Prescription For Health: How Parks Can Replace Pills

This audio piece first appeared on KALW‘s Crosscurrents and again in 2023 in recognition of a SPJ NorCal Excellence in Journalism award.

From the smallest banana slug to the tallest redwood, park ranger Katherine Wright loves introducing new visitors to the sights and sounds of San Mateo County’s beautiful outdoor spaces.

Leafy hiking trails abound at Wunderlich Park. Photo: Liza Ramrayka

As we hike a trail together at Wunderlich County Park in the town of Woodside, she points out a family of deer approaching in the tall grass just a few feet away from us. Loud birdsong resounds from above. Early afternoon sunlight squints through the redwood branches.

Ranger Wright has the enviable job of welcoming people into some of San Mateo County’s 21 parks and open spaces. And, for the past few years, she’s also been part of an initiative to connect a new group of visitors with nature.

San Mateo County is part of an innovative national program where doctors write a “prescription” for park and outdoor time to improve their patient’s physical or mental health and wellbeing.

What you get is similar to a regular prescription slip. But, instead of a list of medicines, there’s a space for your doctor to prescribe how many minutes and how often each week they’d like you to spend outdoors and in nature.

The prescribed activity could be a nature walk, a guided tour, yoga or meditation outdoors. Family activities pre-pandemic included lawn bowling and loteria — a bingo game.

Basically, it’s Mother Nature as medicine.

Activities at Wunderlich Park include horse riding at the historic Folger Stable. Photo: Liza Ramrayka

Research shows that spending regular time outdoors helps to reduce headaches and mental fatigue, lower stress, and improve mood.

Ranger Wright says that many of the patients she meets may not have ever visited their local park. Or even hiked or biked a trail. Park life might not be part of their routine, tradition, or culture. Often, she sees patients visibly relax and immediately enjoy their new surroundings.

“Like looking at the trees, listening for the bird songs. And just having a nice chance to learn more about the natural environment,” she observes.

We often see people just feel like they visibly relax out here… And just kind of being present in the moment here. Like looking at the trees, listening for the bird songs.

Park Ranger Katherine Wright, San Mateo County

San Mateo County has engaged a range of its residents in the parks program, including Tongan Pacific Islanders and the Latinx community — some of whom are in low income groups. These groups have historically been disproportionately affected by health conditions including high blood pressure, diabetes, and mental health issues.

Gloria Cardenas lives in San Mateo with her husband and two teenage children. She’s just turned 50 and her family has been involved with San Mateo’s healthy lifestyles clinic for more than ten years, and with the parks program since 2019 when it started.

Cardenas’s pediatrician originally prescribed healthy eating and outdoor time to improve her children’s health. But now, she says, the whole family visits parks almost every weekend. And she has loved the social aspect of getting out and about — meeting other families, playing games in the park, and sharing healthy food.

But her favorite thing about the program is walking in the woods, and learning about the animals and plants that live there — even the banana slugs.

Cardenas says her children have become more active as a result of the program. Both have taken up wrestling in high school and her son plays tennis. He’s also developed a passion for cooking.

Families play outdoor games in Huddart Park. Photo: Gloria Cahuich-Gonzalez/San Mateo County Health

During lockdown, park rangers hosted Zoom meets for families to stay engaged in the program and offered ideas for outdoor activities in their parks that remained open.

As part of the program, health practitioners use an online system, which syncs with the patient’s existing health record to recommend outdoor activities. 

Dr. Rachel Borovina is a pediatrician who works for San Mateo County Health. For years, she’s run a healthy lifestyles clinic. And, over the past few, she’s worked with county health chief Dr. Scott Morrow on the park prescription program.

For every child aged 2 to 18 years coming in for an annual check up, Dr. Borovina and her team ask about time spent in nature or outdoors. Everyone leaves with a prescription to spend one hour twice a week outdoors. And the team puts together what they call “informational prescriptions” which list the addresses of nearby parks, and the health benefits associated with outdoor time.

Last year, San Mateo County’s Park Prescription program issued annual park passes to 800 families who qualify for the CalFresh low-income benefit.

Dr. Borovina’s program is part of a wider nationwide initiative launched in 2013 by the San Francisco-based Institute at the Golden Gate. It now has an estimated 100 programs across the country.

Yoga and meditation are suggested Park Rx activities. Photo: Gloria Cahuich-Gonzalez/San Mateo County Health

Around three quarters of these programs tackle general wellness. The remainder address specific health goals like managing anxiety and depression, or reducing stress levels. Research into impact shows participation can help reduce blood pressure and feelings of loneliness.

However, Ranger Wright notes that there are barriers, such as transportation: “If it’s not right in your backyard, like it is for some county residents, it can be challenging to get out to some of these more remote park locations,” she says.

Cost is another barrier, she says. “To enter some of the park sites, there’s a vehicle entry fee of $6. And that can be a barrier for certain people. So we were looking into that. At one of our park sites, we’ve taken that vehicle entry fee away so it’s now free to park.” However, she adds that it’s not a permanent solution because the parks need that revenue to support staff and other projects.

Park Rx families playing loteria at a community day in Huddart Park. Photo: Gloria Cahuich-Gonzalez/San Mateo County Health

But for Gloria Cardenas in San Mateo, the parks program has been a game changer. Tonight, her son wants her to pick up fresh vegetables from the market so he can cook the family dinner. The Cardenas family’s involvement in the Park Prescription program has resulted in better eating, regular exercise, and more quality time together.

And that’s a recipe for good health.

Learning From Lockdown: Supporting Teen Mental Health

Wellness counselors from Jefferson Union High School District offer online support to students

This audio piece first appeared on KALW‘s Crosscurrents

2020 was definitely not the year that recent high school graduate Anna was expecting. She’s 18-years-old and asked to use a pseudonym to protect her privacy. Instead of a senior year on campus with her friends, Anna spent most of it at home. In her bedroom. Logging onto classes on a laptop in her closet.

Anna says she had already experienced anxiety attacks before lockdown. But having to join classes from home introduced a whole set of new challenges. And being cooped up at home with her family was really hard.

She says they fought over the littlest of things “like who finished the peanut butter, who finished the yogurt.”

Anna’s experience is quite common. Emotional and behavioral health challenges in teens were already a growing concern before the pandemic. Shelter-in-place just made these challenges worse. So much so, reported suicide attempts increased almost two fold at some points in 2020, compared to 2019.

Research from last year found that remote learning, isolation and disruption in sleep or eating habits can all contribute to teen stress and anxiety.

Laura Fraser is a San Francisco-based psychotherapist who works in private practice with adolescents and families. She says the isolation and the lack of activity removed a huge source of how people can care for themselves. “Which has only exacerbated already existing anxiety and depression and eating disorders and all kinds of things. Family tensions, too,” says Fraser.

Teenagers are social creatures, she says. Their interactions at this age with friends and other people help them develop relationship skills and navigate emotional closeness and distance.

And social interaction is also essential for another reason. Fraser says it’s common for adolescents to compare themselves with their peers, thinking others have it all figured out.

“And so those fears get loud, and part of the way we find out that those fears are only that — fears — is by all the incidental interactions that take place in a day,” she explains.

Of course, those interactions may not always be positive. But being physically on campus can provide a safe environment for students to express themselves.

Fraser says: “So maybe they’re walking down the hall and somebody gives them a big smile or somebody runs up to them and says, ‘Hey, you know that thing you said? It totally cracked me up in class today!’”

And those things are great, she says, because that provides students with “a store of evidence to fight against the fears that they have about how they are in the world.”

In-person learning has other benefits. Anna’s parents are very strict with her, based on their own family traditions. So school was a sanctuary that allowed her to be herself and have conversations that she’d never have at home.

Anna admits that she became “kind of a loner” when her two friends moved away during lockdown: “I’m not really that much of a sociable person anymore… those were my only two friends.”

Melissa Ambrose is wellness coordinator for Jefferson Union High School District in San Mateo County. She hears stories like Anna’s all the time.

Ambrose says that, over lockdown, overcrowded homes, financial distress and family trauma added to students’ stress about home learning.

“These kids have had a year and a half of building the habit of lying in bed, not being dressed, eating, you know, whatever they’re eating in bed. Scrolling through Instagram, tuning into their class and napping intermittently,” she says.

To counter this, Ambrose and other Jefferson Union wellness counselors joined virtual classrooms and hosted small group chats. They also launched Instagram feeds with wellness tips and information on finding mental health counselling if you don’t have insurance.

And they hosted a suicide prevention night with breakout rooms in several languages to reach as many parents and caregivers as possible.

Other solutions to the loss of in-person time came from the students themselves. Last October, Anna and other teens in the Jefferson Union school district decided to make a podcast, called It’s Always Something. They experimented with different styles and topics. MK Munoz, who often leads the podcast discussions, says a good example of this was when insurrectionists stormed the U.S. capitol on January 6.

“That happened like five hours before our normal meeting. It’s like, yo, the capital is under attack. Y’all want to talk about it?” she says.

Making the shows gave the students a regular day and time to meet. Kind of like the locker chat and lunchtime banter that they lost last year.

Anna’s just started classes at a local community college. But she hopes to continue helping with the podcast if she has time, because she likes how being involved makes her feel.

Many California schools are working on programming for mental health this coming year. In addition to pandemic-related federal funds for K-12 schools, the state budget approved in July provides $4 billion over five years to help school and college students cope with anxiety, depression and stress.

report from a coalition of bipartisan education groups — including the California PTA and the California Teachers Association — has urged schools to use their COVID funding to support mental health programs this year.

The report recommends school districts take six weeks to offer students, families and educators what they call “a restorative restart.”

Recommendations include conducting regular student wellness screenings and providing mental health support.

Given teaching pressures, though, many schools may not take that recommended time.

Ambrose says it takes time for post traumatic stress to set in and become activated. “So I think like around December, January, we’re going to start to see the mental health impact both on the adults and the students,” she says.

Ambrose has enlisted the help of a trauma therapist who has worked with students affected by the Paradise and other California wildfires. A grant from the government’s Mental Health Student Services Act will enable the school district to deliver a Stanford-developed social emotional learning curriculum with weekly classes for ninth and tenth graders.

The district also hired three new mental health staff members. Each of its five high schools now has multiple mental health workers to support students.

Ambrose says it’s important to acknowledge that students lost some significant “connectedness and humanity and well being” over lockdown, and then tackle that. She concludes: “Our job is to recreate connections, recreate humanity, recreate resilience. And love the hell out of them and love the hell out of each other.”

September is National Suicide Prevention Month. For more information about mental health and wellness support, contact:

California Parent & Youth Helpline: 877-427-2736

National Suicide Prevention Lifeline: 1-800-273-8255

Crisis Textline: Text HOME to 741-741

The Trevor Project (for LGBTQ+ youth): 1-866-488-7386 or text START to 678-678