For better health: less pill popping, more dance classes. The growing field of "social prescribing"
"Community heals you" may sound like the slogan you'd find on a piece of charity merchandise. But research is beginning to show that, in health terms, it's literally the case.
George Monbiot reports on yet another ground-breaking innovation from the Somerset village of Frome, where local GPs are using community support as "medicine" for those suffering chronic pain and illness. Monbiot writes:
The Compassionate Frome project was launched in 2013 by Helen Kingston, a GP there. She kept encountering patients who seemed defeated by the medicalisation of their lives: treated as if they were a cluster of symptoms rather than a human being who happened to have health problems. Staff at her practice were stressed and dejected by what she calls “silo working”.
So, with the help of the NHS group Health Connections Mendip and the town council, her practice set up a directory of agencies and community groups. This let them see where the gaps were, which they then filled with new groups for people with particular conditions. They employed “health connectors” to help people plan their care, and most interestingly trained voluntary “community connectors” to help their patients find the support they needed.
Sometimes this meant handling debt or housing problems, sometimes joining choirs or lunch clubs or exercise groups or writing workshops or men’s sheds (where men make and mend things together). The point was to break a familiar cycle of misery: illness reduces people’s ability to socialise, which leads in turn to isolation and loneliness, which then exacerbates illness.
As Resurgence reports, the Compassionate Frome project is now the basis of a detailed study that awaits peer review in medical journals. But the preliminary results show that "while emergency admissions to hospitals across Somerset have increased by 29%, incurring a 21% increase in costs, Frome has seen admissions fall by 17%, with a 21% reduction in costs. This represents 5% of the total health budget. No other interventions on record have reduced emergency admissions across a population."
Go Frome (as usual)! But it would be wrong to identify this as an isolated and singular achievement for the mighty parish. The idea of "social prescribing" (which often implies "cultural" prescribing as well) is even broaching hard-nosed outposts like The Economist (excerpt below):
Social-prescribing schemes, in which doctors refer patients to non-medical treatments, are catching on, says Marie Polley, co-chair of the Social Prescribing Network of health workers and academics. That is partly due to recognition that some long-term conditions, such as diabetes, can improve with lifestyle changes. Last year Sadiq Khan, London’s mayor, included the idea in his health plan for the capital. A recent count found that London already had over 50 schemes. All general practitioners (GPs) in Gloucestershire can now refer patients to a social-prescribing service.
One common prescription is for more exercise. In the East Riding of Yorkshire GPs can book patients into sessions at a leisure centre. Invalids can select activities such as swimming and gym sessions. The scheme is subsidised, costing only £33 ($46) for 20 one-on-one sessions.
Many social-prescribing initiatives are aimed at mental-health patients. In Cambridgeshire and Cornwall, Arts and Minds, a charity, runs weekly workshops, part-funded by councils, where patients can sketch and sculpt. Researchers found that most participants on the 12-week course felt happier and less depressed. Volunteering, which eases loneliness, is prescribed in parts of Scotland and in Blackburn. Some GPs refer patients to “link workers” who can arrange for support such as financial advice.
Wellbeing Enterprises, a social enterprise near Liverpool, helps to organise activities including ukulele lessons and tango classes for patients referred by GPs. One group formed a choir. The programme relies on funding from the NHS, National Lottery and local councils. But it more than pays for itself, says Mark Swift, the outfit’s boss. He claims that the project saves the public purse over £10 for every £1 spent, mainly in forgone treatment bills.
This 2014 piece from the former head of the Arts Council UK, Peter Bazalgette, makes a very strong claim for the arts-and-health linkage. However, we need to remember that artists will claim the ultimate health benefits of their practice is the firing-up of imagination and free-spiritedness in its makers and viewers.
Social and cultural prescribing may well improve the bottom-line of health budgets - but we should be wary of bundling too much together. Improving social bonds may not quite be the same as increasing social aspiration, ambition and activism.