Social prescribing needs more evidence to support its benefits over widespread use – new study

Around every fifth visit to the therapist designed for non-medical concerns such as loneliness or financial hardship. However, these non-medical issues are known to greatly affect the health and well-being of patients. General practitioners are aware of this and want to take a more holistic approach to treatment, but often do not know how to do it. This has led to the development of ‘social prescribing’, where GPs ‘prescribe’ social activities or support for people with the help of a referral worker.

A link worker is someone who knows the community well, is a great listener, and knows how to support people to make a difference. They meet with people aimed at a social prescription, talk about what is important to them, and make a personal plan – a “social prescription”.

This may include joining community groups, support to return to work or education, accessing mental health support or making lifestyle changes such as more exercise. The Liaison Officer then helps people join groups or simply keeps in touch and encourages people to do what they are instructed to do. The length and type of link worker support is tailored to each individual’s needs.

These welfare programs (also called “social support”) are deployed in many countries, including Great Britain, Ireland, Australia and USA. Policymakers hope that social prescribing can not only improve health and well-being, but can reduce health inequalities and save money by redirecting people to more appropriate care in the community. My colleagues and I set out to see what evidence there is for this and found mixed results – although we acknowledge that proving the effectiveness of these types of programs is difficult. Our results published in BMJ Open.

We reviewed all medical studies, websites and social project reports on drug prescribing. We looked for studies that compared a group of people who met a social worker for a prescription with a group who did not (known as controlled trials – the high standard of clinical trials) and synthesized the evidence in a ‘systematic review’.

We reviewed all studies, particularly to see whether they measured quality of life or mental health, and whether they included people from disadvantaged areas or with different conditions, as these are often the focus of social care programs.

We found a total of eight studies. Three were published in the US and five in the UK.

The length of time that people could meet the link varied. Most of the studies were quite short (less than six months) and people only met the link worker a couple of times. Because there was so much variation across studies, it was difficult to find consistent evidence that link workers affect patients’ quality of life, mental health, social contact, physical activity, or primary care use.

Three American and one Scottish study included people from disadvantaged areas who also had multiple conditions. Two American studies had longer and more intensive programs in which liaison workers met with people weekly for six months and worked closely with the health system. These two studies found that people reported higher quality of care and there were cost savings due to fewer days in the hospital.

A third US study found a decrease in emergency department visits but an increase in primary care visits. A Scottish study found that people who met with a liaison worker three or more times had improved quality of life, mental health and physical activity.

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Overall, social worker assessment of referrals in this way appears to show limited benefits, but this only provides a partial picture. Social recipes are designed to vary based on individual needs and local resources, so it’s hard to tell whether or not it works on a larger scale. This approach to evaluation is also very health-focused, and the social purpose is likely to bring wider benefits to communities and society.

Our findings suggest that longer, more intensive support from liaison workers working closely with health care providers is likely to benefit people with complex needs, such as those living in disadvantaged areas and with multiple medical conditions.

At the moment, there are very few middle-level workers per capita. In Ireland, for example, a national social welfare scheme is being introduced, which will have one communications worker for every 50,000 people. To see changes in health inequalities and cost savings, our review shows that there is a need to focus on intensively supporting fewer people or increasing the availability of linked workers. Either way, it’s important to continue learning how social assignment works best so that the potential benefits can be realized.