Debs Teale was just 8 years old when she had her first panic attack, setting off a severe, lifelong struggle with mental health. By the time she was an adult, she had been in and out of mental health services and was consuming a daily cocktail of 21 pills that included various mood stabilizers and antidepressants.
When her mother died, Teale, then 41, reached a point of desperation. She begged her psychiatrist for a course of electric shock therapy to help her cope with her illness. After being denied that treatment, she decided on something drastic: to overdose on her medications.
The attempt at taking her own life, however, was unsuccessful. Teale woke up in the hospital, still in total anguish. But it was there that she came across a pamphlet on community art therapy. After being discharged, something compelled her to attend an art class near her home in Huddersfield, U.K.
“As soon as the class got going, that’s the day my life changed,” says Teale, who had never created art before. “Something inside me came alive.”
As she continued to attend the group art classes, Teale’s health began to transform. With the encouragement of her doctor, she eventually stopped requiring any mental health services at all.
Teale, now 54, has been off of all her medications for 11 years — and has since become a fierce evangelist for social prescribing, an emerging movement in health care that focuses on connecting patients not with drugs but instead with social activities, groups and services in their communities in order to boost both physical and mental health.
“We know our health and wellbeing is most affected not by the medicines we prescribe but the lifestyles, social connections and conditions people live in.”
These non-medical interventions “prescribed” by doctors can include everything from volunteering, gardening and spending time in nature to attending theater, taking group walks and visiting museums. The possibilities are nearly endless — as long as they involve some sort of social connection. Social prescribing is not meant to replace drugs or traditional therapies but to complement them.
“Social prescribing is changing the landscape of health care, where our attention is moving beyond the brick and mortar of hospitals and into peoples’ communities,” says Dr. Michael Dixon, co-chair of the U.K.’s Social Prescribing Network, in a comprehensive March report from the Global Social Prescribing Alliance. “We know our health and wellbeing is most affected not by the medicines we prescribe but the lifestyles, social connections and conditions people live in.”
It’s a philosophy that is gaining steam worldwide, with 24 countries adopting some form of the practice — and there’s evidence to show that social prescribing can produce tangible, positive health outcomes. Indeed, advocates and doctors around the globe believe social prescribing may have the ability to transform the health care system altogether.
Healing that doesn’t come from a bottle
“It’s a more humane, holistic approach to health care,” says Dr. Alan Siegel, a family practitioner in the San Francisco Bay area and co-founder of Social Prescribing USA, an advocacy group that aims to advance the practice of social prescribing to all Americans by the year 2035. “We should be offering healing that’s not just coming out of a bottle.”
Siegel says he only learned the formal term “social prescribing” a few years ago, but he’s been practicing it in some form for the last two decades. In fact, he’s been a pioneering physician in his community, where he’s helped create or lead programs that encourage patients to connect with nature through walking and heal through expressive arts training programs. One of his efforts focused on alleviating pediatric obesity through social connection by bringing families to parks and engaging them in yoga, arts and other activities.
The results of these programs have been, he says, “profound” — with patients frequently commenting on how these simple interventions have been incredibly transformative for their health.
Research demonstrating the efficacy of social prescribing is still relatively nascent, though there is a growing body of evidence indicating that social interventions can have positive effects on health outcomes.
A common refrain advocates of social prescribing share is that the practice shifts the focus from “What’s the matter with you?” to “What matters to you?”
One early experiment, the Rotherham Social Prescribing Pilot, was conducted in 2012 to assess the effects of social prescribing in Rotherham, U.K. Over the course of two years, the study funded community organizations to provide 31 social prescribing services for 1,607 patients. Most services fell into the categories of information and advice, community activity, physical activities, befriending, and enabling. Three to four months into the pilot, 83% of patients had experienced improved wellbeing in at least one outcome area.
The pilot also found that over 12 months, inpatient admissions had decreased by 21%, accident and emergency attendances by 20%, and outpatient appointments by 21%. As a result, the study estimated a whopping £552,000 in total cost reductions, based on reduced usage of hospital care.
Other studies have produced similar results. A University of Westminster meta analysis of 14 studies showed that social prescribing led to a 24% reduction in emergency visits and a 28% reduction in the usage of primary care services.
There is also plenty of evidence to suggest that various modalities of social prescribing are beneficial to health. For example, nature-based interventions have shown to have positive physical and mental health benefits. Research shows that the arts can help improve physical and mental health. Even activities such as volunteering have proven to be linked to reduced risk of mortality. But experts agree additional research is needed.
Dr. Indu Subramanian, a neurologist at UCLA and director of the Department of Veterans Affairs Southwest Parkinson’s Disease Research, Education and Clinical Center, has found that social connection can have a profound impact on patients suffering from Parkinson’s disease. In one study, Subramanian and her colleagues interviewed 1,527 Parkinson’s patients and learned that the patients experiencing loneliness reported more severe symptoms and decreased quality of life than their non-lonely counterparts. In fact, patients with “a lot of friends” had 21% fewer symptoms than those with few or no friends.
She says that social connection “has been undervalued in medicine in general, but certainly in Parkinson’s disease.” To help change that, Subramanian launched virtual support groups for her Parkinson’s patients during the pandemic, and she encourages her patients to connect with others and take advantage of community-based services like yoga and other social activities.
A worldwide movement
Nowhere is social prescribing more formalized than in the U.K., where it was integrated into the National Health Service — the country’s publicly-funded health system — in 2019. There, patients can get referrals to “link workers” through their primary care doctors after they are screened for psychosocial issues.
These link workers meet with patients to understand their needs, develop a personalized plan and connect patients to resources in the community. These resources can range from helping patients join a knitting circle or book club to finding sporting activities or even connecting them with social services such as housing aid.
A common refrain advocates of social prescribing share is that the practice shifts the focus from “What’s the matter with you?” to “What matters to you?” Link workers listen to their patients to understand what is important to them — and then they connect them to the appropriate resources, sometimes even accompanying them as needed. There are approximately 3,200 link workers in the U.K., and the country has committed to recruiting 1,000 more.
“We should be offering healing that’s not just coming out of a bottle.”
Two dozen countries have joined the movement in some form. A recent report from the Global Social Prescribing Alliance (GSPA) details how these countries, ranging from the Americas to Europe to Asia, have adopted social prescribing. In Canada, there is a diverse and growing number of national initiatives and local projects focused on social prescribing. The national Parks Prescription program offers resources to health care professionals to make effective nature prescriptions. The Netherlands established a “Wellbeing on Prescription” program in 2011 that connects patients with “wellbeing coaches” similar to the U.K.’s link workers. Singapore launched a social prescribing pilot in 2019 that focuses on care after patients are discharged from a hospital.
In the United States, where the Surgeon General recently declared loneliness an “epidemic” and called for health care professionals to “integrate social connection into patient care,” implementing social prescribing at a national level is challenging without any universal health coverage. But there are a number of fledgling programs underway in communities across the country.
Artist Gillion Fallon, who received an Atlantic Fellowship grant to focus on brain health, is piloting a nature prescription program for patients with cognitive impairment. The program will include guided art walks through Brooklyn’s Prospect Park. Project Connection, a nonprofit based in Utah, connects mental health patients with services and people in the local community. And a new initiative in New Jersey will allow patients to attend events at the New Jersey Performing Arts Center for free. The program is offered through RWJBarnabas Health System and the philanthropic arm of insurer Horizon Blue Cross Blue Shield — possibly paving the way for insurance companies to consider reimbursements for social prescribing treatments.
The future of health care
Hamaad Khan, a graduate medical student in the U.K. and a development officer for the GSPA, says that social prescribing is necessary for the future of health care reform.
“We’re actually not caring for the healthy. We’re caring for the sick. We admit the sick. We tend to the sick. We try to heal and practice on the sick. And then we send them back out into the environment that made them fall sick in the first place.”
Instead, social prescribing is about “inverting this whole model.”
“Social prescribing,” Khan says, “is a pillar of health creation and sustainable health care, ensuring people move from becoming health consumers to health producers.” He adds that the COVID-19 pandemic exposed how our current health care system isn’t sustainable. “We need to reimagine a health service that has in its design and in its infrastructure the idea of creating health” rather than only treating patients when they fall sick.
It’s future doctors like Khan who will be key to advancing the practice of social prescribing. Advocacy organizations like Social Prescribing USA understand how instrumental students are to the movement, says co-founder Dan Morse. In addition to supporting pilot programs around the country, Social Prescribing USA plays an active role in developing college chapters where the gospel of social prescribing can be shared more widely.
Teale, who says social prescribing saved her life, is doing her part to grow the movement, as well. She serves as a trustee for the National Centre for Creative Health in the U.K., which aims to “foster the conditions for creative health to be integral to health and social care and wider systems.” She’s been invited to share her story at places like Buckingham Palace and Clarence House.
But perhaps most importantly, Teale is content and healthy. “He [my psychiatrist] said, ‘You’re always going to be ill. You’re always going to be medicated.’” Social prescribing helped her to prove him wrong.
