Community activity as a path to better health

When Arabella Tresilian, a management consultant, suffered a mental breakdown in 2015, her doctor recognised that her autism had combined with other events to cause post-traumatic stress disorder and chronic fatigue.

Ms Tresilian did not want to return to the antidepressants she had taken on and off over the previous 27 years.

Luckily, her doctor’s surgery offers “social prescribing” — patient referral to community activities as an alternative therapy. These range from art classes, singing, knitting, cookery and reading groups to walking clubs, gardening, yoga and museum visits.

A “link worker” at the surgery helped Ms Tresilian find the right activity — joining a choir in her case. She has now recovered and regained her confidence to the point where she helps other people cope with mental health problems. “I’m balancing my life, I work part-time, I’m involved in many activities and I feel good about the future,” she says.

Social prescribing is a “no-brainer because you’re using local assets to provide something shown to reduce NHS costs”, says Michael Dixon, a GP in Devon who in 2015 set up the Social Prescribing Network (SPN). When the idea is working well, in areas such as London, Brighton, Bristol and Weston-super-Mare, GP consultations are down 28 per cent and there are 24 per cent fewer A&E attendances, according to a University of Westminster review in England over a 12-month period in 2017.

Initially used to combat anxiety, depression and stress, social prescribing is now also being applied to diabetes, chronic illnesses and palliative care.

There is consistent and growing evidence that it works, says Marcello Bertotti, senior researcher in health and human development at the University of East London. “But more rigorous evaluation is needed in the form of randomised control trials, as in other areas of healthcare.”

The idea of providing community support for therapy has been around for a long time. But Dr Dixon says it has only recently started to take off, and the UK is a global leader.

In June 2016, NHS England appointed a national clinical champion for social prescribing to promote schemes and share lessons from successful projects.

Last month, Theresa May mentioned social prescribing in the launch of the UK’s loneliness strategy. The UK prime minister says she wants to see universal social prescription by 2023 and it is expected to be a key component of the NHS 10-year plan.

The UK government will establish a National Academy for Social Prescribing to offer training to GPs and other health professionals on “the benefits of social prescribing across the board”.

Dr Dixon set up the SPN to provide support and share best practice. Its 2,000 members include health professionals, ambulance and fire service staff, police and the voluntary community. “Now there is a national conversation and the idea has gone viral,” he says.

Social prescribing is available in areas of the UK including Glasgow, Rotherham, Gloucestershire and London boroughs Newham, Hackney and Tower Hamlets. Funding is typically from local authorities and/or clinical commissioning groups, about 60 per cent of which are investing in social prescribing in England.

The scheme puts patients in touch with voluntary groups and charities such as Citizens Advice. “Some 20 per cent of patients visit their doctor with social problems, which GPs are not best placed to deal with,” says Dr Dixon.

Among other countries adopting social prescribing are Japan, Canada and the Netherlands.

Professor Satoko Hotta, of Keio University’s graduate school of health management in Japan, is chairing a three-year project involving doctors, social workers, public health nurses, local government and the ministry of health. “Although we don’t have a formal social prescribing scheme, interest is increasing and we have various initiatives that share the same vision,” Prof Hotta says.

In Canada, the Montreal Museum of Fine Arts is allowing doctors to assign up to 50 “museum prescriptions” over the next year, which will allow free entry for a single visit of up to two adults and two children. Hélène Boyer, vice-president of Médecins Francophones du Canada and associate professor at McGill University, faculty of medicine, says such visits can help treat and relieve symptoms of medical conditions such as heart attack, chronic pain and cancer.

In the Netherlands, social prescribing is used mainly for psychosocial problems. “Doctors would love to extend it to chronic illness,” says Jan Joost Meijs, chairman of the SPN in the Netherlands. “The problem is that the insurance companies . . . want to see hard evidence of return on investment for the €500-€700 per patient cost of social prescription, before they co-finance it,” he adds.

Given the difficulty of measuring exact cost-benefits, Dutch doctors are looking at the social returns, as such enabling people to continue working.