A new systematic review, published in Arts & Health, examines the evidence base for ‘social prescribing,’ a practice of connecting primary care patients with community supports and resources. The results of the study, which reviewed 86 articles, suggest that social prescribing in the UK improves self-esteem and mental well-being. However, the authors also note significant gaps in the literature base. The researchers, led by Helen Chatterjee, a professor at the University College London, write:
“Social prescribing, including arts on prescription, is an innovative approach to public health, as it advocates the use of voluntary and third sector organisations and creates referral pathways so that primary care patients with non-clinical needs can be directed to these sources of community intervention.”
Social prescribing is defined by CentreForum Mental Health Commission as “a mechanism for linking patients with non-medical sources of support within the community.” Types of community referrals include art workshops (e.g., painting, dance, music, poetry); self-help books; education; exercise or physical activity; healthy living (e.g., health checks, eating healthy); volunteering; and support with employment, finances, housing, etc. Social prescribing can be used with individuals who experience challenges in social, emotional, or practical areas of their lives.
The authors describe social prescribing as “an emerging strategy for tackling health inequities through partnerships between primary care and third sector organizations,” especially as healthcare services are searching for lower cost solutions to improving mental health. However, despite the greater emphasis and support of social prescribing in the UK, funding for rigorous evaluation of these programs is limited. The authors sought to review the current evidence base for social prescribing and identify where more research is needed.
The authors systematically searched peer-reviewed journals and identified 86 articles on UK social prescribing schemes. Of the 86 studies, only 40 reported on primary research (i.e., reported on a study the article researchers conducted, versus reporting on previously done studies). Articles included both quantitative and qualitative studies and participants who had mental or physical health challenges. Exercise (n = 14) and art (n = 9) were the most commonly studied community referrals. Findings suggest social prescribing can benefit individuals in a number of ways:
- “Increases in self-esteem and confidence, sense of control and empowerment;
- Improvements in psychological or mental well-being, and positive mood;
- Reduction in anxiety and/or depression, and negative mood;
- Improvements in physical health and lifestyle;
- Reduction in visits to general practitioners, referring health professionals and primary or secondary care services;
- Provision to general practitioners of a range of options to complement medical care for a more holistic approach;
- Increases in sociability, communication skills, and social connections;
- Reduction in social isolation and loneliness, support for hard-to-reach people;
- Improvements in motivation and meaning in life providing hope and optimism; and
- Acquisition of learning, new interests, and skills. ”
The authors highlight a number of gaps in the research, including (a) limitations in the use of quantitative questionnaires since these surveys were not designed for art or health contexts, (b) lack of evaluation for prescribing self-help books, (c) limited use of statistical tests in the reviewed studies, and (d) limited use of control groups in experimental studies. The researchers note that there is no ‘one size fits all’ approach to program evaluation but do recommend more rigorous studies that include both quantitative and qualitative methods:
“Robust evaluation of such schemes are needed which integrate the views of all key stakeholders including patients, referrers, commissioners and providers, to ensure that as schemes are developed that they meet primary health care objectives as well as delivering the wider quality-of-life outcomes characteristic of non-clinical interventions.”
Chatterjee and colleagues are one of many research teams to review the research literature on social prescribing and conclude that more research is needed. In a recent commentary, Kerryn Husk discusses the potential benefits of social prescribing, while acknowledging that the research evidence is currently insufficient. Husk also makes a strong call for more research on social prescribing:
“We must seize the opportunity we have now to develop a programme of research alongside implementation of social prescribing, combining mixed methods evaluations with embedded RCTs, so as to understand which patients can accrue benefits (improved social functioning, disease prevention, fewer admissions) and from which interventions, as well as to deepen our understanding of patients’ nuanced interactions with their referring practitioner, signposting expert, care navigator, and the workers in the range of social interventions available.”
Chatterjee, H. J., Camic, P. M., Lockyer, B., & Thomson, L. J. (2017). Non-clinical community interventions: A systematised review of social prescribing schemes. Arts & Health, 1-27. Advance online publication. https://doi.org/10.1080/17533015.2017.1334002 (Link)
Sounds at first glance like another condescending strategy to keep people locked into the system and focused on their “illness,” replete with art “therapy” — and basket weaving, I presume.