Sydney GP Dr Jaspreet Saini has been handing out written prescriptions with a difference for a couple of years now.

Saini splits his time between his general practice in the Hills District and Healthicare, a newly established, innovative integrated primary healthcare service, and Neighbourhood Health Hub in Mount Druitt, where he is increasingly likely to prescribe a social remedy for his patients’ ills.

He proffers these prescriptions – a product of shared decision making with his patients – for participation in sport, arts, community groups and other social activities, in the same format he uses to prescribe medications.

Social prescriptions should carry the same gravitas as pharmaceutical ones, Saini told Croakey, “because really, it’s just like prescribing a medication, but potentially more potent and more effective”.

Saini told Croakey about one patient, a 60-year-old man who had recently moved to Sydney from the Indian subcontinent. With poorly controlled type 2 diabetes and hypertension, and early kidney disease, he came to see Saini with concerns about his physical health, as well as the toll on his mental health and loss of social connection resulting from the move.

“He was feeling depressed and alone,” said Saini. “When we first got talking, we spoke about ways in which we could optimise his medications to improve his physical health, but then identified that really what he needed was more opportunities to connect with people around him and to improve his health through implementing lifestyle changes in behaviours.

“So one of the first things I connected him with was parkrun.”

The patient, who had never been a runner and was concerned about being embarrassed in such a group, was reluctant at first, but Saini linked him up with another patient in the same area who was also a fledgling parkrun participant on a social prescription, and the two agreed to attend together.

At a recent consultation, the patient excitedly mentioned that he had completed 100 parkruns. Over the months, Saini has watched his blood pressure normalise with a marked decrease in antihypertensive requirements, his diabetes control improve, and his kidney function return to almost normal.

Importantly, social isolation is no longer a problem.

Says Saini: “He’s now joined with a few other people from the Indian subcontinent who have built their own running and walking group that they participate in on other days of the week. So he’s done really well for himself, with a group of friends around him, both from the parkrun but also in this other capacity.”

Can we embed social prescribing in the health system?

While it is not unusual for Australian healthcare professionals to recommend parkrun and other social activities, Saini told Croakey that what’s new is that the formalisation of social prescribing provides a structure.

This is, he said, “a framework for helping people connect with better health outcomes, but also a framework for helping people connect with better social outcomes”.

In addition to “chronic conditions being a huge thing for society, social disconnectedness and social isolation are particularly prevalent now”, he said.

There are many examples from overseas, including Canada, and in Australia of social prescribing being formalised into practices and programs. Australian models often use research grants, or Primary Health Network (PHN) or specialised service funding, with demonstrable gains for participants.

And Aboriginal Community Controlled Health Organisations (ACCHOs) have long built social cohesion, action on the social determinants of health, culture and social capital into their service models.

A recent consensus statement from the Australian Social Prescribing Institute of Research and Education (ASPIRE) advocated for “swift, unified action to embed social prescribing within our healthcare system” arguing that it has a pivotal role in “addressing the social determinants of health and championing preventive health measures across communities”.

EACH24: a social prescribing happening in Sydney

An upcoming conference, to be held on Gadigal land in Sydney later this month, will explore a broad church of what’s on offer for social prescribing in Australia and internationally.

The conference is hosted by ASPIRE, and is titled EACH24, an acronym for four important tenets of social prescribing: Environment, Activity, Connection, Health.

Presenters will include international keynote speakers:

• Dr Seth Kaplan, a Professorial Lecturer and expert on fragile states, societies, and communities, from the Johns Hopkins University, Baltimore Maryland (See ‘Strong Neighborhoods: Key to Reviving America and Building a Flourishing Society’)
• Dr Kate Mulligan, an Assistant Professor in Social and Behavioural Health Sciences in the Dalla Lana School of Public Health at the University of Toronto, who is a globally recognised expert in community approaches to health and wellbeing (see ‘Strengthening community connections: the future of public health is at the neighbourhood scale’).

Much local talent will also be on show, with panels, plenaries and research presentations on topics as diverse as nature, art, sport and music-based prescribing, community and connection, co-design and co-production, social determinants, youth, older people, workforce, the operationalisation of social prescribing, addressing loneliness, applying design thinking, mental health and preserving wellbeing.

Conference MC, Robin Mellon, Director UN Global Compact Network Australia and CEO of Better Sydney, will provide opening and closing remarks.

You can find the program and links to the topics and speakers here.

Prescription for connection and collaboration

The conference itself will be a social prescription of sorts for participants, with plenty of space for connection and even a choice of a group session encompassing activities based in nature, visual arts, music, adventure, food, history, Indigenous history and culture, or games and leisure.

Welcome to Country will be offered by Deputy Chair of the Metropolitan Local Aboriginal Land Council, and Sydney City Councilor, Yvonne Weldon AM.

Conference sessions will be held at the State Library of NSW and the Museum of Contemporary Art.

The Chair of ASPIRE and CEO of Primary and Community Care Service (PCCS), Dr JR Baker, told Croakey these locations were chosen quite deliberately with social prescribing in mind.

“It’s an area rich with resources,” he said. “There are real roles for both public libraries and the visual arts in social prescribing and the venues are close to museums, galleries and the Royal Botanic Garden, for those who need some forest therapy.”

One of the nearby galleries is the Art Gallery of NSW, which has been running everything from arts prescription for carers, in palliative care, to anxiety programmes for young people.

The Croakey Conference News Service reporters – myself and Dr Amy Coopes – are also in training for our own version of parkrun as we jog between venues to bring readers the conference highlights!

Baker told Croakey one of the things he enjoyed most about last year’s conference was watching the connections take place.

“I’d look over and think, oh, there’s an executive director at Queensland Health and they’re sitting next to an assistant secretary for the Commonwealth Department of Health, just by chance. You just sit there and smile,” he said.

The time is now!

Baker told Croakey that the time is ripe for the expansion of social prescribing in Australia, with widespread acknowledgement, several years into the COVID pandemic, that there is a loneliness epidemic, an ageing population with high rates of chronic disease, and recognition that many in the community carry mental health problems and work-related psychosocial injuries.

This is coupled with an over-burdened health workforce who would benefit from multidisciplinary expansion and access to new tools and therapies.

And social prescribing leaders are optimistic that there is political will.

Leanne Wells, former CEO of the Consumers Health Forum of Australia, and Chair of ASPIRE’s Community and Consumer Expert Panel, told Croakey that there is growing momentum at national and state levels.

“There’s the Federal Government feasibility study into social prescribing in the Australian context [which has consulted widely and is due to be handed to the Commonwealth after the conference], there’s momentum particularly in Victoria and Queensland because those governments are funding some additional initiatives, and the Primary Health Networks are getting more and more interested and more and more active.”

While there was nothing startling in the most recent Federal Budget, Wells and Baker agreed there had been an incremental change starting with last year’s budget, towards strengthening Medicare with measures such as team care arrangements, My Medicare Patient Registration and blended payments.

“Part of those models of care and next installments in Medicare need to be about integrated health and social care, which is where the opportunity is for social prescribing,” said Wells.

“What we are really looking for, I suppose, and why we think the timing’s now, is for integrated care to become truly that.”

Wells pointed to a speech made by Federal Health Minister Mark Butler at the Whitlam institute last year, in which he flagged the Albanese Government’s desire to weave the ethos of the Whitlam-era Community Health Program into Medicare reform with a focus on principles “of equity and of universal access, of community involvement and of team-based care, of proactive health protection and of care that looks beyond the medical to the social determinants of health”.

In the same speech, Butler said the Aboriginal Controlled Health Organisation (ACCHO) sector was a model for such care in the broader Australian health sector.

Wells agreed: “ACCHOs do it really well. They’ve always had that ethos around super extended multidisciplinary teams. If we can bolster the rest of the primary care workforce in the same way with nurses, allied health, link workers; with more structured connection into social prescribing pathways, it will be a huge help.”

Sound evidence

A clinical psychologist by trade, Brisbane-based Genevieve Dingle has been involved in research and programs using music to improve mental health, address loneliness and encourage social connection for many years.

She told Croakey that her interest evolved when she noticed that her addiction and mental health clients tended to do well while in a hospital or community rehabilitation program, but struggled to find the supports they needed back out in the community.

“At the same time, I was really interested in music psychology and applied music programs, like choir, singing, that sort of thing, as a way of supporting people with chronic mental health problems.”

Dingle, who is now a Professor in Clinical Psychology at the University of Queensland, has since worked to establish and evaluate multiple music programs and choirs. She was also involved in the evaluation of a social prescribing project in Queensland.

Hampered and delayed by COVID restrictions, the program demonstrated modest effects at eight weeks, and lasting benefits at 18 months.

“I would say that social prescribing is a slower thing than, say, a structured group program that goes for eight weeks,” she said, “but it’s likely to be more sustainable over time, because people are learning ways that they can deal with these things naturally in their own community, and they can continue to use those skills.”

Dingle will be involved in several sessions at EACH24, including a co-presentation with Associate Professor Melissa Forbes from the University Southern Queensland on their paper about preparing musicians, music educators and health services to move from music for performance to music on prescription.

Dingle is particularly excited to see what will come from a session she has convened at EACH24 on the role of nurses and allied health workers, an area that she says has been less explored than the roles of GPs and link workers doing social prescribing.

The EACH24 session will include representatives of physiotherapy, occupational therapy, psychology, pharmacy and nursing, bringing people together to present ideas about how their training, frameworks and skills could be useful in this space, both as prescribers and trusted links to community resources.

Dingle is committed to evaluation and excited about the potential benefits of social prescribing but worries about sustainable funding models. Research grants don’t extend to implementation after the research has finished, even when there is evidence of efficacy.

“I get a bit nervous around this point of time, when there’s a lot of expectation, but we still don’t have coherent funding structures, and we don’t have coherent mapping of what’s available… it comes down to resources,” she says.

“There can be a lot of goodwill and a lot of interest, but if you haven’t got the funding to pay your community group facilitators properly, you really can’t…exploit people. You do need to have a certain amount of funding to sustain them and have a viable program.”

A sporting chance

Another eager EACH24 attendee and presenter is Rob Bradley AM, CEO of the Confederation of Australian Sport.

With more than 35 years of sports leadership roles under his belt, Bradley, in his role at the Confederation, has been looking at the concept of social prescribing in sport for some years.

The Confederation worked with Professor Rosemary Calder and Australian Health Policy Collaboration, on the Health Tracker series and has long taken a cross sectoral approach to its advocacy for the health, social and economic benefits of sport.

This has led to relationships with multiple stakeholders – chronic disease prevention groups, education peak bodies and others. It became clear to him that sport and Australia’s rich seam of sporting clubs and organisations could benefit people locally, if sport participation were available via GPs on prescription.

“It’s been something I’ve been working on in the background for, I don’t know, six or seven years, but I was unaware of the ASPIRE group until the past few months. I made contact and found that there’s a whole family of us. I’m sort of the long lost sheep that’s found the flock!”

Bradley will be involved in a panel on designing out loneliness through community and place-based activation and is looking forward to reflecting with the other panelists on the topic.

“I’ve always felt that sport is a diamond,” Bradley told Croakey. “But the Health department doesn’t know how to use it. And it doesn’t appreciate the contribution that it makes. Because health has its own language and the research that health looks at it is done in such a way that sport doesn’t necessarily fit into neatly. A lot of the benefits of sport are intangible –  a bit less specific and measurable.”

Bradley sees great potential that could be harnessed from the resources already existing in Australia’s massive network of sporting clubs. Despite his reluctance about “asking sport to do more” in an environment where costs are up and resources like volunteers are often down, he says sports prescriptions could be a win-win situation.

“I think that the challenges are now as much in the mental health space as they are in the physical,” he said.

“I’ve always felt that sport is uniquely structured with the clubs system. Say there are 90 different national sporting organisations with a great, broad menu of opportunities – from the AFL and cricket right down to, say boccia – you have a massive menu of opportunities.”

Sports prescriptions could include a range of activities, including playing, coaching, volunteering on the sidelines, catering or just spectating.

“The common theme is that they’re together for a bit of a common purpose. I think the variety of opportunities within the club environment is a useful thing for GPs and other allied health professionals to be aware of.”

Program of note

Bradley admits that preparing clubs to receive people on social prescriptions will be important. A pilot study on Queensland’s Gold Coast, set to start later this year, will include the role of a club “welcomer,” who will help those on prescriptions with the important first steps.

Bradley’s years of involvement in sport tell him all he needs to know about the benefits of involvement in sport for mental health and social cohesion, but when pressed for an example, one program stood out.

During his tenure as CEO of the Royal Lifesaving Society of Australia, in around 2009, an increase in older Australians, particularly men, became apparent in the national drowning statistics, and it was thought that perhaps people were returning to the water with grandkids in their care, a bit rusty with their swimming skills and over-estimating their own abilities.

The Society developed a program called the Grey Medallion, designed as a refresher course, for older Australians, with the courses running in aquatic centres across the nation. The skills refresher and encouragement to do some training were useful, but Bradley observed that a huge benefit was the group just spending time together.

“An extremely beneficial part was the cup of tea together at the end of the program. They were brought together in a common experience, and the exchange of views and collaboration and camaraderie really developed,” he said.

“You can imagine some of the difficulties in getting people to agree to put their swimmers on and stand in front of a group of strangers and get involved. And I’m sure that was an issue for some.

“There will be barriers in the social prescribing system, I think. There will be things that need to be addressed. But if we can get through that, and get people engaged and involved, they’ll be motivated to continue. At the end of the day, that’s the proof of the pudding, isn’t it? Whether people see the value and whether they continue.”

 

Courtesy: Croakey Health Media