Social prescribing; a pathway to sustainability?
Could our current mental health care system be too ‘deficit’ focused? This may explain why we have a system that is very well geared up for managing patients during relapse, but a system that has perhaps less to offer patients in supporting the maintenance of their health between relapse. I believe there is much to be gained by broadening the management options that mental health services offer to include asset-focused social prescribing. Supporting confidence building and skills-based training and creating avenues into employment services could lead to reduced demand on services by reducing relapse.
The excellent Ecominds programme focused on these wider social benefits. Ecominds was a lottery funded project that developed 130 projects across England between 2009 and 2013. Over 12,000 people with mental health conditions used these projects to learn skills in gardening, farming, food growing, exercise, art and craft, or environmental conservation work. These projects are sustainable because they have the potential to have positive social impacts through promoting resilience, building relationships, vocational skills and confidence in individuals. This then has the potential to lead to reduce mental health care service use due to reduced relapse rates and therefore reduced economic and environmental costs.
These types of projects, however, have real difficulty in embedding themselves within health care settings and getting funding from commissioners, despite good RCT level evidence for their effectiveness. Unfortunately, some of these Ecominds projects have had to stop in April this year due to lack of funding despite evidence of their positive economic basis and social return on investment. It seems that, given the current constraints in health care, greater focus is needed on the direct savings that could be achieved for health care from these types of projects. A report published last month has demonstrated these potential cost savings by analaysing the number of GP contacts and secondary care referrals from primary care.
Greater clarity about the potential benefits of these community projects is certainly needed. Developing these types of additional services in secondary mental health care could bridge the gap between reducing environmental and economic costs of services while improving quality of care.