CHEX-Point Newsletter: Sharing the prescription for better health

Elspeth Gracey, CHEX Development Manager speaks about her experiences with social prescribing. To read the rest of the issue, please download CHEX-Point here. For physical copies, please contact sam.jordan@scdc.org.uk.

Walking groupIn Scotland between April 2011 and March 2012, over 387,400 patients consulted their GP or practice nurse about anxiety or depression.  This, in addition to other mental health consultations and the impact of physical ill health on wellbeing accounts for the use of substantial amounts of primary care resources.
Recognising the complementary contribution that can be made to public health by more than the statutory sector alone offers the opportunity to expand the boundaries of primary care.

More than 40% of the organisations in the CHEX network define at least some of their work under the heading of ‘mental health’ and many take referrals from both health and social care professionals into the services and activities that they offer.

Integration of health and social care services , a move towards greater person-centred care , more emphasis on self-management  of long term conditions and Self Directed Support (SDS)   - all of these things highlight the opportunities that exist for strengthening the links of statutory services to community and voluntary sector organisations.

CHEX is currently a member of the National Mental Health Improvement Network, facilitated by NHS Health Scotland and contributing to the implementation of commitments found within the Mental Health Strategy for Scotland.  Through this network we bring information to the national arena of the work undertaken by organisations within the CHEX network. Recently we have been involved in a sub-group of this network looking at Self-Management and Social Prescribing. The sub group work to date includes updating the evidence and mapping local social prescribing activity.In this article we seek to illustrate the concept of social prescribing and how organisations in the CHEX network provide these services.

Sitting with a GP colleague in his surgery, 25 years ago I recall one particular patient; a man widowed three months earlier who described the impact of losing his wife of 50 years.“I’m not sleeping. I’m irritable with my daughter, she‘s only trying to help me but I find myself snapping at her. What can you do for me doctor?”
The best the GP was able to do for him was to prescribe sleeping pills. I recall my sense of despair that we could not link him to others who would understand the normal grieving process he was going through, people who, having been through similar experiences themselves, could listen to his plight  and help him to cope with what life had thrown at him and to find meaning in his life again. I didn’t know it then but if his GP could have referred him to such a group that would have been what is now called ‘social prescribing’.
Alternatively known as ‘community referral’, social prescribing has been defined as: “linking patients in primary care with non-medical sources of support within the community.”  

The process itself can apply to both mental and physical health. Although many can benefit from social prescribing, it is particularly helpful for those who:

  • experience mild to moderate depression or anxiety
  • find themselves returning repeatedly to their GP or other health professional with symptoms for which standard pills and potions are not the answer e.g. people who are lonely, isolated or socially excluded. These might be people on low income, lone parents, older people, and people from newly arrived communities
  • experience of long-term mental or chronic physical health problems which reduce their sense of wellbeing
  • might benefit from increased exercise but are not comfortable with standard leisure services provision
  • might benefit from additional information about nutrition and cooking.

Local community-led health organisations are well placed to offer a range of support activities to help somebody who is vulnerable in terms of their physical or mental health. Many such organisations now accept referrals to their activities from local health professionals.

Examples include:

  • Self-help/support groups where people who have had similar experiences help and support each other• Supported access to information e.g. guided reading (bibliotherapy) or referral to web-based information and programmes including cognitive behavioural therapy (CBT) programmes
  • Physical activities often encompassing outdoor activities including walking, gardening activities. The social aspects of these are often as important, if not more important, than the physical side of the activity
  • Creative Arts activities e.g. writing, drawing and painting, photography, dancing, community choirs, theatrical groups etc. These provide the vehicle for therapeutic self-expression and increased social connectedness 
  • Volunteering where finding that you can contribute to something in your community enhances your sense of self-worth and confidence. This may also lead to people gaining practical skills and to finding employment and it provides the community with services which might not have existed otherwise.
  • Befriending or buddying services tackle loneliness and isolation or simply help somebody back into a more sociable existence after a setback e.g. bereavement or serious illness
  • Literacy or numeracy support difficulty with words or numbers can result in people being left behind in terms of life’s opportunities and addressing these issues with a trusted tutor, often a volunteer, can be life changing enhancing a person’s sense of control and reversing social exclusion.
  • Time banking where people ‘bank’ the time they might contribute in terms of a service to others which they can then redeem when in need of a service that someone else will provide for them.
  • Cooking classes and advice and information about food and nutrition
  • Financial advice services this can include welfare advice or information about managing on a budget so that money worries are lessened and income maximised.

There are many places across Scotland where social prescribing is and has been used. Just a few examples from within the CHEX network include:

  • Stepping Stones in Clydebank is contracted by the local Community Health and Care Partnership to provide the ‘social care’ component for patients referred to them by primary care staff. Over the past two years referrals have continued to rise by nearly 50% from 45 to 65 people a month Stepping Stones provides one to one support and uses Wellness Recovery Action Planning WRAP  for their members who can also access a range of peer support groups.
  • Pillar Kincardine based in Stonehaven, Aberdeenshire complements clinical and medical support and are clear that social prescribing is not a replacement for that. They offer a range of activities tailored to members needs including work on their allotment, physical activity classes, preparation of a shared lunch and peer support groups. People can also simply pop-in for a chat. Manager, Sara Kamrath says: “It’s not usually possible to ‘pop in’ and see your psychiatrist. What we do can prevent somebody becoming more seriously unwell. Having somebody listen to you can help to prevent a crisis.” 
  • COPE in Drumchapel, Glasgow has long been involved in supporting local people through their individual work, training and advice, community capacity building and alternative therapies programmes. They recognise that encouraging people to be actively involved in their own recovery can require a shift in understanding for some professionals. “If they are used to having people who are the passive recipients of services then solution focused work with people as equal partners can be quite scary for those who are not used to this way of working” However, COPE believes supporting people to self-manage and /or be active in their own recovery is essential for building resilience and well-being . 
  • Dundee Healthy Living Initiative has been a key partner in the Equally Well initiative, which established a process called Sources of Support, (SOS). GPs in designated practices refer patients to a Link Worker who identifies what non-clinical sources of support would best suit their needs. There have also been Links projects in both Glasgow  and Fife  where links between primary care teams and local community organisations have strengthened referral routes and increased awareness amongst primary care workers of the assets a community has to offer. 
  • Stewartry, Dumfries and Galloway A partnership including CHEX network member, Building Healthy Communities, DG Health & Wellbeing and the Stewartry Public Health Practitioner have been working together with 2 GP practices to establish Healthy Connections Stewartry. Since May 2013 people with ‘low mood’ have been signposted into a range of support opportunities available in the local community as an alternative approach to improving their wellbeing. This includes access to activities such as exercise, art and volunteering or employment and financial advice.

With this range of community-led health organisation offering such a wide array of locally available support services for people I would hope that nowadays the consultation with my GP friend and his grieving patient would have gone quite differently. The GP might be able to tell him about a self-support group or other locally available activity which would have helped to support him. Allowing him the space to talk and work through his grief and then find his way back to being able to enjoy life again. In time he too might feel able to offer support to others who follow him on this path, continuing the process of social prescribing through community-led health.

Elspeth Gracey, CHEX Development Manager. For more info please contact elspeth.gracey@scdc.org.uk.

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