Beyond the Pill: How ‘Nature Prescriptions’ Are Transforming College Mental Health

In 1984, Don Rakow was a graduate student at Cornell University, navigating the high-pressure environment of academia while struggling with the personal turbulence often associated with young adulthood. For Rakow, the remedy wasn’t found in a clinical office or a pharmacy, but in the quiet, meticulously tended rows of the campus gardens. "They were my sanctuaries," Rakow recalls. "Those gardens were essential for me to maintain balance and to survive."

Decades later, that personal epiphany would become the cornerstone of a nationwide movement. Now a professor of plant science, Rakow began observing a starkly different reality among his students: a burgeoning mental health crisis that seemed to outpace the university’s ability to provide traditional care. Drawing on his own history, Rakow asked a provocative question: Could the campus itself—its forests, lawns, and gardens—serve as a medical intervention?

The result was NatureRx, one of the nation’s first dedicated programs to integrate nature-based activities into the formal student health system. Today, this initiative has expanded into a multi-campus, data-driven movement known as "social prescribing," where doctors and counselors move beyond traditional pharmacology to write "prescriptions" for nature, art, movement, and community service.

The Evolution of a Campus Crisis

The history of mental health support in American higher education is relatively brief. While colleges have existed for centuries, it wasn’t until 1910 that Princeton University officially recognized the link between student attrition and emotional distress, hiring its first psychiatrist to address the issue.

For the next century, counseling services remained a niche resource. However, the last two decades have seen a seismic shift. Between 2009 and 2015, the utilization of campus counseling centers spiked at a rate far exceeding the growth of student enrollment. A comprehensive study of 350,000 students across 373 campuses between 2013 and 2021 revealed a staggering trend: rates of depression climbed by 135 percent, while anxiety increased by 110 percent. By the end of that period, the number of students meeting the criteria for at least one formal mental health diagnosis had doubled.

At Cornell, a series of student suicides in the early 2010s served as a grim catalyst for change. The university accelerated its mental health response, hiring more clinical staff and training faculty in bystander intervention. It was within this climate of urgency that the university administration supported Rakow’s proposal to launch NatureRx.

The Science of the "Green" Prescription

It is a common misconception that social prescribing is merely a suggestion to "go outside." Instead, it is a clinical framework rooted in physiological research.

"This is actually physiologically proven medical treatment," says Dr. Jonathan Keffer, a physician at Cornell Health. He notes that the medical community has long understood the impact of stress on the body, specifically the role of the parasympathetic nervous system. Exposure to natural environments is proven to lower cortisol levels—the body’s primary stress hormone—and regulate the "fight-or-flight" response.

Cornell-led research, co-authored by Rakow, suggests that the mental health benefits of these interventions can manifest in as little as 10 minutes. By "medicalizing" the experience—framing nature as a treatment that can modulate anxiety and enhance the body’s restorative processes—physicians at Cornell are able to integrate these referrals into the electronic health records of their patients.

For many students, the barrier to nature is not lack of access, but lack of intent. As Emily Dunuwila, health initiatives coordinator for NatureRx, explains, the program provides a "prescription" that acts as a bridge. "We have a little card that providers can give out to help students make their own nature plan," she says. "We give specific examples because some of our students are less familiar with what to do outside."

Scaling the Model: The Campus Nature Rx Network

The success of the Cornell model led Rakow and Dorothy Ibes of the College of William & Mary to co-found the Campus Nature Rx Network in 2019. Funded by the REI Cooperative Action Fund and a sliding-scale certificate program, the network provides resources and guidance to universities looking to build their own social prescribing infrastructure.

To date, approximately 120 colleges and universities have joined the network. The programs vary by campus but share a core philosophy: mental health is not just the absence of illness, but the presence of wellbeing, and that wellbeing is inextricably linked to the environment.

At the University of Arizona and Stanford University, this philosophy has evolved into partnerships with private entities like SocialRx. At Stanford, students are assigned a "care navigator" who assesses their interests and schedules before prescribing up to nine "doses" of cultural engagement, such as pottery classes, museum visits, or live performances. Early data from Stanford is promising: 84 percent of students who received a referral attended their assigned activity, and 80 percent reported a subsequent improvement in their mental health.

Addressing the Barriers to Connection

If campuses are already hubs of activity, why is social prescribing necessary? This was the primary question asked by Dr. Lindsey Mortenson, chief mental health officer of student life at the University of Michigan.

"The problem that we have at Michigan is definitely not lack of opportunity," Mortenson notes. After surveying 1,400 students, she discovered that the primary barrier was not a lack of events, but a lack of time and, crucially, a lack of social confidence. Many students reported feeling "70 percent of the way there"—they wanted to connect, but they needed a formal nudge to overcome the initial hurdle of isolation or social anxiety.

In response, Michigan launched Experience Rx, a comprehensive initiative that prescribes everything from shared meals to community service. The university also established the Institute for Social Prescribing to study the efficacy of these interventions, aiming to create a formal evidence base for what has historically been viewed as "extracurricular."

Implications for the Future of Healthcare

The implications of this movement extend far beyond the campus quad. With campus counseling centers reporting that 86 percent of students are presenting with increasing needs, the traditional "1-on-1 therapy" model is facing a sustainability crisis. Social prescribing offers a scalable, low-cost complement to clinical treatment.

At the University of Oregon, teaching professor Lisa Abia-Smith has taken the concept into the classroom, leading what is believed to be the nation’s first undergraduate course dedicated to social prescribing. Similarly, at New York University, David Hollander teaches "How Basketball Can Save the World," a course that trains students to lead programs like HoopsRx, which connects middle schoolers facing anxiety with structured, community-based sports.

The narrative of these programs is best captured by the students themselves. Sofia Mattson, who leads guided nature walks at Cornell, often sees students who have spent the entire day tethered to their laptops. "This is the first time I’ve actually touched grass," a student told her after a walk.

For many, this simple act of re-engaging with the physical world is a revelation. As Ani Minic, a student athlete at NYU, reflected, "A lot of people say their ‘happy place’ is at a beach or somewhere peaceful… I step on the field, and all of my worries disappear."

As universities across the United States continue to grapple with a mental health landscape that has fundamentally changed, the "prescription" for better health may increasingly involve a change of scenery. By integrating the natural and social environment into the standard of care, institutions are not just treating symptoms—they are helping students find the balance necessary to navigate an increasingly complex world.

This report was supported by The Carter Center for Mental Health Reporting, as part of the 2025-2026 Rosalynn Carter Fellowship for Mental Health Journalism.