Social prescribing tackling loneliness and isolation

Doug Hendrie

29/11/2019 3:43:54 PM

Innovative trials and a high-level discussion forum have put social referrals high on the primary care agenda.

Group of young people chatting over coffee.
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When Tom* went to his GP in Melbourne’s west earlier this year, his doctor asked him about his ongoing health issues.
But although Tom had suffered an acquired brain injury as a child, leaving him with an intellectual disability, this time there was another reason he had sought help.
It was his long-term social isolation.
Thirty-something Tom had no shortage of confidence. But he told his GP he struggled to find people with shared interests. He knew people. What he lacked, he said, was close friendships.
And this time, his GP had a new pathway to try.
Tom’s community health organisation, IPC Health, has been running a trial of social prescribing since June this year, aimed at finding non-medical pathways for patients experiencing loneliness, isolation or struggling with nutrition.
So his GP referred him to the new linkworker – who connects clients to community services – at the organisation. Tom came in two days later.
Over the course of an hour, Tom told the linkworker his ultimate goal was to meet someone with whom he could share a holiday. He also wanted to meet people who had similar issues to himself, as he did not want, in his words, to ‘stand out’.
The linkworker suggested a number of possible activities, such as walking or cooking groups. They agreed to visit the local community centre – to which Tom had never been – together.
At the centre the next day, the linkworker spotted a sign for an acquired brain injury group to meet there that morning, and asked Tom if he would be interested. He said yes.
So Tom was introduced to a group of people who had similar experiences to his own. There were 12 there that morning, several around Tom’s age. Even better, one of the regular activities was experimenting with cooking techniques.
Tom decided to stay and try the group. The group’s leader, Steve, agreed to drive Tom home afterwards.
When the linkworker checked in the next day, Tom seemed excited. He felt comfortable there, and he was already planning to go back.
While Tom knew about the existence of the centre, it had taken the involvement of the linkworker to get him to actually try it out.
Dr Sara Nairn, a GP at IPC Health, describes the program as ‘a great idea’ to address the problem of loneliness, which cuts across all age groups. 
‘It took me a while to understand exactly what the program was offering because it’s so novel,’ she told Primary Pulse.  ‘And I think once we all get our head around what the program is offering, I think we will recognise what an incredible hole it is filling in what we can offer to our patients and their lives.’
IPC Health CEO Jayne Nelson told newsGP she got the idea after visiting a social prescribing centre in Quebec, Canada.
‘The City of Brimbank is the third most in need across Victoria. The council was looking for a project, and I suggested, why not try social prescribing?,’ she said.
The council and local Primary Health Network (PHN) were soon on board, with the PHN contributing funding for a linkworker to be based at IPC Health.
‘Referrals started coming internally from our GPs, and soon from allied health. Now they’re coming from external GPs and self-referrals as well,’ Ms Nelson said.
The trial is up to 96 patients and growing rapidly.
In contrast to the UK’s experience, where social prescribing clients tend to be older people, the IPC Health trial has a much more varied age range, with many younger people also concerned about their isolation.
Longer-term, Ms Nelson wants to expand social prescribing into a large-scale service delivery – as long as the trial proves it has merit.
‘The indicators at the moment are fairly positive. This would suit clients with mental health issues, anyone who is lonely – not just older people, but younger people are lonely, too,’ she said. ‘New residents to Australia, refugees, the strong culturally and linguistically diverse community.
‘This model tackles loneliness and can help with chronic disease management – this helps get people out of the GP clinic and into activities.’
Ms Nelson also hopes social prescribing can help reduce emergency department visits for clients who would otherwise present frequently.
The key to large-scale adoption will be whether the Australian Government decides – as has the UK Government – that social prescribing is worth trying as a way to keep healthcare costs from spiralling due to an ageing population with widespread multimorbidity.
For Ms Nelson, funding is key.
‘It’s just not recognised by any funding models,’ she said. ‘In the UK, the NHS [National Health Service] now has item numbers, so they can account for visits to the linkworker. Right now, we’re subsidising the cost of that.’
It’s fair to say social prescribing is having a moment. In the UK – which has pioneered the technique – the NHS is investing in social prescribing as a way to tackle the global epidemic of loneliness.
A major meta-analysis found that loneliness, is just as harmful to health as heavy smoking and is directly connected to death rates.
While social prescribing trials are now running everywhere from Denmark to Canada, in Australia the practice has been ad hoc and under the radar, despite the fact that one in five GP visits is estimated to be for a reason likely to have a social cause rather than medical.
Many Australian GPs and healthcare professionals report referring patients to non-medical services. But the practice has not been formalised – and attracts no funding.
To tackle this issue, the RACGP and the Consumers Health Forum (CHF) recently hosted a social prescribing roundtable to explore the potential for the technique in Australia, backed by Department of Health and National Mental Health Commission funding.  
Ms Nelson and others from IPC Health were among the presenters.
RACGP President Dr Harry Nespolon believes it is time to change the slow adoption rate of social prescribing in Australia.
‘We live in a time where many people are increasingly feeling isolated and this is a recipe for poor health outcomes,’ he said. ‘Research tells us that social isolation is associated with a 29% rise in mortality, so it simply makes sense to help our patients fight loneliness and the myriad physical and psychological problems that result from a lack of positive, social interaction.
‘[N]ot every patient’s health issues can be addressed through medication. Sometimes the key is prescribing non-clinical solutions to help people improve their health and wellbeing.’

CHF Chief Executive Officer Leanne Wells said social prescribing will help people take a more active role in managing their own health.
‘Measures to support personalised care, such as social prescribing, are the kinds of things that matter to consumers,’ she said.
‘CHF would like to see social prescribing incorporated into future health system planning, including in the development of the 10-Year Primary Healthcare Plan and the National Preventive Health Strategy.’

Parkrun is an emerging social prescribing option in Australia.
Associate Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care, said the roundtable will give social prescribing a boost.
‘We will be developing recommendations that we will put to Government and stakeholders to give social prescribing a real kick-start in Australia,’ he said.

In recent months, the RACGP has been exploring social prescribing possibilities with social running organisation parkrun, coming after the RCGP in the UK signed a formal partnership with parkrun to allow GPs to ‘prescribe’ the group.
Another roundtable presenter was University of Queensland Associate Professor Genevieve Dingle, a clinical psychologist who has researched the importance of belonging and social group membership as protective measures against isolation.
She told newsGP social prescribing offers a ‘social cure for social issues such as loneliness and marginalisation’.
‘[It addresses] the problem of people either not coming forward for help or presenting frequently at GP clinics or hospital emergency departments when their underlying issue is unmet social needs,’ she said.
‘No medication can address these issues directly – people need to connect and have a sense of belonging. In providing a non-clinical pathway to community group programs, social prescribing helps people to connect with others in the community around their interests and strengths.
‘It’s more than simply signposting groups. Linkworkers have detailed knowledge and relationships with these group providers so they can help individuals to safely and effectively engage with a new group and follow up if the individual doesn’t feel that it’s a good fit for them.’
What social prescribing – when backed by professional linkworkers – offers GPs is a referral pathway, Associate Professor Dingle said.
‘It provides someone with the time to build those community relationships and keep up-to-date knowledge of group programs in the local area. As more isolated people get out and join groups in the community, they will make a valued contribution and the community will be stronger as a result,’ she said.
Associate Professor Dingle believes there is growing evidence of the benefits of social prescribing.
‘What the field needs now is a theoretical framework to explain how social prescribing works and why some groups are effective for some individuals yet not for others,’ she said.
* Not his real name

chronic disease depression isolation mental illness social prescribing

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