The proposed NHS ten-year strategy focuses on illness prevention. This includes 'social prescribing', enabling healthcare professionals to refer people to local, non-clinical services. We examine whether this is a viable alternative for those who would otherwise need medication.
Imagine this scenario: you've been feeling mildly depressed due to social isolation or low self-esteem. You take a trip to your GP, expecting a dose of antidepressants, but instead, you're put in contact with a local community gardening group and recommended to attend weekly sessions. Would you give it a go?
This new approach is called 'social prescribing' and more and more GPs are exploring it. Doctors are now linking their patients with sources of support within the community. These non-medical referral options can complement existing treatments to improve health and well-being.
Programmes such as dance classes and art therapy, as well as agricultural activities like gardening, have become popular options for social prescribing as they help to combat loneliness and improve mental health, due to their physical demand and social focus.
And there's evidence to support this new initiative. For instance, a new study by the National Council for Voluntary Organisations (NCVO) asked over ten thousand adults about the effects volunteering had on their mental health. 77% of respondents said the activity had improved their mental well-being and reduced loneliness, as well as 74% agreeing that it had also boosted their confidence.
The Royal College of General Practitioners (RCGP) has also teamed up with Parkrun, encouraging GP practices to develop close links with their local running group for the benefit of both the patients and the staff. They aim to help those with conditions such as multiple sclerosis, osteoarthritis and depression.
Looking at your lifestyle
The problems many patients present to their GP with are not always directly medical, which is where social prescribing can be useful. For instance, the risk of developing conditions such as type 2 diabetes, high blood pressure and high cholesterol depends on an individual's level of physical activity, diet and a number of lifestyle factors.
"And we've seen a huge increase in the number of patients presenting with mental health problems," reveals Dr Sarah Jarvis, clinical director of Patient. "Social prescribing looks both at lifestyle elements that will help people's physical health and social elements which will specifically target loneliness and social isolation."
A two-way street
"Overall, social prescribing offers huge advantages to both patients and GPs," says Jarvis. "It may well free up more time for GPs to spend with other patients whose problems are more specifically medical."
This means more efficient and appropriate care for everyone.
However, "the benefits of social prescribing for the patient may not feel immediately obvious," advises Kate Carney, co-founder of My Community Referral, a platform that enables GPs to find appropriate social prescribing options for their patients.
"Some patients find it difficult to understand that there is not 'a pill for every ill'," Jarvis agrees, admitting that some may struggle with the idea of their GP referring them for a gardening session when they make an appointment for depression.
But social prescribing could be more effective than you think. For example, GPs have been trying to reduce prescribing medication for mild to moderate depression for two main reasons:
"Firstly, antidepressants are not very effective in many people with mild depression, and can cause marked side effects in some people," reveals Jarvis. "And secondly, tablets only work while you're taking them."
And even if you are on a course of antidepressants, joining a community group or activity could further help to treat loneliness and social isolation.
Social prescribing gives GPs the option to explore reliable, non-clinical treatment options for patients they may be unable to assist further but who still require support.
"When there is no clear, clinical pathway, social prescribing activities provide an alternative and often complementary approach," suggests Carney.
Sadly, a huge issue for GPs is the lack of a central database for these initiatives. As many activities are funded by the third sector, by the time a practice has found out about them, may have closed down. However, this should improve as the proposed NHS funding is implemented.
"Not only are we going to be able to refer patients to 'social prescribers', but if we feel a patient is either resistant to being referred to a social prescribing worker or that they will respond better to advice from us, then by having local services and databases that are up to date we may be able to refer some patients directly," says Jarvis.
In it for the long run
The potential long-term benefits of social prescribing are enormous for patients, says Jarvis.
"For someone who has low self-esteem, effectively believes their life is over and is sinking into a negative spiral of social isolation, if we can turn that around then the benefits for individuals may be vast."
But unfortunately, there are currently huge problems getting patients to engage with the scheme for long enough to have a benefit, Jarvis points out. This not only greatly lowers your chance of effective treatment, but it potentially takes a space from someone who may also have benefited from the scheme.
If you are thinking of participating in a social prescribing initiative it's important to stick with it, even if you don't feel any immediate benefits.
"If we can improve lifestyles then we can often treat the root cause rather than just the symptoms and improve endurance and resilience for the longer term," assures Jarvis.
Carney believes that social prescribing has long-lasting effects, even if you only participate for a short amount of time, as it gives patients something that traditional prescription services may not be able to.
"Becoming part of a community of like-minded people has advantages that far outweigh the immediate benefits to someone's physical or mental health."
What about medication?
Carney argues that social prescribing gives patients additional, sometimes alternative, options to medication, but only where appropriate. For example, social prescribing could assist with pain management in physical conditions.
"People with osteoarthritis who engage with holistic pain management services where they have group sessions focused on reducing the impact of pain on your life and a multidisciplinary team, along with exercise 'prescriptions', are much more likely to be able to reduce their dependence on long-term medication," reveals Jarvis.
Of course, some people rely on medication to manage their illness and social prescribing is not an alternative to antidepressants for everybody.
"Depression is very much an illness every bit as much as asthma, diabetes and even a broken leg," says Jarvis. "We must remove the misconception that you can 'cure' depression by doing a bit of gardening."
She shares a great analogy: "If you've got type 1 diabetes, you are always going to need insulin. That does not mean that diet and lifestyle are unimportant - if anything they are more important. But this is not 'either or'; it's a combination of the two."
If you are taking antidepressants and want to try out a social prescribing programme, talk with your GP before you stop taking them. They will be able to assess your needs, and you may find that social prescribing will be a complementary addition to your treatment, rather than an alternative.
How can I get involved?
Carney shares a few top tips for those wanting to learn more:
"Before you start any new activity it's best to consult your GP," she advises.
Depending on your condition and abilities, they will be able to recommend programmes to try. Then, once you’ve consulted your GP, you can also do your own research.
"Look for community clubs, and social activities, and try to find other people with some of the same challenges as you," Carney suggests.
Social prescribing is an opportunity to try something new and make a long-term positive change for your well-being, she believes.
"Remember that social prescribing activities are not clinical solutions; they have a more holistic approach to your well-being, so try to go feeling optimistic and with an open mind."