Clinicians' Perceptions of Nature-Based Interventions in Mental Health Care: A Qualitative Descriptive Study from Pakistan.

BACKGROUND: Mental health conditions remain a major yet underrepresented public health concern in Pakistan and globally, highlighting the need for innovative and complementary interventions. Nature-based interventions (NBIs), which involve structured engagement with natural environments to enhance health and wellbeing, offer a promising approach, particularly in the Hazara Division of Khyber Pakhtunkhwa, Pakistan, a region renowned for its Himalayan forests, scenic valleys, and rich biodiversity. METHODS: This study employed a qualitative descriptive design to explore mental health clinicians' perceptions of NBIs in community mental health settings. Fourteen clinicians from the Hazara Division, Khyber Pakhtunkhwa, Pakistan, were recruited using purposive and snowball sampling between February and March 2026. Data were collected through semi-structured interviews and audio-recorded. Transcripts were analysed using inductive thematic analysis following Braun and Clarke's framework, supported by HyperRESEARCH software. RESULTS: Participants generally perceived engagement with nature as calming, restorative, and therapeutically beneficial, and many reported informally encouraging clients to participate in nature-related activities. Clinicians expressed willingness to integrate NBIs into routine practice and identified potential benefits including improved mood, relaxation, empowerment, and enhanced social connectedness. However, several barriers were also identified, including client-related factors such as anxiety, low motivation, and skepticism, as well as contextual and organisational constraints such as gender-based limitations in access to natural spaces and safety-related policies. CONCLUSIONS: Despite these challenges, clinicians demonstrated strong support for NBIs, suggesting their potential as a feasible adjunct to mental health care in Pakistan. Addressing identified barriers may facilitate integration into routine services and enhance access to holistic mental health support in community settings.