From one kind of social prescribing to another kind of social prescribing: a change in focus? by John Sawkins

It has long been apparent to service users that their treatment has very little to do with therapy for the individual, and everything to do with social control, with disinhibition, hyperconnectivity and hypersensitivity being the main causes of concern for society. Thus the individual was treated for the benefit of his or her fellow-citizens, rather than as a means to help him/her recover.

social controls

There is, however, some movement on this front. Increasingly, G.P’s are prescribing more with the individual in mind, as opposed to family, community or state. Hence, creative pursuits, exercise and community engagement are now regularly on the agenda. In Edinburgh, NHS Lothian has canvassed the views of service users as to how services might more effectively, and consequently, more efficiently, delivered.
The first stage involved four of us being filmed. During the filming, we were asked what worked for us, in terms of WELLNESS. This helped us to focus on the positives rather than what was wrong with the system. One common theme was the therapeutic value of exercise. We acknowledge that getting people motivated in a major hurdle, but for those of us who overcame this there was a marked improvement not only on our mental health, but also in our physical health. Getting a buddy to accompany you can make all the difference.
On another level, we all felt that volunteering has helped: it is a win-win situation with obvious benefits for the recipients, of course, but also a chance for us as service users to focus for once on other people’s needs as opposed to our own: self-obsession can be very destructive. Of course, this needs careful management to avoid a volunteer becoming loaded down with other folks’ problems – mentors can help in this respect.
There was a realisation that isolation can be a problem for many of us, and that the best solution to this seems to be community involvement, as well as building good, loving relationships. Some of us, rather than expecting someone to do it for us, have set up our own community activities, including open mic sessions, gardening and craft groups. We keep well by eating fresh fruit and vegetables and we try to avoid processed food and fizzy drinks.
The next stage in this initiative is currently being rolled out across Edinburgh as well as further afield. It involves inviting a balanced mix of professionals and service users to attend events in their locality to debate issues arising around the concept of wellness. Key to this is the re-examination of terms used. The deficit model needs replacing with one that focusses on people’s assets.
It was generally agreed at the first of these meetings, which I also attended, that the NHS does not save money through a one-size-fits-all system: in fact, it ends up being far more expensive over the long term through “system churn” and the revolving door scenario. Effectiveness means tailoring treatments to individual patients’ needs, alongside early intervention, and ideally, prevention of conditions that have become increasingly more complex through waiting until they became a crisis.
Again, the one-size-fits-all option is also counterproductive when it comes to the effective use of support-workers. As one patient put it, “it’s no use offering me help with dealing with rent arrears when I have already paid off my mortgage”. Not everyone needs a support worker, but some of us do. Identifying when, and in what capacity is crucial.

John Sawkins, 19 January 2017

Edinburgh NHS Lothian’s consultation with service users on Wellness and service provision:
From one kind of social prescribing to another kind of social prescribing: a change in focus?