Social prescribing: A paradigm shift in our discussion on student mental health and wellbeing

​In the UK, there is increasing interest in social prescribing as a possible approach for addressing complex health and psychosocial issues in primary care, as well as its potential to reduce existing health inequalities (1).

Social prescribing enables frontline healthcare professionals to refer patients to a wide range of non-clinical services, by connecting patients, via a link worker, to assets within the voluntary and community sector to encourage self-care and facilitate healthy communities (2, 3).

Social prescribing link workers offer patients face to face conversations which focus on ‘what matters to them’ by taking a holistic approach to people’s health and wellbeing. Patients are encouraged to co-produce and design their own personalised solutions, called ‘social prescriptions’, where they feel empowered to improve their own health and wellbeing (4).  Social prescribing is not a single intervention but a pathway and series of relationships, all of which need to work simultaneously to meet the patients’ needs (5).
Social prescribing encompasses a wide range of activities including arts on prescription, singing groups, dance classes, volunteering, exercise referral schemes and physical activity (6).
The underpinning ethos of social prescribing emerged from early twentieth century social models of health such as The Peckham Experiment, where the concept grew in the 1980s at the Bromley-by-Bow Centre, London. The term ‘social prescribing’ was not formally coined in the academic literature until the start of the twenty-first century (7) and more recently highlighted in the policy arena (8). While there is growing evidence demonstrating the efficacy of social prescribing in diverse population cohorts, one limitation of this approach is the absence of a theoretical framework (9).
Social prescribing is designed to support a wide range of patients including people with one or more long-term conditions, who are lonely and isolated, who have complex social needs which affect their wellbeing, and people who need support with their mental health (10). A particular population who are known to experience poor mental health and have been the focus of increasing concern in the UK are university students (11).
In the last two decades, there has been a five-fold increase in the number of UK students disclosing a mental health condition to their university (12). Furthermore, universities have reported an increase in demand of students seeking support for counselling services (11). Despite increased demands, professional services are limited in their capacity to offer one-to-one support to students, subsequently leading to long waiting lists (13).
While traditional services such as counselling and therapy can be effective responses to poor student mental health (14), to date no literature has explored the role social prescribing can play in supporting university students with poor mental health.
Therefore, my PhD will seek the explore the use of social prescribing to address poor mental health in UK university students, focusing on students’ experiences of being in receipt of this initiative, and the perspectives of general practitioners and social prescribing link workers supporting university students.  Particular reference will made to the University Mental Health Charter framework (15).

Any feedback is welcome.

Thomas George
Researcher and part-time PhD student, School of Health and Social Care, University of Lincoln
Email: tgeorge@lincoln.ac.uk
Twitter: @A1859826
 
References
1.       Moffatt, S., Wildman, J., Pollard, T.M., Penn, L., O’Brien, N., Pearce, M.S., and Wildman, J.M. (2017) Evaluating the impact of a community based social prescribing intervention on people with type 2 diabetes in North East England: mixed-methods study protocol. BMJ Open; 9: doi:10.1136/ bmjopen-2018-026826.
 
2.       South, J., Higgins. T.J., Woodall, J., and White, S.M. (2008) Can social prescribing provide the missing link? Primary Health Care Research and Development, 9:310–318. doi:10.1017/S146342360800087X

3.        Brandling, J., and House, W. (2009) Social prescribing in general practice: adding meaning to medicine. British Journal of General Practitioners; 59:454–456. doi.org/10.3399/bjgp09X421085

4.       Social Prescribing Network (2016) Report on the annual social prescribing network conference. Available from https://www.artshealthresources.org.uk/docs/report-of-the-inaugural-social-prescribing-network-conference/ [accessed 29 January 2021].

5.       Husk, K., Blockley, K., Lovell, R., Bethel, A., Lang, I., Byng, R., and Garside, R. (2019) What approaches to social prescribing work, for whom, and in what circumstances? A realist review. Health and Social Care in the Community. 28:2; 309-324. https://doi.org/10.1111/hsc.12839

6.       Thomson, L.J., Camic, P.M., and Chatterjee, H.J. (2015). Social Prescribing: A review of community referral schemes. London: University College London.

7.       Friedli, L., and Watson, S. (2004) Social Prescribing for Mental Health. Durham, NC: Northern Centre for Mental Health.

8.       NHS (2019) The NHS Long Term Plan. National Health Service. Available from https://www.longtermplan.nhs.uk/publication/nhs-long-term-plan/ [accessed 29 January 2021].

9.       Stevenson, C., Wilson, I., McNamara, N, Wakefield, J., Kellezi, B., and Bowe, M. (2019) Social prescribing: A practice in need of a theory. British Journal of General Practitioners. Available from https://bjgp.org/content/social-prescribing-practice-need-theory [accessed 29 January 2021].

10.   NHS England (2020) Personalised Care – Social Prescribing. National Health Service. Available from https://www.england.nhs.uk/personalisedcare/social-prescribing/ [accessed 29 January 2021].

11.   Thorley, C. (2017). Not by degrees: Improving student mental health in the UK’s universities. IPPR. Available from https://www.ippr.org/publications/not-by-degrees [accessed 29 January 2021].

12.   Brown, J.S.L. (2018) Student mental health: some answers and more questions, Journal of Mental Health, 27:3, 193-196, DOI:10.1080/09638237.2018.1470319

13.   Brown, P. (2016) The invisible problem? Improving students’ mental health. HEPI Report. Higher Education Policy Institute. Available from https://www.hepi.ac.uk/wp-content/uploads/2016/09/STRICTLY-EMBARGOED-UNTIL-22-SEPT-Hepi-Report-88-FINAL.pdf  [accessed 29 January 2021].

14.   Worsley, J., Pennington, A., and Corcoran, R. (2020) What interventions improve college and university students’ mental health and wellbeing? A review of review-level evidence. What Works Centre for Wellbeing. Available from https://whatworkswellbeing.org/resources/student-mental-health-review-of-reviews/   [accessed 29 January 2021].

15.   Hughes, G., and Spanner, L. (2019) The University Mental Health Charter. Student Minds. Available from https://www.studentminds.org.uk/charter.html  [accessed 29 January 2021].