Imagine a pill could help treat symptoms of everything from depression to dementia. Imagine this pill could reduce hospitalizations, doctor’s office visits and health care spending. And then, imagine this pill came with no side effects or backbreaking costs; imagine a pill that doctors would feel good about prescribing, and patients would feel good about taking.
This medicine does exist, but it doesn’t come in a pill; instead, it comes as a “social prescription”—a referral to nonpharmaceutical, community-based resources and activities, like art classes and cycling clubs.
Instead of a recommendation to exercise or socialize, a social prescription is tailored to that patient’s specific interests—what brings them joy, purpose, awe, flow and childlike curiosity. It’s a medicine based on what matters to a patient, instead of just what’s the matter with them.
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This might sound woo-woo, but social prescribing is rooted in rigorous research and a critical public health fact: more than 80 percent of our health outcomes are driven by social factors in our environments, while only 16 percent are related to clinical care. In other words, to be healthy, we need access to basic resources—clean air, nutritious food, stable housing, freedom from violence and discrimination, and psychological resources—outlets that help us cope with stress, activities that give us a sense of purpose, people we can call at 3 A.M. in a crisis.
Social prescriptions addressing both kinds of these social needs should be a no-brainer addition to the menu of options that American docs, therapists and social workers can prescribe. Granted, they’re not “cure-alls”, especially for the most severe symptoms of mental distress. And, of course, therapy and medication should continue to be prescribed, too. But I’ve seen firsthand how social prescriptions can not only alleviate symptoms of sickness but also create lasting wellness—from the woman whose prescription for a sea-swimming prescription severely reduced her antidepressant dosage and helped “her life become bright again,” to the man whose prescription for a cultural excursion group helped him overcome his social anxiety and “feel like himself again.”
These patient success stories are two of thousands, and represent a massive change in how other countries are integrating social prescriptions. And, here in the U.S, if 80 percent of our health is driven by social factors, you’d think 80 percent of our health care spending would go towards investing in social prescriptions. But despite their demonstrated wins around patients’ health, their proven pressure reductions in health care and their potential to help all of us—even the not “sick”—feel well, social prescriptions, though gaining traction in the U.S., are still not mainstream. It’s time to change that.
For starters we’re getting sicker. Psychological illnesses like depression and anxiety and ADHD, have risen , along with related states like stress and loneliness. And yet, as people need more medical care, the health professionals tasked with providing it are becoming more in demand. Estimates predict physicians and behavioral health workers will see massive and inequitably distributed shortages in the next decade.
Meanwhile those who do remain in health care report rampant burnout and mental health issues of their own. Some blame time pressures; one study suggests it would take primary care doctors 26.7 hours per day to see an average number of patients while meeting their guidelines. But others blame “moral distress”—“the psychological unease” felt by those in health care when they “identify an ethically correct action to take but are constrained in their ability to take that action,” as defined by one shocking survey, which found eight in 10 doctors reported moral distress during the pandemic.
In other words, beyond just more hours in the day to do the prescribing, it seems what most health workers really want is more, and better, options to prescribe. An American Academy of Family Physicians survey of more than 1,500 physicians found 95 percent agreed their patients’ health outcomes were affected by at least one social determinant of health, and 87 percent wish they had both more time and ability to address social needs. A separate survey found most patients also wish their doctors would focus more on the social drivers of health, and support social prescriptions becoming a regular part of healthcare. And yet, especially as individual therapy gets harder to access, most health workers are forced to resort to prescribing pills; nearly half of America takes at least one prescription drug, and at least one in six takes a psychiatric drug, even though some of the most commonly prescribed drugs, like antidepressants, show a mixed bag around their evidence base and side effects.
Social prescriptions can address these shortcomings. One review of 86 social prescribing programs in the U.K. found patients who received social prescriptions experienced not only a decrease in anxiety, depression and negative mood, but also an increase in self-esteem, confidence, mental well-being and positive mood. This complements decades of research demonstrating the ways certain kinds of social prescriptions are effective for treating certain kind of ailments, like exercise for depression, or forest bathing for stress and heart diseases.
These gains in patients’ health translate to gains in health care. In the U.K., where an estimated one in five patients come to the doctors for purely social reasons, social prescribing has proven to reduce pressure on the system. Onereview found social prescriptions led to an average 24 percent reduction in emergency room visits and 28 percent reduction in doctor visits, which translated into savings of 2.30 British pounds for every pound (roughly $3 for $1.30) invested in the first year. And some evidence suggests social prescriptions can help prevent patients from coming to the doctor in the first place; apopulation analysis found weekly visits to natural environments, for instance, prevented 12,763 cases of noncommunicable diseases like type 2 diabetes and major depression disorder, and saved 108.7million pounds (roughly $142 million) per year.
And yet, beyond numbers, the most memorable gains from social prescribing come through in its before-and-after stories. Whether its patients sharing how social prescriptions have provided a “reason to wake up in the morning,” or doctors sharing how it feels like “prescribing beauty in someone’s life,” as they told me in my June book, The Connection Cure, they personify the medicinal powers of social prescriptions.
Though groups like Social Prescribing USA are helping to spread the practice, and investments in statewide arts prescribing in Massachusetts are showing what’s possible, we need all hands on deck to make social prescribing go mainstream. Though they may not come in a pill bottle, social prescriptions can help our health, our health care and all of us get well. And they can help us have a little fun while we’re at it.
This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.