Tourism-based activities are emerging as promising psychosocial adjuncts in treatment of schizophrenia. Recent randomised controlled trials have tested structured tourism programmes for people with schizophrenia, typically adding group outings to usual care. These included two randomised controlled trials with 100 and 80 participants, using either 2-day group trips every fortnight for 12 weeks or 12-week cultural heritage tourism activities three times per week, the latter led by professional guides. ^{Reference Gao, Huang and Chen1,Reference Wang2} Across these studies, participation has been associated with improvements in social functioning, negative symptoms and subjective well-being, while remaining firmly adjunctive to pharmacological and psychological treatments rather than replacing them. ^{Reference Gao, Huang and Chen1,Reference Wang2} However, the current evidence base consists of only a small number of randomised trials, so the overall findings can still reasonably be regarded as preliminary. The approach is group-based, ecological and practical, situating therapeutic work in everyday environments rather than exclusively in clinics.

In parallel, health systems have experimented with ‘social prescribing’ of nature- and arts-based activities, directing people to community programmes as part of routine care pathways. ^{Reference Beauchet, Moret, Deveault, Thiboutot, Parent and Boyer3–Reference Mughal, Polley, Sabey and Chatterjee5} The shared idea is simple: participation in cultural and natural settings can support recovery, reduce isolation and self-stigma, and strengthen a sense of belonging. For many people with schizophrenia, social functioning remains the hardest treatment target; tourism-based work offers a concrete way to practise social roles and interaction in the real world.

Within this broader model, cultural heritage tourism deserves explicit articulation as a specific subtype. Tourism programmes commonly include repeated small-group visits to both natural and cultural environments, and recent work has implemented immersive cultural heritage tourism as a dedicated rehabilitation component. ^{Reference Gao, Huang and Chen1,Reference Wang2} Beyond generic leisure or green-space exposure, studies in heritage and museum contexts suggest that historic places, monuments and museums may exert distinctive effects on identity, belonging and social connectedness. ^{Reference Beauchet, Moret, Deveault, Thiboutot, Parent and Boyer3,Reference Mughal, Polley, Sabey and Chatterjee5,Reference Richardson, Butler, Alcock, Tindley, Sheffield and White6} For people who live with disrupted narrative identity, internalised stigma and withdrawal from the shared social world, these dimensions are not decorative extras; they may be mechanistically relevant to recovery goals.

Conceptually, cultural heritage sites offer several plausible mechanisms that complement existing tourism-based frameworks. Historic places embody shared stories about ‘who we are’ as communities, and guided visits with group reflection can help participants to resituate themselves within broader cultural narratives, potentially softening estrangement and supporting self-esteem. Visiting museums and heritage sites as ordinary citizens repositions people with schizophrenia from being primarily ‘patients’ in clinical spaces to being citizens participating in common cultural experiences; this may counter internalised stigma and foster more symmetrical interactions with companions, staff and the wider public. ^{Reference Beauchet, Moret, Deveault, Thiboutot, Parent and Boyer3,Reference Mughal, Polley, Sabey and Chatterjee5} Evidence from nature-based ‘green care’ interventions points in a similar direction: group-based horticultural programmes can improve symptoms and emotional well-being in people with schizophrenia. ^{Reference Cuthbert, Kellas and Page4,Reference Lee, Chen, Hsu, Chen, Lin and Huang7} These findings support the broader idea that structured contact with natural and cultural environments can aid recovery, providing a contextual frame for heritage-focused tourism work.

Viewing tourism-based work through this lens highlights synergies between nature-based and heritage-based components. Cultural programmes rooted in museums, galleries, heritage sites and community archaeology are often delivered through interdisciplinary facilitation, including social prescribing schemes that link primary care to community arts and heritage providers. ^{Reference Beauchet, Moret, Deveault, Thiboutot, Parent and Boyer3,Reference Mughal, Polley, Sabey and Chatterjee5} Participants practise social engagement, report stronger connectedness and belonging, and describe empowerment and growth in identity and self-efficacy. ^{Reference Beauchet, Moret, Deveault, Thiboutot, Parent and Boyer3,Reference Mughal, Polley, Sabey and Chatterjee5,Reference Richardson, Butler, Alcock, Tindley, Sheffield and White6} For some, visiting museums and heritage sites on prescription helps to normalise help-seeking, reduce self-stigma and create new social roles outside mental health services. Travel achievements, even modest ones, can build confidence, and being a ‘tourist’ rather than a ‘patient’ may help to shift self-perception in a recovery-oriented direction. These benefits will not be accessible to everyone: cognitive impairment, prominent negative symptoms, social anxiety and mobility or transport barriers may limit participation. Programmes may therefore need to offer shorter visits, smaller groups, additional staff or peer support, and accessible itineraries to accommodate individuals with these challenges.

Making cultural heritage tourism explicit within tourism-based interventions has several practical implications. Future trials could distinguish nature-focused, heritage-focused and mixed itineraries, rather than aggregating all activities under a single, undifferentiated label. This would allow examination of whether heritage-rich itineraries yield differential benefits with respect to outcomes such as social participation, self-stigma, sense of belonging or identity, beyond global symptom change. Implementation could be strengthened through partnerships with local museums, archaeological parks, heritage sites and tourism organisations, in line with emerging museum-based and culture-on-prescription initiatives. Such collaborations could support sustainable, low-cost group programmes; staff training in working with people with severe mental illness; and co-produced activities tailored to cognitive and sensory needs. In many settings, historic urban fabric and heritage sites are more accessible than extensive natural landscapes and can be integrated into routine community mental health practice with relatively modest resources.

The aim is not to replace multidimensional tourism models with a narrow ‘heritage-only’ intervention but to name and harness the unique affordances of heritage-rich environments within the broader tourism paradigm. Taken together, the emerging results of trials of tourism-based activities, cultural heritage programmes and green care suggest that such approaches are feasible and potentially effective adjuncts to standard pharmacological and psychological treatment for people with schizophrenia. ^{Reference Gao, Huang and Chen1–Reference Cuthbert, Kellas and Page4,Reference Lee, Chen, Hsu, Chen, Lin and Huang7} Cultural heritage tourism merits explicit consideration as a theoretically grounded refinement of this work, with particular potential to strengthen social functioning, identity and inclusion. Future research should test the relative contributions of heritage-focused components and develop cross-sector collaborations between psychiatry, tourism studies and cultural heritage institutions to create therapeutic heritage routes for people living with schizophrenia.