Social prescribing --- an ideal time for consumers to write the script
Leanne Wells, Mark Morgan and Leanne Beagley
Social prescribing presents a step forward in healthcare. Far from being left behind by the dominating impact of COVID on health thinking, it appears that the pandemic is reinforcing the potential of social prescribing as a spur to improved health care, including mental health care.
The all-pervading impact of the pandemic on preventative health, physical health, mental health and social supports has made it more evident that effective care must reach well beyond the boundaries of traditional medicine to encompass all of life’s determinants.
A landmark report on social prescribing in Australia, produced by CHF and the RACGP was released late last year stimulating discussions among consumers and clinicians about how we could go about implementing a national scheme, just as COVID was revealing itself. It showed that while both GPs and patients with chronic conditions would welcome closer links between general practices and community services, these were frequently absent.
Social prescribing involves the referral of people to non-medical activities to supplement conventional care.
A prescription to improve one’s health can be much more than a prescription you take to a pharmacist.
Many people visit their health care provider because of the combined effects of loneliness, mental and physical illness. Many also have long term medical conditions that would benefit from community support and opportunities to engage in physical activity.
Social prescribing offers a system of support and guidance for people struggling with chronic conditions to connect with their community and improve their overall health outcomes by taking up activities including walking groups, book clubs and art classes, as just a few examples.
Social prescribing is a way of delivering truly person-centred, comprehensive care that embraces social and lifestyle risk factor management support as well as conventional medical care.
Social prescribing works best when consumers are empowered to engage in activities that are meaningful to them.
The growing support for the development both in Australia and elsewhere, including in Canada, Singapore and England, now makes it imperative for the concept to be transformed into routine reality.
COVID has brought both new challenges and fresh thinking to health and social policy.
We know now that loneliness and social isolation, accentuated by pandemic measures, are major risk factors for mental illness, particularly when it comes to depression. Social support, connectedness and community engagement can often have a huge impact on consumer wellbeing and recovery.
There are promising reports that social prescribing results in significant improvements in patient wellbeing and community connections, increasing healthy living behaviours, reductions in anxiety and depression, increases in community engagement and feelings of empowerment, confidence for self-care and resilience to manage health and psychosocial problems.
Now an exciting opportunity to cement social prescribing firmly in the health system is approaching with the development of the Federal Health Minister, Greg Hunt’s Primary Healthcare 10-year Plan expected to be included in the budget next May.
But how do we achieve that for a development which, at the moment at least in Australia, has no clear place in the system, let alone a practitioner base (such as link workers) to demonstrate and advocate for its formal inclusion in the health system?
This state of affairs provides a rare opportunity to steward a national social prescribing scheme, an opportunity for national peak and professional bodies to co-design a workable scheme, and an opportunity to conceive of a scheme that makes best use of so many of our healthcare assets such as existing workforce, Primary Health Networks and infrastructure such as community health, neighbourhood houses and local government.
This partnership can collect and develop the evidence for the benefits of non-medical interventions for improving health and wellbeing. Vigour and rigour will be required to achieve the cultural shift to recognise this.
And of course, any effective development will demand ongoing resourcing to be sustainable, for both health and community service providers. It would also require input from across different sectors and levels of government. Blended and pooled funding approaches should be considered.
Measuring outcomes is important – we have early data from colleagues in Canada1 and expect to see data from Australian pilots in the coming months. In Ontario, the evaluation found that clients reported a 12 per cent increase in mental health, a 49 per cent decrease in loneliness and a 19 per cent increase in participating in social activities.
As well, 84 per cent of health providers reported improvements in clients’ wellbeing, and 42 per cent reported a decrease in the number of repeat visits from these clients. There was a stronger sense of integration across clinical care, interprofessional teams, social support and community.
At Brimbank in Melbourne, IPC Health is running a pilot where early results are showing in pre- and post-survey data an increase in client wellbeing, connection and ability to deal with problems.
It is important we take a coordinated approach to measuring both qualitative and quantitative outcomes so different models can be compared, and we can identify best practice.
While there are some key elements to social prescribing – the presence of a link worker position, systems to collect data and map local services and connections with health providers – each model will also be different and needs to cater to the needs of the local community, including specific population groups. Regionally designed models work best and it is likely each social prescribing program will look a bit different.
Social prescribing can and should include a wide range of stakeholders, including GPs, allied health professionals, peer workers and many others.
A national social prescribing scheme will enhance primary and mental health care, be job creating and provide a positive response to the ‘COVID normal’.
Social prescribing is an idea whose time has come.
Leanne Wells is CEO of the Consumers Health Forum
Leanne Beagley is CEO of Mental Health Australia
Professor Mark Morgan is Chair of RACGP’s Expert Committee on Quality Care