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Social prescribing in the age of COVID-19

Life in the age of COVID-19 can feel very inward looking as we hunker down at home, focused on caring for our loved ones.

Two people hold hands.

Trish Hennessy

On social media—our lifeline during physical isolation—people talk about their lack of productivity, their inability to concentrate, feelings of anxiety and dread.

For people living on their own, the loss of human touch for weeks, maybe months, can be hard to cope with.

“Staying home has awakened us to the necessity of social connection and how difficult it is to live without it,” says Kate Mulligan, assistant professor at the Dalla Lana School of Public Health.

“We know from prior quarantine situations, like SARS, it’s quite normal to have mental health impacts like anxiety and depression and physical impacts like heart and stroke. We also know the deeper your social networks, the more likely you’re going to emerge from that situation more healthy and well.”

How do we stay healthy and balanced during a pandemic?

What we do during a time of social isolation matters, says Mulligan, who was the Alliance for Healthier Communities lead for a pilot project on social prescribing involving 11 Ontario community health centres.

Social prescribing is a new way to think about health care. It’s a way to go beyond simply treating a medical issue and getting at the heart of the social determinants of health. Think doctors and nurse practitioners working with a client to determine social prescriptions such as volunteering, connecting with nature, supports for single parents or people who are grieving the loss of a loved one. These aren’t medical issues, per se, but they can impact a person’s overall health.

As part of the pilot project, those 11 participating community health centres employed their network of service providers, from September 2018 to December 2019, to refer people to a range of non-clinical services to provide holistic care. Altogether, they provided 3,300 social prescriptions to more than 1,100 clients.

In many ways, social prescribing is what community health centres do, but in a less integrated way than a fully coordinated social prescribing approach requires.

“The real innovation of social prescribing is in the tracking,” says Mulligan. “Community health centres have been doing it forever but we weren’t linking it back to the health system. We weren’t measuring.

“Community kitchens, gardens, chronic disease self-management systems were perceived as costs. This is a way to demonstrate that they are assets.”

As a result of the pilot project, Ontario now has a set of “bespoke data analytics” that can help analysts understand who is seeking primary care for reasons that aren’t solvable for primary care workers.

“We had a fairly intensive research arm,” Mulligan says, where they conducted interviews with people at three-month intervals. They also asked the health providers questions to learn from their experiences with social prescribing.

Among the findings:

  • Clients reported mental health improvements; they felt less lonely and more connected;

  • Health care providers found it improved clients’ wellbeing and decreased repeat visits;

  • There was deeper integration between clinical care, inter-professional teams, and social support.

“Front line physicians were skeptical at the beginning, but 68 per cent found it to be helpful for their work,” Mulligan says.

She says there’s still a long way to go towards fully integrated social prescribing teams that work together co-designing social prescriptions with their clients and then tracking their journeys throughout the system.

The biggest takeaway for Mulligan was the value of volunteering. People who volunteer and give back showed the biggest improvement in their health and wellbeing.

“Going from seeing yourself as someone with an illness to seeing yourself as a gift, with something to offer, is really transformative,” she says. “It gives you a feeling of more control of your health and wellbeing.”

With the advent of COVID-19, social prescribing is more relevant than ever.

It's a finding that is especially relevant in the age of COVID-19.

“Social connection has landed in a way that it hadn’t before,” Mulligan says.

Now that Ontario has this proof of concept that social prescribing works, she’s hoping for provincial funding to embed social prescribing into the system.

It’s happened elsewhere: “In the UK it went from idea to full implementation in less than three years,” she says.

Australia, meanwhile, is embedding social prescribing into its first 10-year health plan. Yes, you read that right: a 10-year health plan. Perhaps a post-COVID goal for Canada?

As Mulligan puts it, we’re recognizing “the fact that we live on a planet. We don’t live in an economy, we live in a biophysical society in which an economy is an important part but it’s not a fundamental reality in our lives.”

Trish Hennessy is director of Think Upstream.


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