Social Prescribing: Beyond Medication, for Health and Well-being

Summary

Social Prescribing is a relatively new concept in healthcare. It acknowledges that, for some patients, treatment must go beyond medication. Treatment must be holistic and factor social determinants of physical and mental health. The social aspect of treating the person is important. To enable this, an entire ecosystem must be built around it. While there are challenges and limitations with the concept, it is still finding favour with a lot of countries who are introducing some initiatives in this regard. In this article, we will learn more.

Introduction

It is no secret that there is both a physical and mental aspect of illness. Yoga, and several oriental medicinal practices have explored this connection and have always advocated holistic healing to cure any disease. However, allopathy and other western treatment systems have separated the physical, mental and social aspects of healing or disease treatment. Medication, surgery, physiotherapy, rest, recuperation, diet and exercise have always been the mainstay of western treatment systems. All that could be changing now, with Social Prescribing.

Social Prescribing (SP) is a primary care service in which patients undergoing treatment for a condition, and who have non-medical needs – are linked to support sources or groups in the community and voluntary service sector. For example, people suffering from illness could also be grappling with isolation, loneliness, mental-health issues such as depression, anxiety and stress, and in some cases – debts or poverty. All these only worsen the patient’s overall health and delay his/her healing and recovery. It is not enough to treat the physiological aspects of the patient’s condition alone, when these larger concerns remain. It is this gap that SP aims to address.

General Practitioners (GPs) or doctors have limitations in addressing social, financial and mental-health aspects of the patient, and stay largely focused on the anatomic health. This is where Social Prescribing comes into play. SP relieves the GP of his/her responsibility in this regard and takes an active role in working on the non-medical aspects of the patient’s situation. SP believes that such an approach is not only beneficial but also critical in ensuring better treatment outcomes. SP goes a step further and creates a framework to build an ecosystem that will make this approach practicable.

Who may need social prescribing?

There are various demographics of people for whom, or real-life situations when – the need for SP is acutely felt.

• Death or bereavement of a parent/spouse/child, or a divorce or separation, leading to psychosomatic illness, social isolation and depression.
• Physical or mental health problems brought about by old-age, such as Parkinson’s disease, dementia, Alzheimer’s disease, arthritis, vision problems, etc. These can affect the person’s functional abilities and impair his/her quality of life
• Relocating to a new town, state or country and not knowing anyone there to turn to for help.
• Elderly couples, where one of them has to provide long term care for a partner or family member such as a challenged child.
• Cancer patients suffering from depression
• Low-income families grappling with the cost of treatment, and desperately seeking loans that are hard to come by

Origins of Social Prescribing

In the late 2010s, the UK started exploring the social aspect of healing or disease treatment. It coined the phrase ‘Social Prescribing’. The UK’s National Health Service or NHS was involved in various projects and initiatives to gather data around how improving the social aspect of a patient’s life improved the outcomes of his/her treatment. A pilot program introduced in Catalonia, Spain in 2012 has been closely monitored for success and outcomes. In the last 10 years or more, the UK has made rapid strides in the area of SP. The NHS is documenting data around improvement in treatment outcomes and pushing for a more organized system around SP. Inspired by its success and progress, other countries in the Europe, as well as the US, are working on the same concept in their own unique ways.

How does it work

Social Prescribing provides a formal channel or process for doctors and community-based organisations to refer or connect patients to each other through a ‘link worker’. The affected person is now able to access a range of non-clinical services in the local community which has health and well-being benefits such as:

• Emotional support and well-being monitoring
• Increasing employability skills to overcome job or income loss
• Debt management advice for financial well-being
• Support groups to stop substance abuse and overcome addictions
• Weight and nutrition advice from qualified experts
• Opportunities for physical activity, including sports, exercise and recreation
• Access to hobby and special interest groups (such as knitting, reading, writing, gardening, singing, dancing, etc)

5 Key Elements of effective Social Prescribing

1. The patient – or a person or client who is experiencing physical, mental, social and/or financial health challenges
2. A prescriber: A person who appreciates the importance of social determinants on a person’s health and well-being, and then uses SP as a tool to achieve that
3. A navigator: Also called link worker, community connector or health advisor who receives the referrals and, then working closely with the client, connects him/her to relevant non-clinical support groups or agencies in the local community
4. Social prescriptions, non-medical and co-created community-based supports: These are defined on a case-to-case basis.
5. Data tracking models and channels: These help in regular collection of useful data for monitoring improvements in the person’s situations, and for tweaking the process as needed.

Benefits of SP

Documented benefits of SP include:

• Reduced time and expense around medical/clinical treatments
• Reduced workload on doctors, GPs and the primary care system
• Improved health and well-being of the patient/client
• Reduced hospital admissions
• Faster recovery from depression or anxiety

Challenges and limitations

• Not enough evidence of the effectiveness of SP: This is largely due to small sample sizes of surveys done, and subjectivity in measuring improvements due to social connects.
• No clear definition of outcomes versus initiatives: in such a situation, all evidence is seen with suspicion.
• Financial limitations: Social, community and voluntary groups need to be well-funded to ensure the referred client’s needs are met. Sometimes this can be a challenge, as during the pandemic.
• Risk of treating SP as a quick-fix: SP cannot be a quick fix and must be able to complement clinical and psychiatric help for the patient. Unless the latter is addressed, SP will be limited in its effectiveness.

How Social Prescribing is evolving

Social Prescribing may be a new phrase, but the concept is not entirely new. Developed countries already had many such SP programs since long. For example, in the US, UK, Canada and Australia, drug-abusers and homeless people are often given advice and routinely referred to free or paid social services including internet or telephone facilities, rest-rooms and washrooms, food and beverages, and legal services.

Social Prescribing is called different names in different parts of the world. It is called ‘Social care coordination’ in Canada, ‘Social determinants of health’ in the USA and ‘community referral’ in some countries. But the UK model is attracting interest from countries around the world who are trying to replicate the model, while adding their own tweaks and improvements. Needless to say, it’s a hot area of interest and in the coming years, we may see corporate healthcare institutions and NGOs jumping into the fray, to create viable business models around SP.

Social Prescribing in India

SP is a relatively new concept in India. Although there is a plethora of NGOs, social, community and voluntary service organizations in India, they all working independent of each other with no clear mechanism or charter for collaboration. For patients and their family members, what this means is they must do their own independent research and take the effort in availing help. Hopefully, this will change soon.

The progress made by Western countries in the area of SP will cause a ripple effect and lead to more discussions in India around this concept. India also faces the challenge of inadequate primary care in remote locations. This plus the costs involved in SP may make it affordable, or an attractive option for upper-middle and affluent classes only. It will be interesting to see when and how SP will become a part of mainstream healthcare services in India, such that a large section of its population is benefited.

 

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

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