Social Prescribing – Beyond the repair shop
At a time when pharmacies, GPs, mental health providers and the broader health system are straining at the seams, we are presented with another great opportunity to look at the way we approach caring for those in our community who are ill, and to take a proactive and non-clinical approach where relevant.
Social prescribing is an awkward term; it was coined to highlight the contrast of writing a traditional pharmaceutical prescription, with a ‘social prescription’ (social plan) when more appropriate. Social prescriptions can help people improve their health by addressing the root cause of their illness—to determine a solution—rather than solely relying on trying to repair the consequences.
Social prescribing has rapidly caught on in other countries around the world as a powerful and proven approach to increasing wellbeing, producing positive outcomes for individuals, communities and the health economy. It’s also been endorsed by the World Health Organisation, has its own global movement and is starting to gain traction here in Australia. Throughout this column series, we’ll take a look at exactly what social prescribing is, who could most benefit, examples already in place and the role pharmacists can play.
To kick off, let’s look at the social determinants of health. The contemporary approach to health and wellbeing recognises that the extent to which we connect with others and the world has significant bearing on our health and longevity. Human beings are complex creatures, with a range of factors contributing to our wellbeing. There are the basics such as age, place and gender; and the social, economic and political landscapes that surround us. And then there are our individual needs and preferences across a range of domains, including occupational (purpose), spiritual, intellectual, social, financial, emotional, creative and environmental.
Physical and mental illness often show up when our needs are unmet, so it’s important to dig beneath the symptoms for a holistic look at what it is that’s making us unwell.
Research shows that up to 50% of an individual’s health is the outcome of a range of ‘social determinants’. This has played out through the current health crisis. By seeking to protect our physical health (against COVID), our ability to achieve almost all other determinants of health has been compromised. Socialising, working, volunteering, and doing community activities and hobbies have been almost impossible; church has been halted and the arts crushed. We’ve become increasingly lonely, with an estimated two in five adults experiencing problematic loneliness (up from 1 in 4 in 2019).
‘Because we are members of a social species, loneliness is a dangerous disease, increasing the risk of anxiety, depression, disturbed sleep, cognitive decline and other health issues.’ Hugh Mackay, author of The Kindness Revolution
Loneliness is the leading cause of anxiety and depression, whilst obesity, cardiovascular disease, hypertension,
sleeplessness, addiction and substance abuse are all strongly linked to loneliness and isolation.
‘Chunk, hunk or drunk?’ I heard someone ask a friend about the effects of COVID on their life. Funny as it was, this is exactly what the research is predicting—that the long tail of COVID, or ‘shadow pandemic’ will bring a swathe of poor health outcomes linked to prolonged poor social health. But as leading researcher Juliann Holt-Lunstad tells us, ‘While social factors are the most important protectors against mortality, individuals rank them least important”.
Being popular and liked by others is such an important part of the human psyche, so it’s no wonder there is also stigma attached to admitting loneliness. Not only are most of us unaware that our social health is as important as quitting smoking (loneliness is as bad for you as smoking 15 cigarettes a day) or eating well, but we’re ashamed to tell anyone too.
‘It’s embarrassing.’ Peta, 15 years old
‘I just don’t want to be a burden.’ Charles, 87
Many of us need help to understand that our health relies on more than physical inputs and that we have our own individual needs. We need help to dig into ‘What matters to me?’ as much as ‘What’s the matter with me?’, and to nut out ‘What’s missing in my life that’s making me unwell?’ And for many, we need help to address any barriers and start making the links to connect.
That’s a time-consuming job and not one that all GPs are resourced to do. 25% of GPs say their time is spent on non-clinical matters and that’s too much. It takes far more than 15 minutes to help a person understand their social health, and as for helping them link to community, that’s another skill entirely.
Many areas in Australia are now trialling forms of social prescribing, where the person is referred to a ‘link worker’ (just one of a long list of titles for the same role), who is a health coach and community connector all in one, for a social prescription instead of, or alongside, a clinical prescription. Generally time limited, with a focus on building skills to manage their own social health and using validated tools to assess impact, these pilots are mounting evidence that this approach has huge potential on many levels.
The widow who isn’t sleeping at night recognises that she is sleeping in the day to pass the hours and is ‘prescribed’ a support group and some volunteering; the new single mum with hypertension is introduced to a new mums group and a free yoga class for mums which she didn’t know existed.
One such pilot is Feros Care’s Beating the COVID Blues (https://www.feroscare.com.au/beating-the-covid-blues/clinicians-community), a partnership with the Hunter New England and Central Coast PHN to help seniors suffering the impact of COVID self-isolation through a social prescription.
So, what does this mean for pharmacy?
Pharmacy staff are considered trusted advisors to many patients, and most pharmacy staff recognise those repeat patients who pop in for a chat about their health as much as to collect their script. Most will know of those who are lonely. If you have been advised of a local social prescribing program, it’s great to refer; unlike the UK, most programs in Australia don’t require a GP referral. There’s also a pharmacist training program available for those wanting to learn and do more for those customers where medication may be only part of the solution, and over time, lobbying may create funding for pharmacies to provide a social script.
Over the coming issues, we will take a deeper look at loneliness, now considered ‘the biggest social issue of our time’, programs that are working and the circumstances where social prescribing delivers the best results.
Jo Winwood is the Head of Be Someone For Someone, an initiative of Feros Care to tackle loneliness in Australia. She is a member of a range of national and international organisations focusing on ending loneliness and improving social, heath and economic outcomes through evidence-based programs that tackle loneliness and isolation.
Feros Care (Feros) is a reputable not-for-profit organisation, providing a broad range of services in both the ageing and disability sectors across Australia. We are registered with the Australian Charities and Not-for-Profits Commission.
Our mission is to enable customers to grow bold, supporting them to live vibrant, healthy, independent and connected lives.
For years, what has become increasingly distressing for our teams is the amount of loneliness and isolation we see—a tragedy in itself and with devastating impacts on physical and mental health. Our model of care has repeatedly shown us that addressing social determinants of health is key to wellbeing and good health, supported by ever increasing academic and social research.
Feros is committed to tackling loneliness, now cited as the ‘greatest social issue of our time’, as a strategic imperative, establishing a major initiative, Be Someone For Someone, to spearhead this work.