Nature as a therapeutic place and tool for enhancing service users' ' engagement in mental health services: A comprehensive synthesis of evidence

This systematic review explored how nature-based care settings influence engagement in mental health therapy. We relied on Joanna Briggs Institute's guidelines for systematic reviews to synthesise data from nine articles selected from an initial pool of 649 records retrieved from PubMed, CINAHL, ScienceDirect, SocINDEX, and JBI EPB. Synthesis revealed six analytical themes: nature as a therapeutic tool, therapeutic relationships, nature's impact on power balance, nature as a safe space, risk of nature and patient-centered care. The findings shed light on the benefits while highlighting some challenges that influence participation in mental health interventions. The findings suggest that integrating nature into mental health care could be an alternative or complementary approach to enhancing patient engagement. However, the specific types of mental health care of this impact vary. Robust clinical trials that examine the effectiveness of the reported benefits are recommended. Such studies must target specific patient groups, such as the young and the elderly. Longitudinal studies that examine the long-term effects and moderating factors are needed to strengthen the evidence base and enhance patientcentered care.