Social prescribing can't happen from behind a desk: designing community-led approaches
June 25, 2019
Loneliness, isolation and mental health are becoming bigger issues in our society. It can be a problem for anyone, of any age or gender. There's more talk about how, as individuals, we need to be more resilient to handle the stresses of modern life, but we're also becoming more disconnected from one of the most important things in our lives that helps us to be more resilient, and better cope with mental health problems, loneliness and isolation.
In the UK, traditional institutions that could help are struggling to remain relevant - church attendance is declining, local assets and services cannot rely on the funding they require to survive and flourish, and our health and care system has become chronically over-stretched and under-resourced. This has left fewer opportunities to connect with others, to be a part of a supportive network of people and to know that someone cares and has your back.
One approach to this that the NHS is currently exploring and promoting to help tackle these issues is the concept of social prescribing - connecting patients with local communities to support each other.
Social prescribing should be about human connections, not just a way to alleviate pressure on primary care
The King’s Fund describe social prescribing as:
“Social prescribing enables GPs, nurses and other primary care professionals to refer people to a range of local, non-clinical services.”
Framing social prescribing in this way obviously helps to relieve some of the burden both in terms of time and money from primary care - patients can get support with managing conditions, new diagnoses, or mental health problems, all without demanding more time from their GP. However, it also misses the huge potential of social prescribing to tap into local assets and community resources that could not only help people build resilience and handle health and other issues as they arise, but improve general health and wellbeing.
To begin exploring how social prescribing can be facilitated across local communities, an Unboxed team recently undertook a pilot research project in Nunhead, South London. Through an initial kick-off workshop with a wide range of VCS (Voluntary Community Sector) organisations from the local area, the room defined a local definition of social prescribing:
“Social prescribing is improving people’s health and wellbeing by enabling them to create their own local support networks.”
The emphasis here is on creating human connections that hopefully will lead to meaningful and supportive relationships that see people through tougher times.
You can’t create human connections from behind a desk
Creating the spaces and places that enable people to connect in this way requires people on the ground, focussed on creating and facilitating those sorts of connections. As part of our research, we’ve identified a group of people that we called “Activators”. These people are highly active in their community, super networkers and are at the heart of a community group or service.
“It’s a regular set of people who come in - if there’s a new person, I always make a point of talking to them and introducing them to someone at the cafe.”
Once people have taken the difficult step to attend a group meeting and meet people, they often keep coming back, and these Activators have a number of techniques for helping people feel part of their community;
“When people come to their first elderly lunch club, they are given a buddy, who will have a chat with them and introduce them to others at the lunch. If they don’t come the next time, the buddy will call them up and check that everything’s ok.”
However, a challenge they have is getting new people to attend. Activators have raised the challenges of bridging the gap between the “old community” (people who have lived locally all their lives) and the “new community” (people who have moved to the area more recently), the barriers of charging for events and the message this sends depending on the price points and the challenges in building engagement from local businesses.
“Getting new people through the door is hard - some people feel at home in community centres, other people feel it’s not for them.”
Our team has also identified a second group of people that could be invaluable to helping create local support networks. We call this group of people “Listeners”. These are people who hold a position within the community that afforded them to spend some time individually with local residents and really get to know them, even though they aren’t really connected to the health and care system. In Nunhead we found Listeners in the local hairdresser, the local pharmacy staff, and even to a certain extent the owner of the cafe and the barman in the local pub.
“Some of my clients have been coming for 15 or 20 years and it’s quite an intense period of time they spend here. I’ll notice changes in my clients immediately, sometimes before they do.”
This group of people can observe and get to know people in a more relaxed environment, without the pressure of having to ‘put on a face’ that we heard about at the GP surgery. It’s a great opportunity to catch when things change for someone and be able to provide them with useful support.
“When a client started missing her appointments I called her, she was touched I cared. She was struggling to come to terms with her recent Alzheimers’ diagnosis, I called the Alzheimers’ society on her behalf.”
The challenges for these people, firstly, is that they already have another job to do, so demands on them can’t be too high. Another challenge in this situation is knowing when it’s ok to get involved or ask questions of people. We heard from the GP surgery for example that due to patient privacy, they wouldn’t even confirm if a patient was or wasn’t registered there, let alone if someone unrelated to a patient tried to let them know that a person was struggling.
There’s plenty of opportunity to take better advantage of local assets and resources within the community
Despite the challenges these valuable people within the community face, there’s still plenty of ways we think they could be supported to help local residents when they need it, and encourage resilience and better relationships locally.
For example, currently the hairdresser has set up a WhatsApp group for local people to offer to help an elderly lady get to her weekly hair appointment when she became too frail to walk there on her own. This idea could be used in other contexts, with residents helping elderly people get out and about, get to GP appointments, the pharmacy, have lunch out, all the while also creating opportunities for human connections to happen.
Or perhaps we could provide a space or platform for Listeners and Activators to share any concerns they have about residents they’ve come across recently that they felt could use some support. This could be as simple as a WhatsApp group as well. Maybe it’s as simple as having a community newsletter with local events listed that Listeners could give out to people who would like to meet others locally.
Perhaps businesses could contribute to a local loyalty card, encouraging people to visit local businesses, which could also have physical cues to signal if people are open to conversations with someone new.
Or maybe there could be a paid local Wellbeing Coach, with whom GPs could prescribe time with. They could spend time getting to know you, help you to identify what you would like to do, and empower you to get involved.
None of these ideas are brand new, but simple things that could be done to help local communities work to support people who need it to find and create local support networks. Bridging this gap between the formal health and care sector and the informal community support that is available feels like unlocking the real potential of social prescribing, helping people to become more resilient through better human connections.