Social prescribing: from knowledge to action

Introduction

Patients with severe mental illness die, on average, 10 - 25 years earlier than someone without mental illness (WHO, 2016a). Most of these deaths are from chronic health diseases, including cardiovascular diseases such as hypertension, stroke, and coronary heart disease. A huge component of their causal pathway is lifestyle and interventions delivered early enough could be preventative (WHO, 2016a; WHO, 2016b).

What if we saw hospital admission as an opportunity for preventative strategies using social prescribing?

Following necessary interventions to treat an acutely unwell patient, there is often a period of stability whilst work is put in to finding suitable accommodation and ensuring relevant support packages are in place in the community. This is where social prescribing can start.

Understandably, doctors may not feel that they are equipped for social prescribing – it is not something usually taught at medical school, where often the biopsychosocial approach can get reduced to largely a biological slant. Particularly when new to a region (but even when that is not the case), doctors may not know where to access resources and the beginning of this process is for healthcare professionals to educate themselves. Fortunately there are increasingly high quality resources becoming available for improving knowledge around the field of social prescribing, what it means and what it might look like in a given region or trust (Healthy London Partnership, 2017; Health Education England, 2016). Not only this, but there are resources specifically geared towards patients with mental health difficulties and in turn, this equips us to be able to pass this information on to patients (Brag. R & Leck. C, 2017).

Two big areas for social prescribing involve the use of green spaces for walking groups as well as the use of focusing exercises such as mindfulness and meditation. But any group that can encourage the building of social relationships and improvements in health (psychological or physical) can be considered under the umbrella term of social prescribing. What about skills such as cooking? Not only is this likely to support patients living independently but also encourages healthy nutrition which in turn can have a marked impact on a patient’s physical health and contributors to that increased mortality risk (Farmer et al, 2018).

Walking Groups

More and more mental health trusts are incorporating walking groups into their adult inpatient services as a cheap and effective adjunct to treatment. Examples and case studies of how this has been achieved and the benefits of walking groups are plentiful (The Centre for sustainable healthcare, 2019; WHO, 2016b; Hanson & Jones, 2015).

Difficult conversations may be somewhat easier when performing another activity such as walking, perhaps starting therapeutic discussions with professionals, or perhaps developing a sense of community when talking to fellow patients. If we can encourage patients to take part in walking groups in hospital, perhaps patients will be motivated to develop social relationships when they have left hospital.

Walking isn’t just an important way to improve mental health, but it has a knock on impact on physical health e.g. fitness and blood pressure as well as social health e.g. by increasing their social network (WHO, 2016b; Maller. C et al, 2006).

Mindfulness Skills

Skills such as mindfulness based meditation can equip patients with the tools they need to moderate their emotions without the need for medication. Mindfulness is a common practice for many around the world, and studies suggest that skills in mindfulness are useful for OCD, anxiety, depression and even schizophrenia (Chien & Thompson, 2014; Hale et al, 2013; Teasdale et al, 2000).

Other social prescribing groups relevant to inpatient and community mental health services can consider improving skills which can support patients to live independently. Not only does this empower patients, it can help them feel better able to take charge of their health and, hopefully, this will support their mental health and keep them well for longer.

Actions for You

Social prescribing works best when the NHS has strong links with community programmes such as charities and voluntary organisations. Where these organisations exist, healthcare professionals need to be made aware of them so they can refer accordingly.

So what can you do?

The first step is to explore your local area for organisations that your patients could reach out to such as walking groups, free cookery skills workshops, volunteer organisations, gardening groups and more. If you work in an inpatient setting, look at what groups there are within your wards and see if these have scope to expand.

Rather than considering social prescriptions as “activities”, it might help to see them as a treatment to prescribe. By encouraging your patients to attend these groups you are empowering them to take back some control, in an environment where it might feel they have limited ability to feel in control.

Perhaps an audit of patients use of medications (e.g. for anxiety) such as lorazepam and diazepam before and after a social prescription might demonstrate the difference that social prescribing can make!

References

• Brag. R & Leck. C, 2017, Good practice for social prescribing for mental health: the role of nature-based interventions [online], accessed on 14 October 2019

• Chien.W & Thompson. D, 2014, Effects of a mindfulness-based psychoeducation programme for Chinese patients with schizophrenia: 2-year follow-up, The British Journal of Psychiatry, 205 (1), pp 52-59

• Farmer. N, Touchton-Leonard. K et al, 2018, Psychosocial Benefits of Cooking Interventions: A Systematic Review, Health Education & Behaviour, 45 (2), pp 167-180

• Hale. L, Strauss. C et al, 2013, The Effectiveness and Acceptability of Mindfulness-Based Therapy for Obsessive Compulsive Disorder: A Review of the Literature, Mindfulness, 4 (4), pp 375-382

• Hanson. S & Jones. A, 2015, Is there evidence that walking groups have health benefits? A systematic review and meta-analysis, British Journal of Sports Medicine, 49 (11), pp 710-715

• Health Education England, 2016, Social prescribing at a glance: North West England [online], accessed on 14 October 2019

• Healthy London Partnership, 2017, Steps towards implementing self-care: A resource for local commissioners [online], accessed 14 October 2019

• Maller. C, Townsend. M et al, 2006, Healthy nature healthy people: ‘contact with nature’ as an upstream health promotion intervention for populations, Health Promotion International, 21 (1), pp 45 – 54

• Teasdale. J, Segal. Z et al, 2000, Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy, Journal of Consulting and Clinical Psychology, 68 (4), pp 615-623

• The Centre for sustainable healthcare, 2019, Green Walking Project [online], accessed on 14 October 2019

• WHO, 2016a, Premature death among people with severe mental disorders [online], accessed 13 October 2019

• WHO, 2016b, Urban Green Spaces and Health: A review of Evidence [online], accessed 14 October 2019