Keeping the body in mind: Social prescribing and mental health

All GPs will likely recognise the patient who does not have anything especially ‘wrong’, but who has a lot of questions and is keen to linger longer in the consultation than seems necessary.
 
Up to 20% of GP visits are for social rather than physical issues. Professor Katherine Boydell, Professor of Mental Health at mental health research and advocacy organisation the Black Dog Institute, has found these patients often experience social isolation, a condition that can have serious implications for mental and physical health.
 
‘Social isolation is a huge issue and is associated with a 29% increase in mortality,’ she told newsGP.
 
The issue of social isolation has come under particular focus in recent years. This is especially true in the UK, where extensive research has been undertaken on a possible solution – social prescribing, a holistic healthcare approach in which doctors prescribe a range of non-clinical, community-based services.
 
Because social prescribing is focused on community, connectedness, and mind–body care, the tools of treatment can be incredibly broad, including everything from gardening groups to literacy classes. Professor Boydell feels that, at its best, social prescribing can be used together with the biomedical model to address some of the wider social determinants of health.
 
‘For example, if poor housing is a factor in people’s depression, you’ve got finance and employment concerns that might have adverse impacts,’ she said.
 
‘You have to think about moving beyond the medical model to address people’s needs in a bespoke, holistic way.’
 
A number of different models of social prescribing, all with the basis of building on already-existing resources within the community, have been trialled in the UK.
 
‘Everything from a very low-intensity model which might be information only, so a brochure at a GP office,’ Professor Boydell said. ‘And then it might go up to a where a GP or allied health professional
refers someone to a community activity or program.
 
‘But the more intense models would encompass a social prescriber or a link worker, where they offer a face-to-face or telephone co-production with an in-depth coaching service.
 
‘A lot of the models in the UK have that link worker, so they’re the uber knowledge base that work with the patient or client, saying, “What are your needs? Do you have difficulty accessing this resource? How can we help get you there?”
 
‘That’s the best-practice model.’
 
Professor Boydell has often found many Australian GPs are already engaging in this type of prescribing, without having a term for it. However, she believes implementing a specific model can still be extremely helpful.
 
‘Many physicians, especially GPs, will say, “Social prescribing, I’ve been doing this for years, I do this in my practice”,’ she said.
 
‘But I think that, even though many GPs undertake social prescribing-like activities, it might often be somewhat ad-hoc, or they might feel varying levels of confidence and comfort in doing so.
 
‘What a social prescribing model does is formalises it, and offers us the support of link worker that assists in referrals.’
 
The Black Dog Institute’s recent Exercise your mood campaign was an example of applying a social-prescribing mindset to the issue of mental health.
 
‘Our research has shown that any extra physical activity you can manage in a day is going to make a difference to your mental health,’ Professor Boydell said. ‘So we were promoting doing any form of exercise or movement; the main message was, try to get in an hour a week.
 
‘Again, that is very much linked with the notion of social prescribing and highlighting the role exercise can play in mental health. It’s really about keeping the body in mind, building in that regular hour into your week, taking the stairs, whatever is going to make an impact.’
 
Professor Boydell is keen to further explore the impacts of social prescribing within Australia and, in conjunction the Black Dog Institute, is conducting research into its efficacy in the treatment of mental health conditions.
 
‘Right now we are piloting an exercise prescription program and an art prescription program,’ she said.
 
‘We just got the ethics approval for the art prescription program, and that’s a partnership with the Art Gallery of New South Wales. So we will see in that pilot trial what the impacts are, but I’m really excited about moving forward.’
 
Professor Boydell is also working towards greater exploration of the social prescribing ethos in broader ways, extending further into the arts and beyond.
 
‘My colleague and I just submitted a grant application to focus on a social prescribing project that is focused on creative reading and writing, based on the literature showing the positive impact and results of bringing people together in these creative reading and writing groups,’ she said.
 
‘And last week we met with Lisa Chimes, the TV vet, who’s interested in incorporating companion animals into the social prescribing program. So we’re exploring that as another possibility.
 
‘I just think there are so many wonderful opportunities and activities to draw on, fabulous resources that already exist in our communities.’

Black Dog Institute Mental health Physical health Social prescribing