The Social Prescription: A UK Innovation With Legs
Raymond Rupert MD, MBA.
The social determinants of health must be addressed to promote health and avoid illness as people age. Pills won’t cure everything.
Isolation, boredom, lack of activity and exercise, loss of meaning and purpose as a productive person, lack of creative outlets, sensory deprivation from loss of vision or hearing, persistent noise, clutter, financial stress can lead to depression, hopelessness and can be detrimental to an individual’s health status.
Social prescribing is a way of linking patients with sources of support within the community to help improve their health and well-being by addressing the issues listed above.
Social prescribing is the use of non medical interventions to achieve sustained healthy behaviour change and improved care. It is particularly impactful for patients with chronic conditions like depression and substance use disorder
Social prescribing programs are being widely promoted and adopted in the UK’s National Health Service.
Research from the UK shows that social prescribing is associated with the reduced use of health services by patients referred, including a 28% reduction in GP appointments (range 2% to 70%). Demand for hospital care was also reduced. Emergency admissions fell between 6% and 36%, and most studies showed a reduction in outpatient referrals with up to 64% for patients engaged in social prescribing.
Case Study Illustrating RCM’s Social Prescription Plan (SPP):
Eric was 69 years of age. He had dementia but was mostly cognitively intact. Eric was always a great story teller but had started to ramble. He was social and very energetic and was always in motion. However, Eric had become isolated and very lonely. His wife was his primary caregiver. She had burnout.
RCM was retained to create a social prescription for Eric. The planning team at RCM got creative in matching Eric’s prior interests with activities to his individualized program, to keep Eric engaged and motivated and, hopefully, improve his cognitive skills and overall health.
The Montessori Method:
As per the way social programing was established in the UK, RCM uses the Montessori Method in the design of a client’s social prescription. Each person has many dimensions (physical, emotional, cognitive, social, spiritual, aesthetic) that must be integrated in a social prescription that engages the whole person.
Montessori was developed for children who have very many neural connections in their developing brains. The Montessori method helps to shape the neural pathways. This is based on the neuro-plasticity which is the brain’s ability to change.
Montessori applied to the elderly works in a similar way to improve the neural pathways based on the brain’s inherent neuro-plasticity. Brain science has shown that cognitive reservoirs are developed with the activities inherent in a social prescription. This shifts electrical brain activity to areas that are least impacted by dementia and improves overall cognitive function.
Eric’s Social Prescription:
Eric’s social prescription included art therapy, music therapy, movement to music, tai chi, reading together and out loud, physiotherapy, exercise at a gym, walking Bart the therapy dog, story telling, speaking a foreign language which Eric had grown up with and the creation of a legacy storybook with pictures rescued from Eric’s shoe boxes full of old family pictures. RCM’s job was to retain and manage the talent required for these activities and organize Eric’s schedule.
Eric would leave his home with his driver in the morning and return in time for afternoon tea with his wife. This was also extremely beneficial for Eric’s wifes’ well-being and ability to continue on as his primary caregiver. In addition, RCM had one of our senior social workers work with Eric’s wife to support her in this transition, recognizing that Eric would likely some day enter into residential care.
The team at Rupert Case Management has recognized the importance of the social prescription plan (SPP) and is responding our client’s needs by designing and delivering social prescriptions.