Social Prescribing, a panacea or another top-down programme? Part 1
(this is part 1 of 4 in a blog series)
Over the next four blogs I wish to critically explore an approach to patient support called Social Prescribing. While Social Prescribing is happening in Ireland, the Netherlands among other countries, it has really taken off in the UK
Here are two definitions of Social prescribing from two respected sources in the UK:
“Social prescribing is a mechanism for linking patients with non-medical sources of support within the community. These might include opportunities for arts and creativity, physical activity, learning new skills, volunteering, mutual aid, befriending and self-help, as well as support with, for example, employment, benefits, housing, debt, legal advice, or parenting problems. Social prescribing is usually delivered via primary care – for example, through ‘exercise on prescription’ or ‘prescription for learning’, although there is a range of different models and referral options.”
(Social prescribing for mental health – a guide to commissioning and delivery; Lynne Friedli with Catherine Jackson, Hilary Abernethy and Jude Stansfield)
“Social prescribing enables GPs, nurses and other primary care professionals to refer people to a range of local, non-clinical services.”
Throughout this series, entitled: ‘Social Prescribing, a panacea or another top-down programme?’ I will argue:
- that Social Prescribing at best is a misnomer and at worst is a counter-productive and disabling term. Instead we ought to be speaking about the doctor as a potential ‘participation advocate’ who can work in partnership with key allies. Doctors also engage in medical proscription (preventing inappropriate medicalization).
- That Social Prescribing as broadly practiced in the U.K is too focused on referrals to community/voluntary initiatives/sector (CVS), and in so doing falls short of supporting socially isolated individuals to become participating interdependent members of their communities. Far too many of the referrals are to programmes or structured services run by salaried strangers, as distinct from near neighbours interested in fostering reciprocal relationships, where the person is received and celebrated for their gifts. Hence, Community and Voluntary organisations are often being treated as a proxy for resident to resident relationships.
- That its (Social Proscribing) current shortcomings are inevitable and that the prime reason for them is that too much emphasis and expectation is being placed on the doctor and CVS organizations and not enough support and animation is being offered to associational life of communities themselves. While the doctor holds the keys to the medicine cabinet, they do not have the same access to associational/civic life of the neighbourhoods they serve. Which is to say that the doctor can’t be expected to do it all, and even with the support of CVS, unless we move beyond referrals to resident relationships and local associational life, we will fail in our duty of care to those who have been pushed to the margins.
- That there is a better way to build on some strong elements of current practice. In the last blog of this series I will scope out what I believe a more viable framework within which the assets of patients, doctors, CVS and local residents and their associations can be discovered, connected and mobilized towards authentic relationships and communities of expanding welcome.
Here’s a 10 minute interview I did recently with Public Health Wales, setting out my thoughts on Social prescribing, and some of the cautions I have around how current custom and practice is unfolding in the UK. The interview is entitled Health Beyond Healthcare:
Next week’s blog entitled: ‘Social Prescribing or Medical Proscription and Participation advocacy?’, will ask the following questions:
- Should we be using the term ‘social prescribing’ at all? Does “prescribing” appropriately describe what it is the doctor does when they successfully support isolated people back into interdependent lives in their communities?
- Does the term and the practice of “prescribing” place the doctor and allied services in an inappropriate power dynamic with the people they serve?
- Does “prescribing” programmatize relationship building and reduce it to manageable and measurable referrals and signposting?
Should we be speaking about medical proscription, what the doctor will stop happening (like the medicalization of social issues); social prescribing? Hence talking about structural issues, and issues of patriarchy and power.
- Should we be speaking about the doctor as a ‘participation advocate’ who collaborates with their patients, other allies and residents to increase the prospects of an interdependent life for those at the margins, in preference to medical or institutional dependency?