With mental health issues on the rise among young people, Dartmouth is expanding its efforts to support student wellness with a free program known as Arts and Nature Rx.
It launches Jan. 5 and uses social prescribing, a model of care in which health care providers recommend community-based activities such as group hikes or craft workshops to improve mental health and well-being.
Jennifer Rosales, senior vice president for community and campus life and chief student affairs officer, says Arts and Nature Rx offers an important new avenue for engagement.
“Our experiences with art and nature are individual intrinsic experiences, but they can also provide the experience of engaging with somebody else and having a social connection,” Rosales says. “That within itself is a very healthy practice.”
The yearlong pilot, a partnership with Art Pharmacy, is designed for undergraduate and graduate students with mild to moderate symptoms of loneliness, anxiety, social isolation, or depression. The Atlanta-based company provides social prescribing services for organizations throughout the United States.
The Dartmouth initiative—the first in Art Pharmacy’s portfolio to pair art and nature activities—includes everything from hikes on local trails to craft workshops at the Hopkins Center for the Arts, live performances, and visual arts such as painting, sculpting, and drawing.
How it works
As part of Arts and Nature Rx, providers at Dartmouth Student Health Service at Dick’s House will refer students based on routine mental health screenings or their clinical judgment. Students who opt in will meet online with Art Pharmacy care navigators, who help them set well-being goals and suggest several possible activities, taking into account students’ interests, availability, cultural values, and lived experience. Students can choose one activity each month.
Nick Davis, the senior director for inclusive culture and special projects in the Collaborative Operations for Results and Engagement unit at Dartmouth who is managing Arts and Nature Rx, says that agency is key.
“We’re not telling students, ‘This is what you need,’” Davis says. “You decide what’s going to fill your cup.”
Quick monthly check-ins with care navigators provide a measure of accountability, says Chris Appleton, founding CEO of Art Pharmacy, and more than 90% of participants follow up.
“We see such high engagement rates and adherence rates to the care plan because we’re connecting people to life-affirming, life-enriching resources,” Appleton says.
So far, programming is available through 15 partner organizations, among them the Outdoor Programs Office, the Hood Museum of Art, the Hop, and several student-led clubs. Local nonprofits such as AVA Gallery in Lebanon, N.H., the Montshire Museum of Science in Norwich, Vt., and Northern Stage in White River Junction, Vt., are also involved.
Ann Bracken, director of clinical medical services, says she and her colleagues at Dick’s House are excited to participate.
There’s lots of good evidence that art prescriptions, and interacting with nature, reduce anxiety and depression while increasing positive affect and well-being, Bracken says. For students, who often struggle to take study breaks, the program “is another way of maybe having a little bit of fun, and expressing their creative side.”
Eliminating barriers
Thankfully, campus and the surrounding communities offer an array of cultural and outdoor events year-round, including those highlighted during the symposium on youth mental health in October that was co-hosted by Dartmouth and the United Nations Development Programme’s Human Development Report Office.
But awareness isn’t always enough.
“We hear time and time again from students who say, ‘I know I should exercise, I know I should be engaging socially, but I have a final. I can’t do any of this, and I feel burnt out,’” says Emily Devlin, a clinical social worker who leads strategic partnerships at Art Pharmacy.
Social prescribing programs can provide the structure—and impetus—students need to prioritize their well-being, Devlin says.
Hearing a trusted professional say, “This is something that I want you to try” gives students permission to close their laptops and take a break, she says. “Having that permission has been extremely impactful for students.”
Arts and Nature Rx also aims to eliminate financial barriers and decision fatigue.
“There are a million things thrown at students,” Davis says, so being provided with short, curated lists of ideas makes it easier to engage.
Participation is confidential and free; Arts and Nature Rx covers expenses such as tickets and transportation for students and, if they like, an additional ticket for a friend to attend with them.
“If we’re trying to do things like boost connection and belonging and reduce loneliness, we should enable people to do things with loved ones,” says Appleton, who spoke at the project kickoff in November at the Top of the Hop.
Bringing together arts and nature
The kickoff, which drew about 50 people, followed months of brainstorming sessions with scores of people from all corners of campus.
Mary Lou Aleskie, Howard Gilman ’44 Executive Director of the Hop, had started the ball rolling last winter, contacting Rosales with research about arts as a prescription, and wondering whether Dartmouth might try it. A similar email—this time about nature prescriptions—arrived three days later from Willow Nilsen, associate director of Dartmouth Outdoors, said Rosales, who was struck by the timing.
Rosales checked in with Estevan Garcia, chief health and wellness officer, who shared that he had often used social prescribing with patients.
“So, I said, let’s do it,” Rosales says. “Let’s try to put a group together and think about how we might do it here, bringing arts and nature together, being that we are in the beautiful Upper Valley, with all of the wonderful richness that we have.”
Students have provided feedback along the way and will continue to do so in the coming year.
‘Not spending as much time spiraling’
Geisel School of Medicine professors are also supportive.
In more than two decades as an emergency physician, Sarah Crockett, assistant professor of emergency medicine, has seen a dramatic rise in the number of young people arriving in crisis.
While the causes are complex, the research is clear, Crockett says. “Belonging, strong relationships, time in nature, and reflective activities significantly improve mental health.”
By creating such opportunities, Arts and Nature Rx “has the potential to make a real difference in student well-being,” she says. “My hope is that this pilot highlights the lifesaving impact of connection—to nature and to community.”
Appleton says Arts Pharmacy has had good results so far in its other projects.
Of students who score as lonely on baseline screenings, 79% see improvement after activities, and among students who are depressed, 83% see improvement, he says. The benefits are especially noticeable after the first, second, and sixth “doses.”
That said, he emphasizes that Arts and Nature Rx is not meant to replace clinical treatment, such as therapy or medication, nor is it for people in crisis.
If a provider or care navigator hears something concerning, or a student’s screening scores fall below a certain threshold, there is a protocol in place “to make sure we’re getting students the right level of support when they need it and where they need it,” Appleton says.
Ravi Malhotra ’29, chair of the People of Color Outdoors Club, took part in a feedback session in December. Malhotra says that based on existing research and personal experience, he is feeling “very positive” about Arts and Nature Rx.
A seventh-grader at the start of the COVID-19 pandemic, he had found himself feeling lonely, anxious, and depressed. But with encouragement—and some nudging—he was able to leave his comfort zone, get therapy, and explore new activities.
As a busy first-year student, Malhotra empathizes with the reluctance to take breaks and the inclination of some students “to just keep powering through.”
But he urges his classmates to approach Arts and Nature Rx with an open mind.
“You take a couple hours a week to be outside or do these programs, and in return you’re much more focused, you’re feeling better, you’re not spending as much time spiraling and feeling depressed or stressed in your day-to-day life,” he says. “The benefits are huge.”
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Mental health support is available through Dartmouth 24/7 for students, faculty, and staff. Any Dartmouth student experiencing a mental health crisis can call the Counseling Center at 603-646-9442.
