The NHS has been struggling to meet the mental health needs of the population. An alternative candidate to costly pharmaceuticals and the more cost-efficient cognitive behaviour therapy is social prescribing, where activities of ordinary life, such as art, music and gardening are offered as a form of therapy. Jonathan Wolff, Jon Hall and Elaine Collins make the case for more consistent funding of this approach.
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The charity Mind estimates suggests that 1 in 4 of the UK population experience difficulties with mental health in any year, although only a small proportion of this number seek and receive treatment. Yet a fraction of a large number can still be a large number and many millions of people in the UK are currently receiving treatment for mental health problems. With such numbers there is a search for cost-effective treatment that can be delivered at scale, with pharmaceuticals often the first recourse, and short-course cognitive behavioural therapy also sometimes available. Many have benefited from these forms of treatment, but not everyone. And, of course, if a therapy is not effective, it cannot be cost-effective, however inexpensive. Indeed, ineffective therapies can make things worse, even aside from the waste of time and money: failed attempts to mitigate or manage a condition can increase a sense of hopelessness and desperation.
Social prescribing – where activities of ordinary life, such as art, music, gardening or sport are offered as a form of therapy – is much talked about but the sums currently involved are tiny in comparison to the need.
The NHS has been aware for some time that it will need innovative approaches if it is going to have any chance of reaching unmet mental health needs. Often, we talk of “pockets” of unmet need, but in the case of mental health need this language barely scratches the surface. Social prescribing – where activities of ordinary life, such as art, music, gardening or sport are offered as a form of therapy – is much talked about but the sums currently involved are tiny in comparison to the need. For example, in 2022 the Conservative Government announced a £3.6m fund to build on previous initiatives, which were said to have helped 10,000 people.
While there is uncertainty about the benefits of social prescribing so far, and it hasn’t helped that its roll-out in the UK coincided with the COVID-19 pandemic, there are nevertheless, shining examples of what could be achieved with the right commitment and resources. One such is Outsider Music which is a small Community Interest Company that focuses on individuals with complex mental health needs and offers a unique music-based therapy. Through an intensive programme working with therapist Jon Hall (one of the authors of this piece) participants are supported to write, record, and even perform songs to a high standard, even if they have had no experience of doing so before. A wide range of people have benefitted from this programme, ranging from teenagers with severe eating disorders, to adults with schizophrenia, brain damage and diverse mental and physical health issues. From regular project evaluations, it is clear that those who participate in the programme find it a highly fulfilling experience. Participants, when interviewed, say that not only do they feel that they have developed their musical skills, but also that they felt more engaged with a community. Most found the programme enjoyable in itself and for some, it revealed a potential that they barely knew existed.
Small, short-term funding has allowed schemes such as Outsider Music to demonstrate their worth. Independent evaluations of pilot schemes show that participants report that they develop their individual creativity, reduce isolation, as well as developing coping strategies, improving wellbeing, self-esteem, and stress relief. During the programme they feel part of a particular social network, and many were able to increase their engagement in a wider community.
At the same time, the drip-feed nature of funding from a patchwork of funders, including, private philanthropy, and, indirectly, The Arts Council and the NHS, has often led to frustration among providers of social prescribing, who report spending disproportionate time and effort scrambling for the resources to provide their services with one 2020 survey with more than 300 participants reporting: “Funding was by far the biggest concern for all those involved in this review. In our interviews and workshops, and in the online survey, respondents consistently identified funding as the highest priority issue to enable effective social prescribing.” For example, Outsider Music has not been able to deliver its services at any scale, and struggles to maintain continuity even when pilots have been evaluated as highly successful. Currently, within the general social prescribing landscape, some funding is made available for link workers who connect patients with existing voluntary services, but organisations delivering services have found it harder to access the resources they need.
The NHS has been aware for some time that it will need innovative approaches if it is going to have any chance of reaching unmet mental health needs.
Here, of course, concerns about the cost, and even the possibility, of delivering at scale arise. Many schemes such as Outsider Music heavily rely on particular individuals to deliver services, and a first step towards scaling up services would seem to be train a cohort of therapists who can offer similar services. This would be a considerable risk, though. The training would be expensive and if funding for services is not later made available the training would be futile. Outsider Music has therefore proposed a type of “snowball” method of increasing and sustaining services, where the participants in the group themselves acquire the skills first to continue projects with minimal outside support, and then, ideally, to offer similar services to others. In this way funding provided can be immediately put to therapeutic use and also, potentially, to scale up services. It would not be quick, or easy, but this type of organic growth may be the best chance for such services to take hold.
Social prescribing is often linked to the idea of “thriving communities“, and we see evidence that the collective nature of programmes developed by Outsider Music draw in not only a community of participants, but a wider community of family, friends, neighbours and service professionals. Without continued, and indeed increased, funding, such communities are hard to sustain and will wither. Now is the perfect opportunity to assess the benefits – and failures – of examples of social prescribing and to bring it more firmly into the public health landscape, without putting unreasonable strain on those who deliver.
All articles posted on this blog give the views of the author(s), and not the position of LSE British Politics and Policy, nor of the London School of Economics and Political Science.
Image credit: Simon Kadula in Shutterstock
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