Social prescribing works, so why isn't it everywhere?

Tegan Taylor: So, think about the things that make you feel good, really in charge of your health. For me at least, they're (quote, unquote) healthy behaviours, working up a sweat, putting together a really gorgeous, colourful, veggie-rich meal. And of course, that boost you get from spending time with the people you really like. It's a real privilege to have these things because of course not everyone does. We've reported quite a bit over the years on the idea of social prescribing, where we know things that help us connect with other humans is good for our health, so why couldn't a doctor prescribe that instead of or in adjunct to a script that you fill out at a pharmacy? I've been talking to Ilya, she's an artist based on the Gold Coast, and a few years ago she was diagnosed with fibromyalgia and chronic fatigue syndrome, and coupled with the fact that she's also autistic, she found it increasingly hard to connect with her old social groups. But she found a lifeline in the form of social prescribing, which she actually initially heard about through an ABC podcast.

Ilya: Look, I originally heard about on All in the Mind, and they were talking about how successful it was in the UK. All the time I hear about the value of social engagement and social interaction. And during my illness, I kind of withdrew from the people I knew, and I realised at one point that my social life basically involved just the medical professionals I saw. I didn't actually see anyone socially and I didn't want to, I just withdrew, and I realised that's something that I just wasn't able to address.

I personally got involved in a gardening group. I've got chronic fatigue, so I would need to rest a lot and sit in the shade. And that was okay, because I could paint pebbles. So you weren't obliged to talk to anyone but you were in the company of others that were similar, so it was a very safe kind of space. Some of the other activities I got involved in, there was one called forest bathing where we would go out and explore the forest. We also did a barista course, there was an art course.

Tegan Taylor: How is the social prescribing side of things different to you than just deciding to enrol in a forest bathing session or take an art class off your own bat?

Ilya: Well, it's interesting you say that because I used to be involved in life drawing at a community group, and I still haven't returned to that group. And it's not because of them or anything to do with that group, I love life drawing. However, when you're feeling this kind of 'ugh' and withdrawn from people, you isolate yourself, and you tend not to want to go out, and the social prescribing kind of formalises it. And it's kind of like going back to school where someone says to you, right, you've made this commitment, you need to turn up at this time, here's the form, sign yourself in, sign yourself out.

It's rebuilt my confidence in people, I just got my confidence in creating back, I got my art mojo back. I am really hesitant about spruiking the value of doing social prescribing, simply because I know it's not available everywhere. You know, if you get interested in doing something like this and it's not available, it's really crushing. And I really, really want it to be available to others. I feel so fortunate to have been able to do it. I had that benefit, and I wish others could but I don't want to put people's hopes up when I know it's not easily accessed.

Tegan Taylor: So Ilya is lucky enough to live in a part of Australia with a social prescribing provider. But, as she says, it's not available everywhere. There are lots of small programs around the country, but we don't have consistent coverage. But there is a push to change that with a roundtable in Canberra coming up at the end of the month. Leading the charge is social prescribing researcher, JR Baker.

JR Baker: There's lots of good benefits at the health system level, interestingly, which is a bit of a surprise. So once people are doing stuff that's interesting or matters to them, they're less likely to do extra visits to the GP and usually see a reduction in medication usage or attendances at emergency departments. So one thing that's interesting is it takes a bit of pressure off of the health system. But at the personal level, you see general improvements in quality of life and measures of psychosocial wellbeing, so improvements in mood, connection with others. And then even in the case of people who've had injuries at work, more confidence to return to work and greater ability to return to work and improvements in return-to-work outcomes. So it's quite broad, but at the personal and the system level, generally it means reasonable improvements for everybody.

Tegan Taylor: Who pays for these programs?

JR Baker: So some of the stuff is free and just exists. So social prescribing, on the plus side, can leverage free or low-cost services sitting in communities that are there already that people might not know about, so part of it is creating access to those sorts of things. Your local council might have lots of stuff available that you don't know about. The actual act of connecting itself tends to be paid for at the minute by Commonwealth government funded initiatives, usually through PHNs or Primary Health Networks. So across the country, PHNs are trialling different ways of rolling out social prescribing initiatives for different communities and different sorts of groups of people within the communities, so that's pretty exciting. And then, of course, some people are doing it themselves. So some GPs or primary care nurses or social workers, they've just jumped right into it and they've embraced that idea of asking; what matters to you, and how can we make your life more wonderful?

Tegan Taylor: So what you're kind of running up to at the moment is a big roundtable conversation in Canberra talking about how to make this more consistent across Australia. What are you asking for, if it can be done at a real grassroots level like it is?

JR Baker: It can be done but where the opportunities exist are with scaling things up so that it's accessible to everybody. So right now most of healthcare is delivered still in that biomedical model, where you focus on blood results and weight and disease and genetics and all those sorts of factors. But GPs and primary care providers, they do want to actually address the broader determinants of health and wellbeing, and so it takes resources to actually do that.

So one option is to make Medicare work a bit better for that. So things like creating social wellbeing plans, in addition to chronic disease management plans and mental health treatment plans might be an option, supporting PHNs to actually find more link workers, people who actually connect people to the available services is another option. And of course, putting a robust framework to do research evaluation and to scale things up is another great opportunity. So all those things actually improve the system, the framework it's based on, and the actual capacity and capability of people to leverage it.

Tegan Taylor: So one country that's a couple of years ahead of us in this space is the UK. They've had a national scale version of this for the last few years. What are you seeing there that you hope we could replicate in Australia?

JR Baker: Yeah, the UK has done all sorts of very cool things. So they are seeing those things we talked about earlier, reductions in healthcare utilisation and improvements in social connection and wellbeing. There's lots of really interesting programs. So they have heritage connectors to actually tap you back into history. And they have nature connectors that actually get you out and about in the environment, and that can lead to other activities, like fishing is quite nice and nature based. So I suppose, what you have in the UK, because they have a bit of a head start, is a broad range of activities that you can be referred into, and a much broader range of refers. GP practices can get link workers put right into the practice to help people access all those sorts of rich opportunities. That's fantastic that that funding is at both the medical primary care level and also at the community level, to help people access more opportunities.

Tegan Taylor: Why is now the time for this?

JR Baker: There's a lot of reasons social prescribing is really timely at the minute. I suppose the first is post the Covid pandemic (not that it's ended). We've been talking a lot about the loneliness epidemic, and there's been a tonne of media about it, the World Health Organisation's onto it, the US Surgeon General's onto it, we've all noticed that people are feeling a lot more lonely and socially isolated. So social prescribing is one opportunity at connecting people back into communities.

Then we have the risk of chronic disease and larger ageing populations, increases in mental health issues, and increase in psychosocial injuries in the workplace even. So there has to be another solution to actually supplement what we have in place, and to look at all those other factors that address some of the aspects of health and wellbeing, including social and economic factors, health behaviours, environmental factors.

Then there's the workforce, we keep seeing news articles and hearing about how the workforce isn't going to be sustainable over time, especially in light of the other things I just mentioned, so it's quite important to give additional tools to the primary care workforce at the minute. And I guess the most important factor is everyone deserves a good quality of life. And the Commonwealth Treasury is looking at measuring what matters and a Wellbeing Framework, and the question is, why not now? Why not now invest in healthy, connected communities with high quality of life?

Tegan Taylor: JR Baker is chair of the Australian Social Prescribing Institute of Research and Education or ASPIRE, and he's an Adjunct Associate Professor at Southern Cross University and CEO of Primary and Community Care Services.