Social prescribing: Has the time come for this idea?

Doug Hendrie

5/06/2018 4:07:52 PM

Should GPs be prescribing social groups to their more isolated patients?

The feeling of connectedness that comes from being part of a group can be more important than many people realise.
The feeling of connectedness that comes from being part of a group can be more important than many people realise.

It was August 2016 when Dr Charlotte Hespe visited the Bromley by Bow Centre, a pioneering charity combining GPs with social services and social linkages, tackling entrenched disadvantage in a low socioeconomic area of London.
Back in the 1980s, a local pastor saw there was need everywhere in the area. So he opened his church and invited people, organisations and doctors to set up shop.
‘It’s an amazing set-up where the whole practice is very much around the whole needs of the patient,’ Dr Hespe, RACGP Vice-President and Chair of RACGP NSW&ACT, told newsGP.
‘A doctor or reception staff member can figure out when a patient needs assistance with finding a job or food vouchers or a course [as well as health]. It’s a really great concept.’
The centre is premised on ‘social prescribing’, the idea that doctors can link their patients into social services – or even social groups – in a bid to stave off the epidemic of loneliness and social isolation and their associated harms, including depression.
Social isolation is associated with a 29% rise in mortality, according to a 2015 meta analysis published in Perspectives on Psychological Science.
The UK is at the forefront of the push to embed social prescribing into healthcare.
A major reason for this push is that in an era in which the country’s National Health Service (NHS) is perpetually cash-strapped, social prescribing may reduce healthcare costs by minimising the number of consultations where loneliness is the underlying issue.
While Dr Hespe believes social prescribing is a long way off from widespread acceptance in Australia, she has found that many GPs are likely already doing it – just without the name.

‘Last week, I consciously thought about the number of times my advice for patients had something to do with social prescribing, and it was about 60% of patients,’ she said.
Patients with chronic mental health issues, people experiencing homelessness, older people – these are the patients social prescribing could help.
‘One of my patients suffers depression, so I was organising someone to help her get out of house and go for a walk,’ Dr Hespe said. 
‘The circles of health are eating well, exercising well and socially interacting well, to really have a healthy life.’
In a forthcoming Annals of Behavioural Medicine paper, ‘A doctor a day keeps loneliness at bay? Social isolation, health status, and frequent attendance in primary care,’ University of Queensland researcher Dr Tegan Cruwys and her co-authors find that low social group connectedness is associated with greater use of GP services.
Dr Cruwys and her team ran a small intervention study with 46 participants. They found that bringing people with low social connectedness to a social group, such as indoor soccer or sewing, significantly lowered rates of GP attendances.
Participants came an average of one visit fewer over a three-month period after the social intervention.                
University of Queensland Professor of Psychology Alex Haslam finds it surprising that Australia has not taken up social prescribing.
‘In the UK, there is a strong push to encourage GPs to offer “social prescribing” as part of their treatment for patients with a range of conditions including stress, trauma, ageing, depression, addiction, eating disorders and brain injury,’ he said.
‘Social prescribing focuses on building people’s social connections by linking them with social or physical activities in their community such as local sports, arts and voluntary organisations.’
Professor Haslam’s team has found that only around 15% of 500 people surveyed saw social factors as a key component on mortality and health.

‘Although research shows that lack of social integration and support are the most important determinants of mortality, we found that people tend to see them as among the least important,’ Professor Haslam said.
‘We know from a wealth of previous research that people who are more socially connected live longer and have better health than those who are socially isolated.’
Professor Haslam told newsGP that social isolation is linked to the biggest killer of the young – suicide.
‘We’re not talking about a peripheral health issue; that’s the strange thing,’ he said.
‘For most people, up until you’re in an advanced age, social isolation is the biggest killer because of self-harm. And for older people, isolation as a cause of depression and low motivation is a massive [issue].
‘You feel sometimes desperately alone, and there’s that sense of not being part of a community, of losing the will to live.’
Professor Haslam said that traditional medical responses might include anti-depressants, which are often of limited use in these situations. He said that the key intervention is trying to rebuild a sense of group connection, not simply increasing individual friendships.
Professor Haslam recently co-authored a book, The new psychology of health: Unlocking the social cure, in which he and his co-authors offer social identity tips for better health, mirroring better known preventive health tips such as ‘avoid smoking’.
They wrote:
If you feel socially isolated try to join a group. If you can, join more groups. Try to hold on to positive group memberships, especially if you are going through a challenging time. If you lose membership in an important group, seek out a new one. Invest in groups that are important to you and in groups by which you are valued.’
‘The core intervention we have developed is where you take people through a process sensitising them to the importance of group connections. Because it’s not just social connections, it’s about being integrated into social groups,’ Professor Haslam said.
‘Groups have an ameliorative power, over and above a few individual friends.’ 
Professor Haslam’s research team has experimented with setting up social groups and training people to help them get over the anxiety of a room full of strangers, and finding strategies to boost the likelihood they’ll come back.
So will Australia’s GPs embrace social prescribing?
Dr Charlotte Hespe believes that day will come.
‘We do help people at times in their lives where it’s not about managing disease, but managing wellness. “How do I get from one milestone in my life to the next?”, she said.
‘Doctors might not think that this is part of the role. But part of looking after someone is noticing what’s not right and helping them get through it.’

loneliness mental-health social-isolation social-prescribing

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Dorte Hansen   23/01/2019 4:50:15 PM

Nice article Doug !