Over the last few years, you may have seen or heard the term social prescribing being thrown around. Social prescribing is the new buzz term in the fight against poor mental health, but what exactly is it and how can it help?
What Is Social Prescribing?
The purpose of social prescribing is to link patients in primary care with other sources of support from within the community to improve quality of life outcomes (Bickerdike, Booth, Wilson, Farley, and Wright, 2017). Social care organisations, local councils, and other community organisations can become involved with patients needs and by using this process they can develop and expand local community resources to improve the communities level of quality of life (Chatterjee, Camic, Lockyer, and Thomson, 2018).
According to the University of Westminster, establishing a social prescribing movement allows GPs and other frontline healthcare professionals to refer patients to a specialised social prescribing worker. This worker will have a one-to-one conversation with the referred patient, during which the patient will learn about opportunities to improve their quality of life.
The purpose of this is to allow people with social, emotional, and/or practical needs to feel empowered to co-create their own personal solutions. This will all be done with the aid of services provided by the voluntary and community section as part of the social prescribing movement.
According to Brandling and House (2009), social prescribing is about giving GPs and patients additional options for tackling patients’ problems, especially if the origins of the problems are socioeconomic deprivation or long-term psychosocial issues. Thus, for issues like financial problems, they’ll suggest talking to someone from Citizens Advice or for loneliness, they could suggest a dance class.
For a while now, people have championed social prescribing as being an innovative movement that might reduce the financial burden on the NHS and primary care (University of Westminster; and South, Higgins, Woodall, and White, 2008). Thus, this could make our GP surgeries more sustainable by providing options that can work alongside existing treatment options (Bickerdike, Booth, Wilson, Farley, and Wright, 2017), not as a replacement for exists options.
Social prescribing promotes using the voluntary sector to support primary healthcare by providing pathways for patients with non-clinical needs to connect with the community and voluntary services (South, Higgins, Woodall, and White, 2008).
If social prescribing networks and its pathways are properly maintained, then it would allow for monitoring of how effective it is as a whole and separately for specific needs, which should allow for fine tuning.
However, a couple of questions seem to be overlooked in social prescribing which will need addressing. For example, how do you know if a patient is clinical or not without a proper assessment? And can a 5-10 minute conversation with a GP really determine if their patient is at a non-clinical level and thus suitable for social prescribing?
How Can Social Prescribing Affect Mental Health?
The rationale for social prescribing is rooted in its potential benefits in three areas, according to the Scottish Development Centre for Mental Health (2007). These three areas are: reducing prevalence of and improving mental health outcomes and therefore demands on health services; improving community wellbeing; and reducing social exclusion.
Although there is nothing wrong with taking medication for your mental health, it shouldn’t be the de facto treatment option for GPs, due in part, too long waiting lists for talking therapy on the NHS. Thus, methods like social prescribing could bridge that gap in treatment. If done right, then it could be of benefit to our mental wellbeing.
Chatterjee, Camic, Lockyer, and Thomson (2018) believe that a referral to a mental health practitioner can help some patients while others might benefit from social prescribing instead. And, according to the Scottish Development Centre for Mental Health (2007), social prescribing could help people with mild to moderate mental health issues, producing a range of positive outcomes such as enhanced self-esteem and reduced low mood.
Brandling and House (2009) found that social prescribing can enhance engagement with prescribed health-related activities, such as weight loss, through the use of exercise programmes. Another example of this could be supporting a patient that’s socially isolated to engage in a lunch club so they can meet new people.
Support for social prescribing through prescribing hobbies as a supplement to a patient’s existing care plans was found by Fancourt, Opher, and de Oliveira (2020). They also found support for the use of a social prescribing worker to explore a patient’s engagements and willingness to engage in the prescribed hobbies.
However, overall, a systematic review of twenty-four studies by Kilgarriff-Foster and O’Cathain (2015) found only limited support for social prescribing in increasing patients’ mental wellbeing and decreasing health service use.
The Problems With Social Prescribing
One problem with this new type of prescribing is that it sounds like they’re passing the buck when dealing with people’s problems. More often than not, people have already looked for support from charities before waiting two weeks to see a GP.
The voluntary and community services that this system would rely on only exist in the first place because of the government and health sector not fulfilling their roles adequately. But, we are where we are, so if there’s a way to connect this patchwork of services to our healthcare to improve quality of life outcomes, then by all means, let’s do that.
Few would argue that social prescribing is a magic bullet. It is unlikely to transform people’s lives nor does it detract from the need to address health inequalities through macro-economic policies and public health programmes (South, Higgins, Woodall, and White, 2008).
As someone who’s worked in the volunteer sector in mental health and substance abuse, it’s actually a bit concerning that what they’ve outlined social prescribing to be doesn’t already exist. We do it all the time within the volunteer sector without the need of having to create a specialised network to do that; we call in signposting.
However, I guess given how healthcare works, creating a social prescribing network and worker would offer a range of perspectives on the causes and treatments of mental wellbeing issues (Scottish Development Centre for Mental Health, 2007).
One of the main issues with social prescribing is the logistic challenges that go with it. Keeping track of the NHS is hard enough, but community groups can come and go in the blink of an eye. Furthermore, patients who are given information about a community opportunity will not necessarily take it up without some hand-holding (Brandling and House, 2009).
One benefit of being a counsellor is that you can signpost client’s and be able to follow-up on the progress in subsequent sessions, which isn’t likely to happen with a GP. Thus, a more generalised non-clinical counsellor or befriender (or social prescribing worker) could offer that level of accountability that’s lacking while freeing up GPs from follow-ups. If you use a befriender system, then the patient would have someone they could go with while sampling hobby ideas.
This is supported by Bickerdike, Booth, Wilson, Farley, and Wright (2017) who evaluated 15 social prescribing programmes between 2000-2016. They found that most of the social prescribing programmes were small scale, limited by design, limited by reporting, and all rated as high risk of bias. Thus, these studies presented positive conclusions that can’t really be trusted too much. Because of the issues identified, there isn’t any clear evidence that supports social prescribing as being successful or value for money.
Complex interventions can be resistant to explanation and clarification through research (Brandling and House, 2009), and social prescribing can and will fall into that difficulty.
As a substance abuse recovery worker in my former job and as a volunteer psychological therapist in my current role, I’ve tried ‘social prescribing’ or signposting, as we call it. I’ve recommended my clients take up a new hobby or reconnect with an old one. It’s a nice idea, but I’ve found it challenging to do in practice and certainly isn’t something that should be done as a replacement for therapy.
The problem I’ve found, in my experience at least, is how difficult it is to get clients motivated to take up a hobby or to get the client motivated to engage in the hobby even if they find one that interests them.
One of the biggest roadblocks is being too tired from work and family obligations, which isn’t a surprise. If you have young children, then you have to factor that in. You have to looking after the kids, putting them to bed, deal with morning routine, commute time, work, help the kids with their homework, and doing household chores. All that doesn’t leave much room for a hobby. Trying to get people to take up past hobbies they enjoyed can be difficult when they’re exhausted from work and looking after their children. Most people working in London would be lucky to get home from before 19.00.
Even those without families rarely have the motivation to engage with their hobbies; you first need to get them motivated, which can be challenging. As a client, per se, I’ve tried taking up new hobbies, from going to the gym, art, and weekly ballroom dancing classes. The problem with these hobbies is that they didn’t help me; they worked as a distraction only when I was doing them, and then it was back to my depressive state. That’s the problem with distractions; they don’t help you when you’re not using them, and you can’t use them all the time.
Engaging in hobbies gives me something to do, but it has done nothing to improve my mental health. Hopefully, other people will benefit from hobbies more than I do. However, the real problem is that our work/life balance is all wrong, and there’s little we can do without government intervention to address that.
When I was working as a substance abuse recovery worker, I tried forming a partnership between the local adult education centre and our service to get our clients to try new activities. I tried to do this to help the clients’ fill the void that the substances were filling for them. However, my manager at the time decided against finalising the process. Same with my attempts to arrange activities like bowling and day trips for the clients.
I’ve also referred clients to Citizens Advice, Beat, and Mind because signposting is an important part of providing a holistic approach to helping someone, at least in the charity sector. I wouldn’t call that social prescribing, though. What I’d call social prescribing, and the version I’ve seen most in the news as of late, is stuff like prescribing you to go to the gym. This was a social prescribing option I experienced myself.
I got a reduced membership at the local gym for a year. Not free, even though I’m on disability benefits, which is annoying as my other prescriptions are free. You can’t really ‘social prescribe’ something to someone that’s going to leave them with an expense they can’t afford. The lack of follow-up on this is also problematic. Do they just count it as a success if I try the option when there’s zero follow-up?
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Unwanted Life readers.
Bickerdike, L., Booth, A., Wilson, P. M., Farley, K., & Wright, K. (2017). Social prescribing: less rhetoric and more reality. A systematic review of the evidence. BMJ Open, 7(4). Retrieved from https://dx.doi.org/10.1136/bmjopen-2016-013384.
Brandling, J., & House, W. (2009). Social prescribing in general practice: adding meaning to medicine. British Journal of General Practice, 59(563), 454-456. Retrieved from https://bjgp.org/content/59/563/454.short, https://bjgp.org/content/bjgp/59/563/454.full.pdf, and https://doi.org/10.3399/bjgp09X421085.
Chatterjee, H. J., Camic, P. M., Lockyer, B., & Thomson, L. J. (2018). Non-clinical community interventions: a systematised review of social prescribing schemes. Arts & Health, 10(2), 97-123. Retrieved from https://doi.org/10.1080/17533015.2017.1334002, https://www.tandfonline.com/doi/full/10.1080/17533015.2017.1334002, and https://www.tandfonline.com/doi/pdf/10.1080/17533015.2017.1334002.
Fancourt, D., Opher, S., & de Oliveira, C. (2020). Fixed-Effects Analyses of Time-Varying Associations between Hobbies and Depression in a Longitudinal Cohort Study: Support for Social Prescribing?. Psychotherapy and psychosomatics, 89(2), 111-113. Retrieved from https://doi.org/10.1159/000503571 and https://www.karger.com/Article/PDF/503571.
Kilgarriff-Foster, A., & O’Cathain, A. (2015). Exploring the components and impact of social prescribing. Journal of Public Mental Health, 14(3). Retrieved from https://doi.org/10.1108/JPMH-06-2014-0027 and https://www.emerald.com/insight/content/doi/10.1108/JPMH-06-2014-0027/full/html.
Scottish Development Centre for Mental Health. (2007). Developing social prescribing and community
referrals for mental health in Scotland. Retrieved from https://www.webarchive.org.uk/wayback/archive/3000/https://www.gov.scot/Resource/Doc/924/0054752.pdf.
South, J., Higgins, T. J., Woodall, J., & White, S. M. (2008). Can social prescribing provide the missing link?. Primary Health Care Research & Development, 9(4), 310-318. Retrieved from https://doi.org/10.1017/S146342360800087X and https://www.cambridge.org/core/journals/primary-health-care-research-and-development/article/can-social-prescribing-provide-the-missing-link/9AEB484609AADB9EAA480D42E301700F.