Sarah’s Health Notes: Let's celebrate Social Prescribing Day (Wednesday 19th March)
In 2016 the Kings Fund, a London-based charity that works to improve health and care in England, published a report on Gardens and Health, making the case for integrating gardening into mainstream health policy and practice under the umbrella of social prescribing. It was the first time I’d heard the term ‘social prescribing’ and when I understood more about it, I thought it was one of the most brilliant all round policies for supporting people’s health and wellbeing.
So what are ‘social prescriptions’? Put simply, they’re a holistic non-drug way of helping patients with social, economic or environmental problems that affect how they feel and function. Take someone who’s suffering from insomnia after losing their job, for instance. With no work, one woman patient (this is a real story) did very little all day and, in a vicious circle, her low mood dipped further and made her insomnia worse.
Feeling helpless and hopeless, she went to her GP who suggested that, rather than taking prescription sleeping pills which can be hard to get off and won’t solve underlying problems like unemployment, she talked to a social prescribing link worker, attached to the practice.
The link worker, lets call her Joy, gave the patient six 45-minute sessions: time to listen, probe gently about underlying problems and talk about what matters to her rather than what’s the matter with her. ‘If people’s finances are restricted, it generally affects everything else’, Joy told me. ‘Unemployment keeps people at home because they can’t afford to go out. Then they often lose touch with others, which also affects their mood.’ Joy and her team found the patient free local activities that she could join in with, which she had no idea existed but began to turn her life round, in tandem with sorting out her benefits. Her sleeping problems resolved as she felt better - without pills.
That’s just one example of the thousands of marvelous stories I hear through my work with the College of Medicine Beyond Pills Campaign, which we launched in June 2022. This followed on from the Government’s National Overprescribing Review, published in autumn 2021, which found that 10% of drugs dispensed in primary care were unnecessary, inappropriate and could cause harm, including premature death. Dr Keith Ridge, the for.mer Chief Pharmaceutical Officer who authored the Review, emphasised the crucial importance of social prescribing for redressing this. It’s now well established that many of the patients going to their GP do not need medical solutions. They need help with emotional problems such as loneliness and isolation, practical help with, say, housing or debt, as well as what one GP called ‘joylessness’ and a sense that their life has no purpose. As well as practical support, link workers can signpost patients to a variety of community services for all ages, from carers to choirs, gardening to walk and talk groups, even help with getting online.
In December 2023, we launched the Beyond Pills All-Party Parliamentary Group (APPG), with a call to reduce antidepressant prescribing for people with mild to moderate depression. The evidence for efficacy is slight for this cohort (although the drugs may help with serious depression) but one in five over-18s are prescribed these pills, which can have serious side effects and many find it very hard to come off. Sadly, in England, nearly 450,000 children and young people under 18 – almost 4,000 under ten - were prescribed antidepressants in 2022/23.
The Chair of the Beyond Pills APPG is Dr. Simon Opher, an NHS GP for over 30 years, and a pioneer of social prescribing. He says: ‘I found that, as for many doctors, about one in three patients described feeling anxious or depressed, often with sleep problems. With the time constraints on doctors, it’s not surprising these patients tend to be diagnosed with mild to moderate depression and prescribed an antidepressant, despite NICE [National Institute for Health and Care Excellence which assesses drugs and provides guidance] stating that antidepressant medication should not be routinely offered as first line treatment for less severe depression.’
‘Rather than a mental health condition, I found the underlying problem affecting my patients’ state of mind was often a social or economic problem: lonliness or isolation, redundancy, inappropriate housing, debt management or marital and family issues. Prescribing a pill cannot solve these problems.’
In 2000, Dr. Opher employed an artist in his surgery and referred patients with mild to moderate depression rather than offering antidepressants. ‘We had a really good response and the project is still ongoing’, he reports.
Exercise is proven to be as effective as pills or talking therapy for many people. A recent review of 218 studies found that taking aerobic exercise, joining a yoga, walking or dancing group had a bigger impact on mood than CBT (cognitive behavioural therapy) or medication.
What’s termed ‘green social prescribing’ is increasingly recognised as being valuable. The Government-funded ‘Prescribing Nature Works’ project, offering nature-based activities for people with poor mental health and carried out with NASP (National Academy for Social Prescribing), has shown participants' feelings of happiness and life being worthwhile improved, and anxiety levels decreased.
Well-prescribed drugs are essential for some people but for many ‘social prescriptions’ will help much more.
