Social prescribing complements clinical care

What's the issue?

Social prescribing involves referring people to non-clinical care to address or prevent negative effects of the social, environmental and economic factors that are closely linked to health and wellbeing. These factors are commonly referred to as the social determinants of health.

Mental health and wellbeing are most commonly supported through traditional models of clinical care (medical care and treatment provided by healthcare professionals, such as doctors, nurses and therapists). Clinical care alone may not always be able to support people experiencing mental health concerns and distress. In many cases, clinical care providers and staff do not have the skills, resources or time required to address the complex needs of individuals.

Attending to people’s needs through social prescribing often addresses the social determinants of health and broader health concerns. Many psycho-social risk factors such as physical illness, mental health concerns, loneliness and other socio-economic factors can be addressed through social prescribing, and it has been found to be effective in reducing depression and anxiety.¹

In Australia, there are a growing number of programs featuring social prescribing however there is limited literature showing the benefits in suicide prevention.

What was done?

Researchers conducted a rapid literature review by searching four databases (Medline EBSCOhost, PsychInfo, Wiley and Sage) as well as grey literature, for publications relating to social prescribing and suicide.

Publications were included if they:

• addressed social prescribing for suicide or suicide risk factors
• included an evaluation component
• included referral outside of the medical system
• were published in English
• did not include community referral (for example, referred only to an emergency department or helpline), and
• focused only on a standalone suicide prevention intervention (for example, gatekeeping).

Publications were excluded if they:

• did not include an evaluation component
• were not explicitly about suicide
• were not about social prescribing, or
• a full text could not be sourced.

3,063 publications were identified from all databases. Eight publications met the inclusion criteria and were included in this rapid review. Six additional publications were identified from the authors’ libraries and included. The total number of studies included in the review was 13.

What was found?

The researchers examined the literature in three key areas.

Area 1: Social prescribing to address risk factors of suicide

Studies showed that social prescribing programs had positive outcomes, including decreased use of services like general practitioners and social workers, reduced loneliness and enhanced sense of belonging.

The literature indicates positive impacts through social prescription initiatives on suicide risk factors such as loneliness, belonging, social connectedness and sense of purpose.

Area 2: Social prescribing for suicide bereavement and prevention

Three studies included information about support groups and programs for those bereaved by suicide. These studies found there was difficulty in engaging people with social prescription-based programs, possibly due to stigma, and that social prescription programs may be best suited as early intervention programs rather than during periods of crisis and emotional distress.

Area 3: Social prescribing pilots in Australia

Several social prescribing programs targeting risk factors associated with suicide have been trialled and evaluated in Australia.

Included in the review was a 2021 paper by Aggar et al.² describing Australia’s first social prescribing pilot program (Plus Social) for individuals with mental illness (mood and psychotic spectrum disorders). The results indicate that participants who completed the program experienced significant improvements in psychological and physical quality of life, health satisfaction and self-perceived health status. The results however showed no significant differences in social participation and self-rated loneliness.

MATES in Construction is another social prescription-based program that has been evaluated. The evaluation showed that the MATES program was effective in improving mental health and suicide literacy among participants, helping intentions and reducing stigma surrounding mental health. These results were positively related to a reduced suicide risk in the construction industry.³

Australian research by Dingle et al.⁴ evaluated a social prescribing project addressing loneliness in adults in Queensland. There were significant positive effects on loneliness and trust among those in the program who received social prescription initiatives compared to those who only received clinical care.

The authors note that there were limited studies in this rapid review which may have restricted the findings of the review.

Overall, the review found that:

• Acceptability of social prescribing by health providers and consumers is important for initiatives to have a positive impact.
• Triage and referral pathways are necessary for social prescription initiatives to increase participation. Warm and person-centred approaches by triage and referring staff play a role in the uptake of social prescription initiatives and can improve trust between individuals and clinical care providers.
• Social prescription initiatives may be best suited to people who are not in crisis and may be more willing to participate.
• Clinical providers may require additional training and resources to support those with a high risk of suicide to identify the suitability of social prescription initiatives.
• Digital-based social prescription initiatives are being explored for suicide bereavement.

Why is it important?

Evidence surrounding social prescribing models that address suicide prevention through reducing risk factors is only just beginning to emerge in the literature. The literature indicates positive impacts on suicide risk factors such as loneliness, belonging, social connectedness and sense of purpose.

Referral pathways to access social prescribing initiatives are important to encourage uptake and acceptance for individuals.

Although social prescribing does not replace clinical care it can support individuals in ways that clinical care cannot and has the potential to enhance care approaches for individuals.