Social Prescribing December 2005 Stress, anxiety and depression are the most common reasons for consulting a doctor, and the largest group of prescriptions are for anti-depressants or painkillers. PCTs of the future will work on the wider determinants of health rather than just focus on the medical approach. One GP, who has been involved in a pilot scheme of learning on prescription, feels that health centres should be one- stop shops where a variety of patient support is provided. It is now quite common for patients to be prescribed exercise by their GPs but other forms of ‘social prescribing’ are also emerging to improve physical and mental health. A basic model of social prescribing, signposting seeks to link patients up with the non-medical facilities and services available in the wider community that they can access to address the factors that influence their wellbeing. Arts on Prescription Creative activity has been shown to increase self esteem, provide a sense of purpose, give structure to an otherwise shapeless day, help people engage in social relationships and friendships. Enhance social skills and community integration and improve an individual’s quality of life. “Stockport Arts on Prescription has been unique in the country in providing a ten year social prescribing intervention for people suffering from mental health difficulties. The continuing success of Stockport Arts on Prescription has largely stemmed from it's securing mainstream PCT funding, retaining its highly skilled and committed artists and the support of Health Care and Arts & Health organisations. In many ways, the Stockport Arts on Prescription has been ahead of it's time: • the scheme both promotes mental wellbeing and prevents mental ill health. This fits with the current move to rescope the concept of mental health to encompass wellbeing as well as illness. • there is a gathering momentum to provide social prescribing services in response to the need for mental health/wellbeing services (arts, books, exercise, learning and information on prescription) This movement is a response to a recognition that : • a person's mental wellbeing needs extend beyond solely medical interventions. • Primary Care, where most of the mental health work goes on, needs to provide and link up to services which support people's holistic wellbeing needs whether that is artistic, physical, social or developmental. • the prevalence of mental health problems (one in four) calls for the expansion of self help and self care services." Elysabeth Williams-Senior Health Promotion Advisor-lead for Mental Health Stockport PCT "Arts on Prescription is a course of art sessions that introduces participants to basic drawing and painting techniques. The course is structured yet flexible and aims to provide a supportive environment to people who are vulnerable due to an experience of mental or emotional distress. The people who are referred often have anxiety or depression and the project hopes to help people regain their confidence, learn about art and meet others whilst involved in a positive activity. A Mental Health worker organises referrals, supports the group and provides advice and relevant information along the way. Professional artists run the art classes. This is NOT art therapy, the work produced is not analysed. The introduction course lasts 16 weeks, after that participants can opt to continue into the next class, with more advanced painting techniques, and beyond that is the opportunity to join Artistic Moves, a participant managed project which meets weekly." Alison Kershaw Lead Artist Stockport Arts on Prescription The evaluation method used is completion of a questionnaire before and after the sessions. As well as obtaining information about the person’s age and ethnic origin, questions are also asked on Contact with the GP in the last 3 months Contact with other health professionals in the last 3 months General Health Questionnaire (assesses anxiety, depression, somatic complaints and social functioning) Social relationships Activities, interests and hobbies Self-concept People who remain in the project report a better self-concept, their mental health does not deteriorate and for many, it improves. They appear to be using fewer resources and participating in more social and leisure activities. Bibliotherapy-Books on Prescription The implementation of a bibliotherapy service means that GPs will have access to an alternative method of treatment for those suffering with mental health problems. The GP may give a patient a paper based “prescription” of recommended self help books. These books can then be borrowed from the local library free of charge. The topics covered will be depression, anxiety, social phobia, panic, anger, stress, low self-esteem, eating disorders, obsessional compulsive problems, compulsive gambling, the aftermath of sexual abuse and bereavement. Most of the books present a structured Cognitive Behavioural Therapy approach, offering complete step-by-step treatment programmes. A recent Department of Health commissioned review concluded that self help methods have a high potential in mental health treatment. Trafford are working on a pilot project, no one else in GM is looking at this yet. They are working closely with the arts officer, libraries, a local GP and Bluesci (A&H organisation working in community mental health). They are working on the premise that the GP will help to suggest the list of books required and suitable. Learning on Prescription GPs, practice nurses, health visitors, counsellors and mental health nurses refer patients, usually with symptoms such as anxiety, agoraphobia, low self esteem or chronic pain to a learning advisor. The advisor works with the patient to identify activities that could help alleviate symptoms such as assertiveness class, yoga, painting or computer training. The patient is then supported through the enrolment process. One GP said “Prescriptions for learning have helped lots of our patients live fuller lives. People report less pain, more energy, greater amounts of fun, and they consult less often.” Research by NIACE (National Institute of Adult Continuing Education) in 2001 revealed that 87% of people felt physically better as a result of learning while 89% reported positive emotional or mental health benefits. Laughter on Prescription Just by laughing, we release chemicals into our bodies that reduce stress, boost our immune system and make us feel great! So it can be like a therapy but we help ourselves without having to engage brain and just by playing and having fun. Laughter on prescription could be developed by • creating a performance piece based on happiness • creating photocollages of laughing faces • running laughter sessions through performance theatre or comedy Social Prescribing In Choosing Health, the aim is to build on the public’s desire for a healthier future by ensuring that the self care support is in place for people, particularly those in disadvantaged groups and areas, to make healthier choices about diet, physical activity and lifestyle. Social prescribing builds on those aims to include a local process to access self help tools and groups, creative and physical activities and ensure a more holistic approach to health, increase social inclusion and social capital.