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The Case for Social Prescribing

Social prescribing is a way of connecting people to services that can help to address the determinants of health – that is, by trying to address a range of social, economic and environmental factors. This article will take an in-depth look at social prescribing and how it may be used by allied health practitioners in their daily work.

What is Social Prescribing?

Social prescribing can be used to connect people with others. It enables medical and allied health professionals to refer people whose health is affected by housing affordability, monetary problems, health literacy, social isolation or loneliness.

Social prescribing is a means of referring people to non-clinical health, welfare, and social support services. A prime example would be a mental health worker referring a male patient to the Australian Men’s Shed Association, an organisation aiming to improve health and wellbeing and reduce the number of men at risk from preventable diseases stemming from social isolation and loneliness.

Social prescribing programs may include: art class prescriptions, book club prescriptions, exercise group prescriptions and pet prescriptions—“comfort” dogs are a good example for those living alone and socially isolated.

What evidence exists for social prescribing?

Studies assessing social prescribing have shown encouraging results. International evidence demonstrates that it improves health-related quality of life and reduces the burden on GPs. Social prescribing is a component of the NHS Long Term Plan in the UK. Further, evidence shows that it can reduce healthcare demands and costs. Importantly, improvements in physical and mental health are also well documented.

While most work in this field originates from the UK, Australian researchers recently assessed the nation’s first pilot project on social prescribing. The authors found that it may improve self-perceived quality of life, welfare needs, health status, loneliness, social participation, and economic participation for those with mental health diseases. The results parallel Australian health policy and funding models, which focus on strengthening community care, especially in rural and remote communities where loneliness has worsened since the COVID-19 pandemic.

Loneliness and social isolation are international public health concerns. Loneliness is considered the social epidemic of the 21st century. With health consequences similar to those of many chronic illnesses, loneliness is a complex challenge to overcome. However loneliness comes in many forms. It can be caused by physiological, psychological and physical complications of illness, it can be situational and temporary, or it could be due to societal structures. Understanding the causes of loneliness also enables policy makers and professionals to identify the consequences an prioritise appropriate solutions. Social isolation is determined by the quality and quantity of social relationships, whereas loneliness is a person’s subjective feelings about these relationships. Combined, social isolation and loneliness are closely linked to the social determinants of health (SDH).

Social prescribing is closely linked to SDH. SDH describes the conditions people inherit depending on where they live and work and the health systems they can access. These conditions are influenced by political, social and economic factors.

An article published in the USA highlights the relationship between social prescribing and SDH. Clinical interventions in the United States are now being supported with social and economic resources such as the delivery of food hampers by recognised community organisations supported by federal funding models. Connecting patients with community-based resources such as food banks have also been recognised as an important way of improving SDH for patients on the lower end of the social gradient. The social gradient in health defines those people who are disadvantaged by socioeconomic status and have worse health than those who are advantaged. Therefore, social prescribing is an SDH-focused intervention in western health systems such as the USA.

 

Use cases for allied health professionals

Numerous patient populations may feel the impact of social isolation, from those suffering from relationship breakdowns and seeking psychological support to those on elective surgery waiting lists wondering if they will ever receive the appointment they have been referred for.

A social prescription should include these key components:

  • a referral from a healthcare professional
  • a consultation with a link worker
  • an agreed referral to a well-organised community group.

When a link-worker is unavailable, allied health professionals (especially those working in private practice) may need to use their creative skills and phone. Too busy? Could a practice manager take on that role? Accessing a link-worker should be achievable so long as the referral is made to an appropriate community organisation.

Regarding patient populations requiring a social prescription, most commonly, it is mental health that is affected. A recent study protocol suggested ‘Forest Therapy’ (group nature walk) with prescribed activities may promote mindfulness, relaxation, and shared experience. For allied health practitioners, becoming aware that such groups exist is the first step. Then, it is a matter of making the referral and following up with the patient (or preferably the link-worker) to assess their attendance and satisfaction.

While social prescribing is an exciting wave that health systems should ride, it cannot be considered a solution on its own but rather an adjunct to quality health care. While many patients may utilise a social prescription, others may never get the prescription filled.

Further, social prescribing alone will not alleviate pressure on health systems but may supplement existing services. A social prescribing system must be supported by appropriately trained and funded link workers for the model to succeed. Alternatively, linkage to appropriate resources should be considered where volunteers perform this role.

 

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