Social prescribing is a hot topic in Australia now. This is because of the increased burden placed on the health system by increasing levels of mental illness, loneliness and isolation and chronic disease.
The health system is stretched to breaking point, accounting for 10% of the budget spend and there is a shortage of GPs and long waiting lists to see mental health professionals. Given universal acknowledgement that social aspects of life impact on health, it makes sense to look outside the health system for solutions.
Social prescribing is seen as one way to improve health outcomes and take some pressure off the health system. A Round Table recommends that social prescribing become part of the Australian health system to build in more prevention and early intervention.
So what is social prescribing?
In a nutshell, social prescribing is when a GP or other health practitioner prescribes or recommends a community response rather than medication to a person who comes to them for help.
Up to 30% of visits to GPs are for non-medical reasons. That is people are needing some kind of help with psychological or social aspects of their life.
Who is social prescribing for?
Social prescribing is considered well suited to people experiencing mental health issues; people with chronic physical health conditions and multiple coexisting conditions; people experiencing social isolation, parents of babies and young children; and older people.
How does social prescribing work?
Usually when the person is offered a social prescription, they are sent to a link worker. This role can be called other names. The link worker asks lots of questions to find out what the person’s interests and needs are. Together they co-design what type of community activity or group or service would suit the person best.
What is prescribed will depend not just on the person’s interests, but what is available and accessible in their local community. This could be a walking group or a craft group or joining the local men’s shed.
Depending on how the link worker role is set up, they may stay in contact with the person for a defined period of time and they may be able to go with the person to the activity initially.
Advantages of Social Prescribing
Being part of the community is undoubtedly good for mental health. It has been known for centuries that being part of community and feeling a sense of belonging is an important part of meaning and purpose. Some research shows that being part of multiple communities can be even better for our mental health.
There is plenty of evidence that a reduction in loneliness and isolation improves physical and mental health. So at face value, introducing social prescribing seems like a no brainer. Everyone wants to make sure we avoid people getting unnecessary medical intervention in the form of medicine which can be expensive and have side effects.
Cautions for social prescribing
Like any new initiative, how well it works depends on many things including the model, how it is positioned within the existing health system, availability of the workforce, skills and training for the workforce; sufficient infrastructure and low levels of red tape.
Here are a few cautions to consider.
There is potential for the medicalisation of everyday experiences. People can currently attend social activities and groups in the community without a doctors prescription. Group activities like meditation, walking and craft are not medical interventions.
Social prescribing could be seen as minimising the impact of systemic issues outside of the person that impact on their mental health such as poverty, domestic violence or disability.
Other community programs with link worker type roles have inadvertently resulted in small groups and organisations with limited funding pressured with multiple referrals stretching their capacity. Shifting the burden from the health system to other systems needs to be avoided.
There is a risk that some people may feel invalidated or patronised by being offered a social prescription if they are expecting medication. They may feel their pain and suffering is being downplayed or trivialised by recommending an everyday activity they could have thought of themselves.
If socialisation is seen as the solution to all the problems does that take into account the needs of people who prefer their own company or are autistic and recharge their batteries alone?
What if the person attends a community group and feels excluded or uncomfortable, will they feel like they have failed and feel lonelier and worse about themselves.
Will the person for whom the activity was not a good fit feel comfortable about returning to the doctor about their health concern if they think they will get prescribed another social activity?
Is there enough support at the activity for the person to attend and follow up for people prescribed groups to ensure they are working out.
What is new about social prescribing?
Doctors have been advising their patients to get some sunlight and fresh air, eat a healthy diet, have regular physical exercise, reduce alcohol intake and get a good night’s sleep since the dawn of time. Maybe people see this type of advice as an optional extra when presented alongside medications.
Most people know these ideas are sound advice, but they may have barriers to implementing them including lack of knowledge, support, finances and motivation. Most GPs and allied health professionals say that that they already recommend community activities but interestingly most clients say they have never had these discussions with their treating professionals.
Maybe when the social prescription is explicit and there is resourcing and infrastructure for link workers to send people to, then it will seem more official and acceptable to people. Also having time to speak with a link worker so that the social prescription is individualised to the person rather than a generic suggestion would be helpful.
Where in the world uses social prescribing?
The UK is the first country to roll out social prescribing as part of their health policy in 2019. Another 20 odd countries are also using or trialing various models of social prescribing. However, it is still early days for social prescribing in Queensland.
There is currently a trial of social prescribing on Brisbane’s southside across 18 suburbs that is funded by the Queensland government that has been going for a few years. The link workers are based at a local community centre and accept self-referrals as well as referrals from GPs and other health professionals. The University of Queensland is doing research on the model and its effectiveness but the research has yet to be published.
There is very little Australian research available on social prescribing. One Melbourne study looked at people’s awareness of social prescribing and their openness to the concept. They found that only 14% of people said their GP had recommended a social activity or group. Of those people, 84% took up the recommendation and 91% found it beneficial.
Why is this important to you?
Social prescribing is one of the recommendations from the recent Australian Senate Inquiry into Loneliness. The Queensland Alliance for Mental Health supports this recommendation and advocates for rolling out social prescribing broadly. They see community mental health services as playing a key role in this.
As mental health help providers this is a development we need to keep an eye on and consider the role we will play in social prescribing in the future.
Melody Edwardson, Mind-Life Project Manager - September 2023
Sources:
Friends for Good. (2021). More than Medicine: Exploring Social Prescribing in Australia Melbourne. Retrieved from https://friendsforgood.org.au/assets/downloads/FriendsForGood-ResearchReport-SocialPrescribing.pdf
National Academy of Social Prescribing. (2023). Social Prescribing Around the World https://socialprescribingacademy.org.uk/media/1yeoktid/social-prescribing-around-the-world.pdf
Pescheny, J.V., Pappas, Y. & Randhawa, G. (2018). Facilitators and barriers of implementing and delivering social prescribing services: a systematic review. BMC Health Serv Res 18, (86) https://doi.org/10.1186/s12913-018-2893-4
Royal College of General Practitioners. (2019). Social Prescribing Roundtable, November 2019: Report .. retrieved from https://chf.org.au/sites/default/files/social_prescribing_roundable_report_chf_racgp_v11.pdf