Education and Social Prescribing for Mental Health

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Education and Social Prescribing for Mental
Health

• Hilary Abernethy
• March 2007

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What is Social Prescribing?

• It is a mechanism for linking people with, or
  who are at risk of developing, mental health
  problems (in primary or secondary care) with
  non-medical sources of support within the
  community. It involves developing alternative
  responses to mental distress and a wider
  recognition of the influence of social and
  cultural factors on mental health outcomes.

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Social Prescribing Development Project

• Aim to support localities in developing,
  implementing and evaluating social prescribing
  schemes with particular, but not exclusive, focus
  on mental health.
• Objectives
• Work with pilot sites to develop comprehensive
  schemes and best practice, based on social
  prescribing guidance.
• Facilitate the development of protocols and
  systems for referral, monitoring and evaluation.
• Producing and disseminating information and
  guidance.

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Pilot Sites

• North Lancashire/Blackpool
• Liverpool/Sefton
• East Lancashire
• Stockport

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Project Outcomes

• The outcome of the work with the pilots is to
  develop implementation guidance which will then
  be rolled out across the region.
• The guidance will be ready by the end of April.
• Many localities have expressed an interest in
  taking Social Prescribing forward and have
  already begun to get systems in place, some are
  waiting for the guidance to use as evidence to
  influence commissioning decisions.

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Determinants of mental health

• Mental health problems tend to proliferate as a
  result of complex and multiple biological,
  psychological and, most importantly, social
  determinants.
• Social Prescribing uses an holistic approach to
  address social determinants not just clinical
  symptoms.

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Risk factors

• Isolation and alienation.
• Poor access to education, transport, housing,
  recreational facilities.
• Socio-economic disadvantage/poverty.
• Work stress, unemployment.
• Poor nutrition/lack of exercise.
• Social or cultural injustice and discrimination.
  
• Violence and anti-social behaviour.

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Protective Factors

• Empowerment.
• Positive interpersonal interactions.
• Social support and attachment to community
  networks.
• Access to social services and a variety of
  leisure activities.
• Social participation and inclusion.
• Economic security and access to meaningful
  employment.

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Uses of Social Prescribing

• The Public Mental Health agenda - improving
  community well-being through increased provision
  of and access to sustainable health improvement
  and self management particularly for at risk
  groups.
• Early intervention, reducing prevalence and
  increasing choice of interventions in a cost
  effective way e.g. as part of a stepped care
  approach to treating depression.
• Recovery from mental illness and increased social
  inclusion for people with mental health problems

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Who might be helped by social prescribing?

• People who   
• Have psycho-social support needs because of
  mental health problems, either mild to moderate
  or severe and enduring.
• Are at risk of developing mental health problems
• Are at risk of being socially excluded as a
  result of experiencing emotional distress. This
  includes unemployment or risk of job loss and
  factors of social isolation.

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Policy drivers

• Our Health Our Care Our Say White Paper
• Mental health and social exclusion social
  exclusion unit report.
• National Service Framework for Mental Health
  Standard One

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The Choice Agenda

• Part of the governments modernisation plans for
  public services
• Choice is about empowering people to make
  decisions - To do this people need access to
  relevant and accurate information and a range of
  options to develop personalised care
• Social Prescribing can increase choice of
  interventions.

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Social Prescribing and Primary Care

• Depression is very common in primary care, and a
  major cause of disease burden generally. The
  prognosis of many depressive disorders is poor,
  and rates of relapse are high.
• There is rarely capacity within primary care
  settings to manage depression in the optimal way.
• There are some key issues that are important in
  delivering of primary care services depression.

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Social Prescribing and Secondary Mental Health
Care

• Moving on from secondary care services can
  sometimes be difficult. The nature of the
  interventions to maintain engagement with
  services can create dependence and there often
  seems no half-way point between full engagement
  in services and discharge. Social Prescribing may
  be able to help facilitate such a process

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Social Inclusion

• Adults with long-term mental health problems are
  one of the most excluded groups in society, with
  71 not being in work. Too often people
  experiencing mental health difficulties do not
  have other activities to fill their days and
  spend much of their time alone. Such social
  isolation is an important risk factor for
  deteriorating mental health and suicide.

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Recovery Theory

• We need to create an optimistic, positive
  approach to all people who use mental health
  services.
• The vast majority have real prospects of recovery
  if they are supported by appropriate services,
  driven by the right values and attitudes.

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Recovery is.

• not just about what services do to or for
  people. Rather, recovery is what people
  experience themselves as they become empowered to
  manage their lives in a manner that allows them
  to achieve a fulfilling, meaningful life and a
  contributing positive sense of belonging in their
  communities.

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Delivery Methods

• The delivery methods for social prescribing will
  depend on
• Size and range of organisations involved
• Population size and demographics
• Cultural diversity
• Capacity and resources
• More than one model is required to reflect these
  issues

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Potential Partners

• NHS public health primary care secondary
  mental health services PALS
• Social Services
• Local Authorities leisure services, libraries,
  parks, cultural facilities
• Voluntary Sector
• Education Sector
• Employers and employment support job centre plus

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Social Prescribing Interventions

• Community groups focusing on self management,
  skills development and building confidence and
  self-esteem.
• Educational opportunities
• Arts and Health projects
• Promotion of physical activity and biophilia
• Bibliotherapy
• Supporting people to return to work, volunteering
  or vocational/further education.
• Increasing social support and inclusion

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Education and Mental Health

• Formal referrals aim to offer patients
• experiences that will help them cope with their
  illness and improve their confidence,
• an aim of reducing dependence on primary care
  professionals

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Evidence of effectiveness includes

• The relationship between learning and key risk
  factors for mental health problems, notably
  unemployment and social exclusion
• improved health outcomes, which are related to
  three forms of capital
• Human capital (knowledge and skills)
• Social capital (trust and interdependency)
• Identity capital (positive self image,
  assertiveness and confidence).

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Learning can contribute to shifts attitudes and
behaviours that take place during mid adulthood.

• These included positive changes in
• Exercise taken
• Life satisfaction
• Race tolerance
• Authoritarian attitudes
• Political interest,
• Number of memberships
• Voting behaviour.

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• Conversely, there is a much higher prevalence of
  depression among women and men with low literacy
  skills (Hammond 2002)
• Both NIACE and the WBL centre suggest that
  education impacts on health through
• Socio economic position
• Access to health services and information
• Resilience and problem solving
• Improved self esteem and self-efficacy

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Factors crucial for success

• The provision, through a learning advisor, of one
  to one guidance, which is important to motivation
  and supports access to learning
• A positive relationship between the learning
  advisor and healthcare staff, which raises
  awareness of the health benefits of participation
  in learning
• Immediately available learning opportunities

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Implementation Framework

• A lead person to take responsibility
• A whole system approach
• A form of coordination an individual role
  within statutory or voluntary services a
  database of services accessible to a wide range
  of referrers an information/signposting service
• Integration into established care pathways (ie.
  Stepped Care)
• A system for evaluating outcomes/impact