How does being engaged with society affect health outcomes for patients? The answer could change how practitioners handle referrals forever. Social prescribing enables nurses, general practitioners (GPs), and other health care professionals and specialists to broaden their referral horizons.
Using social prescribing, providers are able to refer their patients to a wide range of locally based, nonclinical services that support health and wellbeing. While social prescribing is not currently as robustly used in the United States as it is in places like Canada and the United Kingdom, it is rapidly gaining both interest and endorsements in the healthcare community.
Keep reading to learn more about where the future of social prescribing is heading.
What Is Social Prescribing?
Social prescribing is sometimes referred to as "community referral" in the healthcare industry. This is an apt way to describe social prescribing because it leans heavily on the use of community resources to provide supportive, connected care services. When practitioners use social prescribing, they refer their patients to non-medical interventions that offer life-enriching, therapeutic benefits.
In many health systems that currently integrate social prescribing work into healthcare practices, the prescriber operates in collaboration with a link worker. Also known as a community connector or health advisor, a link worker is someone who processes referrals. These professional "advocates" then work on a one-on-one basis with each patient to connect them with an appropriate nonclinical support resource.
Social prescribing isn't done in place of normal referrals to other licensed care providers. This is generally a supplemental strategy that uses nontraditional therapeutic modes to enhance standard treatments. What's more, social prescribing can be done in a number of ways.
In some cases, a physician or care provider will link a patient directly with the resource. In other cases, the referring care provider links a patient with an agency that can direct them to an appropriate resource.
Social prescribing is an empowering mode of care that encourages patients to take more control over their own health and wellbeing. When engaging in prescribed environments, patients get to build on their individual strengths while taking on challenges, learning new skills, and coming into contact with new experiences.
What Is an Example of Social Prescribing?
Social prescribing can cover a wide range of different activities and services. Generally, the purpose of social prescribing is to help patients engage in social interaction.
This mode of care prioritizes creativity, expression, and the therapeutic benefits of art. When appropriate, physical activity is also prioritized. Here are some examples of activities that physicians might refer patients for:
- Pottery class
- Arts activities
- Knitting class
- Cooking class
- Walking groups
- Hiking clubs
- Dance class
- Yoga/Pilates class
- Meditation class
- Singing groups/choirs
- Gardening clubs
- Supportive peer networks
- Bereavement support groups
- Community dining groups.
- Volunteer organizations.
- Caregiver support groups
Using helpful resources, physicians and nurses connect people to low-cost, engaging social activities in the local area that can have positive effects on people's health. For a GP practice, social prescribing work provides an easy way to address social isolation in primary care patients. However, a key component to working social prescriptions into the current model is acceptance from both government sources and the healthcare system.
Social Prescriptions in Action: What Are Examples of Social Prescribing for Mental Health in the Real World?
Let's focus on what social prescribing programs might look like in real-world scenarios. In this first situation, a recently widowed woman visits her primary care doctor at a general practice to complain about feeling lethargic. After performing a physical and running some routine tests, the doctor determines that the woman is not experiencing ill health.
The physician does ask the patient some mental health questions related to her mood, connections to other people, and other factors. He learns that the woman doesn't have much social interaction throughout the week. In fact, she is relatively isolated in her home.
After talking with the patient about the ways that social inclusion and social interaction can help to improve outcomes, the physician asks if the woman would be interested in joining a local bereavement group. The patient agrees. The receptionist then provides the patient with referral information.
In another case, a 58-year-old man shows depressive symptoms on a questionnaire during a visit to an office with general practitioners. The physician examining him offers him a referral for therapy at a practice that focuses on cognitive behavioral therapy (CBT). The GP practice also provides a referral to a center for therapeutic arts activities.
How to Make Social Prescribing Successful
Researchers working in partnership with the Canadian Institute for Social Prescribing (CISP) and the Canadian Social Prescribing Community of Practice (CoP) did a deep dive on the current state of social prescribing in Canada.
The researchers were able to look at past research to come up with a list of factors needed for successful implementation. They used 140 studies that explored social prescriptions to come up with this list:
- Sustainable local networks.
- Endorsement via primary care to give credibility.
- Regular feedback to referring primary care practitioners to encourage future referrals and ensure the appropriateness of care.
- Integrated information governance and sharing strategies to ensure connected and coherent services.
Interestingly, this health research found that interpersonal and organizational relations that emphasized trust, endorsement, and collaboration helped to address diverse community priorities. This mostly came down to practitioners collaborating with patients in ways that built trust. However, results were best when all stakeholders ultimately "bought in" to the process.
Health Outcomes With Social Prescribing: Does Evidence Show Positive Outcomes From Non Clinical Services?
There's strong evidence that good things happen when people engage with other people!
The growing body of evidence-based work linking social interventions with improved healthcare outcomes shows that social connectedness and connection with the natural world can provide benefits for chronic disease, emotional health and wellbeing, and general health.
During a period lasting from April of 2022, to March of 2014, researchers participating in the Rotherham social prescribing pilot looked closely at the potential benefits of social prescription intervention within a metropolitan borough with a population of over 100,000 people. A total of 1,607 patients received referrals for services connected with community activity, social interactions, physical activity, and mentoring as part of the pilot.
After a period of three to four months, 83% of participants experienced improved wellbeing based on the pilot's validated outcome measures. Even more notable is the fact that inpatient admission was reduced by around 21%. Additionally, accident and emergency attendance decreased by around 20%. England's National Health Service (NHS) estimated that the pilot represented cost reductions of £552 000.
Researchers overseeing the pilot also projected that the return on investment of prescribing these alternative services would increase each year due to the reduced long-term operational burden. That means that social prescriptions have the potential to improve patient outcomes while also generating positive economic returns.
How Is Social Prescribing Used in the United States?
England's NHS has been at the forefront of normalizing social subscriptions. In 2019, the NHS began a national rollout that included funding for link workers in all of the country's 1,300 primary care networks. Well-funded social prescribing is one of the central components of the NHS's long-term plan to reduce health inequalities.
Ireland and Scotland also have robust, large-scale government programs that integrate social prescriptions into healthcare. The strides being made in many European countries highlight the fact that the United States is behind many of its peers when it comes to embracing this scientifically backed holistic approach to wellness.
In the United States, social prescribing is still very much in a pilot phase. However, public-health officials have been giving increasing attention to the link between health-focused social needs (HRSNs) and health outcomes. HRSNs to consider can include food insecurity, transportation struggles, and financial strain when trying to find solutions for reducing the burden of illness and disease on the nation's healthcare systems.
A recent study involving enrollees in the country's Medicare Advantage program identified strong links between the presence of HRSNs and admittance to acute-care facilities. The researchers involved with the study introduced the idea that addressing the HRSNs that plague that nation's elderly populations may help to reduce the overall utilization of emergency and long-term care settings. What's more, the study's researchers concluded that targeting HSRNs could help to improve health outcomes.
The Future of Social Prescribing
The social prescriptions of tomorrow won't just focus on providing people with outlets that keep them "busy." While the engagement aspect of these interventions cannot be underestimated, researchers are discovering that "activities for the sake of activities" may not be enough to create significant results that actually address culturally relevant determinants of health.
Recently, the CultureRx pilot conducted in Massachusetts became the first U.S. model of "arts" prescription. Under the pilot, 20 healthcare providers and 12 cultural organizations have linked together to provide prescriptions to cultural experiences that support physical and mental health. The results from the CultureRx pilot show that integrating arts and culture into healthcare programs actually boosted existing models of community referrals.
When art and culture are combined, evidence shows that health professionals are able to better address social determinants of health. As a result, communities are in stronger positions to equitably and holistically treat patients.
Ultimately, social prescriptions that are the most meaningful will be the most powerful. For people who are experiencing depression and compromised mental health that may be influenced by societal or cultural issues, culturally appropriate and culturally sensitive treatments can be especially meaningful. What's more, age-appropriate resources are also important.
What Are Some Obstacles to Social Prescribing in the United States?
Something that is becoming abundantly clear to United States healthcare workers is that the nation is suffering from a loneliness epidemic. Social prescribing is both an obvious and easy answer to this problem. However, lack of training, lack of funding, and lack of awareness on behalf of both care providers and patients are all hindrances to wide-scale adoptions of social prescribing practices.
This is where a holistic approach will need to be embraced to generate the desired outcomes of supporters of social prescribing. With the gp workload already being so heavy, the idea of learning a new method of referrals can be overwhelming for the average doctor or nurse. This is where link workers become extremely important.
In many cases in the United States, front-desk staff and receptionists are currently tasked with linking patients to social services. However, these staff members often lack the skill and knowledge necessary to provide adequate referrals. What's more, they do not have the time to see the patient through the process of following up with the referral.
In an ideal situation, private or government-backed enterprises that employ link workers would be available to physicians and practices. These link workers would handle all of the referral tasks needed to ensure that patients actually connect with the resources that are prescribed to them.
While physicians would be in the loop regarding the referral, they wouldn't necessarily be tasked with managing the referral on their own. In this way, social referrals become important pieces that doctors have in their toolkits that they know they can count on without necessarily taking on the responsibility of monitoring a patient's progress while using this alternative mode of care.
Patient education is another important aspect of making holistic care effective. The average person is unaware of the roles that loneliness and isolation can play in physical and mental health. Many patients will simply dismiss suggestions to attend local events or classes.
With the right education, patients can learn about the benefits of community integration for preventing health relapses, health episodes, or the need for acute medical interventions.
When an activity is presented as a "prescription" to the patient, it takes on a new level of legitimacy that may make the patient more likely to follow through. What's more, learning about the potential cost savings associated with socially based interventions can also motivate patients who are funding their own healthcare costs.
Final Thoughts on the Holistic Future of Health
There's no healthy community without a healthy sense of community. This is essentially the messaging behind social prescribing. There’s no longer any question about the benefits of using social prescriptions in public health for improving mental health and physical health outcomes.
While the importance of social connectedness has gone overlooked for far too long, government officials, physicians, and leaders of healthcare systems are finally embracing the fact that addressing the social-emotional needs of patients can provide better outcomes.
At this time, leaders are becoming motivated by the financial savings that can be enjoyed by reducing burdens on the healthcare infrastructure caused by repeated hospitalizations that could potentially be avoided by addressing the "whole person" during health interventions with general practitioners.
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