The Time Has Come for Social Prescribing

PSYCHIATRIC VIEWS ON THE DAILY NEWS

My last column was on the “Social Prescribing of Music and Other Cultural Arts for Our Madness.” However, that covered only a part of what is apparently a wider social prescription movement in Great Britain’s National Health Service (NHS). There is much more. It may be the most important health and mental health development that you have never heard about—at least I did not, until recently.

Social prescribing was rolled out in 2019 as 1 of the 6 core pillars of a comprehensive model of personalized patient care. Its goal was to be able to link patients to community activities and groups that can meet their other socially-related medical needs.¹ Besides the arts and culture, referrals include assistance with debt, discrimination, education, food, fuel, housing, loneliness, and transportation, among other needs. The social prescribing link workers—also called community connectors, well-being advisors, or community navigators—are mainly located in primary care network teams, though that is not a necessity. Prior research has indicated that social needs can affect up to half of health outcomes.

This new endeavor is scheduled to be reevaluated in 2024 for possible continued funding. However, much of the time it has existed has been during the unexpected COVID-19 pandemic, which will complicate its assessment. It disrupted the integration of the social prescribing link workers into existing primary care teams.

In some ways, social link workers are similar to the roles that caseworkers and paraprofessionals have had with the most seriously mentally ill for decades in the United States.² It is just that this model never expanded into other mental health and general health care, but our experience with that certainly suggests a wider social model can work well.

Recently, the New England Journal of Medicine’s Catalyst Insights Council examined social needs. As a participant in the council, I just received the results and commentary. Strong interest was present in the representatives from the United States and other countries for addressing social determinants of health, but alongside that, frustration in establishing actual programs and getting adequate funding coverage. Only half of respondents said that their health care organizations efforts in addressing social needs were going well. Most said that government funding was necessary, which is exactly what Great Britain’s NHS is doing.

The good news, then, is that concern about social needs is increasing globally in health care. Now the practical problems need to be overcome. If that occurs, the social in the traditional bio-psycho-social model of medicine will become more of an equal partner. Just as there is no health without mental health, there is no optimal health without adequate social health, is there?

Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times.

References

1. Westlake D, Tierney S, Wong G, Mahtani KR. Social prescribing in the NHS - is it too soon to judge its value? BMJ. 2023;380:699.

2. Moffic HS, Patterson GK, Laval R, Adams GL. Paraprofessionals and psychiatric teams: an updated review. Hosp Community Psychiatry. 1984;35(1):61-67.