Ethical Challenges to Green Social Prescribing in the UK Mental Health System

Green Social Prescribing (GSP) – nature-based interventions offered through healthcare services – is gaining momentum in the UK. While celebrated for its potential to improve mental health and reduce strain on health services, its ethical foundations remain underexamined. This paper critiques the normative and operational assumptions underpinning GSP, arguing that current implementation risks undermining transparency, autonomy, and equity in healthcare. Using the UK’s NHS as a case study, we identify three critical challenges: (1) a weak and heterogeneous evidence base, (2) lack of referral and outcome tracking infrastructure, and (3) significant inequities in access to prescribed green spaces. We show how GSP, framed as a “prescription,” may mislead patients, burden providers, and responsibilise individuals without adequate systemic support. In response, we outline a three-pronged strategy for ethical implementation: improving transparency and communication, building infrastructure for equitable delivery and outcome evaluation, and embedding GSP within a broader ethics of collective responsibility.Authors on this paper are funded by the following bodies: SM, KW, LI, IS, EP are supported by the National Institute for Health and Care Research (NIHR) Oxford Health Biomedical Research Centre [NIHR203316]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. DL, IS, and WHF are supported by The Wellcome Discovery Research Platform for Transformative Inclusion in Ethics and Humanities Research (ANTITHESES) (226801/Z/22/Z). For the purpose of open access, the authors have applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission.