What is social prescribing? What are the disadvantages?

This is a guest blog by Chelsea Kou


Research has shown that ⅓ of people visit their doctors for non-clinical and/or social issues. With the NHS understaffed, overworked and under-resourced as it is (let’s not forget the estimated £30 billion funding gap), social prescription is definitely becoming more widespread and is contributing to The Five Year Forward View.1

What is social prescribing?

Social prescribing is an innovative form of health care that intends to improve a patient’s physical and mental health through social intervention. It allows patients to identify their own social needs and develop personalised action plans, with aid of course, and connects them to non-medical sources of support in their own communities. In short, it is a community development approach to improving wellbeing.

How does social prescribing work?

Here are a few steps that summarise the stages involved in social prescribing:

  1. A patient is referred to a link worker by a healthcare professional (usually their GP) or a community-based practitioner.

  2. The patient and the link worker co-design a non-clinical social prescription that best suits their needs. Link workers are professionals who inform, set a goal and offer health coaching. (Benefit: reduces workload for GPs).

  3. Commonly, the patient is referred-out to the voluntary and community sector whose services can include practical information, advice and guidance, income support, social support, community activity, physical activities, befriending and enabling services.

Remember, the main focus for each service is to address the psychological problems of the patient and improve well-being.

Who is social prescribing recommended for?

Social prescribing can be offered to anyone who is affected by social issues. However, it is a service that is offered increasingly to older populations, as it attempts to address loneliness, improve physical activity, and mental wellbeing. In this blog entry I will be focusing more on loneliness and social isolation as it is something that I am particularly interested in, having volunteered in a care home for just under a year. Social isolation is a mental disorder that the average person may quickly dismiss but the fact is, loneliness increases the likelihood of mortality by 26%, and so must be dealt with effectively and diligently.

What are the disadvantages of social prescribing?

Despite the continued support, some patients may find it hard to reap the benefits of social interaction. After all, to prosper from social prescription seems to depend almost entirely upon a person's sociability, yet, loneliness affects sociability.

For a patient who suffers from social anxiety, social prescribing may work in a similar way to exposure therapy as the patient could feel forced, or challenged, to engage in community activity. Patients may find themselves in uncomfortable situations which may heighten feelings of anxiety. The same applies for patients in less extreme cases who, although may not suffer from social anxiety, are already vulnerable. One qualitative study reported that a patient’s confidence may be impacted if, for example, they struggle to make friends, have a lack understanding of the service, or cannot see progress through their participation.2 This raises ethical concerns as there is no medical professional on-hand to support the patient if a situation becomes to distressing, or even to monitor improvement in the patients wellbeing.

Kimberley Brownlee, a Professor of Philosophy at the University of Warwick, raises another important concern for social prescribing: "It might seem to trivialise the pain and complexity of loneliness as something easily solved with some chat”. She says “If a GP gives someone a social prescription, he might leave her office feeling more disheartened and incompetent than when he walked in.” This is particularly alarming, especially when there are still so many stigmas that deem mental health as unimportant.

Having said this, there is more evidence that supports social prescribing than that which goes against it. Studies have shown that patients feel better faster than those treated with medicine. In fact, GP consultation rates fell for patients who were socially prescribed in the year following referral. For more on the benefits of social prescribing, please read:https://www.bwams.co.uk/post/what-is-social-prescribing-and-what-are-the-benefits

References:

1 "Five Year Forward View - NHS England." https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf. Accessed 10 Apr. 2020.

2 "Social prescribing: less rhetoric and more reality. A ... - NCBI." 7 Apr. 2017, https://www.ncbi.nlm.nih.gov/pubmed/28389486. Accessed 10 Apr. 2020.

Sources Used:

https://www.mentalhealthtoday.co.uk/news/awareness/the-benefits-of-social-prescribing-and-a-word-of-warning

https://bjgp.org/content/69/678/6

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