Socialisation is increasingly being prescribed by healthcare professionals as a solution to loneliness and poor mental health.
Loneliness: prevalence and its effects*
Research shows that loneliness is widespread, so much so that almost one fifth of the UK population say that they are always or often lonely. Medical professionals have noticed the prevalence of loneliness, with three quarters of GPs surveyed claiming to see between one and five people a day suffering with loneliness. With 51% of people age 75+ living alone, two fifths of them say the television is their main companion (Age UK, 2014) and around 200,000 older people have not had a conversation with a friend or relative in more than a month.
The link between loneliness and poor physical health is supported by research - loneliness increases the likelihood of mortality by 26%. Loneliness is associated with an increased risk of developing coronary heart disease, high blood pressure, and strokes.
Loneliness also puts individuals at greater risk of cognitive decline, with one study concluding that lonely people have a 64% increased change of developing clinical dementia. Unsurprisingly, lonely individuals are more prone to depression, and loneliness is a predictive risk factor of suicide in older aged people. 59% of adults aged over 52 who report poor health say they feel lonely some of the time or often, compared to 21% who say they are in excellent health.
Government's strategy for tackling loneliness
Prime Minister Theresa May deemed loneliness "one of the greatest public health challenges of our time" in a governmental report on how to tackle it, committing to improving the evidence base surrounding its causes, effects, and solutions. The report cites "to embed loneliness as a consideration across government policy" as a goal to "build a national conversation" on it, helping to reduce stigma.
"The Strategy recognises the importance of volunteering as a mechanism for tackling isolation and creating opportunities for positive and empowering social interaction. Government has set a target for
all GPs to start social prescribing to address loneliness, citing engagement in community groups as a powerful antidote", reads the report.
By 2023, all GPs in England will be able to refer patients to community activities and voluntary services - this is known as social prescribing.
NHS England estimates that 60% of Clinical Commissioning Groups (CCGs) have commissioned some form of social prescribing scheme. CCGs tend to commission schemes based upon a core model in which link workers connect people to community groups and activities based upon individual needs.
The government's report is quick to reiterate that social prescribing is more than just sign-posting. Instead, it's "a way in which people can be helped to take active steps to seek out support and engage with their communities."
More research needs to be done on social prescribing, but preliminary studies have encouraging results. For example, research found an average of 28% fewer GP consultations and 24% fewer attendances at A&E in instances where the social prescribing connector service was working well.
In order to "strengthen knowledge and share best practice on effective social prescribing", the government report pledges to create a national database of social prescribing connector schemes as well as launching an online platform for commissioners and practitioners.
Charity's report highlights the benefits of social prescribing
Following a survey of 1,629 volunteers, the RDA has created a report on the impact of volunteering on health and wellbeing and the benefits for both RDA participants and the volunteers. The report was presented at a Parliamentary Reception in Westminster, hosted by MP for Cheltenham, Alex Chalk on February 6, with the charity calling on the government to recognise the dual benefit that volunteering brings.
The people that volunteer with RDA come from all walks of life and span all ages. Many end up giving up their time as a way to help them with difficulties in their own lives. This often leads to a positive, life-enhancing improvement which is demonstrated by the findings of the RDA report.
Judi Singer was severely agoraphobic but having being a horse rider in the past she decided to join her local RDA Group in Surrey in the hope it would change her life - and it did. “To start with I was only happy leading at the horse’s shoulder and not really talking to anyone", says Judy. "I then progressed, through the kindness and understanding of my colleagues, to being able to join in the fun that everyone was having. Through the RDA volunteers’ non-judgmental understanding, I am now able to go anywhere, speak to anyone, chair meetings and speak in public.”
Of the people surveyed, 92% said that volunteering makes them feel more useful. Their moods improved too, with 84% reporting that it makes them feel more cheerful. With over 500 volunteer groups across the UK, volunteering is clearly a route to making new friends, with 78% of volunteers chatting to members of the community regularly.
The RDA is calling for local government and appropriate agencies, such as Clinical Commissioning Groups and local GPs, to signpost and refer volunteering opportunities through social prescribing, for volunteers to work with RDA.
RDA Chief Executive Ed Bracher said; “The report shows clear and robust evidence that our volunteers feel more useful and better about themselves, they are more sociable and physically active and learn new skills and gained more confidence.
“With a clear sense of our future vision and direction, RDA is committed to attracting and supporting increasing numbers of volunteers.”
- See more: "Can I even be ill if my life is this fulfilled?": challenging misconceptions of millennial mental illness
- See more: Personal budgets for mental health issues: a blessing or a burden?
"Being given a social prescription might feel like being prescribed broccoli on the NHS"
Whilst it seems that social prescribing can be beneficial, it is not a substitute for psychological therapy.
Perhaps instead of being "prescribed", socialisation could be recommended alongside other support. The benefits of therapy dogs has been documented but not under the guise of a prescribed treatment.
Kimberley Brownlee, a Professor of Philosophy at the University of Warwick, draws attention to ethical issues surrounding social prescribing. "Being given a social prescription might feel like being prescribed broccoli on the NHS", she says. "It might seem to trivialise the pain of loneliness as something easily solved with some chat, the social equivalent of eating more greens. If a GP gives someone a social prescription, he might leave her office feeling more disheartened and incompetent than when he walked in."
She raises a valid concern. It may seem patronising to prescribe socialising to someone dealing with poor mental health: a superficial short term "solution" without examining the cause. Social prescribing facilitates opportunities for interpersonal engagement, but that isn't to say that other mental health or wellbeing concerns are addressed by it. Perhaps social activities serve only to worsen existing problems rather than treat them.
A patient suffering with social anxiety may be prescribed a local group (such as cookery or gardening) in which they must interact with others, acting similarly to exposure therapy - only there's no mental health professional involved. Lacking a clinician to oversee the process and intervene if the patient becomes too distressed seems unethical. If a patient is being prescribed engagement in a potentially upsetting situation, then surely they should receive adequate psychological support whilst doing so. Attending a community group may be more anxiety-provoking than staying at home, becoming something that the patient begins to dread.
And what happens if a patient, failing to reap benefits from social prescribing, stops attending the group? Are they labelled as uncooperative? Difficult? Or perhaps they become disillusioned with mental health and social care services, becoming even more isolated. Benefiting from social prescription seems to rely upon a person's sociability. What will attending a weekly group - yet making no friends - do for a person's self-confidence?
Social prescribing also relies upon the assumption that socialising is synonymous with good mental health, failing to recognise individual differences. Different people have different thresholds for how much socialisation they need. Some people may feel burned out after an afternoon of it, others after an hour.
The government's report discusses "the importance of personalised approaches [...] given the complex and subjective nature of loneliness", yet social prescribing seems to undermine the complexity of it. If only it were always as simple as socialising - as if this hadn't crossed the patient's mind.
Loneliness is complex and often runs deeper than something that can be solved by socialising. For fmany people living with mental illness, they feel lonely in a more profound and existential way: as if no one can ever truly understand them and their experiences. Enforced socialisation may even serve to worsen this deep-seated sense of being utterly different from those around you.
As far as personalisation goes, is this a reference to whether someone is prescribed a gardening, cooking, or art class? Take your pick.
* For research citations, see Campaign to End Loneliness
Read the government's report into a strategy to tackle loneliness here
Find out more about the Riding for the Disabled Association