Making health equity a reality through research, education, policy and practice
Social Prescribing, Donegal – A Non-Medical Approach to Health and Wellbeing
After a long and winding journey into the heart of Ireland’s northernmost county I reached Carraigart, my first destination on a whistle-stop tour of Donegal’s Social Prescribing Programme. I was warmly greeted by Lesley Newberry one of the Social Prescribing Co-ordinators for the Ros/Goill/Milford/ Fanad area, see facebook page. We made our way to the welcoming Tramore Inn in the village of Downings to meet members of the community for a fireside discussion about Social Prescribing. They described how they had become involved in the programme and the activities they took part in. They also described the positive impact Social Prescribing had had on their lives.
The enthusiasm of those I spoke to in the Tramore Inn was palpable. Over the course of the discussion I learnt about the benefits of the Social Prescribing Programme to the health and general wellbeing of people living in the area.
Social Prescribing refers to the use of non-medical support to address the needs of people whose mental health is affected by depression or anxiety. It may also be a route to reducing social exclusion, both for vulnerable populations in general, and for people with enduring mental health problems. It emphasises supporting health and wellbeing, through non-medical, community-based activities and supports, such as exercise, art, reading or gardening1. It has been shown to have positive outcomes including emotional, cognitive and social benefits2. Many of those who take part in the Socially Prescribed activities have reported improvement in mood, increased social interaction within the community. Proponents of social prescribing understand health as being influenced by social determinants and assert that solutions to health problems can be found outside of the medical domain3. Common activities include self-help, exercise, arts and creativity, green activity, community involvement and supports including volunteering, debt advice etc.
How it works
While the Social Prescribing Model can vary greatly in how it’s implemented, in Donegal Primary Care Teams (PCTs) are a central component of the model, acting as referrers and sometimes as co-ordinators of the Social Prescribing service. The initial target group for this project was community members in the catchments of six PCTs in Donegal who were suffering mild to moderate depression or who were socially isolated.
Referrals to the service can be made by GPs or other primary healthcare professionals. Clients can also self-refer. Social Prescribing Co-ordinator Lesley explained that engaging with the programme may be the first time a person will have thought in non-medical terms about their illness. People are often unaware of the numerous services they can access that may benefit them, for example exercise classes, employment initiatives, art or book clubs. The GP or health professional’s role as a trusted confidante can be to encourage the person to meet with the social prescribing co-ordinator to see what social activity may work best for them. One example is a man who was living in nursing home who didn’t know how he could improve his mood. After being referred by his doctor to Social Prescribing Co-ordinator, Triona Stafford, in Letterkenny, and discussing his interests , he enrolled in a draughts club and now attends once a week. Another example is Vivien who was suffering with mild depression. She visited her local GP who referred her to Social Prescribing Co-ordinator, Lesley, with whom she discussed possible activities. Vivien decided to join a local walking group and has since gone on to set up her own activity group in the community.
Lesley says that GPs are often the first port of call for matters of health and so by getting them involved in the Social Prescribing Programme, they can provide reassurance to patients that non-medical approaches to managing their mental health are viable and relevant.
Development of the programme
The Social Prescribing Programme was established as a pilot project in Donegal in August 2013. Funding for the pilot phase was provided by National Office for Suicide Prevention (HSE). Joint applications from Primary Care and community representatives were a prerequisite. According to Maire O’Leary, Social Inclusion Manager in the HSE Northwest, the fact that all PCTs in Donegal are obliged to have community representatives meant that most were in a position to bid without much adjustment to their basic structure. In 2013, four primary healthcare teams were awarded funding and employed a Social Prescribing Co-ordinator for ten hours per week. In 2014, a further two projects were funded.
The Social Prescribing Co-ordinator’s role
The Social Prescriber’s role once a patient is referred to them is to find out exactly what activities could benefit them e.g. a dance class, a book club, a walking group. Though some clients are happy to go ahead and attend their prescribed activity without any further intervention from the co-ordinator, others need more support as they start on a new activity or course. In these cases, a buddy scheme is used whereby the client is met and greeted by someone already in the group, on their first day, and shown around and introduced to other members.
The first four months of a Social Prescribing Co-ordinator’s post sees a lot of ground work and research into what resources are available in the area. Lesley discovered a vibrant community sector in the Ros Goill/Milford/Fanad area, identifying over 500 active community groups and activities that she could use to match up with clients’ needs.
Lesley feels that her location in the Primary Care Centre with members of the Primary Care team including the GP has been one of the key elements to getting the message out about Social Prescribing and its benefits to the health and wellbeing of an individual. When not in the centre, Lesley is travelling around the area covered by her Primary Care Team, making links with GPs, getting to know everyone within her catchment and creating a Social Prescribing presence.
In Letterkenny, I met Social Prescribing Co-ordinator Tríona Stafford, based in the Letterkenny Youth and Family Service Centre. The advantage for Tríona of being based at the centre means she can easily recommend courses that are taking place there if they are suited to the needs of the clients such as fitness classes or computer classes. A slight drawback however is being located outside of a Primary Care Centre which increases the need for Tríona to continuously remind the health professionals about the Social Prescribing service she provides. The strong links developed by the Social Prescribing Co-ordinator with community groups are a vital part of what makes the programme work. The buy-in from all community groups, according to both Lesley and Tríona, has been phenomenal.
Outcomes and impact
Anecdotally the impact of Social Prescribing on both the individual and the community appear to be positive. The simple premise and practice of Social Prescribing seem to have had far-reaching effects on both the individual and the community. A formal evaluation of the project has provided concrete evidence of the efficacy of social prescribing. Preliminary results from an evaluation based on patient feedback both pre and post-participation in a Social Prescribing activity showed positive outcomes.
Most notable perhaps, were the statistically significant 20% decrease in anxiety and depression and 30% increase in wellbeing among those surveyed. The results also showed a 20% decrease in GP attendance among participants.
Transport to and from prescribed activities can be an issue for some clients due to their rural location. This is a problem that can have a negative impact on the success of the programme. While the Lion’s Club provided invaluable support by way of a grant to the Donegal Social Prescribing Programme further ongoing funding towards transport is needed. In addition, whilst co-ordinators try to prescribe according to the financial means of clients, the cost of some activities may in certain cases be prohibitive. There also appears to be a slight gap in the service for clients in their 20s and 30s and attempts are being made to look at how this gap can be filled. Finally, lack of referrals from primary care teams was also cited as an issue.
Social Prescribing into the future
While in Donegal, I also met with the Social Prescribing Steering Committee. They spoke among other things, about the future of the Social Prescribing Programme in Donegal. Maire O’Leary, Social Inclusion Manager, HSE, is hopeful that further funding for the short-term will be made available to the programme. The hope is that longer-term funding solutions will be provided in order to ensure the sustainability of the programme. Attempts will be made to continue to promote Social Prescribing among GPs and Primary Healthcare professionals in order to increase referral rates and thus the impact of Social Prescribing. In some areas, the programme would benefit from greater visibility and further promotion. Through its Social Prescribing pilot project, Donegal has shown how a structured approach to a cost-effective and simple health intervention can yield positive outcomes for both the individual and the community. Its client-centred, practical approach encourages the individual to take their health and well-being into their own hands. It also provides health care professionals with the opportunity and resources to facilitate social solutions to enhance their patients’ health.
For more information on Donegal’s Social Prescribing Programme, contact Maire O’Leary, Social Inclusion Manager, HSE
T: 074 9123757
1 Alive2Thrive. Social Prescribing. alive2thrive. [Online] [Cited: 12 December 2014.] http://www.alive2thrive.ie/social-prescribing/
2 Social Prescribing and Primary Care in Ireland. Keenaghan, C, Sweeney, J and
McGowan, B. Dublin : ICGP, January 2013, Forum, pp. 17-18.
3 Social Determinants of Health http://www.who.int/social_determinants/en/
Profile of the initiative
Name: Social Prescribing Project, Donegal
Team Members: Six Primary Care Teams (including community representatives and GPs) and six Social Prescribing Co-ordinators.
Commenced when: April 2014
Key stakeholders: HSE Social Inclusion, Northwest; National Office for Suicide Prevention; Primary Care Teams; Social Prescribing Co-ordinators.
Target Population: People living in the six Primary Care Team areas of Donegal with mild to moderate mental health problems and those experiencing social isolation.
Funding: National Office for Suicide Prevention.
Triona Stafford Social Prescribing Co-ordinator Letterkenny
by Suzanne Barror PHE
John is an active 73 year old who was referred to the Social Prescribing co-ordinator by his GP. He described himself as usually calm and relaxed but had developed high levels of anxiety over the last year. He reported waking up during the night and not being able to complete simple chores . His quality of life was effected. His wife was becoming increasingly concerned about him but he did not want to take medication as he was worried about the addictive nature of the tablets. After meeting with the Social Prescribing Co-ordinator, John was referred to two options. Several self-help books were also recommended to him that were available in the local library. The first option was yoga, which was on in the local community centre. John immediately took to yoga and found the breathing aspect especially useful even though he had a very physically active lifestyle. The second option was counselling. John found this extremely beneficial as he felt it was getting to the root of his problems. John reports that there is a calmness in his life now that hasn’t been there for years and he is sleeping well at nights. His wife found the self-help books to be a great source of support for her and feels more equipped to deal with John’s anxiety. John also started attending GROW and is taking guitar lessons every Thursday.