Social prescribing is emerging as an area of practice in mental health promotion and prevention and primary care provision. This paper draws on a recent HSE report which explains what social prescribing is and what it has to offer primary care practice in Ireland.¹

Writing in the Foreword to this report, ICGP president Prof Bill Shannon states: “The term ‘social prescribing’ was certainly a new one for me and I expect will be for many of my GP colleagues, and possibly other professionals in primary care. Essentially, it covers a whole raft of possible non-medical interventions aimed at supporting people with mental health needs. That covers all of us, because it includes a major emphasis on health promoting activities, as well as those proven to help people struggling with common mental illnesses, such as anxiety and depression”.¹

The social importance of mental health is widely recognised. The WHO has found that mental disorders rank second in the global burden of disease, following infectious diseases.² The economic costs of mental health problems are considerable.^3-5 Among HSE priorities for 2012 are the promotion of positive mental health and suicide prevention, the development of the capacity to effectively manage mental health needs appropriate to a primary care setting and the development of effective partnerships with voluntary and statutory agencies to deliver integrated care for service users. Social prescribing is one method of delivering on these priorities.

Social prescribing in primary care is a relatively recent concept describing the use of non-medical support to address the needs of people affected by depression or anxiety. It is one means of providing psychosocial and/or practical support for people with mild to moderate mental health problems, with a range of proven positive outcomes, including emotional, cognitive and social benefits.

Core elements of social prescribing

Social prescribing may also be a route to reducing social exclusion, both for disadvantaged, isolated and vulnerable populations, and for people with enduring mental health problems.^6-9 Common activities included in social prescribing, among reports reviewed, include self-help, exercise, arts and creativity, green activity, community involvement and supports including volunteering, debt advice etc.

Social prescribing practice takes a range of forms but a number of core elements can be identified from models reviewed. The primary care team is a central component of the social prescribing model, acting as referrers and sometimes as coordinators of the social prescribing service. Often, coordination of social prescribing is contracted out to voluntary or community services. Activities to which people are referred are located within the community, generally provided by voluntary and community groups and organisations. An information resource such as a directory or a service that keeps up-to-date information on what supports are available in the community is another key element. A range of mechanisms is involved relating to referral pathways (including feedback), quality and review processes.

Referrals

The primary care team is the main source of referral. They need to know what to look for in patients who might be suitable for social prescribing and be clear about what is achievable from this approach, and so training and support is an important consideration. Service users for whom social prescribing has been found to be particularly suitable include those with vague or unexplained symptoms or inconclusive diagnoses, those with many symptoms affecting multiple systems, frequent attenders for GP appointments, those with poor social support mechanisms and those experiencing psychological difficulties.

Primary care team/voluntary sector relationship

The role of facilitator/coordinator who acts as a link between health professionals and the community services has been identified time and again as key to successful social prescribing. The relationship between the primary care team and the services delivering activities in the community has emerged as a pivotal aspect of social prescribing models.^10-13 Most of these services are provided by the voluntary sector and it is vital that the relationship between the primary care team and the local voluntary sector is nurtured and supported.

Projects reviewed vary in scope and definition but have a number of common threads. The relationship between PCT and community sector is pivotal to successful working. A shared language and a common understanding of goals and expected outcomes is vital. Measurement is challenging but a number of innovative approaches are emerging to address these challenges. Quality assurance is important and can be developed within a framework of existing quality initiatives within the primary care and community sectors.

Implementing primary care team-led social prescribing

Recommendations for the definition and implementation of social prescribing practice in Ireland include:

• A collaborative approach to the development of social prescribing practice at national and local level
• Social prescribing should be considered as part of the ongoing development of primary care teams and mental health services. Identification of where co-ordination of the scheme is best located should be one of the first steps in initiating a local social prescribing scheme
• Planning needs to take into account that social prescribing practice can increase demand on voluntary services
• Resource allocation is a key consideration in the development of social prescribing practice. Project costs and model of delivery will be determined by the nature and range of activities selected and the nature of the referral
• A database of all users of a social prescribing service should be initiated and maintained by the facilitator/co-ordinator to enable a longitudinal study to be carried out to monitor the effectiveness and the cost-effectiveness of the individual projects to all stakeholders
• A national research and evaluation framework for social prescribing projects, bringing together expertise in mental health promotion and primary care, would ensure best use of resources locally in terms of building an evidence base and generating effective evaluations.

Conclusion

Social prescribing practice expands the range of service options for those with mental health needs, as well as providing greater opportunities to improve health and social outcomes that are connected to mental wellbeing.

Authors: Celia Keenaghan, director, Keenaghan Research & Communications, Joanna Sweeney, lecturer in social studies, St Angela’s College, Sligo (NUIG)/family therapist in private practice and research associate in Keenaghan Research & Communications, Bernie McGowan, RGN, senior research co-ordinator, The North Western Rheumatology Unit, Our Lady’s Hospital, Manorhamilton, Co Leitrim

Note: This research was commissioned by Care Options for Primary Care Steering Group, HSE West

References

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