Social prescribing can be an important approach to self-managing mental health. Medication and psychological therapies do have an integral role to play. Yet, social prescribing offers a further opportunity for intervention. It is a means of dealing with the early stages of mental distress.

Many things in life can make one feel unhappy or anxious. Addressing these issues may take a little extra time and support. From housing advice to online counselling, social prescribing can improve accessibility to local support. In this way, it has the potential to be an alternative response to mental health concerns. Though it does not seek to replace clinical intervention, it can provide a proactive approach to managing mental wellbeing.

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What are the key concerns about mental health struggles?

1 in 6 people aged 16+ experience a common mental health problem, such as depression or anxiety. Mental health concerns constitute 23% of NHS activity. Still, mental health trusts have been subject to continuous budget cuts.

Drugs remain the most common treatment for anxiety, depression, and panic attacks. The number of prescriptions dispensed has almost doubled from 2008 to 2018. Cognitive behavioural therapy (CBT), can also be an effective form of treatment. Yet, this is often only available on the NHS to the person for 8–12 weeks following long waiting times. The fact remains that the majority of individuals do not seek help for mental health concerns until in crisis. This would explain the upward trend in the number of people detained under the Mental Health Act.

Academics and GPs have since called for more community-based approaches to mental health. These tackle the social determinants of mental health and are more preventative.

Social prescribing can be one such route providing practical support to key populations:

• vulnerable groups, e.g. low-income single mothers and newly-arrived communities;
• individuals with mild to moderate depression and anxiety;
• individuals with long-term mental health problems;
• frequent attenders in primary care.

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‍Why is social prescribing necessary for mental health?

For one, social prescribing addresses a key distinction: mental health versus mental disorders. Mental disorders may need clinical support but community support can improve mental health. Depending on an individual’s needs, this may look like:

• reducing isolation by forming new connections in community activities;
• building interpersonal skills with career advisors;
• finding a sense of purpose through volunteering etc.
  

Psychiatrists often adopt a biopsychosocial model to varying degrees in their approach. This considers the overlap between biological, psychological, and socio-environmental factors in mental health. For psychiatrists, social prescribing supports the 'social' aspect of this model.

Individuals from lower socio-economic backgrounds are more prone to mental health problems. Factors include poverty, unemployment, low educational attainment, and poor housing. Social prescribing can be a good option for those who face such psychosocial stressors. It targets the root causes of mental health concerns like financial debt or lack of community support.

These individuals often do not have a diagnosable illness. Lack of access to community care leads to seeking support within primary healthcare. A medical model may not be necessary here as it risks over-pathologising. In this context, social prescribing may fill in the gap. 

Rather than being symptom-oriented, social prescribing focuses on quality of life. With the help of a link worker, individuals can address complex root causes of poor mental health. Finding community-based solutions also reduces the tendency to resort to medication. In other words, social prescribing de-medicalises mental health concerns.

What is the evidence for social prescribing for mental health?

A recent study explored Life Rooms as a social prescribing model. Life Rooms aim to address social determinants of mental health in the North West Coast (NWC) of the UK. NWC is one of the most disadvantaged areas in the country, with high rates of mental health concerns.

An ethos of lived experiences lies at the core of the Life Rooms services. The goal is to meet the social needs of the communities they serve.

Life Rooms offers a range of services from advisors and library services to community spaces.

All participants in the study reported the Life Rooms approach to be effective. Key successes include:

• increase in social belonging;
• resourcefulness and accessibility;
• improved social inclusion and connectedness;
• self-development and independence.
  

Participants highlighted the importance of choice embedded in the programme. This included being able to structure their own social prescription. Empowering individuals to self-manage their mental health reduced the need for clinical services.

Life Rooms addresses individualised needs by filling in the gaps between services. They offer support at different stages of mental health. This means early periods of distress, ongoing struggles, and recovery. This emphasises the need for reaching out to individuals in ways that are meaningful to them.

Key caveats to consider 

Kimberley Brownlee, a Professor of Philosophy at the University of Warwick, highlights ethical issues surrounding social prescribing:

"It might seem to trivialise the pain of loneliness as something easily solved with some chat, the social equivalent of eating more greens. If a GP gives someone a social prescription, he might leave her office feeling more disheartened and incompetent than when he walked in."

It is important to note that social prescribing is not a substitute for psychological support. Rather, it facilitates opportunities for other forms of local community care. In cases where mental health concerns are socially-determined, clinical support may be inappropriate.

Likewise, it is beneficial to consider the stigma surrounding mental health. Some may prefer to access support that does not fall under a mental health system. Almost 9 out of 10 people say discrimination has a negative effect on their lives. Individuals with mental health problems are among the least likely of any group with a long-term condition or disability to:

• secure employment;
• be in a steady relationship;
• have decent housing;
• be included in mainstream society.

It makes sense why some may distance themselves from the 'mental health' label.

In any case, link workers are key to addressing the ambivalence individuals may harbour. By identifying individualised needs, they can streamline the process of mental health referrals. This would also reduce the strain on over-stretched primary care services post-pandemic. Social prescribing can help promote the sustainability of mental health care.