Social Prescribing: 21st century approach to wellbeing

In a world operating beyond the pandemic, traditional approaches to health and wellbeing might no longer be enough. Helping people fulfill their social needs can offer an alternative route to recovery, with pharmacies a natural place to start.

Introduction

This foreword from the Global Social Prescribing Alliance playbook prefaces guidelines for leaders, organisations and communities to look at health care in a different way, focusing on: ‘What matters to me?’, rather than ‘What’s the matter with me?’ – what’s called a Personalised Care Approach. As one of the playbook’s authors, James Sanderson, Director of Personalised Care in the UK’s NHS told me over coffee in London recently, ‘Our outdated approach to health care pretty much goes straight from, “Don’t smoke, don’t drink, don’t get fat” to “Let’s amputate your leg because of your diabetes”. There’s a whole lot that can be done throughout the health system in between those two ends of the spectrum.’

So, What Could That Be?

Drawing from the masses of research linking physical or mental illness with unfulfilled social and other needs, it stands to reason that helping a person to get what they need across all aspects of their life is highly likely to help prevent disease and often help them recover more quickly.

Let’s take social connections and loneliness as a starter since its beyond doubt that COVID-enforced social isolation has caused millions of Australians to experience unwanted feelings of loneliness over the last two years. Unable to meet their social needs, we have seen what researchers have been telling us for decades – loneliness makes people sick. Heart disease, insomnia, diabetes, blood pressure, obesity, addiction, anxiety and depression. Most pharmacy team members will have noticed someone whose health is declining through loneliness and probably made the connection.

So, what if, either as an early intervention or route to recovery, we helped the patient identify what relationships and connections they are missing, those that they would like to have and offer some strategies to get them there? That’s what social prescribing does. In a formal, personalised care approach, such as that operating right across the UK’s primary care system, link workers are often attached to GPs and co-produce a social plan with those patients whose medical symptoms might be addressed in ways beyond a pharmaceutical script – linking someone to Rotary, Men’s Shed, local arts classes or volunteering for example. Here in Australia, we are still working out how to formally embed such an approach into national health care, with just a handful of localised programs operating. But that doesn’t mean we can’t find other ways to notice those showing signs of loneliness and help them find ways to connect to support good health.

Here’s a case in point. Social prescribing changed the life of NEWCASTLE-BASED SONIA, an older Australian who for a decade had attended senior-specific gym classes to help her manage her anxiety and panic attacks and enjoy social interaction. These closed during the pandemic and Sonia became withdrawn and anxious. Referred to Beating the COVID Blues, a social prescribing program specifically aimed at helping seniors improve their social connections as an early intervention mental health strategy, Sonia was supported by a Wellbeing Coach/Link Worker to identify and attend new activities, re-build her confidence and physical strength. Sonia said, ‘I’ve become rather shy over the last two years as I’ve been cooped up at home, and it’s been no good for my mental health. So, it’s great that Simon is coming (with me), and we’re actually going places now.’

Teams in pharmacies play a critical part in social prescribing, either as referrers where schemes like Beat the COVID Blues exist or simply as advocates for the importance of social health. Not only are pharmacies the ultimate hub for community health and one of a few outlets, like banks and supermarkets that cut right across society and stay open – especially in a pandemic. Pharmacy staff are very likely to encounter people with health issues regardless of whether they are in the health system or not. As trusted advisors, it’s a great opportunity to start conversations about wider health challenges across all the social determinants of health and what’s behind the cardboard box.

What’s In It For Us?

There is a commercial reality that parallels the social purpose of a pharmacy – whatever we spend time on has to make business sense. So, what are the benefits of pharmacies getting involved?

While there are few direct financial incentives to get involved with social prescribing, advantages include:

• Social Prescribing is coming to Australia – your pharmacy can demonstrate your pivotal role in the health and wellbeing ecosystem and claim your stake in the social prescribing movement and future funding.
  
  
• Show your patients that you care about what matters to them, not just what’s the matter with them as competitive advantage.
  
  
• Create opportunities to support patients in new ways.
  
  
• Learn about what’s going on in local population health so you can adapt your services accordingly.
  
  
• With training to spot the signs, pharmacy staff can play an essential role in preventative health and especially social prescribing, which can be much more satisfying than dispensing medications and checking compliance.
  

In her article, AN UNLIKELY CONNECTION: LONELINESS AND MEDICATION ADHERENCE, Jenny Hirschner says, ‘Pharmacists should screen their patients for the social determinants of health to understand the barriers to care management. In doing so, they can move on to identifying the strategies that will help their patients remain adherent to their medication plans.’

Training and awareness are key: ‘Who is most at risk of loneliness and isolation?’ ‘What are the signs we need to look for?’ and importantly, ‘What guidance should pharmacy staff give?’ if any. How do we know what’s available in our community?