Cipriani A, Singh I. Effect of nature on the mental health and well-being of children and adolescents: meta-review. Br J Psychiatry. 2024;1–9. https://doi.org/10.1192/bjp.2024.109 . Loose T, Fuoco J, Malboeuf-Hurtubise C, Ayotte-Beaudet JP, Gauvin L, Chadi N, Ouellet-Morin I, Masse B, Cote SM, Geoffroy MC. A Nature-Based Intervention and Mental Health of Schoolchildren: A Cluster Randomized Clinical Trial. JAMA Netw Open. 2024;7(11):e2444824. https://doi.org/10.1001/jamanetworkopen.2024.44824 . Lorimer J, Menon S, Polgreen K, Wilhelm K, Singh I. (2025). A scoping review of nature-based programmes in schools for mental health and wellbeing in young people (pre-print). https://doi.org/10.31234/osf.io/rf5xd_v1 Lovell R. (2019). What Works in school based natural environment interventions: A scoping review . Lumber R, Richardson M, Sheffield D. Beyond knowing nature: Contact, emotion, compassion, meaning, and beauty are pathways to nature connection. PLoS ONE. 2017;12(5):e0177186. https://doi.org/10.1371/journal.pone.0177186 . Lyreskog D, Menon S, Hohnen-Ford W, McKeown A, Wilhelm K, Pulcu E, Iyadurai L, Singh I. (2025). Ethical Challenges to Green Social Prescribing in the UK Mental Health System (pre-print). https://doi.org/10.31234/osf.io/ehbq5_v1 MacGregor S, Friesen S, Turner J, Domene JF, McMorris C, Allan S, Mesner B, Sumara D. The Side Effects of Universal School-Based Mental Health Supports: An Integrative Review. Rev Res Educ. 2024;48(1):28–57. https://doi.org/10.3102/0091732x241256628 . MacLean A, Hunt K, Sweeting H. Symptoms of Mental Health Problems: Children's and Adolescents' Understandings and Implications for Gender Differences in Help Seeking. Child Soc. 2013;27(3):161–73. https://doi.org/10.1111/j.1099-0860.2011.00406.x . MacNaughton P, Eitland E, Kloog I, Schwartz J, Allen J. Impact of Particulate Matter Exposure and Surrounding Greenness on Chronic Absenteeism in Massachusetts Public Schools. Int J Environ Res Public Health. 2017;14(2). https://doi.org/10.3390/ijerph14020207 . Mann J, Gray T, Truong S, Brymer E, Passy R, Ho S, Sahlberg P, Ward K, Bentsen P, Curry C, Cowper R. Getting Out of the Classroom and Into Nature: A Systematic Review of Nature-Specific Outdoor Learning on School Children's Learning and Development. Front Public Health. 2022;10:877058. https://doi.org/10.3389/fpubh.2022.877058 . Marselle MR, Lindley SJ, Cook PA, Bonn A. Biodiversity and Health in the Urban Environment. Curr Environ Health Rep. 2021;8(2):146–56. https://doi.org/10.1007/s40572-021-00313-9 . McCormick R. Does Access to Green Space Impact the Mental Well-being of Children: A Systematic Review. J Pediatr Nurs. 2017;37:3–7. https://doi.org/10.1016/j.pedn.2017.08.027 . Montana J, Ferguson C, Marshall T, Barrios-O’Neill D, Bavin S, Cardinal I, Crockatt M, Gent J, Hafferty C, Hirons M, Hughes J, Janda E, Maxwell S, Mailley J, McDermott M, Mitchell M, Owen R, Rydlewski J, Sheffield D, Simms C, Slessor J, Veríssimo D, Wilhelm K. (2023). Large-scale social surveys on people and nature relations: Report on the state of the art in the UK . Montero-Marin J, Allwood M, Ball S, Crane C, De Wilde K, Hinze V, Jones B, Lord L, Nuthall E, Raja A, Taylor L, Tudor K, Team M, Blakemore SJ, Byford S, Dalgleish T, Ford T, Greenberg MT, Ukoumunne OC, Kuyken W. School-based mindfulness training in early adolescence: what works, for whom and how in the MYRIAD trial? Evid Based Ment Health. 2022;25(3):117–24. https://doi.org/10.1136/ebmental-2022-300439 . Moore J, Malhi Y, Wilhelm K, Awad E, Broome M, Crisp R, Geddes J, Hart A, Hinze V, Hiscock S, Lomax T, Kuyken W, Maloney S, Marlowe K, Montero-Marín J, Murphy K, De Neve JE, Reinecke MG, Savulescu J, Singh I. (2025). Ecological-Collective-Flourishing: A radical proposal for research and policy to develop and sustain human and environmental flourishing (pre-print). https://doi.org/https://doi.org/10.31234/osf.io/5gphe Natural England. (2024a). The Children and Nature Programme 2019–2022 . Natural England. (2024b). The Children’s People and Nature Survey for England . Natural England. (2024c). NEER030 A narrative review of reviews of nature exposure and human health and well-being in the UK (NEER030). Natural England. (2025). The Children’s People and Nature Survey for England: 2025 update . https://www.gov.uk/government/statistics/the-childrens-people-and-nature-survey-for-england-2025-update/the-childrens-people-and-nature-survey-for-england-2025-update Neurohr AL, Pasch N, Otto S, Moller A. Measuring adolescents' level of interest in nature: a promising psychological factor facilitating nature protection. Front Psychol. 2023;14:1186557. https://doi.org/10.3389/fpsyg.2023.1186557 . Le Newberry J, Cunningham A, Soul L, Dave H, Hoath L, Lawrance EL. Integrating mental health into climate change education to inspire climate action while safeguarding mental health. Front Psychol. 2023;14:1298623. https://doi.org/10.3389/fpsyg.2023.1298623 . NHS Digital. (2023). Mental health of children and young people in England, 2023: Wave 4 follow–up to the 2017 survey. NHS England https://www.gov.uk/government/statistics/mental-health-of-children-and-young-people-in-england-2023-wave-4-follow-up-to-the-2017-survey NHS England. (2019, updated 2025). Fit for the future: 10 Year Health Plan for England https://assets.publishing.service.gov.uk/media/6888a0b1a11f859994409147/fit-for-the-future-10-year-health-plan-for-england.pdf Nisbet EK, Zelenski JM, Murphy SA. The Nature Relatedness Scale. Environ Behav. 2008;41(5):715–40. https://doi.org/10.1177/0013916508318748 . O’Malley S, Pierce J. Mainstream or margins? The changing role of environmental education in Irish primary school curricula, 1872 to 2021. J outdoor Environ Educ. 2022;26(2):189–206. https://doi.org/10.1007/s42322-022-00118-w . Ofsted. (2025). Education inspection framework: for use from November 2025. https://www.gov.uk/government/publications/education-inspection-framework/education-inspection-framework-for-use-from-november-2025 Olsson D, Gericke N. The adolescent dip in students' sustainability consciousness—Implications for education for sustainable development. J Environ Educ. 2015;47(1):35–51. https://doi.org/10.1080/00958964.2015.1075464 . Overbey TA, Diekmann F, Lekies KS. Nature-based interventions for vulnerable youth: a scoping review. Int J Environ Health Res. 2023;33(1):15–53. https://doi.org/10.1080/09603123.2021.1998390 . Patel V, Saxena S, Lund C, Kohrt B, Kieling C, Sunkel C, Kola L, Chang O, Charlson F, O'Neill K, Herrman H. Transforming mental health systems globally: principles and policy recommendations. Lancet. 2023;402(10402):656–66. https://doi.org/10.1016/S0140-6736(23)00918-2 . Pereira M, Forster PM. (2015). The Relationship between Connectedness to Nature, Environmental Values, and Pro-environmental Behaviours. Reinvention: Int J Undergrad Res, 8 (2). https://warwick.ac.uk/fac/cross_fac/iatl/research/reinvention/archive/volume8issue2/pereira/ Pirchio S, Passiatore Y, Panno A, Cipparone M, Carrus G. The Effects of Contact With Nature During Outdoor Environmental Education on Students' Wellbeing, Connectedness to Nature and Pro-sociality. Front Psychol. 2021;12:648458. https://doi.org/10.3389/fpsyg.2021.648458 . Price A. Improving school attendance: can participation in outdoor learning influence attendance for young people with social, emotional and behavioural difficulties? J Adventure Educ Outdoor Learn. 2013;15(2):110–22. https://doi.org/10.1080/14729679.2013.850732 . Price E, Maguire S, Firth C, Lumber R, Richardson M, Young R. Factors associated with nature connectedness in school-aged children. Curr Res Ecol Social Psychol. 2022;3. https://doi.org/10.1016/j.cresp.2022.100037 . Qin Z, Wu Q, Bi C, Deng Y, Hu Q. The relationship between climate change anxiety and pro-environmental behavior in adolescents: the mediating role of future self-continuity and the moderating role of green self-efficacy. BMC Psychol. 2024;12(1):241. https://doi.org/10.1186/s40359-024-01746-1 . Reed H, Couturiaux D, Davis M, Edwards A, Janes E, Kim HS, Melendez-Torres GJ, Murphy S, Rotevatn TA, Smith J, Evans R. Co-production as an Emerging Methodology for Developing School-Based Health Interventions with Students Aged 11–16: Systematic Review of Intervention Types, Theories and Processes and Thematic Synthesis of Stakeholders' Experiences. Prev Sci. 2021;22(4):475–91. https://doi.org/10.1007/s11121-020-01182-8 . Reed H, Murphy S, Evans R. Optimising a co-production framework for developing public health interventions: application and testing of school-based Research Action Groups. Health Res Policy Syst. 2023;21(1):133. https://doi.org/10.1186/s12961-023-01086-3 . Rian SW, Coll KM. Increased Exposure to Nature Reduces Elementary Students' Anxiety. Ecopsychology. 2021;13(4):257–64. https://doi.org/10.1089/eco.2020.0070 . Rice B. (2023). The missing link. Social prescribing for children and young people . Richardson M, Hunt A, Hinds J, Bragg R, Fido D, Petronzi D, Barbett L, Clitherow T, White M. A Measure of Nature Connectedness for Children and Adults: Validation, Performance, and Insights. Sustainability. 2019;11(12). https://doi.org/10.3390/su11123250 . Richardson M, Passmore H-A, Lumber R, Thomas R, Hunt A. Moments, not minutes: The nature-wellbeing relationship. Int J Wellbeing. 2021;11(1):8–33. https://doi.org/10.5502/ijw.v11i1.1267 . Rigolon A, Browning M, McAnirlin O, Yoon HV. Green Space and Health Equity: A Systematic Review on the Potential of Green Space to Reduce Health Disparities. Int J Environ Res Public Health. 2021;18(5). https://doi.org/10.3390/ijerph18052563 . Robinson JM, Barrable A. (2023). Optimising Early Childhood Educational Settings for Health Using Nature-Based Solutions: The Microbiome Aspect. Education Sciences , 13 (2). https://doi.org/ARTN 21110.3390/educsci13020211. Ruiz-Gallardo J-R, Verde A, Valdés A. Garden-Based Learning: An Experience With At Risk Secondary Education Students. J Environ Educ. 2013;44(4):252–70. https://doi.org/10.1080/00958964.2013.786669 . Rushton EAC, Walshe N. Curriculum making and climate change and sustainability education: a case study of school teachers’ practices from England, UK. Environ Educ Res. 2025;31(5):1083–97. https://doi.org/10.1080/13504622.2025.2471990 . Shrestha T, Voon Yi Chi C, Cassarino M, Foley S, Di Blasi Z. Factors influencing the effectiveness of nature-based interventions (NBIs) aimed at improving mental health and wellbeing: An umbrella review. Environ Int. 2025;196:109217. https://doi.org/10.1016/j.envint.2024.109217 . Singh I, Viding E, Spencer L, Austin C, Kokan ZR, Stringaris A. The need for a science of patient and public involvement and participation in child and adolescent mental health research. Nat Mental Health. 2025. https://doi.org/10.1038/s44220-025-00497-1 . Snaith B, Odedun A. Weeds, wildflowers, and White privilege: Why recognizing nature’s cultural content is key to ethnically inclusive urban greenspaces. J Race Ethn City. 2023;5(1):1–27. https://doi.org/10.1080/26884674.2023.2224115 . Solmi M, Radua J, Olivola M, Croce E, Soardo L, Salazar de Pablo G, Il Shin J, Kirkbride JB, Jones P, Kim JH, Kim JY, Carvalho AF, Seeman MV, Correll CU, Fusar-Poli P. Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Mol Psychiatry. 2022;27(1):281–95. https://doi.org/10.1038/s41380-021-01161-7 . Sprague N, Berrigan D, Ekenga CC. An Analysis of the Educational and Health-Related Benefits of Nature-Based Environmental Education in Low-Income Black and Hispanic Children. Health equity. 2020;4(1):198–210. https://doi.org/10.1089/heq.2019.0118 . Staniszewska S, Denegri S, Matthews R, Minogue V. Reviewing progress in public involvement in NIHR research: developing and implementing a new vision for the future. BMJ Open. 2018;8(7):e017124. https://doi.org/10.1136/bmjopen-2017-017124 . Tanaji AT, Usman AH, Jackaria PM, Jaudinez AS, Abubakar A-JU. Effectiveness of outdoor mathematics in developing grade 7 students’ ability on measurement. J Educ Learn (EduLearn). 2026;20(1):48–55. https://doi.org/10.11591/edulearn.v20i1.22780 . Taylor L, Hochuli DF. Defining greenspace: Multiple uses across multiple disciplines. Landsc Urban Plann. 2017;158:25–38. https://doi.org/10.1016/j.landurbplan.2016.09.024 . The Wildlife Trust. (2023). A Natural Health Service - Improving lives and saving money . Tillmann S, Tobin D, Avison W, Gilliland J. Mental health benefits of interactions with nature in children and teenagers: a systematic review. J Epidemiol Commun Health. 2018;72(10):958. https://doi.org/10.1136/jech-2018-210436 . Tsiachristas A, Arshad S, Lorimer J, Singh I, Wilhelm K. (2025). Conceptual Framework for Assessing the Economic Impact of Nature-based Programmes on the Mental Health and Well-Being of Adolescents (secondary school-aged students) . Turcotte-Tremblay AM, Fortier G, Belanger RE, Dion B, Gansaonre C, Leatherdale RJ, S. T., Haddad S. Adolescents' impairment due to climate anxiety is associated with self-efficacy and behavioral engagement: a cross-sectional analysis in Quebec (Canada). BMC Public Health. 2024;24(1):3009. https://doi.org/10.1186/s12889-024-20333-y . Twohig-Bennett C, Jones A. The health benefits of the great outdoors: A systematic review and meta-analysis of greenspace exposure and health outcomes. Environ Res. 2018;166:628–37. https://doi.org/10.1016/j.envres.2018.06.030 . UK Parliament. (2020). Nature Premium campaign (Early Day Motion No. 953) . Retrieved from https://edm.parliament.uk/early-day-motion/57507/nature-premium-campaign Ulrich RS, Parsons R. (1992). Influences of passive experiences with plants on individual well-being and health. In D. Relf, editor, The role of Horticulture in Human Well-being and Social Development . Timber Press. https://www.researchgate.net/profile/Roger-Ulrich-2/publication/343722421_Ulrich_Parsons_1992_Influences_of_experiences_with_plants_on_well-being_and_health/links/5f3be9e892851cd3020190cd/Ulrich-Parsons-1992-Influences-of-experiences-with-plants-on-well-being-and-health.pdf UNESCO, editor. (2024). Green school quality standard – Greening every learning environment . https://doi.org/10.54675/locx2930 Vakalis D, Lepine C, MacLean HL, Siegel JA. Can green schools influence academic performance? Crit Rev Environ Sci Technol. 2020;51(13):1354–96. https://doi.org/10.1080/10643389.2020.1753631 . van Poortvliet M. School absence, academic attainment, and mental health: Longitudinal findings from the UK. Child Youth Serv Rev. 2025. https://doi.org/10.1016/j.childyouth.2025.108634 . Veibiakkim R, Shkaruba A, Sepp K. A systematic review of urban ecosystem disservices and its evaluation: Key findings and implications. Environ Sustain Indic. 2025;26. https://doi.org/10.1016/j.indic.2025.100612 . Waite S, Husain F, Scandone B, Forsyth E, Piggott H. It’s not for people like (them)’: structural and cultural barriers to children and young people engaging with nature outside schooling. J Adventure Educ Outdoor Learn. 2021;23(1):54–73. https://doi.org/10.1080/14729679.2021.1935286 . Walker E, Bormpoudakis D, Tzanopoulos J. Assessing challenges and opportunities for schools’ access to nature in England. Urban Forestry Urban Green. 2021;61. https://doi.org/10.1016/j.ufug.2021.127097 . Wang H, Gholami S, Xu W, Samavatekbatan A, Sleipness O, Tassinary LG. Where and how to invest in greenspace for optimal health benefits: a systematic review of greenspace morphology and human health relationships. Lancet Planet Health. 2024;8(8):e574–87. https://doi.org/10.1016/S2542-5196(24)00140-2 . Whitburn J, Linklater W, Abrahamse W. Meta-analysis of human connection to nature and proenvironmental behavior. Conserv Biol. 2020;34(1):180–93. https://doi.org/10.1111/cobi.13381 . WHO. (2017). Urban Green Space Interventions and Health - A review of impact and effectiveness . https://www.cbd.int/health/who-euro-green-spaces-urbanhealth.pdf Wilhelm K, Lomax T, McCarthy L, Boyle JS, Menon S, Hall J, Freebody J, Hart A, Fleming W, Danziger J, Coombes MA, Singh I. (2026). The Role of Hybrid Green Spaces in Secure Psychiatric Care. Wellbeing, Space and Society . https://doi.org/10.1016/j.wss.2026.100348 Wilkening JL, Chausson A, Smith A, Reger RZ-Z, O’Callaghan B, Clement M, Zapata Y, F., Seddon N. Harnessing nature-based solutions for economic recovery: A systematic review. PLOS Clim. 2024;3(10). https://doi.org/10.1371/journal.pclm.0000281 . Yamashita R, Chen C, Matsubara T, Hagiwara K, Inamura M, Aga K, Hirotsu M, Seki T, Takao A, Nakagawa E, Kobayashi A, Fujii Y, Hirata K, Ikei H, Miyazaki Y, Nakagawa S. The Mood-Improving Effect of Viewing Images of Nature and Its Neural Substrate. Int J Environ Res Public Health. 2021;18(10). https://doi.org/10.3390/ijerph18105500 . Zamora AN, Waselewski ME, Frank AJ, Nawrocki JR, Hanson AR, Chang T. Exploring the beliefs and perceptions of spending time in nature among U.S. youth. BMC Public Health. 2021;21(1):1586. https://doi.org/10.1186/s12889-021-11622-x . Zhang Y, Mavoa S, Zhao J, Raphael D, Smith M. The Association between Green Space and Adolescents' Mental Well-Being: A Systematic Review. Int J Environ Res Public Health. 2020;17(18). https://doi.org/10.3390/ijerph17186640 . Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9131492","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":616797933,"identity":"b350fc6a-f9fa-47ac-abcd-c5bc83bb36fa","order_by":0,"name":"Jessica Lorimer","email":"","orcid":"","institution":"University of Oxfrd","correspondingAuthor":false,"prefix":"","firstName":"Jessica","middleName":"","lastName":"Lorimer","suffix":""},{"id":616797934,"identity":"492bd13a-8da5-4b63-9713-f292a589217d","order_by":1,"name":"Apostolos Tsiachristas","email":"","orcid":"","institution":"University of Oxford","correspondingAuthor":false,"prefix":"","firstName":"Apostolos","middleName":"","lastName":"Tsiachristas","suffix":""},{"id":616797935,"identity":"a9c52440-6a65-4177-932e-35330b9fd3c4","order_by":2,"name":"Sabah Arshad","email":"","orcid":"","institution":"University of Oxford","correspondingAuthor":false,"prefix":"","firstName":"Sabah","middleName":"","lastName":"Arshad","suffix":""},{"id":616797936,"identity":"74ab4ebb-453e-46fe-86d1-1981c3492799","order_by":3,"name":"Kim Polgreen","email":"","orcid":"","institution":"University of Oxford","correspondingAuthor":false,"prefix":"","firstName":"Kim","middleName":"","lastName":"Polgreen","suffix":""},{"id":616797937,"identity":"e3712965-0135-4730-92ef-709a0cfa92b7","order_by":4,"name":"Rodger Caseby","email":"","orcid":"","institution":"University of Oxford","correspondingAuthor":false,"prefix":"","firstName":"Rodger","middleName":"","lastName":"Caseby","suffix":""},{"id":616797938,"identity":"c7100606-910d-41ea-b1bd-c8fcc4f716e9","order_by":5,"name":"Sasha Menon","email":"","orcid":"","institution":"University of Cambridge","correspondingAuthor":false,"prefix":"","firstName":"Sasha","middleName":"","lastName":"Menon","suffix":""},{"id":616797939,"identity":"dd6ef217-fff4-41e3-95c8-2930f9cdedd4","order_by":6,"name":"Madelyn Letendre","email":"","orcid":"","institution":"University of Oxford","correspondingAuthor":false,"prefix":"","firstName":"Madelyn","middleName":"","lastName":"Letendre","suffix":""},{"id":616797940,"identity":"2e2f5bb8-14e5-4912-a7c6-181be492bd71","order_by":7,"name":"Ilina Singh","email":"","orcid":"","institution":"University of Oxford","correspondingAuthor":false,"prefix":"","firstName":"Ilina","middleName":"","lastName":"Singh","suffix":""},{"id":616797941,"identity":"6de787ed-9506-4f74-963d-265bb06d45e4","order_by":8,"name":"Katrin Wilhelm","email":"data:image/png;base64,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","orcid":"","institution":"University of Oxford","correspondingAuthor":true,"prefix":"","firstName":"Katrin","middleName":"","lastName":"Wilhelm","suffix":""}],"badges":[],"createdAt":"2026-03-15 23:38:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9131492/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9131492/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106208607,"identity":"ab869040-a62f-4212-b5b9-67fef4475fe8","added_by":"auto","created_at":"2026-04-06 06:33:02","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":227956,"visible":true,"origin":"","legend":"\u003cp\u003eFramework for economic evaluation of student mental health and wellbeing (MHWB) interventions. The model illustrates a range of potential outcomes that NbPs could have at different levels and timeline.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9131492/v1/4b06015265b2dfd6b354ed7b.jpeg"},{"id":106208608,"identity":"00a483fb-97f2-4f32-a064-a8f5ff86c57b","added_by":"auto","created_at":"2026-04-06 06:33:02","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":88785,"visible":true,"origin":"","legend":"\u003cp\u003eBenefit-led, J-shaped cost–benefit model showing how early, targeted NbP investment can generate long-term social and educational returns (Tsiachristas et al., 2025).\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9131492/v1/a6d05dac6048356f521c0d04.jpeg"},{"id":108180657,"identity":"65847a0f-2d57-4939-bc13-06a08ff71175","added_by":"auto","created_at":"2026-04-30 08:51:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1149799,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9131492/v1/fed1a598-d104-4be0-8416-0f4654a32b32.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Scaling nature-based programmes for adolescent mental health and wellbeing: Evidence- informed policy and research directions from England","fulltext":[{"header":"Panel 1: Policy Highlights as roadmap for implementation","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"603\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePanel 1: Policy Highlights as roadmap for implementation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThese short-, medium-, and long-term action pathways are designed for England but can be adapted to other contexts integrating nature-based programmes into education and mental health and wellbeing policy.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48.5904%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eImplementation priorities\u003c/strong\u003e\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eIntegration: School leaders align NbPs with \u003cem\u003ewhole-school\u003c/em\u003e MHWB approaches and Climate Action Plans, embedding activities within core curriculum and pastoral provision where feasible, rather than treating them as optional enrichment, with a blended universal‑plus‑targeted offer for pupils at greater risk (for example in flood‑ or heat‑exposed communities and those with higher MHWB need). Given growing evidence linking climate change and mental health risk, such integration is preventative, not an optional add-on\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(Lawrance et al., 2022; Newberry Le Vay et al., 2023)\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eInspection alignment:\u003c/strong\u003e \u003cstrong\u003eOfsted\u0026rsquo;s Education Inspection Framework, which places greater emphasis on pupil personal development and wellbeing\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(Ofsted, 2025)\u003c/strong\u003e\u003cstrong\u003e, could explicitly recognise nature-based work as evidence of behaviour, attendance, attitudes, and personal development.\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCo-design and equity assurance:\u003c/strong\u003e Engage students, teachers, and families, supported by national guidance from DfE\u003csup\u003e1\u003c/sup\u003e and local authorities, ensuring equitable access and participation, with attention to underserved groups.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eTime and training: DfE and teacher-training providers should, where feasible, embed NbPs within existing ITT\u003csup\u003e2\u003c/sup\u003e, PGCE\u003csup\u003e3\u003c/sup\u003e, and CPD\u003csup\u003e4\u0026nbsp;\u003c/sup\u003econtent offers (e.g., science, geography PE), while schools protect flexibility in directed time so educators can build capacity to deliver and evaluate NbPs confidently.\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eInteroperability: DfE, DEFRA\u003csup\u003e5\u003c/sup\u003e, DHSC\u003csup\u003e6\u003c/sup\u003e, and NHS\u003csup\u003e7\u003c/sup\u003e England work toward a shared core set of high-level definitions, outcome domains and minimum data items for NbPs, while allowing locally chosen and co-produced measures, so that innovative approaches can still be compared, evaluated and learned from across sectors.\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCross-sector coordination\u003c/strong\u003e: Central government (DfE, DEFRA, DHSC), local authorities, NHS partners set out high-level frameworks for roles and funding levers: local authorities and ICS\u003csup\u003e8\u003c/sup\u003e/NHS partners agree local\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.15091%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48.2587%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003earrangements with schools to join up existing MHSTs\u003csup\u003e9\u003c/sup\u003e, climate and NbPs initiatives, rather than creating new structures from scratch.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePathway for action\u003c/strong\u003e\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eImmediate (12\u0026ndash;18 months): DfE, local authorities, NGOs, and NENP partners support schools to establish baseline data on MHWB and green estate, pilot evidence-informed programmes across diverse secondary settings, and co-develop\u0026nbsp;\u003c/strong\u003edevelopmentally appropriate and adolescent-informed\u0026nbsp;\u003cstrong\u003emeasures with students and staff.\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eMedium term (2\u0026ndash;3 years): National and local agencies (e.g., DfE, local authorities\u0026rsquo; education, children\u0026rsquo;s services and public health teams; ICS) build interoperable datasets, align education, sustainability and MHWB systems, while schools and teacher-education providers expand cross-sector training, evaluation capacity and curriculum integration.\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eLong term (3\u0026ndash;5\u003csup\u003e+\u003c/sup\u003e years): Government departments formally embed NbPs within statutory guidance and curriculum frameworks\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(including careers guidance and relevant national curriculum subjects such as geography, science, citizenship and PE; Department for Education, 2025b)\u003c/strong\u003e\u003cstrong\u003e), RSHE\u003csup\u003e10\u003c/sup\u003e, and the core enrichment entitlement, while schools institutionalise co-production and establish ongoing NbPs cycles with education, sustainability, and MHWB policy.\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003e\u003cstrong\u003eRisks and safeguards\u003c/strong\u003e\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eRisks:\u003c/strong\u003e Without thoughtful design and targeting, NbPs may disproportionally benefit already well served pupils and schools, missing those facing the greatest barriers and widening wellbeing or attainment gaps. Support for inclusive design, simple evaluation, and shared practice might mitigate for this risk (while allowing for local innovation and adaptation to context).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSafeguards:\u003c/strong\u003e Ensure participatory and evidence-informed design, rigorous data-driven evaluation, and continuous equity audits.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"1 Introduction","content":"\u003cp\u003eChildren and young people (CYP) in England are facing rising mental health challenges and environmental decline. One in five children and young people aged 8\u0026ndash;25 now experience a probable mental health disorder (NHS Digital, \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). At the same time, 59% of young people age 16\u0026ndash;25 globally report serious worries about climate change (Hickman et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). A growing body of research indicates that climate-related worry may contribute to distress for some children and young people, particularly in combination with other risk factors (Newberry Le Vay et al., 2023). The UK is one of the most nature-depleted countries in Europe (Taylor \u0026amp; Hochuli, \u003cspan citationid=\"CR108\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Here we define \u0026ldquo;\u003cem\u003eNature\u003c/em\u003e\u0026rdquo; following The Children\u0026rsquo;s People and Nature Survey for England (2024) definition, encompassing everyday green and blue spaces such as gardens, parks, woods, and waterways (Natural England, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e2024b\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAddressing these intersecting trends is therefore essential for developing effective and timely responses for this generation. Hence, policy professionals and other stakeholders are increasingly exploring nature-based programmes as a means to supporting mental health and wellbeing while simultaneously addressing environmental decline. Recent policy developments include the UK Department for Education\u0026rsquo;s (DfE) Sustainability and Climate Change strategy 2023 (Department for Education, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2023c\u003c/span\u003e), the National Education Nature Park (NENP), and school gardening initiatives (Gush et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), which signal growing political commitment to embedding nature in education.\u003c/p\u003e \u003cp\u003eCurrent evidence indicates that, in some contexts, nature contact and certain nature-based programmes have been associated with improvements in specific aspects of young people\u0026rsquo;s mental health and wellbeing, but overall findings are mixed and study quality is variable (Campbell et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2026\u003c/span\u003e; Lorimer et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Twohig-Bennett \u0026amp; Jones, \u003cspan citationid=\"CR113\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Although some initiatives explicitly aim to strengthen nature connection (Barthel et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), much of the child and adolescent literature still conceptualises nature primarily as exposure or engagement, rather than rigorously testing nature connection as a primary mechanism of change. As a result, the active pathways through which nature-based programmes might support mental health and wellbeing, including, but not limited to, changes in nature connection remain only partially specified and empirically under-tested (Loose et al., \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Tillmann et al., \u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). In view of this, nature-based programmes remain uncommon in UK secondary schools, and the evidence base for both universal and targeted school-based approaches remains limited and uneven (Chiumento et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTaken together, these limitations pose a practical policy challenge: waiting for more definitive evidence may delay potentially beneficial interventions, while large-scale implementation without rigorous evaluation could lead to inefficiency or unintended harms. However, in the context of rising demand and constrained mental health and wellbeing provision in England, nature-based programmes represent a relatively low-risk approach, where risks relate mainly to opportunity costs and the potential for unintended harms from poorly designed or implemented programmes. They also offer the prospect of multiple co-benefits, including potential mental health and wellbeing gains, educational and socio-emotional benefits, and contributions to environmental stewardship and biodiversity where programmes involve conservation or habitat-enhancing activities (Bratman et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Garip et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Thus, while direct evidence that increasing nature connection causes improved mental health and wellbeing in young people remains limited, the combination of early positive findings, indication that many children value time in nature, relatively low cost, and environmental co-benefits creates a reasonable case for further implementation and rigorous evaluation (Natural England, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2024a\u003c/span\u003e; Tillmann et al., \u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). A pragmatic approach is therefore to treat nature-based programmes as emerging but not yet fully evidenced approaches that warrant cautious piloting, rigorous evaluation, and iterative development within existing school educational, mental health and wellbeing systems.\u003c/p\u003e \u003cp\u003eThis paper proposes evidence-informed policy directions and research priorities for the integrated development and rigorous evaluation of nature-based programmes in secondary schools, with the aim of improving adolescent mental health and wellbeing while building the evidence base needed to scale effective provision. We first outline why adolescence and schools are critical for both mental health and wellbeing, and nature engagement, and why this moment presents a unique window for policy and research.\u003c/p\u003e"},{"header":"2 Why adolescence, why schools, why now?","content":"\u003cp\u003eThree observations motivate our focus. First, mental health challenges intensify at the start of adolescence, with data suggesting a rise in anxiety and depression between ages 11\u0026ndash;15 (Clarke et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Solmi et al., \u003cspan citationid=\"CR104\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Second, during this same period, subjective reports of nature connection measured using tools such as the Nature Connectedness Index (NCI) reach a lifetime low, a phenomenon termed the \u0026ldquo;teenage dip\u0026rdquo; (Olsson \u0026amp; Gericke, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Price et al., \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Richardson et al., \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Third, studies suggest that \u0026lsquo;nature connectedness\u0026rsquo; is linked both to positive mental health and wellbeing (MHWB) outcomes in adolescents and with greater pro-environmental attitudes and behaviours, suggesting that fostering this relationship may yield both psychological and ecological benefits (Lumber et al., \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Mann et al., \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Nisbet et al., \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Pirchio et al., \u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eTaken together, these observations support two related hypotheses: (1) Nature-based Programmes (NbPs) that maintain the human-nature relationship before and during early adolescence may buffer against MHWB decline; and (2) that adolescents who are encouraged to maintain this relationship will be more likely to develop pro-environmental behaviours, influenced by factors including green self-efficacy, biospheric values, and climate concerns (Balundė et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Becht et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Pereira \u0026amp; Forster, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Qin et al., \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Turcotte-Tremblay et al., \u003cspan citationid=\"CR112\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Such outcomes would also align with the DfE's green skills agenda (Department for Education, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). These hypotheses are particularly salient given that schools often provide the primary \u0026ndash; for some students, the only \u0026ndash; reliable access to nature, emphasising their pivotal role in equitable exposure. A recent review by Natural England identified England\u0026rsquo;s schools as the main source of access to nature for 28% of children, increasing to 43% for those with disabilities (Natural England, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Children from low-income families, minority ethnic and refugee backgrounds, and those with disabilities face the greatest barriers to nature engagement outside school, making schools a critical setting for equitable provision (Waite et al., \u003cspan citationid=\"CR120\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBeyond access, schools provide stable institutional settings for multi-year programmes and longitudinal evaluation of student outcomes; though realising this potential requires additional capacity and resources (Comber et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Price et al., \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Rigolon et al., \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Emerging evidence links NbPs to improved attendance, though effects are modest and require rigorous evaluation (MacNaughton et al., \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Price, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Rice, \u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Ruiz-Gallardo et al., \u003cspan citationid=\"CR99\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Schools\u0026rsquo; dual roles in providing equitable nature access and delivering sustainability education position them uniquely to prepare young people for a rapidly changing environment and to address inequalities in nature engagement (Department for Education, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2025b\u003c/span\u003e). However, translating this potential into effective and equitable practice is not straightforward. Four challenges account for this gap.\u003c/p\u003e \u003cp\u003eFirst, evidence for universal school-based programmes is mixed. Outcomes appear sensitive to programme quality, facilitator confidence, contextual fit, and implementation fidelity, rather than nature exposure alone (Richardson et al., \u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Sprague et al., \u003cspan citationid=\"CR105\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Poorly designed or delivered universal approaches may even produce unintended harms (Foulkes et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2026\u003c/span\u003e; MacGregor et al., \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), a risk that is unevenly distributed given substantial variation in green space access and resources between state and private school settings. In contrast, targeted interventions for adolescents with existing anxiety or depression demonstrate more consistent symptom reduction, which is particularly relevant given the impacts of climate change on MH (Overbey et al., \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Rian \u0026amp; Coll, \u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Second, inconsistent definitions and metrics hinder implementation and evaluation. Constructs such as \u0026lsquo;\u003cem\u003enature connectedness\u003c/em\u003e, \u003cem\u003e\u0026lsquo;nature relatedness\u003c/em\u003e,\u0026rsquo; and \u0026lsquo;\u003cem\u003enature exposure\u0026rsquo;\u003c/em\u003e capture different dimensions (emotional connection to nature (feeling good in nature), ecological understanding (knowing about nature), and environmental values (caring about protecting nature), yet are used interchangeably. This matters theoretically as well as methodologically, because cognitive recognition of nature\u0026rsquo;s value and emotional closeness to nature may not align for all individuals, and their respective links with adolescent wellbeing and pro‑environmental behaviour are not yet well characterised. Most scales are developed either for children or for adults and fail to address important adolescent motivational and social dynamics (Greenwood \u0026amp; Gatersleben, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Neurohr et al., \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). This is particularly important as adolescents may perceive NbPs as inappropriate for their age group (Hopkins van Mil, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Clarity about targeted outcomes is essential for effective design and evaluation (Pereira \u0026amp; Forster, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThird, practical barriers to implementing NbPs in schools divide into (i) contextual factors, such as weather, health limitations, academic pressures, and safety perceptions, and (ii) operational constraints, including limited teacher training, inadequate facilities, and sustainability challenges (Price et al., \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Finally, the school green estate requires attention as a MHWB and nature relationship determinant (McCormick, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Socioeconomic and spatial inequities mean that under-resourced communities are more likely to have smaller, lower-quality green spaces, potentially limited biodiversity, reduced maintenance budgets, safety concerns such as vandalism and environmental hazards in addition to outdoor spaces that might not reflect the cultural identities and practices of the communities they serve (Bar\u0026oacute; et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Zhang et al., \u003cspan citationid=\"CR129\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTogether these gaps argue for a cautious yet pro-active stance: NbPs should not be treated as a simple or stand-alone solution, yet their demonstrated benefits for targeted groups justify equity-focused pilot-to-evaluation pathways that can generate transferable evidence for wider and scalable adoption. Building on a rapid scoping review (Lorimer et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), stakeholder interviews (Hopkins van Mil, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), and an economic modelling exercise (Tsiachristas et al., \u003cspan citationid=\"CR111\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), we therefore present a tiered policy pathway that prioritises co-production with young people and educators, as the primary mechanism for ensuring programmes are developmentally appropriate, equitably delivered, and safeguarded against ineffectiveness and unintended harm.\u003c/p\u003e"},{"header":"3 Methodological Approach","content":"\u003cp\u003e \u003cb\u003eDesign and Rationale\u003c/b\u003e \u003c/p\u003e \u003cp\u003eGuided by the questions of what kinds of nature-based programmes are currently used in UK secondary schools, what forms they take, and what outcomes they report for adolescent mental health and wellbeing, this study used a mixed-methods approach, with evidence gathered through:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eA rapid systematic scoping review of peer-reviewed and grey literature on NbPs and adolescent mental health and wellbeing (2014\u0026ndash;2024; (Lorimer et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2025\u003c/span\u003e),\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eSemi-structured interviews with 16 educators from state and independent secondary schools in England (Letendre, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2025\u003c/span\u003e);\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eA deliberative policy action (DPA) workshop with 30 cross-sector participants (DfE, Natural England, educators, and youth advisors (including the trained NeurOx YPAG); that co-developed a cost\u0026ndash;benefit modelling framework (Hopkins van Mil, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eFour practice-led school examples (Bassett et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2026\u003c/span\u003e; Cappleman et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2026\u003c/span\u003e; Kelly et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2026\u003c/span\u003e; Ladbrook et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2026\u003c/span\u003e)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThis research project was co-produced with educators, policy professionals, and youth partners, spanning three University divisions (Medical Sciences, Social Sciences, and Gardens, Libraries and Museums). The approach builds on principles of transdisciplinary co-production designed to accelerate policy-relevant evidence generation (Chambers et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eTerminology\u003c/b\u003e \u003c/p\u003e \u003cp\u003eFor this study, nature-based programmes (NbPs) for mental health and wellbeing (MHWB) were defined broadly as structured workshops, interventions, or programmes that (i) involve learning about or through nature and/or (ii) draw on nature\u0026rsquo;s contributions to wellbeing, skills development, or alternative pedagogies. This definition encompassed both outdoor learning of standard curriculum subjects (e.g., maths, science, history; Tanaji et al., \u003cspan citationid=\"CR107\" class=\"CitationRef\"\u003e2026\u003c/span\u003e) where nature serves as a learning context, and explicitly therapeutic or wellbeing-oriented activities. This broad definition is consistent with recent syntheses on NbPs (e.g., (Coventry et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Harris et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Mann et al., \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eAnalysis and Synthesis\u003c/b\u003e \u003c/p\u003e \u003cp\u003eData from the educator interviews and the DPA workshop were analysed thematically using grounded theory and an implementation-science lens to identify barriers, facilitators, and system levers for NbPs delivery. Evidence from all sources was then integrated to develop the sequenced policy pathway and six consolidated policy directions presented in this paper. The approach followed principles of evidential pluralism, recognising that robust policy synthesis draws on both qualitative and quantitative insights.\u003c/p\u003e"},{"header":"4 Results","content":"\u003cp\u003e \u003cb\u003eEvidence of Impact: Scoping Review\u003c/b\u003e \u003c/p\u003e \u003cp\u003eOverall, our scoping review suggests that school-based NbPs are associated with improvements in MHWB, particularly reductions in anxiety and stress, and gains in self-esteem, resilience, prosocial behaviour, school connectedness, and nature connectedness (Lorimer et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Academic outcomes were less consistent, with modest improvements reported in science engagement and arithmetic, but limited evidence of broader attainment gains (ibid). NbPs also show stronger and more consistent MHWB benefits for adolescents with existing mental health needs, while impacts in general student populations are smaller and more variable (Loose et al., \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Natural England, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e2024c\u003c/span\u003e; Shrestha et al., \u003cspan citationid=\"CR101\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). However, study quality was moderate, constrained by small samples, limited controls, and heterogeneous outcome measures, indicating a developing but methodologically uneven evidence base.\u003c/p\u003e \u003cp\u003e \u003cb\u003eImplementation Dynamics: Teacher Interviews and Stakeholder Workshop\u003c/b\u003e \u003c/p\u003e \u003cp\u003eOur research highlighted that NbPs implementation operates across interlinked individual and institutional domains (Hopkins van Mil, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Letendre, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). At the individual level, student need, staff confidence, and perceived behavioural risk shaped delivery. At the institutional level, curriculum pressures, inspection frameworks, risk management cultures, and DfE policy priorities acted as structural moderators. Provider type further mediated these dynamics. External providers were more likely to encounter funding and integration barriers but benefited from specialist expertise, whereas internally delivered programmes were more embedded within school culture but constrained by staff capacity and competing priorities. In addition, within the DPA workshop, stakeholders described fragmented nature-based provision and difficulty identifying partners, given limited school capacity for outreach (Hopkins van Mil, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eEconomic Case: Economic Modelling Analysis\u003c/b\u003e \u003c/p\u003e \u003cp\u003eOur economic cost-benefit model incorporated both positive developmental trajectories and counterfactual scenarios where mental health needs remain unmet (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). This benefit-led, J-shaped cost\u0026ndash;benefit model illustrated how early (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), targeted investments in NbPs (particularly for students with existing MHWB needs), may generate disproportionate long-term returns through avoided service use, improved educational engagement, and enhanced life course outcomes. Taken together, the framework provides policymakers with a structured approach to assessing NbPs not solely as enrichment activities, but as preventative public health infrastructure within the urban school system.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"5 Policy directions – ‘what’ and ‘why’","content":"\u003cp\u003eOur synthesis of the evidence and stakeholder insights identifies six interlinked Policy Directions (PD) for implementing NbPs in secondary schools: (1) whole-school integration through a tiered universal-targeted-intensive model; (2) equity safeguards; (3) professional development; (4) developmentally appropriate and adolescent-informed metrics; (5) improved green estates; and (6) cross-sector collaboration.\u003c/p\u003e \u003cp\u003eEach PD targets a critical barrier or enabler for NbPs delivery aligning with and extending the DfE\u0026rsquo;s Sustainability and Climate Change Strategy (SCC; 2023) as well as the new data Evaluation Strategy (2025), which positions robust evaluation as central to delivering the government\u0026rsquo;s Opportunity Mission (Department for Education, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2025a\u003c/span\u003e). These PDs are strategic principles rather than implementation blueprints, outlining what needs to happen and why, grounded in current evidence and stakeholder insights.\u003c/p\u003e \u003cp\u003eOur evidence synthesis showed that NbPs can deliver outcomes across three interconnected domains: (1) mental health and wellbeing related outcomes (e.g., reduced anxiety and climate-related distress, improved mood and resilience); (2) educational outcomes (e.g., attendance, behaviour, engagement, attainment); and (3) environmental outcomes (e.g., nature relatedness, pro-environmental behaviour, biodiversity). The PDs outlined below are designed to support the delivery of each of these outcomes.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePolicy Direction 1 \u0026ndash; Integrate nature-based programmes within whole-school MHWB systems\u003c/b\u003e \u003c/p\u003e \u003cp\u003eDespite adolescence being a pivotal stage for both MHWB and nature connectedness, these areas remain largely separate in research, policy, and practice, the DfE's SCC Strategy (Department for Education, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2023a\u003c/span\u003e), for example, does not explicitly link nature engagement to existing infrastructures such as Mental Health Support Teams (MHSTs). While no established causal link yet exists between nature connection and adolescent MHWB, modest positive findings, low cost, and environmental co-benefits create a pragmatic case for cautious integration, provided poorly designed approaches do not burden overstretched staff or dilute existing provision.\u003c/p\u003e \u003cp\u003eEvidence shows a tiered pattern of benefit. Targeted and therapeutic NbPs for adolescents with existing anxiety or depression show consistent reductions in symptoms (Overbey et al., \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Pirchio et al., \u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Rian \u0026amp; Coll, \u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Universal school-based programmes, by contrast, yield smaller or mixed effects, with outcomes shaped more by implementation quality and contextual fit than by exposure alone (Loose et al., \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Richardson et al., \u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Shrestha et al., \u003cspan citationid=\"CR101\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Sprague et al., \u003cspan citationid=\"CR105\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). This supports a proportionate approach: targeting with intensive support where need is greatest, alongside universal programmes for prevention.\u003c/p\u003e \u003cp\u003eThis points to integration within England's existing three-tier school MHWB model: universal prevention, targeted support for emerging difficulties, and intensive therapeutic provision via MHSTs and community services.\u003c/p\u003e \u003cp\u003eStandardised, developmentally appropriate and adolescent-informed metrics are essential to monitor outcomes (see PD4). Monitoring should operate across the same three tiers used within school MHWB systems: universal indicators (e.g. nature connectedness, MHWB, attendance, behaviour), targeted indicators for students receiving additional support (e.g. changes in anxiety or emotional regulation), and therapeutic outcomes for adolescents engaged in intensive interventions through MHSTs or community services. This would require interoperable datasets linking DfE, MHST, NENP, and school platforms.\u003c/p\u003e \u003cp\u003eAttendance and behaviour are early warning indicators for mental health difficulties with links to attainment and direct impact on educational equity (Dr\u0026auml;ger et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Kearney et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; van Poortvliet, \u003cspan citationid=\"CR118\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Positioning MHWB as an explicit DfE evaluation outcome aligns NbPs with NHS prevention priorities and enables co-benefit assessment across, health, education, and environment.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eRecommendation 1\u003c/strong\u003e \u003cp\u003eIntegrate NbPs within whole-school MHWB systems through a tiered universal\u0026ndash;targeted\u0026ndash;intensive model aligned with existing mental health infrastructure, supported by standardised developmentally appropriate and adolescent-informed measures and shared data infrastructure and environmental datasets (e.g. DEFRA\u0026rsquo;s Access to Nature Statistics 2025) .\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003ePolicy Direction 2 \u0026ndash; Embed equity safeguards and ensure inclusive access\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAccess to NbPs benefits is unequal where socio-economic deprived and ethnically minoritised communities consistently face poorer green-space quality, inadequate maintenance, increased safety concerns, and environments whose design, management norms and cultural narratives my reflect white ethnicities and marginalise other cultural practices and meanings (Bar\u0026oacute; et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Comber et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Rigolon et al., \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Snaith \u0026amp; Odedun, \u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Students with disabilities face additional physical accessibility barriers, while students experiencing multiple, intersecting disadvantages face compounded exclusion. Without explicit equity safeguards, school-based NbPs risk reproducing or amplifying these disparities (Bar\u0026oacute; et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Harvey et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur stakeholder consultations highlighted additional potential barriers specifically for adolescents, such as stigma around nature activities in secondary schools (e.g., perceptions that they are \u0026ldquo;uncool\u0026rdquo;). Similarly, qualitative research indicates that urban adolescents might associate nature with fear, danger, dirt, disgust, and discomfort and feeling isolated (Lekies et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Zamora et al., \u003cspan citationid=\"CR128\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). To resolve this, students suggested integrating nature into academic routines, for example through green study spaces during exam periods and through youth-led design of outdoor areas. Such approaches align with practitioner-led urban design guidance (e.g., Make Space for Girls, 2023) which highlights the importance of youth- (gender-)informed public spaces design. and evidence of strong peer influences on pro-environmental behaviour (Collado et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). These innovations demonstrate the value of both developmentally appropriate and adolescent-informed programme design and positioning young people as co-creators, consistent with child-rights principles (Angel\u0026ouml;w \u0026amp; Psouni, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEquity requires both redistribution and recognition: under-resourced schools need additional resources and approaches that respect diverse cultural relationships with nature. While current monitoring of school-level green provision and NbPs outcomes remain underreported and uneven, existing socio-economic and spatial indicators (e.g., free school meal eligibility, area-level deprivation indices, urban density with limited green access, etc.) might provide pragmatic starting points for target support. Building on this, all schools, and particularly those serving under-resourced students, are likely to require:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eCo-design by schools\u003c/b\u003e and delivery support addressing cultural and safety barriers.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003ePartnerships\u003c/b\u003e with local parks, community gardens, or nature organisations to overcome on-site constraints.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003ePriority funding\u003c/b\u003e for NbPs development and staff training.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eRecommendation 2\u003c/b\u003e: Prioritise schools serving disadvantaged students for additional NbPs funding, staff training, and local green partnerships. Support co-design with students, families, and communities. Where feasible, use existing disaggregated administrative and survey data (e.g., socio-economic status, ethnicity, SEND, gender, and available national nature engagement indicators (i.e., Children\u0026rsquo;s People and Nature Survey for England (Natural England, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e2025\u003c/span\u003e)) to review uptake and distribution of support, to ensure benefits reach those facing the greatest barriers.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePolicy Direction 3 \u0026ndash; Strengthening professional capacity for sustained evidence-led nature-based practice\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe growing recognition of NbPs within DfE and Department for Environment, Food, and Rural Affairs (DEFRA) policies, including the NENP, Children and Nature Programme, and the government-confirmed General Certificate of Secondary Education (GCSE) in Natural History, creates additional demands for educator capacity. Integration within continuing professional development (CPD) is therefore vital, supported by specialist leadership roles and cross-subject learning pathways (for example, geography, science, and English) that embed NbPs in mainstream curricula and deliver more formalised, interdisciplinary outcomes (Dillon \u0026amp; Dickie, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEducators consistently report limited time, confidence, pedagogical support for delivering NbPs, particularly outside traditional classrooms. This finding is consistent across literature and our educator interviews and stakeholder workshops (O\u0026rsquo;Malley \u0026amp; Pierce, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Rushton \u0026amp; Walshe, \u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Walker et al., \u003cspan citationid=\"CR121\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Even where school leadership is supportive, crowded and outcome-driven curricula restrict opportunities to integrate NbPs into the timetable (Letendre, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). These pressures are reinforced by school accountability systems that prioritise measurable educational outcomes (attendance, examination results), while wellbeing and nature connectedness outcomes remain largely unrecognised and difficult to assess through standardised measures.\u003c/p\u003e \u003cp\u003eEvidence indicates that NbPs have dual benefits by also supporting teacher wellbeing, retention, and environmental literacy, generating multiplier effects as educators model pro-environmental behaviour and integrate sustainability across subjects (Crespo-Mart\u0026iacute;n et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Stakeholders emphasised the importance of moving beyond staff retention to fostering conditions that sustain wellbeing and purposeful work. Teachers called for NbPs to be recognised alongside core subjects in school planning and evaluation, while also valuing creative flexibility within clearly defined parameters (Hopkins van Mil, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eRecommendation 3\u003c/strong\u003e \u003cp\u003eEstablish national Initial Teacher Training (ITT) and continuing professional development (CPD) frameworks for NbPs to support MHWB including specialist leadership roles (e.g., Senior Mental Health Leads, Sustainability Leads, PSHE Leads, SENCO/SENDCOs) and protected curriculum time \u0026ndash; prioritising schools serving disadvantaged students. Enable educator-led practitioner research through partnership with communities, education, health, environmental, and local-government actors. Ring-fence targeted funding, aligned with existing MHWB, Pupil Premium, and sustainability streams, to support implementation and robust evaluation.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003ePolicy Direction 4 \u0026ndash; Build developmentally appropriate and adolescent-informed and interoperable evaluation frameworks\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe DfE's 2025 Evaluation Strategy details robust, proportionate evaluation for the government\u0026rsquo;s Opportunity Mission delivery and building an evidence base that supports better life chances, protection, high standard education, training and care (Department for Education, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2025a\u003c/span\u003e). Within this, mission-led approach initiatives such as the NENP have primarily focused on biodiversity, nature access and general wellbeing outcomes, with adolescent mental health not yet consistently specified as a formal outcome domain (Cottrill et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). However, designing future NbPs evaluations to more explicitly include adolescent MHWB outcomes would strengthen coherence with NHS prevention priorities (e.g., MHST in schools mentioned in PD1; NHS England, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e2019\u003c/span\u003e, updated 2025) and enable a more integrated evaluation of the cross-sector value of NbPs for health, education, and environment.\u003c/p\u003e \u003cp\u003eCurrent evidence for NbPs\u0026rsquo; effectiveness is mixed and methodologically limited (Lorimer et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Studies report small to moderate effects that are context-dependent with weak causal design, inconsistent definitions, and short follow-up periods inhibiting effective evaluation and generalisation (Bratman et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Loose et al., \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Tillmann et al., \u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Yet mixed findings might reflect insensitive tools and brief observation windows rather than the absence of real effects. Furthermore, existing tools to assess nature connection are designed for children or adults and miss developmental and social dynamics specific to adolescence (Greenwood \u0026amp; Gatersleben, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Neurohr et al., \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). This highlights the need for developmental sensitivity in validated developmentally appropriate and adolescent-informed measures.\u003c/p\u003e \u003cp\u003eFragmentation across education, health, and environment sectors further hinders progress, because datasets use incompatible definitions, reporting cycles, and privacy protocols, preventing linkage between student MHWB, school performance, and environmental indicators such as biodiversity (Davis et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Montana, 2023).\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eRecommendation 4\u003c/strong\u003e \u003cp\u003eEstablish cross-sector, developmentally appropriate and adolescent-informed evaluation frameworks that explicitly include adolescent MHWB outcomes, harmonise data standards across NENP, MHST, and school datasets, and commission longitudinal studies to support equitable scale-up.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003ePolicy Direction 5 \u0026ndash; Establish evidence-informed green-estate standards for MHWB and learning\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe DfE's SCC Strategy (2023) frames the MHWB and learning benefits of nature contact primarily as co-benefits of climate and biodiversity action rather than core objectives of school estate design. While green infrastructure requirements exist (Department for Education, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2023b\u003c/span\u003e), they do not explicitly prioritise MHWB and learning outcomes, nor sufficiently differentiate between new builds and spatially constraint existing, particularly in urban and underserved areas.\u003c/p\u003e \u003cp\u003eYet, evidence shows that nature contact supports wellbeing and learning through multiple exposure pathways: indirect (views of greenery), incidental (routine contact on school grounds), and intentional (structured outdoor or therapeutic activities) (Cox, Shanahan, Hudson, Plummer, et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Lomax et al., \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Ulrich \u0026amp; Parsons, \u003cspan citationid=\"CR115\" class=\"CitationRef\"\u003e1992\u003c/span\u003e; Vakalis et al., \u003cspan citationid=\"CR117\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Even modest nature exposure such as improved classroom views or small-scale greening like trees, shaded seating, and container gardens may yield measurable MHWB and environmental benefits, including heat buffering, cleaner air, noise reduction, and flood mitigation (Diaz et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Yamashita et al., \u003cspan citationid=\"CR127\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Given the wide variation in estate capacity, a proportionate, tiered approach is needed.\u003c/p\u003e \u003cp\u003eHowever, design must be risk-aware and context-sensitive. Poorly designed green space interventions can pose risks such as allergies, animal nuisance, or bullying in unsupervised spaces in schools (Veibiakkim et al., \u003cspan citationid=\"CR119\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Nevertheless, nature-positive NbPs that enhance habitat quality and ecological connectivity yield reciprocal benefits: healthier ecosystems support more reliable, higher-quality experiences and sustained wellbeing outcomes (Moore et al., \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Robinson \u0026amp; Barrable, \u003cspan citationid=\"CR98\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eRecommendation 5\u003c/strong\u003e \u003cp\u003eIntegrate student MHWB and learning outcomes as core objectives of school estate standards alongside sustainability targets. For new builds and major redevelopments, embed comprehensive green-infrastructure benchmarks. For existing schools, adopt a proportionate, tiered approach matched to spatial and resource capacity. Implement transparent, long-term monitoring of MHWB, learning, and ecosystem outcomes across all settings. Sta\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003ePolicy Direction 6 \u0026ndash; Develop coordinated cross-sector NbPs delivery and leadership\u003c/b\u003e \u003c/p\u003e \u003cp\u003eSchools uniquely reach nearly all young people during a critical developmental window (unavailable to other sectors). In addition, evidence from our workshops and interviews shows that NbPs achieve the strongest outcomes when schools partner with local authorities, health services, and environmental organisations (Hopkins van Mil, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). This aligns with the DfE\u0026rsquo;s SCC Strategy (2023) which commits to a systems-based approach across multiple action areas. Research further indicates that nature connectedness, rather than nature knowledge alone, is the stronger predictor of pro-environmental behaviour (Whitburn et al., \u003cspan citationid=\"CR123\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Together, this evidence reinforces the need for cross-sector partnerships that both connect schools with external organisations and prioritise activities that foster direct relationships with nature across both curricular and enrichment pathways.\u003c/p\u003e \u003cp\u003eThus, age-appropriately designed NbPs, whether delivered through national platforms like the NENP, local partnerships with parks and environmental organisations, or school-led initiatives, can simultaneously:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eAdvance educational outcomes\u003c/b\u003e through curriculum integration (including climate and biodiversity learning), attendance, and engagement (Ardoin et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2020\u003c/span\u003e);\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003ePromote mental health and wellbeing\u003c/b\u003e by addressing climate-related distress and strengthening social relationships (Chawla et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Newberry Le Vay et al., 2023);\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eBuild skills\u003c/b\u003e relevant to the green economy through enhanced self-efficacy, leadership, and competence (Campbell et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2026\u003c/span\u003e; Lovell, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2019\u003c/span\u003e);\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eStrengthen ecological connectivity\u003c/b\u003e by contributing to corridors that defragment urban green space (Hyseni et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; WHO, \u003cspan citationid=\"CR124\" class=\"CitationRef\"\u003e2017\u003c/span\u003e);\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eMitigate environmental pressures\u003c/b\u003e such as air and noise pollution, heat stress, and flooding (Blanuša et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2025\u003c/span\u003e); and\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eFoster environmental stewardship\u003c/b\u003e by strengthening sense of place and long-term care for nature (Ardoin et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Gush et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eRealising these benefits requires coordination across fragmented sectorial systems as currently NbPs operate through disconnected channels such as DfE sustainability initiatives, NHS mental health support (e.g., green social prescribing; Lyreskog et al., \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), local authority environmental programmes, and third-sector providers limiting coherence and impact. Effective coordination requires shared leadership structures, funding mechanisms, common evaluation frameworks, and structured platforms for knowledge exchange.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eRecommendation 6\u003c/strong\u003e \u003cp\u003eEstablish cross-sector coordination mechanisms integrating NbPs across education, health, and environmental policy. Create shared accountability frameworks (for example, joint outcome frameworks and pooled or aligned funding agreements), clarify leadership responsibilities across sectors, and develop formal knowledge exchange infrastructure to support scaling through national platforms (including ONS, NENP, and related systems).\u003c/p\u003e \u003c/p\u003e"},{"header":"6 Implementation pathway – ‘when’ and ‘how’","content":"\u003cp\u003e \u003cb\u003e\u0026lsquo;Quick wins\u0026rsquo;: Immediate actions (12\u0026ndash;18 months) leveraging established evidence and existing capacity\u003c/b\u003e \u003c/p\u003e \u003cp\u003eImmediate actions focus on integrating NbPs into existing teacher capacity and whole-school MHWB and sustainability infrastructure. Integrating with schools\u0026rsquo; Climate Action Plans and sustainability leads could yield co-benefits as interventions that mitigate for flood, heat, and air pollution may also affect MHWB (Newberry Le Vay et al., 2023). (PD1)\u003c/p\u003e \u003cp\u003eCurrent participation in programmes such as the NENP reflects schools that are already incorporating NbPs (~\u0026thinsp;7,380 signed up schools as of July 2025; Cottrill et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). To extend equitable national access beyond these pioneer adopters, immediate focus should aim at identifying and removing barriers to initial implementation of NbPs, particularly for under-sourced schools. Priority actions include improving awareness of NbPs\u0026rsquo; benefits, simplifying administrative steps, and offering easy-start support (e.g., through DfE grants; Cottrill et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). (PD2)\u003c/p\u003e \u003cp\u003eAt the same time, strengthening teachers\u0026rsquo; professional capacity is essential for all schools, especially for those with limited resources, to ensure an effective and sustainable NbPs delivery (Hopkins van Mil, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Teachers are pivotal implementers, and school leads can support teachers\u0026rsquo; agency through protected time, and equitable access to CPD that embeds NbPs in existing curricula (e.g., science, geography, citizenship (Department for Education, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2025b\u003c/span\u003e), and preparation for the Natural History GCSE). While school leads may express concern about introducing additional NbPs on school grounds, sustained delivery depends on leadership legitimacy for outdoor learning (Cottrill et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) and shared responsibility across subjects, supported by standardised metrics linking MHWB, education, and environmental outcomes. (PD3)\u003c/p\u003e \u003cp\u003eAnother priority is to establish robust baseline measurements for both MHWB and school green estate condition (including green-blue-characteristics and classroom views of green space, vegetation structure, biodiversity, etc. (Cox et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Cox, Shanahan, Hudson, Fuller, et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2017\u003c/span\u003e)). Existing initiatives, such as the NENP, provide existing frameworks to pilot data-linkage protocols between MHWB, attendance, estate indicators, and attainment, while large-scale platforms such as ECHILD demonstrate that secure cross‑sector linkage at national level is feasible (Department for Education, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2025a\u003c/span\u003e). In the short term, piloting NbP‑relevant data‑linkage within these platforms can build readiness for future interoperability and longitudinal monitoring of NbPs\u0026rsquo;MHWB\u0026ndash;learning co‑benefits. (PD4\u0026amp;5)\u003c/p\u003e \u003cp\u003eAs noted earlier in the results section (Implementation Dynamics), stakeholders described fragmented nature-based provision and difficulty identifying partners, given limited school capacity for outreach (Hopkins van Mil, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). To \u0026lsquo;de-fragment\u0026rsquo; provision, clearer signposting of existing actors (e.g., DfE sustainability support for education, Climate Ambassadors, NHS green social prescribing, Local Nature Recovery Partnerships, etc.) could function as a practical short-term enabler. (PD6)\u003c/p\u003e \u003cp\u003e \u003cb\u003eSystem Building: Medium-term priorities (2\u0026ndash;3 years) guided by early signals.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eMedium-term priorities should aim at strategic curriculum alignment and link NbPs to the curriculum via the GCSE Natural History qualification and related subjects such as Science and Geography (Cottrill et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Coordination with national initiatives such as the NENP and DEFRA\u0026rsquo;s 25-Year Environment Plan will prevent duplication and maximise impact and extends biodiversity-focused programmes to include MHWB, educational, and behavioural outcomes.\u003c/p\u003e \u003cp\u003eWithin the next 2 to 3 years, DfE, DHSC, and DEFRA, in partnership with NHS England and academic experts, should convene a cross-sector working group aligned with the government\u0026rsquo;s mission-based agenda to: commission and validate developmentally appropriate measures of nature connectedness and adolescent wellbeing; establish interoperable data standards linking NENP, MHST, and school census datasets; and coordinate longitudinal studies in secondary schools to support equitable scale-up.\u003c/p\u003e \u003cp\u003eA sustainable school\u0026ndash;policy\u0026ndash;research interface is required to enable collaborative research designs, shared data protocols, and regular knowledge exchange between educators, youth, researchers, and policymakers. Implementation should be guided by co-produced economic evaluation frameworks \u0026ndash; developed through deliberative policy-action workshops or school research action groups \u0026ndash; that prioritise social value, consider \u0026lsquo;nature\u0026rsquo; as both outcome and stakeholder, context-specific efficacy, and long-term prevention (Hopkins van Mil, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Reed et al., \u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Multi-composite value assessment (including cost\u0026ndash;benefit analysis, social return on investment, and multicriteria decision analysis) should inform decision-making.\u003c/p\u003e \u003cp\u003eEquity must be embedded throughout system building. Shared data interpretation frameworks are needed across education, health, and environment sectors to identify underserved communities accurately and direct resources to areas of greatest need. Secondary-school-specific evidence pathways should explicitly address adolescent developmental mechanisms of change through robust research design and strengthened causal attribution.\u003c/p\u003e \u003cp\u003eGiven the wide variation in estate capacity, a proportionate, tiered approach is needed. High‑capacity sites (those with sufficient space, funding, and organisational capability) can reasonably be expected to meet comprehensive green‑estate standards, whereas constrained sites may focus on incremental greening (for example, container gardens, vertical planting and local partnerships), and severely constrained urban and/or under-resourced sites may prioritise low‑cost strategies such as maximising classroom sightlines to green spaces or sky, nature imagery, and regular off‑site use of local parks.\u003c/p\u003e \u003cp\u003eA critical priority is harmonising MHWB, behavioural, and learning indicators with school-level environmental metrics, including biodiversity proxies derived from NENP habitat mapping (Marselle et al., \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Wang et al., \u003cspan citationid=\"CR122\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), to enable integrated evaluation across domains.\u003c/p\u003e \u003cp\u003eFinally, we acknowledge that delivering NbPs at-scale will require medium-term structural investment, rather than continued reliance on existing school capacity or short-term funding streams. Therefore, a ring-fenced \u0026lsquo;Nature Premium,\u0026rsquo; similar to the PE and Sport Premium, could provide schools with protected and sustained resources to embed NbPs within curriculum delivery, infrastructure development, and cross-sector partnerships. This proposal aligns with the ongoing UK-wide Nature Premium campaign (Forest School Association, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Institute for Outdoor Learning, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2026\u003c/span\u003e; UK Parliament, \u003cspan citationid=\"CR114\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), which promotes a Nature Premium applicable across the full age range of statutory education, extending through secondary school and up to age 18.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTransformational Change: Long-term vision (3\u0026ndash;5\u003c/b\u003e \u003csup\u003e \u003cb\u003e+\u003c/b\u003e \u003c/sup\u003e \u003cb\u003eyears)\u003c/b\u003e\u003c/p\u003e \u003cp\u003eNature-based approaches to youth mental health and wellbeing represent a strategic opportunity to strengthen England\u0026rsquo;s leadership in integrating sustainability and wellbeing within education. While the UK aims to lead on education for sustainability and climate action by 2030 (Department for Education, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2023c\u003c/span\u003e), realising the full potential of NbPs will require sustained commitment and major shifts in how educational systems conceptualise, resource, and deliver these interventions.\u003c/p\u003e \u003cp\u003eThis transformation requires embedding co-production with students, teachers, and families within NbPs governance and decision-making structures. Education has established mechanisms for student voice and participatory research in education, together with the health sector\u0026rsquo;s Patient and Public Involvement and Engagement (PPIE) frameworks, provide complementary models for ensuring that youth and educator experience informs all stages of programme design and evaluation (Staniszewska et al., \u003cspan citationid=\"CR106\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Consistent with typologies of co-production in school health, programmes should integrate these perspectives into formal decision-making structures, strengthening contextual fit, accountability and sustainability by making those most affected active partners rather than passive recipients (Reed et al., \u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis participatory approach should sit within a systems-aligned framework that integrates MHWB, education, climate, and equity priorities to enable coherent policy development and resource allocation across DfE, DEFRA, DHSC, and Ofsted. The ambitious goal is to integrate NbPs with MHWB and education strategies, moving beyond optional enrichment to core provision and from treating nature as extracurricular to recognising it as fundamental to education.\u003c/p\u003e \u003cp\u003eA public health shift is also needed, one that reframes nature relatedness as a modifiable determinant of MHWB and pro-environmental behaviour (Lomax et al., \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). As with physical activity, this should be embedded within whole-school wellbeing systems, coordinated through senior pastoral leadership (including mental health leads, SENCO/SENDCOs, or wellbeing coordinators where these roles exist).\u003c/p\u003e"},{"header":"7 Tiered Policy Pathway for action: synthesising policy directions and implementation stage","content":"\u003cp\u003eThe preceding sections outline both the strategic policy directions (what should change) and the implementation pathway (when and how change might occur). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e synthesises these elements into a staged policy pathway that links immediate actions, medium-term system building, and longer-term transformation. This framework illustrates how NbP development can progress from early experimentation toward integrated, system-level implementation.\u003c/p\u003e \u003cp style='margin:0cm;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eTable 1 Tiered Policy Pathway for action.\u0026nbsp;\u003cspan style=\"font-family:Wingdings;color:#7030A0;\"\u003en\u003c/span\u003e\u003cspan style=\"color:#7030A0;\"\u003e\u0026nbsp;\u003c/span\u003ePD1 \u0026ndash; Whole-school MHWB integration;\u0026nbsp;\u003cspan style=\"font-family:Wingdings;color:#4EA72E;\"\u003en\u003c/span\u003e\u003cspan style=\"color:#7030A0;\"\u003e\u0026nbsp;\u003c/span\u003ePD2 \u0026ndash; Equity safeguards;\u0026nbsp;\u003cspan style=\"font-family:Wingdings;color:#E97132;\"\u003en\u003c/span\u003e\u003cspan style=\"color:#7030A0;\"\u003e\u0026nbsp;\u003c/span\u003ePD3 \u0026ndash; Professional capacity; \u0026nbsp;\u003cspan style=\"font-family:Wingdings;color:#80340D;\"\u003en\u003c/span\u003e\u003cspan style=\"color:#7030A0;\"\u003e\u0026nbsp;\u003c/span\u003ePD4 \u0026ndash; Evaluation frameworks; \u0026nbsp;\u003cspan style=\"font-family:Wingdings;color:#0070C0;\"\u003en\u003c/span\u003e\u003cspan style=\"color:#7030A0;\"\u003e\u0026nbsp;\u003c/span\u003ePD5 \u0026ndash; Green estate standards;\u0026nbsp;\u003cspan style=\"font-family:Wingdings;color:#660033;\"\u003en\u003c/span\u003e\u003cspan style=\"color:#7030A0;\"\u003e\u0026nbsp;\u003c/span\u003ePD6 \u0026ndash; Cross-sector coordination;\u0026nbsp;\u003cspan style=\"font-family:Wingdings;color:#ADADAD;\"\u003en\u003c/span\u003e\u003cspan style=\"color:#80340D;\"\u003e\u0026nbsp;\u003c/span\u003e\u003cspan style=\"color:black;\"\u003eEnabling conditions (cross-cutting across all PDs)\u003c/span\u003e.\u0026nbsp;\u003cspan style=\"vertical-align:super;\"\u003e\u003cspan style=\"font-size:12px;\"\u003e\u003cspan style=\"vertical-align:super;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e[1]\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003eCPD=Continuous professional development;\u0026nbsp;\u003cspan style=\"vertical-align:super;\"\u003e\u003cspan style=\"font-size:12px;\"\u003e2\u003c/span\u003e\u003c/span\u003eCBA=Cost-benefit analysis;\u0026nbsp;\u003cspan style=\"vertical-align:super;\"\u003e\u003cspan style=\"font-size:12px;\"\u003e3\u003c/span\u003e\u003c/span\u003eSROI=Social return on investment;\u0026nbsp;\u003cspan style=\"vertical-align:super;\"\u003e\u003cspan style=\"font-size:12px;\"\u003e4\u003c/span\u003e\u003c/span\u003eMDA=Multicriteria decision analysis; \u003csup\u003e5\u003c/sup\u003eADR=Administrative data research UK; \u003csup\u003e6\u003c/sup\u003eECHILD=Education and Child Health Insights from Linked Data - England.\u003c/p\u003e\n\u003ctable style=\"border-collapse: collapse;border: none;width: 600px;\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.25pt;border: 1pt solid windowtext;background: rgb(232, 232, 232);padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eQuick wins: Immediate actions (12\u0026ndash;18 months) using established evidence.\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.25pt;border-top: 1pt solid windowtext;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-image: initial;border-left: none;background: rgb(232, 232, 232);padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eSystem Building: Medium-term priorities (2\u0026ndash;3 years) guided by early signals.\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.3pt;border-top: 1pt solid windowtext;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-image: initial;border-left: none;background: rgb(232, 232, 232);padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eTransformational Change: Long-term vision (3\u0026ndash;5\u003csup\u003e+\u003c/sup\u003e years) shaped by unknowns.\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 450.8pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(112, 48, 160);padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:white;\"\u003ePD1 \u0026ndash; Whole-school MHWB integration\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.25pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0cm 5.4pt;height: 31.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003eEmbed nature engagement in \u003cem\u003ewhole-school\u003c/em\u003e MHWB approach as the foundation for all subsequent actions. (low cost)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;height: 31.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eAlign school nature programmes with SRP /FS capital programmes, commercial programmes delivered through Risk Protection Arrangement (RPA), NENP and DEFRA\u0026rsquo;s 25 YEP to maximise impact and avoid duplication.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;height: 31.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003ePosition England as a leader in evidence-based, nature-focused youth wellbeing.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 450.8pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(78, 167, 46);padding: 0cm 5.4pt;height: 11.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:white;\"\u003ePD2 \u0026ndash; Equity safeguards\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.25pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0cm 5.4pt;height: 31.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003eUse existing MHWB and cost\u0026ndash;benefit evidence to prioritise initial NbP investments in disadvantaged and restricted settings.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;height: 31.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003ePromoting equity and preventing reinforcement of privilege through targeted NbPs investment using NE GI mapping and Accessible Natural Greenspace Standard (ANGsT) to prioritise areas of greenspace deficiency and deprivation.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;height: 31.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eMake co-production with youth and educators standard in NbPs design and evaluation.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 450.8pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(233, 113, 50);padding: 0cm 5.4pt;height: 11.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:white;\"\u003ePD3 \u0026ndash; Professional capacity\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.25pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0cm 5.4pt;height: 31.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003eClarify teacher/educator roles (link to CPD\u003csup\u003e1\u003c/sup\u003e). (low cost)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;height: 31.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003eImplement targeted teacher and school leader training via continuing professional development (CPD) pathways.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;height: 31.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eEmbed NbPs within whole-school statutory wellbeing/education strategies, aligning with children\u0026rsquo;s rights to a clean, healthy and sustainable environment and environmental education (UN Articles 28, 29(1)).\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 450.8pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(191, 78, 20);padding: 0cm 5.4pt;height: 11.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:white;\"\u003ePD4 \u0026ndash; Evaluation frameworks\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.25pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0cm 5.4pt;height: 31.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003eStandardise terminology for \u0026lsquo;nature\u0026rsquo;, \u0026lsquo;nature-relatedness\u0026rsquo; measures, and nature-based programmes. (low cost)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;height: 31.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-bottom:6.0pt;'\u003e\u003cspan style=\"font-size:13px;\"\u003eValidating measures of nature connectedness and adolescent wellbeing.\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-bottom:6.0pt;'\u003e\u003cspan style=\"font-size:13px;\"\u003eConvene a cross-sector working group (DfE, DHSC, DEFRA, NHS) to validate adolescent-informed measures, coordinate longitudinal studies, and establish interoperable data standards.\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003eEstablish cost\u0026ndash;benefit evaluation infrastructure (CBA\u003csup\u003e2\u003c/sup\u003e, SROI\u003csup\u003e3\u003c/sup\u003e, MCDA\u003csup\u003e4\u003c/sup\u003e), to assess NbPs value-for-money and inform scaling decisions.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;height: 31.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003eInstitutionalise cross-sector data governance and longitudinal research frameworks to embed MHWB-environment-education indicators in national monitoring systems.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 450.8pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(0, 112, 192);padding: 0cm 5.4pt;height: 11.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:white;\"\u003ePD5 \u0026ndash; Green estate standards\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.25pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003eSet baseline MHWB through existing datasets such as Natural England\u0026rsquo;s CPANS and green estate metrics such as percentage of permeable ground /green surface /biodiversity proxies derived either from\u0026nbsp;\u003c/span\u003e\u003ca href=\"https://designatedsites.naturalengland.org.uk/GreenInfrastructure/Map.aspx\"\u003e\u003cspan style=\"font-size:13px;\"\u003eNE\u0026rsquo;s Green Infrastructure Framewor\u003c/span\u003e\u003c/a\u003e\u003cspan style=\"font-size:13px;\"\u003ek combined with the NENP base mapping.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-bottom:6.0pt;'\u003e\u003cspan style=\"font-size:13px;\"\u003eImplement tiered green-estate standards aligned to spatial and resource capacity.\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-bottom:6.0pt;'\u003e\u003cspan style=\"font-size:13px;\"\u003eEnhance NENP mapping through systematic minimal biodiversity metrics (e.g., pollinator count).\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003eIntegrate NbPs into the curriculum, for example through the new GCSE Natural History or existing subjects (e.g., science, geography)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003eAlign NbPs appraisal with NE\u0026rsquo;s Environmental Benefits from Nature (ENCA) framework within FS/SRP capital planning.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 450.8pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(102, 0, 51);padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:white;\"\u003ePD6 \u0026ndash; Cross-sector coordination\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.25pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0cm 5.4pt;height: 56.3pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003ePolicymakers should prioritise scaling interventions that have demonstrated positive cost\u0026ndash;benefit ratios through rigorous economic evaluation.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;height: 56.3pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eCreate school\u0026ndash;policy\u0026ndash;research interfaces for knowledge exchange and data coordination.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;height: 56.3pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Yu Gothic Light\";'\u003eDevelop an eco-biopsychosocial model\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;\"\u003e \u003c/span\u003e\u003c/strong\u003e\u003cspan style=\"font-size:13px;\"\u003eor\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/span\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Yu Gothic Light\";'\u003emixed-methods, transdisciplinary research infrastructure.\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 450.8pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(232, 232, 232);padding: 0cm 5.4pt;height: 18.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eEnabling conditions (cross-cutting across all PDs)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.25pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(232, 232, 232);padding: 0cm 5.4pt;height: 71.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eInitiate linkage protocols between MHWB, attendance, green estate data, and attainment to build toward an integrated evidence infrastructure. (e.g., via ADR UK\u003csup\u003e5\u003c/sup\u003e ECHILD\u003csup\u003e6\u003c/sup\u003e)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(232, 232, 232);padding: 0cm 5.4pt;height: 71.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eDevelop interoperable data infrastructure linking MHWB, educational, and environmental datasets.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(232, 232, 232);padding: 0cm 5.4pt;height: 71.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eBuild a systems framework linking MHWB, education, climate, and equity priorities across DfE, DEFRA, DHSC, Ofsted.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"8 Policy and research implications","content":"\u003cp\u003eRealising this vision requires cross-sector co-production with youth and educators, sustained educator support, and government-funded, mixed-methods transdisciplinary research infrastructure that bridges local evidence with scalable national indicators. Delivering effective nature-based policies requires interdisciplinary collaboration across education, health, and environmental systems, and professionals capable of translating policy into practice within school communities.\u003c/p\u003e \u003cp\u003eConceptual innovation is also important. This includes adopting integrated approaches that recognise the interwoven biological, psychological, and socio-cultural factors linking nature and health, recently referred to as an eco-biopsychosocial model and situating youth MHWB within broader environmental and social systems (Patel et al., \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Wilhelm et al., \u003cspan citationid=\"CR125\" class=\"CitationRef\"\u003e2026\u003c/span\u003e). This is particularly relevant given that many young people face barriers to accessing formal mental health care due to long waiting times, stigma, and language barriers (Aguirre Velasco et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; MacLean et al., \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Schools therefore function as crucial enablers of accessible, equitable support, integrating MHWB (Fazel et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), learning, and environmental connection within a unified framework.\u003c/p\u003e \u003cp\u003eNbPs must be embedded within core educational delivery, addressing curriculum, attendance, behaviour, and wellbeing, rather than treated as optional enrichment that risks excluding disadvantaged students.\u003c/p\u003e \u003cp\u003eWhen effectively integrated, schools' unique position across social, educational, and environmental systems means that NbPs can deliver measurable co-benefits such as improved mood and anxiety (health), enhanced attendance and engagement (education), and strengthened, value-based nature connectedness supporting pro-environmental behaviour (environment). Our CBA model suggests wider economic gains, including improved workforce productivity through better mental wellbeing and reduced absenteeism (Tsiachristas et al., \u003cspan citationid=\"CR111\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). NbPs may also contribute to local and national economic resilience by stimulating demand for green skills, including horticulture, ecology, and landscape architecture, sectors where there is currently a recognised skills shortage (ibid). This is consistent with emerging evidence around the broader economic impacts of nature-based solutions that can create employment, stimulate local economic activity, and reduce pressure on public services while delivering broader ecosystem and community benefits (The Wildlife Trust, \u003cspan citationid=\"CR109\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Wilkening et al., \u003cspan citationid=\"CR126\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, nature relatedness should be understood not merely as self‑reported affinity or aesthetic appreciation, but as a developing ethical relationship with more‑than‑human nature that shapes everyday choices and environmental responsibility, consistent with emerging frameworks and practices such as Ecological-Collective-Flourishing (E-Co-Flourishing) that link human and ecological wellbeing (Moore et al., \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Realising this potential requires alignment across research, policy, and practice to advance MHWB, educational, biodiversity, and equity goals. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e outlines a tiered policy direction and research priorities pathway guiding from immediate foundational actions to long-term transformation and shows how evidence, data infrastructure, as well as co-production can be sequenced to build sustainable change.\u003c/p\u003e"},{"header":"9 Stakeholder roles and responsibilities","content":"\u003cp\u003eThis section addresses the question: \u003cem\u003eWho does what?\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e outlines proposed roles for key actors in scaling NbPs across secondary schools, based on our evidence synthesis and stakeholder consultation. Effective NbPs delivery requires coordinated leadership across England\u0026rsquo;s education, health, and environment sectors.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eProposed roles for key actors in scaling nature-based programmes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePotential System Actors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKey role\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepartment for Education (DfE)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmbed NbPs in whole-school MHWB guidance, as an evidence‑informed, low‑risk approach, that reflects emerging (but still developing) evidence that structured access to nature and greenspace can support aspects of pupils\u0026rsquo; mental health and wellbeing.\u003c/p\u003e \u003cp\u003ePrioritise co-design (with youth and teachers) for equity, curriculum integration, interoperable standards, protected time and training (CPD/ITT), and cross-sector coordination to ensure inclusive, sustainable delivery of nature-based programmes.\u003c/p\u003e \u003cp\u003eSet differentiated green-estate standards (new builds vs existing), and fund targeted estate upgrades.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepartment for Environment, Food \u0026amp; Rural Affairs (DEFRA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHabitat-target guidance and BNG/metric documentation used nationally (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.gov.uk/government/publications/statutory-biodiversity-metric-tools-and-guides\u003c/span\u003e\u003cspan address=\"https://www.gov.uk/government/publications/statutory-biodiversity-metric-tools-and-guides\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepartment of Health \u0026amp; Social Care / NHS (incl. MHSTs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntegrate NbPs into school MHST pathways, co-fund indicated therapeutic programmes and align health metrics.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDigital biodiversity data infrastructures (citizen science\u0026ndash;based)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSchools, pupils, and communities commonly use iNaturalist (and iRecord) to upload observations that are then shared into national repositories (NBN Atlas / GBIF) after verification (\u0026lsquo;research-grade Citizen Science data\u0026rsquo;).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocal authorities / school trusts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrioritise on-site green infrastructure upgrades and coordinated maintenance funding. Where feasible, broker Trust-level and community partnerships to enable shared access to green spaces for targeted use, recognising transport and timetable constraints in secondary settings.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNatural History Museum (NHM), Natural England (NE)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBiodiversity metrics (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://data.nhm.ac.uk/dataset/bii-bte\u003c/span\u003e\u003cspan address=\"https://data.nhm.ac.uk/dataset/bii-bte\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://nbnatlas.org/\u003c/span\u003e\u003cspan address=\"https://nbnatlas.org/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e )\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRoyal Horticulture Society (RHS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHabitat enhancement guidance\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchools /Senior leaders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProtect curriculum time, appoint Nature leads (to incorporate within the role of the Sustainability lead (SL) or to team up with SL), implement CPD\u003csup\u003e1\u003c/sup\u003e and co-produce programmes with pupils.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversities /research partners\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCo-design developmentally appropriate and adolescent-informed measures, run pilots with robust evaluation (CBA\u003csup\u003e2\u003c/sup\u003e, SROI\u003csup\u003e3\u003c/sup\u003e, MCDA\u003csup\u003e4\u003c/sup\u003e), and publish open datasets.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWildlife Trusts, environmental NGOs, programmes such as NENP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntermediary organisations provide technical support and engagement resources\u003c/p\u003e \u003cp\u003eSchools contribute ecological observations to platforms such as ESRI, supporting environmental literacy and contributing to emerging citizen science datasets for local biodiversity monitoring.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eContinuous professional development. \u003csup\u003e2\u003c/sup\u003eCost-benefit analysis. \u003csup\u003e3\u003c/sup\u003eSocial return on investment. \u003csup\u003e4\u003c/sup\u003eMulticriteria decision analysis.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePolicy framework (England\u0026rsquo;s government)\u003c/strong\u003e \u003cp\u003eDfE should embed NbPs within existing MHWB guidance and curriculum frameworks; leveraging existing funding streams (e.g., NENP expansion rounds) to support implementation in under-resourced schools; and develop evidence-informed green-estate standards that prioritise MHWB and learning outcomes, which are differentiated for new builds and existing (constrained) estates. DEFRA and Natural England provide biodiversity guidance through platforms such as NENP, which has a broader environmental and educational remit; alignment with MHWB outcomes should complement rather than define this purpose; however, with opportunities to enhance methodological alignment between participation and ecological data quality. The DHSC and NHS partners can integrate NbPs within MHST pathways and align wellbeing metrics where appropriate.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLocal implementation\u003c/strong\u003e \u003cp\u003eLocal authorities, academy /school trusts, or schools to coordinate place-based upgrades and broker community partnerships and strategically align NbPs with wider funding schemes (e.g., public health grants, climate and sustainability fundings, charitable or corporate partnerships) to maximise impact. School leaders integrate NbPs within existing curriculum and MHWB provision, appoint Nature leads (that can team up with the sustainability lead), and embed continuing professional development (ITT and CPD) through co-production with pupils.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eResearch and evaluation partners\u003c/strong\u003e \u003cp\u003eUniversities co-design developmentally appropriate and adolescent-informed measures, pilot evaluation frameworks (cost\u0026ndash;benefit analysis, social return on investment, multi-criteria decision analysis), and publish open datasets. When aligned, these responsibilities would create the enabling architecture for equitable, evidence-led NbPs delivery. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e identifies key system actors with relevant statutory, technical, or delivery roles in scaling NbPs. Inclusion does not imply formal partnership or endorsement but reflects their existing mandates, infrastructures, or capacities relevant to implementation.\u003c/p\u003e \u003c/p\u003e"},{"header":"10 Risks, safeguards, and success factors","content":"\u003cp\u003eSuccess in scaling nature-based programmes depends on anticipating pitfalls and embedding safeguards throughout implementation while establishing conditions for sustained impact.\u003c/p\u003e \u003cp\u003e \u003cb\u003eUnderstanding the Risks\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe primary risk is that poorly implemented or inequitable NbPs waste resources, widen inequalities, and erode trust in evidence-based interventions and thus, potentially discrediting nature-based approaches more broadly (Forbes et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Garside et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Inequity may arise not only from unequal access to structured programmes, but also from reliance on incidental or passive exposure pathways (e.g., views of greenery or routine access to well-maintained grounds), which tend to be more prevalent in already well-resourced schools and neighbourhoods (Rigolon et al., \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRisks manifest differently across stakeholders. Policymakers risk promoting programmes failing to deliver promised outcomes. Educators risk inadequate preparation for effective delivery, increased strain on provider capacity (Garside et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Individual risk to students (disservices) includes allergies, animal nuisance, bullying risks in outdoor spaces, maintenance costs requiring specialised knowledge, and safety concerns, all of which highlights that proximity to nature alone is insufficient without quality, cultural fit, and institutional support. Communities face dual risks: exclusion from beneficial programmes or interventions inadvertently reinforcing existing disadvantages. Researchers risk producing evidence that is methodologically limited, misinterpreted, or disconnected from practice needs, undermining credibility and impact. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e summarises both contributions and potential disservices of nature in school settings, illustrating the need for transparent monitoring of benefits and harms.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eContributions and potential disservices of nature in school settings\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePros - Contributions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCons - Disservices\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBenefits for SEN students\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAesthetic concerns\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBidirectional benefits for human and ecological health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAllergies and pollen reactions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBiodiversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAnimal nuisance (insects, birds, rodents)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational resource\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBullying and interpersonal conflict risks in outdoor spaces\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFacilitates pro-social behaviour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDirt and cleanliness perceptions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHabitat connectivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGreen space perceived as age-inappropriate (mismatch between design and adolescent social identity and autonomy needs)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImproves air quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLack of maintenance during holidays\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImproves MHWB for students and staff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePerceived maintenance and expertise requirements (although evidence from schemes such as Sheffield\u0026rsquo;s Grey to Green suggests long-term costs can be reduced when well designed; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.greytogreen.org.uk/\u003c/span\u003e\u003cspan address=\"https://www.greytogreen.org.uk/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMitigates flooding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSafety concerns (real and perceived)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMitigates socio-economic disparities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProvides food sources\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProvides sense of place and belonging\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduces noise pollution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduces urban heat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupports biodiversity net gain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupports healthy soil and gut microbiome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMitigating these risks requires design and implementation safeguards, detailed below, embedding co-production and equity monitoring throughout programme lifecycles.\u003c/p\u003e \u003cp\u003eThis participatory approach must be paired with regular equity audits assessing accessibility beyond proximity (including green estate quality, safety, cultural fit), implementation fidelity across contexts, and both benefits and disservices (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The forthcoming DfE Sustainability and Climate Change Strategy refresh offers an opportunity to embed these safeguards formally within national policy, aligning with statutory environmental (Climate Change Act 2008, Environment Act 2021) and wellbeing commitments (Education Act 1996, Health and Social Care Act 2012).\u003c/p\u003e \u003cp\u003e \u003cb\u003eEssential safeguards to mitigate risk\u003c/b\u003e \u003c/p\u003e \u003cp\u003eEvidence from large-scale school mental health trials demonstrates that interventions designed without meaningful student and educator involvement can worsen outcomes for vulnerable young people (Montero-Marin et al., \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Consequently, embedding co-production throughout programme design, delivery, and evaluation functions as protective infrastructure, preventing three failure modes: misaligned priorities (e.g., our DPA workshops identified needs absent from literature such as 'green study spaces,' stigma mitigation strategies, bidirectional ecological concerns), developmental mismatch (adolescents rejecting child-oriented activities; educators prioritising time over training), and undetected harms (bullying, cultural exclusion, exposure-related anxiety). Here the education sector can draw on the medical sector's Patients and Publics Involvement and Engagement (PPIE) framework where NIHR embeds lived experience from priority-setting through evaluation, attributing youth and educators genuine decision-making authority, not tokenistic consultation (Singh et al., \u003cspan citationid=\"CR102\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eCritical success factors\u003c/b\u003e \u003c/p\u003e \u003cp\u003eSustainable scaling of nature-based programmes depends on three interrelated conditions: integrated data and research infrastructure linking environmental, educational, and wellbeing indicators; long-term policy commitments that recognise the interdependence of human and ecological health and extend beyond political cycles; and cross-sector literacy and intergenerational learning that enable educators, health professionals, policymakers, and young people to coordinate implementation. Together these conditions support evidence-based resource allocation, prevent programmes from remaining isolated pilots, and enable sustained, system-level change.\u003c/p\u003e"},{"header":"11 Limitations","content":"\u003cp\u003eThe synthesis prioritised breadth and stakeholder relevance over exhaustive inclusion of all available studies. Although the educator sample was small and geographically limited, triangulation across literature, practitioner insights, and policy deliberation strengthens validity. Future work should extend this analysis longitudinally and across educational phases to test the generalisability of findings.\u003c/p\u003e"},{"header":"12 Conclusion – Call to action","content":"\u003cp\u003eNature-based programmes should be integrated within whole-school mental health and wellbeing policy rather than treated as peripheral interventions. When integrated as a core component of whole-school mental health and wellbeing approaches, supported by teacher continuous professional development, and governed by interoperable data and equity safeguards, nature-based programmes can advance mental health and wellbeing, educational, and environmental outcomes simultaneously.\u003c/p\u003e \u003cp\u003eOur synthesis makes three contributions: demonstrating the importance of adolescence-specific approaches during a critical developmental period when mental health problems emerge and nature connection declines; developing a staged policy pathway that connects immediate \u0026lsquo;quick wins\u0026rsquo; with long-term systemic change; and illustrating how co-production research methods can align practice, policy, and research priorities.\u003c/p\u003e \u003cp\u003eBased on our evidence synthesis and stakeholder consultation, six strategic priorities emerge: (1) integrating nature-based programmes within whole-school mental health and wellbeing systems; (2) embedding equity safeguards and ensuring inclusive access to nature-based programmes; (3) strengthening professional capacity for sustainable, evidence-led nature-based programmes delivery; (4) building interoperable and developmentally appropriate and adolescent-informed metrics and evaluation tools; (5) establishing minimum school green-estate standards that prioritise MHWB and learning outcomes; and (6) developing coordinated cross-sector governance for NbPs implementation at scale. Grounded in UN guidance on children's rights to healthy environments and environmental education (Articles 28, 29), our research also positions nature-based approaches as rights-based imperatives rather than optional enhancements.\u003c/p\u003e \u003cp\u003eHowever, significant evidence gaps remain. English secondary schools are under-represented in research; methodological limitations constrain causal inference; and optimal implementation mechanisms require further development. The emerging evidence suggests nature-based programmes warrant serious investment as part of whole-school mental health and wellbeing provision (through a tiered universal-targeted intensive model), provided implementation includes rigorous evaluation, equity monitoring, and stakeholder co-production. Whether education systems can deliver this with sufficient quality and equity to address adolescent mental health needs at scale remains an open and urgent question.\u003c/p\u003e"},{"header":"Abbreviation","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbbreviation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDefinition\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eADR UK\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eAdministrative data research UK\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eANGSt\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eAccessible Natural Greenspace Standard\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCBA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eCost-benefit analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCPANS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eChildren and People and Nature Survey\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCPD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eContinuous professional development\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCYP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eChildren and Young People\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDEFRA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eDepartment for Environment, Food, and Rural Affairs\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDfE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eDepartment for Education\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDHSC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eDepartment of Health and Social Care\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDPA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eDeliberate Policy Action\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eECHILD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eEducation and Child Health Insights from Linked Data\u0026nbsp;- England\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eGreen infrastructure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eITT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eInitial teacher training\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMAT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eMulti-academy trusts\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMCDA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eMulticriteria decision analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMHST\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eMental health support team\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMHWB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eMental health and wellbeing\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNbPs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eNature-based programmes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eNatural England\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNENP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eNational Education Nature Park\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNGO\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eNon-government organisation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOfsted\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eThe Office for Standards in Education, Children\u0026apos;s Services and Skills (UK)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePPIE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003ePatients and Public Involvement and Engagement\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePSHE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003ePersonal, social, health and economic education\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRPA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eRisk protection arrangement\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSCC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eSustainability and climate change strategy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSENCO /SENDCO\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eSpecial Educational Needs Coordinator / Special Educational Needs and Disabilities Coordinator\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSLT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eSenior leadership team\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSROI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eSocial return on investment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYPAG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eYoung people advisory group\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThis manuscript reports secondary analyses of data collected as part of a prior study. Ethical approval for the original study was granted by the Medical Sciences Interdivisional Research Ethics Committee (MS IDREC 688330). All relevant ethical procedures, including informed consent, were followed in the primary study.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003e\u0026apos;Not applicable\u0026apos;\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003e\u0026apos;Not applicable\u0026apos;\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors report there are no competing interests to declare.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis study is funded by grant from the Natural Environment Research Council (NERC) (grant number NE/W004976/1) as part of the Agile Initiative at the Oxford Martin School and in part by the National Institute for Health Care Research (NIHR) Oxford Health Biomedical Research Centre [NIHR203316] and the Wellcome Trust (grant no. 226785/Z/ 22/Z). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003eJL, KW, and IS contributed to conceptualization. JL, KW, AT, SA, KP, RC, SM, and ML contributed to data curation. JL, KW, AT, SA, SM, and ML conducted formal analysis. KW and IS acquired funding. JL, KW, AT, SA, KP, RC, SM, ML, and IS contributed to investigation. JL, KW, AT, SA, SM, ML, and IS developed the methodology. JL, KW, and IS managed project administration. KW, AT, SA, and IS provided resources. JL, KW, AT, and IS provided supervision. JL, KW, AT, SA, KP, RC, SM, ML, and IS contributed to validation. KW, AT, and SA led visualization. KW wrote the original draft. All authors (JL, KW, AT, SA, KP, RC, SM, ML, and IS) contributed to review and editing.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eWe gratefully acknowledge colleagues at the Department for Education (DfE) for their valuable contributions to the development of this study. While the views expressed are those of the authors, their constructive collaboration and insights have helped shape the conceptual framing and policy relevance of this work.\u003c/p\u003e\n\u003cp\u003eWe would like to express our sincere gratitude to the project\u0026rsquo;s co-researchers, including all Patient and Public Involvement (PPI) contributors and the NeurOx YPAG whose invaluable insights and lived experiences and expertise have significantly shaped our research outputs and this paper.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; information (optional\u003c/p\u003e\n\u003cp\u003e\u0026apos;Not applicable\u0026apos;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAguirre Velasco A, Cruz ISS, Billings J, Jimenez M, Rowe S. What are the barriers, facilitators and interventions targeting help-seeking behaviours for common mental health problems in adolescents? A systematic review. BMC Psychiatry. 2020;20(1):293. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12888-020-02659-0\u003c/span\u003e\u003cspan address=\"10.1186/s12888-020-02659-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAngel\u0026ouml;w A, Psouni E. Participatory Research With Children: From Child-Rights Based Principles to Practical Guidelines for Meaningful and Ethical Participation. Int J Qualitative Methods. 2025;24. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/16094069251315391\u003c/span\u003e\u003cspan address=\"10.1177/16094069251315391\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArdoin NM, Bowers AW, Gaillard E. (2020). Environmental education outcomes for conservation: A systematic review. \u003cem\u003eBiological Conservation\u003c/em\u003e, \u003cem\u003e241\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.biocon.2019.108224\u003c/span\u003e\u003cspan address=\"10.1016/j.biocon.2019.108224\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBalundė A, Jovarauskaitė L, Poškus MS. Exploring the Relationship Between Connectedness With Nature, Environmental Identity, and Environmental Self-Identity: A Systematic Review and Meta-Analysis. SAGE Open. 2019;9(2). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/2158244019841925\u003c/span\u003e\u003cspan address=\"10.1177/2158244019841925\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBar\u0026oacute; F, Camacho DA, Del P\u0026eacute;rez C, Triguero-Mas M, Anguelovski I. School greening: Right or privilege? Examining urban nature within and around primary schools through an equity lens. Landsc Urban Plann. 2021;208. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.landurbplan.2020.104019\u003c/span\u003e\u003cspan address=\"10.1016/j.landurbplan.2020.104019\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarthel S, Belton S, Raymond CM, Giusti M. Fostering Children's Connection to Nature Through Authentic Situations: The Case of Saving Salamanders at School. Front Psychol. 2018;9:928. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyg.2018.00928\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2018.00928\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBassett S, Polgreen K, Wilhelm K. (2026). \u003cem\u003eSchools using nature for education and wellbeing: Burford School\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.agile-initiative.ox.ac.uk/wp-content/uploads/2026/02/Burford-CS.pdf\u003c/span\u003e\u003cspan address=\"https://www.agile-initiative.ox.ac.uk/wp-content/uploads/2026/02/Burford-CS.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBecht A, Spitzer J, Grapsas S, van de Wetering J, Poorthuis A, Smeekes A, Thomaes S. Feeling anxious and being engaged in a warming world: climate anxiety and adolescents' pro-environmental behavior. J Child Psychol Psychiatry. 2024;65(10):1270\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jcpp.14035\u003c/span\u003e\u003cspan address=\"10.1111/jcpp.14035\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlanuša T, Sutcliffe C, Tanner R, Barker J, Woolley O, Naylor R. Implementation of green infrastructure in schools as a science and environmental learning tool \u0026ndash; UK secondary school case study. Acta Hort. 2025;1429125\u0026ndash;30. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.17660/ActaHortic.2025.1429.14\u003c/span\u003e\u003cspan address=\"10.17660/ActaHortic.2025.1429.14\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBratman GN, Anderson CB, Berman MG, Cochran B, de Vries S, Flanders J, Folke C, Frumkin H, Gross JJ, Hartig T, Kahn PH Jr., Kuo M, Lawler JJ, Levin PS, Lindahl T, Meyer-Lindenberg A, Mitchell R, Ouyang Z, Roe J, Daily GC. Nature and mental health: An ecosystem service perspective. Sci Adv. 2019;5(7):eaax0903. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1126/sciadv.aax0903\u003c/span\u003e\u003cspan address=\"10.1126/sciadv.aax0903\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCampbell R, McGaw V, Reupert A. Systematic review and meta-analysis investigating nature-based interventions for adolescent mental health: Program characteristics and effectiveness. J Environ Psychol. 2026;110. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jenvp.2026.102917\u003c/span\u003e\u003cspan address=\"10.1016/j.jenvp.2026.102917\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCappleman S, Polgreen K, Wilhelm K. (2026). \u003cem\u003eSchools using nature for education and wellbeing: The Cherwell School\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.agile-initiative.ox.ac.uk/wp-content/uploads/2026/02/Cherwell-CS.pdf\u003c/span\u003e\u003cspan address=\"https://www.agile-initiative.ox.ac.uk/wp-content/uploads/2026/02/Cherwell-CS.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChambers JM, Wyborn C, Klenk NL, Ryan M, Serban A, Bennett NJ, Brennan R, Charli-Joseph L, Fern\u0026aacute;ndez-Gim\u0026eacute;nez ME, Galvin KA, Goldstein BE, Haller T, Hill R, Munera C, Nel JL, \u0026Ouml;sterblom H, Reid RS, Riechers M, Spierenburg M, Rondeau R. Co-productive agility and four collaborative pathways to sustainability transformations. Glob Environ Change. 2022;72. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.gloenvcha.2021.102422\u003c/span\u003e\u003cspan address=\"10.1016/j.gloenvcha.2021.102422\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChawla L, Keena K, Pevec I, Stanley E. Green schoolyards as havens from stress and resources for resilience in childhood and adolescence [Article]. Health Place. 2014;28:1\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.healthplace.2014.03.001\u003c/span\u003e\u003cspan address=\"10.1016/j.healthplace.2014.03.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChiumento A, Mukherjee I, Chandna J, Dutton C, Rahman A, Bristow K. A haven of green space: learning from a pilot pre-post evaluation of a school-based social and therapeutic horticulture intervention with children. BMC Public Health. 2018;18:836. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12889-018-5661-9\u003c/span\u003e\u003cspan address=\"10.1186/s12889-018-5661-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClarke A, Pote I, Sorgenfrei M. (2020). Adolescent mental health evidence brief 1: Prevalence of disorders. Early Intervention Foundation. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.eif.org.uk/report/adolescent-mental-health-evidence-brief-1-prevalence-of-disorders\u003c/span\u003e\u003cspan address=\"https://www.eif.org.uk/report/adolescent-mental-health-evidence-brief-1-prevalence-of-disorders\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClarke A, Sorgenfrei M, Mulcahy J, Davie P, Friedrich C, McBride T. (2021). A systematic review on the effectiveness of school-basedinterventions. Early Intervention Foundation. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.eif.org.uk/report/adolescent-mental-health-a-systematic-review-on-the-effectiveness-of-school-based-interventions\u003c/span\u003e\u003cspan address=\"https://www.eif.org.uk/report/adolescent-mental-health-a-systematic-review-on-the-effectiveness-of-school-based-interventions\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCollado S, Staats H, Sancho P. Normative Influences on Adolescents\u0026rsquo; Self-Reported Pro-Environmental Behaviors: The Role of Parents and Friends. Environ Behav. 2017;51(3):288\u0026ndash;314. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0013916517744591\u003c/span\u003e\u003cspan address=\"10.1177/0013916517744591\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eComber A, Brunsdon C, Green E. Using a GIS-based network analysis to determine urban greenspace accessibility for different ethnic and religious groups. Landsc Urban Plann. 2008;86(1):103\u0026ndash;14. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.landurbplan.2008.01.002\u003c/span\u003e\u003cspan address=\"10.1016/j.landurbplan.2008.01.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCottrill R, Robinson K, Clowes P, Corrigan S, Williams M, Gill V. (2025). \u003cem\u003eNational Education Nature Park - Process evaluation, research report\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoventry PA, Brown JE, Pervin J, Brabyn S, Pateman R, Breedvelt J, Gilbody S, Stancliffe R, McEachan R, White PL. Nature-based outdoor activities for mental and physical health: Systematic review and meta-analysis. SSM Popul Health. 2021;16:100934. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ssmph.2021.100934\u003c/span\u003e\u003cspan address=\"10.1016/j.ssmph.2021.100934\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCox DTC, Bennie J, Casalegno S, Hudson HL, Anderson K, Gaston KJ. Skewed contributions of individual trees to indirect nature experiences. Landsc Urban Plann. 2019;185:28\u0026ndash;34. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.landurbplan.2019.01.008\u003c/span\u003e\u003cspan address=\"10.1016/j.landurbplan.2019.01.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCox DTC, Shanahan DF, Hudson HL, Fuller RA, Anderson K, Hancock S, Gaston KJ. Doses of Nearby Nature Simultaneously Associated with Multiple Health Benefits. Int J Environ Res Public Health. 2017;14(2). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijerph14020172\u003c/span\u003e\u003cspan address=\"10.3390/ijerph14020172\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCox DTC, Shanahan DF, Hudson HL, Plummer KE, Siriwardena GM, Fuller RA, Anderson K, Hancock S, Gaston KJ. Doses of Neighborhood Nature: The Benefits for Mental Health of Living with Nature. BioScience 67. 2017. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/biosci/biw173\u003c/span\u003e\u003cspan address=\"10.1093/biosci/biw173\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrespo-Mart\u0026iacute;n J, Corbacho‐Cuello I, Mu\u0026ntilde;oz‐Losa A. Teacher Education as an Agent for Sustainability: Validation of an SDGs‐Focused Knowledge, Attitude, and Behavior Questionnaire for Pre‐Service Primary Teachers. Sustain Dev. 2025. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/sd.70084\u003c/span\u003e\u003cspan address=\"10.1002/sd.70084\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavis Z, Jarvis I, Macaulay R, Johnson K, Williams N, Li J, Hahs A. A systematic review of the associations between biodiversity and children's mental health and wellbeing. Environ Res. 2025;266:120551. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.envres.2024.120551\u003c/span\u003e\u003cspan address=\"10.1016/j.envres.2024.120551\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDepartment for Education. (2023a). \u003cem\u003eMental health support team school and college survey\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDepartment for Education. (2023b). \u003cem\u003eSchool output specification Technical annex 2J: sustainability\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDepartment for Education. (2023c). \u003cem\u003eSustainability and climate change: a strategy for the education and children\u0026rsquo;s services systems\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.gov.uk/government/publications/sustainability-and-climate-change-strategy/sustainability-and-climate-change-a-strategy-for-the-education-and-childrens-services-systems\u003c/span\u003e\u003cspan address=\"https://www.gov.uk/government/publications/sustainability-and-climate-change-strategy/sustainability-and-climate-change-a-strategy-for-the-education-and-childrens-services-systems\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDepartment for Education. (2024). \u003cem\u003eDfE Sustainability and Climate Change Strategy: Evaluation Framework\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://assets.publishing.service.gov.uk/media/65b8fed74ec51d0014c9f16e/DfE_SCC_strategy_evaluation_framework_.pdf\u003c/span\u003e\u003cspan address=\"https://assets.publishing.service.gov.uk/media/65b8fed74ec51d0014c9f16e/DfE_SCC_strategy_evaluation_framework_.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDepartment for Education. (2025a). \u003cem\u003eEvaluation strategy 2025\u0026ndash;2029\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDepartment for Education. (2025b). \u003cem\u003eGovernment response to the curriculum and assessment review\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDiaz S, Pascual U, Stenseke M, Martin-Lopez B, Watson RT, Molnar Z, Hill R, Chan KMA, Baste IA, Brauman KA, Polasky S, Church A, Lonsdale M, Larigauderie A, Leadley PW, van Oudenhoven, Plaat F, Schroter M, Lavorel S, Shirayama Y. Assessing nature's contributions to people. Science. 2018;359(6373):270\u0026ndash;2. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1126/science.aap8826\u003c/span\u003e\u003cspan address=\"10.1126/science.aap8826\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. A. P. E., van der.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDillon J, Dickie I. (2012). \u003cem\u003eLearning in the Natural Environment: Review of social and economic benefits and barriers (NECR092)\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDr\u0026auml;ger J, Klein M, Sosu E. The long-term consequences of early school absences for educational attainment and labour market outcomes. Br Edu Res J. 2024;50(4):1636\u0026ndash;54. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/berj.3992\u003c/span\u003e\u003cspan address=\"10.1002/berj.3992\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFazel M, Soneson E, Sellars E, Butler G, Stein A. Partnerships at the Interface of Education and Mental Health Services: The Utilisation and Acceptability of the Provision of Specialist Liaison and Teacher Skills Training. Int J Environ Res Public Health. 2023;20(5). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijerph20054066\u003c/span\u003e\u003cspan address=\"10.3390/ijerph20054066\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eForbes H, Wheeler B, Reeves J, Lovell R. How can funding for nature-based programmes impact health inequalities? A realist protocol. Syst Rev. 2025;14(1):204. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s13643-025-02938-5\u003c/span\u003e\u003cspan address=\"10.1186/s13643-025-02938-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eForest School Association. (2022). \u003cem\u003eThe Nature Premium campaign\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://forestschoolassociation.org/the-nature-premium-campaign/\u003c/span\u003e\u003cspan address=\"https://forestschoolassociation.org/the-nature-premium-campaign/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFoulkes L, Holst G, C., Andrews JL. Potential harm from universal school-based mental health interventions: Candidate mechanisms and future directions. Curr Opin Psychol. 2026;67:102196. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.copsyc.2025.102196\u003c/span\u003e\u003cspan address=\"10.1016/j.copsyc.2025.102196\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarip G, Richardson M, Tinkler A, Glover S, Rees A. Development and implementation of evaluation resources for a green outdoor educational program [Article]. J Environ Educ. 2021;52(1):25\u0026ndash;39. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/00958964.2020.1845588\u003c/span\u003e\u003cspan address=\"10.1080/00958964.2020.1845588\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarside R, Orr N, Short R, Lovell B, Husk K, McEachan R, Rashid R, Dickie I. (2020). \u003cem\u003eTherapeutic Nature: Nature-based social prescribing for diagnosed mental health conditions in the UK\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://arc-swp.nihr.ac.uk/wp/wp-content/uploads/2021/06/15138_TherapeuticNature-Finalreport.pdf\u003c/span\u003e\u003cspan address=\"https://arc-swp.nihr.ac.uk/wp/wp-content/uploads/2021/06/15138_TherapeuticNature-Finalreport.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGreenwood A, Gatersleben B. Let's go outside! Environmental restoration amongst adolescents and the impact of friends and phones. J Environ Psychol. 2016;48:131\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jenvp.2016.09.007\u003c/span\u003e\u003cspan address=\"10.1016/j.jenvp.2016.09.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGush MB, Blanuša T, Chalmin-Pui LS, Griffiths A, Larsen EK, Prasad R, Redmile‐Gordon M, Sutcliffe C. Environmental horticulture for domestic and community gardens - An integrated and applied research approach. Plants People Planet. 2023;6(2):254\u0026ndash;70. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/ppp3.10444\u003c/span\u003e\u003cspan address=\"10.1002/ppp3.10444\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarris NM, Hartwell B, Thomas L, Grace M. How can nature connectedness and behaviours for learning be deliberately developed in children, adolescents and young adults? A systematic literature review. Child Adolesc Ment Health. 2025;30(2):168\u0026ndash;85. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/camh.12774\u003c/span\u003e\u003cspan address=\"10.1111/camh.12774\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarvey D, Jenkins S, Baker D, Hunt A. (2025). Different Journeys: Regional variations in English school residential visits and changes over time. \u003cem\u003eThe Council for Learning Outside the Classroom\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHazell J, Clarke E. (2024). Nurturing future leaders for nature: the example of the UK's National Education Nature Park. \u003cem\u003ePhilos Trans R Soc Lond B Biol Sci\u003c/em\u003e, \u003cem\u003e379\u003c/em\u003e(1903), 20220330. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1098/rstb.2022.0330\u003c/span\u003e\u003cspan address=\"10.1098/rstb.2022.0330\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHickman C, Marks E, Pihkala P, Clayton S, Lewandowski RE, Mayall EE, Wray B, Mellor C, van Susteren L. Climate anxiety in children and young people and their beliefs about government responses to climate change: a global survey. Lancet Planet Health. 2021;5(12):e863\u0026ndash;73. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S2542-5196(21)00278-3\u003c/span\u003e\u003cspan address=\"10.1016/S2542-5196(21)00278-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHopkins van Mil. (2025). \u003cem\u003eNature-based programmes for mental health and wellbeing in secondary schools Deliberative Policy Action (DPA) Workshop February 18th 2025\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHyseni C, Heino J, Bini LM, Bjelke U, Johansson F. The importance of blue and green landscape connectivity for biodiversity in urban ponds. Basic Appl Ecol. 2021;57:129\u0026ndash;45. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.baae.2021.10.004\u003c/span\u003e\u003cspan address=\"10.1016/j.baae.2021.10.004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInstitute for Outdoor Learning. (2026). \u003cem\u003eNature Premium\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.outdoor-learning.org/community/sector-specialist-groups/nature-premium.html\u003c/span\u003e\u003cspan address=\"https://www.outdoor-learning.org/community/sector-specialist-groups/nature-premium.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKearney CA, Dupont R, Fensken M, Gonz\u0026aacute;lvez C. (2023). School attendance problems and absenteeism as early warning signals: review and implications for health-based protocols and school-based practices. \u003cem\u003eFrontiers in Education\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/feduc.2023.1253595\u003c/span\u003e\u003cspan address=\"10.3389/feduc.2023.1253595\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKelly K, Polgreen K, Wilhelm K. (2026). \u003cem\u003eSchools using nature for education and wellbeing: Mount Kelly School\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.agile-initiative.ox.ac.uk/wp-content/uploads/2026/02/Mount-Kelly-CS.pdf\u003c/span\u003e\u003cspan address=\"https://www.agile-initiative.ox.ac.uk/wp-content/uploads/2026/02/Mount-Kelly-CS.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLadbrook R, Polgreen K, Wilhelm K. (2026). \u003cem\u003eSchools using nature for education and wellbeing: Wallingford School\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.agile-initiative.ox.ac.uk/wp-content/uploads/2026/02/Wallingford-CS.pdf\u003c/span\u003e\u003cspan address=\"https://www.agile-initiative.ox.ac.uk/wp-content/uploads/2026/02/Wallingford-CS.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLawrance EL, Thompson R, Le Vay N, Page J, L., Jennings N. The Impact of Climate Change on Mental Health and Emotional Wellbeing: A Narrative Review of Current Evidence, and its Implications. Int Rev Psychiatry. 2022;34(5):443\u0026ndash;98. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/09540261.2022.2128725\u003c/span\u003e\u003cspan address=\"10.1080/09540261.2022.2128725\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLekies KS, Yost G, Rode J. Urban youth׳s experiences of nature: Implications for outdoor adventure recreation. J Outdoor Recreation Tourism. 2015;9:1\u0026ndash;10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jort.2015.03.002\u003c/span\u003e\u003cspan address=\"10.1016/j.jort.2015.03.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLetendre M. (2025). \u003cem\u003eBarriers, Facilitators, and Moderators: Educator Perspectives on Implementation of Nature-based Programs for Mental Health and Well-being in UK Secondary Schools\u003c/em\u003e University of Oxford]. Oxford. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://ora.ox.ac.uk/objects/uuid:42f4f983-be19-484b-bcab-8b61f32924eb\u003c/span\u003e\u003cspan address=\"https://ora.ox.ac.uk/objects/uuid:42f4f983-be19-484b-bcab-8b61f32924eb\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLomax T, Butler J, Cipriani A, Singh I. Effect of nature on the mental health and well-being of children and adolescents: meta-review. Br J Psychiatry. 2024;1\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1192/bjp.2024.109\u003c/span\u003e\u003cspan address=\"10.1192/bjp.2024.109\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLoose T, Fuoco J, Malboeuf-Hurtubise C, Ayotte-Beaudet JP, Gauvin L, Chadi N, Ouellet-Morin I, Masse B, Cote SM, Geoffroy MC. A Nature-Based Intervention and Mental Health of Schoolchildren: A Cluster Randomized Clinical Trial. JAMA Netw Open. 2024;7(11):e2444824. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1001/jamanetworkopen.2024.44824\u003c/span\u003e\u003cspan address=\"10.1001/jamanetworkopen.2024.44824\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLorimer J, Menon S, Polgreen K, Wilhelm K, Singh I. (2025). A scoping review of nature-based programmes in schools for mental health and wellbeing in young people (pre-print). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.31234/osf.io/rf5xd_v1\u003c/span\u003e\u003cspan address=\"10.31234/osf.io/rf5xd_v1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLovell R. (2019). \u003cem\u003eWhat Works in school based natural environment interventions: A scoping review\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLumber R, Richardson M, Sheffield D. Beyond knowing nature: Contact, emotion, compassion, meaning, and beauty are pathways to nature connection. PLoS ONE. 2017;12(5):e0177186. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0177186\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0177186\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLyreskog D, Menon S, Hohnen-Ford W, McKeown A, Wilhelm K, Pulcu E, Iyadurai L, Singh I. (2025). Ethical Challenges to Green Social Prescribing in the UK Mental Health System (pre-print). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.31234/osf.io/ehbq5_v1\u003c/span\u003e\u003cspan address=\"10.31234/osf.io/ehbq5_v1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMacGregor S, Friesen S, Turner J, Domene JF, McMorris C, Allan S, Mesner B, Sumara D. The Side Effects of Universal School-Based Mental Health Supports: An Integrative Review. Rev Res Educ. 2024;48(1):28\u0026ndash;57. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3102/0091732x241256628\u003c/span\u003e\u003cspan address=\"10.3102/0091732x241256628\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMacLean A, Hunt K, Sweeting H. Symptoms of Mental Health Problems: Children's and Adolescents' Understandings and Implications for Gender Differences in Help Seeking. Child Soc. 2013;27(3):161\u0026ndash;73. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1099-0860.2011.00406.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1099-0860.2011.00406.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMacNaughton P, Eitland E, Kloog I, Schwartz J, Allen J. Impact of Particulate Matter Exposure and Surrounding Greenness on Chronic Absenteeism in Massachusetts Public Schools. Int J Environ Res Public Health. 2017;14(2). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijerph14020207\u003c/span\u003e\u003cspan address=\"10.3390/ijerph14020207\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMann J, Gray T, Truong S, Brymer E, Passy R, Ho S, Sahlberg P, Ward K, Bentsen P, Curry C, Cowper R. Getting Out of the Classroom and Into Nature: A Systematic Review of Nature-Specific Outdoor Learning on School Children's Learning and Development. Front Public Health. 2022;10:877058. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpubh.2022.877058\u003c/span\u003e\u003cspan address=\"10.3389/fpubh.2022.877058\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarselle MR, Lindley SJ, Cook PA, Bonn A. Biodiversity and Health in the Urban Environment. Curr Environ Health Rep. 2021;8(2):146\u0026ndash;56. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s40572-021-00313-9\u003c/span\u003e\u003cspan address=\"10.1007/s40572-021-00313-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcCormick R. Does Access to Green Space Impact the Mental Well-being of Children: A Systematic Review. J Pediatr Nurs. 2017;37:3\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.pedn.2017.08.027\u003c/span\u003e\u003cspan address=\"10.1016/j.pedn.2017.08.027\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMontana J, Ferguson C, Marshall T, Barrios-O\u0026rsquo;Neill D, Bavin S, Cardinal I, Crockatt M, Gent J, Hafferty C, Hirons M, Hughes J, Janda E, Maxwell S, Mailley J, McDermott M, Mitchell M, Owen R, Rydlewski J, Sheffield D, Simms C, Slessor J, Ver\u0026iacute;ssimo D, Wilhelm K. (2023). \u003cem\u003eLarge-scale social surveys on people and nature relations: Report on the state of the art in the UK\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMontero-Marin J, Allwood M, Ball S, Crane C, De Wilde K, Hinze V, Jones B, Lord L, Nuthall E, Raja A, Taylor L, Tudor K, Team M, Blakemore SJ, Byford S, Dalgleish T, Ford T, Greenberg MT, Ukoumunne OC, Kuyken W. School-based mindfulness training in early adolescence: what works, for whom and how in the MYRIAD trial? Evid Based Ment Health. 2022;25(3):117\u0026ndash;24. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/ebmental-2022-300439\u003c/span\u003e\u003cspan address=\"10.1136/ebmental-2022-300439\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoore J, Malhi Y, Wilhelm K, Awad E, Broome M, Crisp R, Geddes J, Hart A, Hinze V, Hiscock S, Lomax T, Kuyken W, Maloney S, Marlowe K, Montero-Mar\u0026iacute;n J, Murphy K, De Neve JE, Reinecke MG, Savulescu J, Singh I. (2025). Ecological-Collective-Flourishing: A radical proposal for research and policy to develop and sustain human and environmental flourishing (pre-print). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/https://doi.org/10.31234/osf.io/5gphe\u003c/span\u003e\u003cspan address=\"10.31234/osf.io/5gphe\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNatural England. (2024a). \u003cem\u003eThe Children and Nature Programme 2019\u0026ndash;2022\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNatural England. (2024b). \u003cem\u003eThe Children\u0026rsquo;s People and Nature Survey for England\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNatural England. (2024c). NEER030 A narrative review of reviews of nature exposure and human health and well-being in the UK (NEER030).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNatural England. (2025). \u003cem\u003eThe Children\u0026rsquo;s People and Nature Survey for England: 2025 update\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.gov.uk/government/statistics/the-childrens-people-and-nature-survey-for-england-2025-update/the-childrens-people-and-nature-survey-for-england-2025-update\u003c/span\u003e\u003cspan address=\"https://www.gov.uk/government/statistics/the-childrens-people-and-nature-survey-for-england-2025-update/the-childrens-people-and-nature-survey-for-england-2025-update\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNeurohr AL, Pasch N, Otto S, Moller A. Measuring adolescents' level of interest in nature: a promising psychological factor facilitating nature protection. Front Psychol. 2023;14:1186557. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyg.2023.1186557\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2023.1186557\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLe Newberry J, Cunningham A, Soul L, Dave H, Hoath L, Lawrance EL. Integrating mental health into climate change education to inspire climate action while safeguarding mental health. Front Psychol. 2023;14:1298623. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyg.2023.1298623\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2023.1298623\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNHS Digital. (2023). \u003cem\u003eMental health of children and young people in England, 2023: Wave 4 follow\u0026ndash;up to the 2017 survey. NHS England\u003c/em\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.gov.uk/government/statistics/mental-health-of-children-and-young-people-in-england-2023-wave-4-follow-up-to-the-2017-survey\u003c/span\u003e\u003cspan address=\"https://www.gov.uk/government/statistics/mental-health-of-children-and-young-people-in-england-2023-wave-4-follow-up-to-the-2017-survey\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNHS England. (2019, updated 2025). \u003cem\u003eFit for the future: 10 Year Health Plan for England\u003c/em\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://assets.publishing.service.gov.uk/media/6888a0b1a11f859994409147/fit-for-the-future-10-year-health-plan-for-england.pdf\u003c/span\u003e\u003cspan address=\"https://assets.publishing.service.gov.uk/media/6888a0b1a11f859994409147/fit-for-the-future-10-year-health-plan-for-england.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNisbet EK, Zelenski JM, Murphy SA. The Nature Relatedness Scale. Environ Behav. 2008;41(5):715\u0026ndash;40. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0013916508318748\u003c/span\u003e\u003cspan address=\"10.1177/0013916508318748\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO\u0026rsquo;Malley S, Pierce J. Mainstream or margins? The changing role of environmental education in Irish primary school curricula, 1872 to 2021. J outdoor Environ Educ. 2022;26(2):189\u0026ndash;206. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s42322-022-00118-w\u003c/span\u003e\u003cspan address=\"10.1007/s42322-022-00118-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOfsted. (2025). Education inspection framework: for use from November 2025. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.gov.uk/government/publications/education-inspection-framework/education-inspection-framework-for-use-from-november-2025\u003c/span\u003e\u003cspan address=\"https://www.gov.uk/government/publications/education-inspection-framework/education-inspection-framework-for-use-from-november-2025\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlsson D, Gericke N. The adolescent dip in students' sustainability consciousness\u0026mdash;Implications for education for sustainable development. J Environ Educ. 2015;47(1):35\u0026ndash;51. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/00958964.2015.1075464\u003c/span\u003e\u003cspan address=\"10.1080/00958964.2015.1075464\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOverbey TA, Diekmann F, Lekies KS. Nature-based interventions for vulnerable youth: a scoping review. Int J Environ Health Res. 2023;33(1):15\u0026ndash;53. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/09603123.2021.1998390\u003c/span\u003e\u003cspan address=\"10.1080/09603123.2021.1998390\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatel V, Saxena S, Lund C, Kohrt B, Kieling C, Sunkel C, Kola L, Chang O, Charlson F, O'Neill K, Herrman H. Transforming mental health systems globally: principles and policy recommendations. Lancet. 2023;402(10402):656\u0026ndash;66. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0140-6736(23)00918-2\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(23)00918-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePereira M, Forster PM. (2015). The Relationship between Connectedness to Nature, Environmental Values, and Pro-environmental Behaviours. Reinvention: Int J Undergrad Res, \u003cem\u003e8\u003c/em\u003e(2). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://warwick.ac.uk/fac/cross_fac/iatl/research/reinvention/archive/volume8issue2/pereira/\u003c/span\u003e\u003cspan address=\"https://warwick.ac.uk/fac/cross_fac/iatl/research/reinvention/archive/volume8issue2/pereira/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePirchio S, Passiatore Y, Panno A, Cipparone M, Carrus G. The Effects of Contact With Nature During Outdoor Environmental Education on Students' Wellbeing, Connectedness to Nature and Pro-sociality. Front Psychol. 2021;12:648458. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyg.2021.648458\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2021.648458\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrice A. Improving school attendance: can participation in outdoor learning influence attendance for young people with social, emotional and behavioural difficulties? J Adventure Educ Outdoor Learn. 2013;15(2):110\u0026ndash;22. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/14729679.2013.850732\u003c/span\u003e\u003cspan address=\"10.1080/14729679.2013.850732\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrice E, Maguire S, Firth C, Lumber R, Richardson M, Young R. Factors associated with nature connectedness in school-aged children. Curr Res Ecol Social Psychol. 2022;3. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.cresp.2022.100037\u003c/span\u003e\u003cspan address=\"10.1016/j.cresp.2022.100037\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQin Z, Wu Q, Bi C, Deng Y, Hu Q. The relationship between climate change anxiety and pro-environmental behavior in adolescents: the mediating role of future self-continuity and the moderating role of green self-efficacy. BMC Psychol. 2024;12(1):241. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s40359-024-01746-1\u003c/span\u003e\u003cspan address=\"10.1186/s40359-024-01746-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReed H, Couturiaux D, Davis M, Edwards A, Janes E, Kim HS, Melendez-Torres GJ, Murphy S, Rotevatn TA, Smith J, Evans R. Co-production as an Emerging Methodology for Developing School-Based Health Interventions with Students Aged 11\u0026ndash;16: Systematic Review of Intervention Types, Theories and Processes and Thematic Synthesis of Stakeholders' Experiences. Prev Sci. 2021;22(4):475\u0026ndash;91. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11121-020-01182-8\u003c/span\u003e\u003cspan address=\"10.1007/s11121-020-01182-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReed H, Murphy S, Evans R. Optimising a co-production framework for developing public health interventions: application and testing of school-based Research Action Groups. Health Res Policy Syst. 2023;21(1):133. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12961-023-01086-3\u003c/span\u003e\u003cspan address=\"10.1186/s12961-023-01086-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRian SW, Coll KM. Increased Exposure to Nature Reduces Elementary Students' Anxiety. Ecopsychology. 2021;13(4):257\u0026ndash;64. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1089/eco.2020.0070\u003c/span\u003e\u003cspan address=\"10.1089/eco.2020.0070\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRice B. (2023). \u003cem\u003eThe missing link. Social prescribing for children and young people\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRichardson M, Hunt A, Hinds J, Bragg R, Fido D, Petronzi D, Barbett L, Clitherow T, White M. A Measure of Nature Connectedness for Children and Adults: Validation, Performance, and Insights. Sustainability. 2019;11(12). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/su11123250\u003c/span\u003e\u003cspan address=\"10.3390/su11123250\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRichardson M, Passmore H-A, Lumber R, Thomas R, Hunt A. Moments, not minutes: The nature-wellbeing relationship. Int J Wellbeing. 2021;11(1):8\u0026ndash;33. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5502/ijw.v11i1.1267\u003c/span\u003e\u003cspan address=\"10.5502/ijw.v11i1.1267\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRigolon A, Browning M, McAnirlin O, Yoon HV. Green Space and Health Equity: A Systematic Review on the Potential of Green Space to Reduce Health Disparities. Int J Environ Res Public Health. 2021;18(5). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijerph18052563\u003c/span\u003e\u003cspan address=\"10.3390/ijerph18052563\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRobinson JM, Barrable A. (2023). Optimising Early Childhood Educational Settings for Health Using Nature-Based Solutions: The Microbiome Aspect. \u003cem\u003eEducation Sciences\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e(2). https://doi.org/ARTN 21110.3390/educsci13020211.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRuiz-Gallardo J-R, Verde A, Vald\u0026eacute;s A. Garden-Based Learning: An Experience With At Risk Secondary Education Students. J Environ Educ. 2013;44(4):252\u0026ndash;70. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/00958964.2013.786669\u003c/span\u003e\u003cspan address=\"10.1080/00958964.2013.786669\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRushton EAC, Walshe N. Curriculum making and climate change and sustainability education: a case study of school teachers\u0026rsquo; practices from England, UK. Environ Educ Res. 2025;31(5):1083\u0026ndash;97. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/13504622.2025.2471990\u003c/span\u003e\u003cspan address=\"10.1080/13504622.2025.2471990\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShrestha T, Voon Yi Chi C, Cassarino M, Foley S, Di Blasi Z. Factors influencing the effectiveness of nature-based interventions (NBIs) aimed at improving mental health and wellbeing: An umbrella review. Environ Int. 2025;196:109217. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.envint.2024.109217\u003c/span\u003e\u003cspan address=\"10.1016/j.envint.2024.109217\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSingh I, Viding E, Spencer L, Austin C, Kokan ZR, Stringaris A. The need for a science of patient and public involvement and participation in child and adolescent mental health research. Nat Mental Health. 2025. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/s44220-025-00497-1\u003c/span\u003e\u003cspan address=\"10.1038/s44220-025-00497-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSnaith B, Odedun A. Weeds, wildflowers, and White privilege: Why recognizing nature\u0026rsquo;s cultural content is key to ethnically inclusive urban greenspaces. J Race Ethn City. 2023;5(1):1\u0026ndash;27. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/26884674.2023.2224115\u003c/span\u003e\u003cspan address=\"10.1080/26884674.2023.2224115\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSolmi M, Radua J, Olivola M, Croce E, Soardo L, Salazar de Pablo G, Il Shin J, Kirkbride JB, Jones P, Kim JH, Kim JY, Carvalho AF, Seeman MV, Correll CU, Fusar-Poli P. Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Mol Psychiatry. 2022;27(1):281\u0026ndash;95. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/s41380-021-01161-7\u003c/span\u003e\u003cspan address=\"10.1038/s41380-021-01161-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSprague N, Berrigan D, Ekenga CC. An Analysis of the Educational and Health-Related Benefits of Nature-Based Environmental Education in Low-Income Black and Hispanic Children. Health equity. 2020;4(1):198\u0026ndash;210. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1089/heq.2019.0118\u003c/span\u003e\u003cspan address=\"10.1089/heq.2019.0118\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStaniszewska S, Denegri S, Matthews R, Minogue V. Reviewing progress in public involvement in NIHR research: developing and implementing a new vision for the future. BMJ Open. 2018;8(7):e017124. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/bmjopen-2017-017124\u003c/span\u003e\u003cspan address=\"10.1136/bmjopen-2017-017124\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTanaji AT, Usman AH, Jackaria PM, Jaudinez AS, Abubakar A-JU. Effectiveness of outdoor mathematics in developing grade 7 students\u0026rsquo; ability on measurement. J Educ Learn (EduLearn). 2026;20(1):48\u0026ndash;55. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.11591/edulearn.v20i1.22780\u003c/span\u003e\u003cspan address=\"10.11591/edulearn.v20i1.22780\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTaylor L, Hochuli DF. Defining greenspace: Multiple uses across multiple disciplines. Landsc Urban Plann. 2017;158:25\u0026ndash;38. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.landurbplan.2016.09.024\u003c/span\u003e\u003cspan address=\"10.1016/j.landurbplan.2016.09.024\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe Wildlife Trust. (2023). \u003cem\u003eA Natural Health Service - Improving lives and saving money\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTillmann S, Tobin D, Avison W, Gilliland J. Mental health benefits of interactions with nature in children and teenagers: a systematic review. J Epidemiol Commun Health. 2018;72(10):958. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/jech-2018-210436\u003c/span\u003e\u003cspan address=\"10.1136/jech-2018-210436\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsiachristas A, Arshad S, Lorimer J, Singh I, Wilhelm K. (2025). \u003cem\u003eConceptual Framework for Assessing the Economic Impact of Nature-based Programmes on the Mental Health and Well-Being of Adolescents (secondary school-aged students)\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTurcotte-Tremblay AM, Fortier G, Belanger RE, Dion B, Gansaonre C, Leatherdale RJ, S. T., Haddad S. Adolescents' impairment due to climate anxiety is associated with self-efficacy and behavioral engagement: a cross-sectional analysis in Quebec (Canada). BMC Public Health. 2024;24(1):3009. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12889-024-20333-y\u003c/span\u003e\u003cspan address=\"10.1186/s12889-024-20333-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTwohig-Bennett C, Jones A. The health benefits of the great outdoors: A systematic review and meta-analysis of greenspace exposure and health outcomes. Environ Res. 2018;166:628\u0026ndash;37. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.envres.2018.06.030\u003c/span\u003e\u003cspan address=\"10.1016/j.envres.2018.06.030\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUK Parliament. (2020). \u003cem\u003eNature Premium campaign (Early Day Motion No. 953)\u003c/em\u003e. Retrieved from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://edm.parliament.uk/early-day-motion/57507/nature-premium-campaign\u003c/span\u003e\u003cspan address=\"https://edm.parliament.uk/early-day-motion/57507/nature-premium-campaign\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUlrich RS, Parsons R. (1992). Influences of passive experiences with plants on individual well-being and health. In D. Relf, editor, \u003cem\u003eThe role of Horticulture in Human Well-being and Social Development\u003c/em\u003e. Timber Press. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.researchgate.net/profile/Roger-Ulrich-2/publication/343722421_Ulrich_Parsons_1992_Influences_of_experiences_with_plants_on_well-being_and_health/links/5f3be9e892851cd3020190cd/Ulrich-Parsons-1992-Influences-of-experiences-with-plants-on-well-being-and-health.pdf\u003c/span\u003e\u003cspan address=\"https://www.researchgate.net/profile/Roger-Ulrich-2/publication/343722421_Ulrich_Parsons_1992_Influences_of_experiences_with_plants_on_well-being_and_health/links/5f3be9e892851cd3020190cd/Ulrich-Parsons-1992-Influences-of-experiences-with-plants-on-well-being-and-health.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUNESCO, editor. (2024). \u003cem\u003eGreen school quality standard \u0026ndash; Greening every learning environment\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.54675/locx2930\u003c/span\u003e\u003cspan address=\"10.54675/locx2930\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVakalis D, Lepine C, MacLean HL, Siegel JA. Can green schools influence academic performance? Crit Rev Environ Sci Technol. 2020;51(13):1354\u0026ndash;96. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/10643389.2020.1753631\u003c/span\u003e\u003cspan address=\"10.1080/10643389.2020.1753631\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Poortvliet M. School absence, academic attainment, and mental health: Longitudinal findings from the UK. Child Youth Serv Rev. 2025. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.childyouth.2025.108634\u003c/span\u003e\u003cspan address=\"10.1016/j.childyouth.2025.108634\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVeibiakkim R, Shkaruba A, Sepp K. A systematic review of urban ecosystem disservices and its evaluation: Key findings and implications. Environ Sustain Indic. 2025;26. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.indic.2025.100612\u003c/span\u003e\u003cspan address=\"10.1016/j.indic.2025.100612\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWaite S, Husain F, Scandone B, Forsyth E, Piggott H. It\u0026rsquo;s not for people like (them)\u0026rsquo;: structural and cultural barriers to children and young people engaging with nature outside schooling. J Adventure Educ Outdoor Learn. 2021;23(1):54\u0026ndash;73. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/14729679.2021.1935286\u003c/span\u003e\u003cspan address=\"10.1080/14729679.2021.1935286\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWalker E, Bormpoudakis D, Tzanopoulos J. Assessing challenges and opportunities for schools\u0026rsquo; access to nature in England. Urban Forestry Urban Green. 2021;61. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ufug.2021.127097\u003c/span\u003e\u003cspan address=\"10.1016/j.ufug.2021.127097\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang H, Gholami S, Xu W, Samavatekbatan A, Sleipness O, Tassinary LG. Where and how to invest in greenspace for optimal health benefits: a systematic review of greenspace morphology and human health relationships. Lancet Planet Health. 2024;8(8):e574\u0026ndash;87. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S2542-5196(24)00140-2\u003c/span\u003e\u003cspan address=\"10.1016/S2542-5196(24)00140-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWhitburn J, Linklater W, Abrahamse W. Meta-analysis of human connection to nature and proenvironmental behavior. Conserv Biol. 2020;34(1):180\u0026ndash;93. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/cobi.13381\u003c/span\u003e\u003cspan address=\"10.1111/cobi.13381\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. (2017). \u003cem\u003eUrban Green Space Interventions and Health - A review of impact and effectiveness\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cbd.int/health/who-euro-green-spaces-urbanhealth.pdf\u003c/span\u003e\u003cspan address=\"https://www.cbd.int/health/who-euro-green-spaces-urbanhealth.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilhelm K, Lomax T, McCarthy L, Boyle JS, Menon S, Hall J, Freebody J, Hart A, Fleming W, Danziger J, Coombes MA, Singh I. (2026). The Role of Hybrid Green Spaces in Secure Psychiatric Care. \u003cem\u003eWellbeing, Space and Society\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.wss.2026.100348\u003c/span\u003e\u003cspan address=\"10.1016/j.wss.2026.100348\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilkening JL, Chausson A, Smith A, Reger RZ-Z, O\u0026rsquo;Callaghan B, Clement M, Zapata Y, F., Seddon N. Harnessing nature-based solutions for economic recovery: A systematic review. PLOS Clim. 2024;3(10). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pclm.0000281\u003c/span\u003e\u003cspan address=\"10.1371/journal.pclm.0000281\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYamashita R, Chen C, Matsubara T, Hagiwara K, Inamura M, Aga K, Hirotsu M, Seki T, Takao A, Nakagawa E, Kobayashi A, Fujii Y, Hirata K, Ikei H, Miyazaki Y, Nakagawa S. The Mood-Improving Effect of Viewing Images of Nature and Its Neural Substrate. Int J Environ Res Public Health. 2021;18(10). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijerph18105500\u003c/span\u003e\u003cspan address=\"10.3390/ijerph18105500\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZamora AN, Waselewski ME, Frank AJ, Nawrocki JR, Hanson AR, Chang T. Exploring the beliefs and perceptions of spending time in nature among U.S. youth. BMC Public Health. 2021;21(1):1586. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12889-021-11622-x\u003c/span\u003e\u003cspan address=\"10.1186/s12889-021-11622-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang Y, Mavoa S, Zhao J, Raphael D, Smith M. The Association between Green Space and Adolescents' Mental Well-Being: A Systematic Review. Int J Environ Res Public Health. 2020;17(18). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijerph17186640\u003c/span\u003e\u003cspan address=\"10.3390/ijerph17186640\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":true,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"policy, nature, mental health, wellbeing, schools, education","lastPublishedDoi":"10.21203/rs.3.rs-9131492/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9131492/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eNature-based programmes in secondary schools are attracting growing interest by educators and policy professionals in efforts to link sustainability and climate action with student mental health and wellbeing (Department for Education, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2025b\u003c/span\u003e; Hazell \u0026amp; Clarke, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; UNESCO, 2024). However, policy momentum has outpaced robust evidence to support equitable implementation, particularly for adolescents (Clarke et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), a period marked by rising anxiety and depression and declining nature connection (Price et al., \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Richardson et al., \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Solmi et al., \u003cspan citationid=\"CR104\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDrawing on a rapid systematic literature review (Lorimer et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), interviews with 16 secondary educators, and a co-produced cost\u0026ndash;benefit model developed (Hopkins van Mil, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), this paper proposes a tiered universal\u0026ndash;targeted\u0026ndash;intensive policy framework for evidence-led nature-based programmes\u0026rsquo; implementation in English secondary schools, combining whole-school nature integration with enhanced and specialist-linked provision for students with greater mental health needs.\u003c/p\u003e \u003cp\u003eFindings show that nature-based programmes demonstrated stronger benefits for adolescents with existing mental health needs (e.g., reduced anxiety and stress, improved self-esteem, resilience, and connectedness), while effects in general student populations were smaller and more variable (Loose et al., \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Natural England, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e2024c\u003c/span\u003e; Shrestha et al., \u003cspan citationid=\"CR101\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Economic modelling suggested early, targeted investment may yield long-term returns through reduced demand on mental health services and improved educational outcomes. Six interlinked policy priorities emerged: whole-school integration, equity safeguards, professional capacity, adolescent-informed evaluation, green-estate standards, and cross-sector governance.\u003c/p\u003e","manuscriptTitle":"Scaling nature-based programmes for adolescent mental health and wellbeing: Evidence- informed policy and research directions from England","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-06 06:32:58","doi":"10.21203/rs.3.rs-9131492/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"52797412720299083360624944821874577685","date":"2026-04-02T18:39:20+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-28T03:14:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-24T06:10:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-23T22:13:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-03-23T22:09:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3a313ffc-6157-4d8f-abdb-26c29f0e0db0","owner":[],"postedDate":"April 6th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-06T06:32:58+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-06 06:32:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9131492","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9131492","identity":"rs-9131492","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}