The mental health impacts of COVID-19 are a challenge worldwide as fear and anxiety about the disease are compounded for many by isolation, housing insecurity and financial worries.
However, one potential benefit of this challenge could be that it highlights the need for our health care system to address the social determinants of health.
Below, CEO of the Consumers Health Forum, Leanne Wells, describes how the pandemic could be a catalyst for promoting social prescribing – a promising strategy for integrating a social determinants perspective into routine health service delivery.
Leanne Wells writes:
“Iso” has swiftly passed into common parlance as shorthand for the isolation living arrangements that have confined us.
Who would have thought as Australia emerged from horrific bushfires that another, even more lethal calamity was looming?
The once in 100-year scale of the COVID-19 pandemic has brought with it another dramatic impact to lives. That’s the isolation that brings a sense of social disconnect that, for many, can also bring a new level of mental anguish.
A timely catalyst
This predicament may provide a timely catalyst for Australia to consider the emerging practice of social prescribing in responding to the ill-effects of isolation that defeat conventional medical care.
And now that most parts of Australia are emerging to some extent from isolation, it is a fitting time for us to consider ways of countering the harmful mental effects of isolation which can linger for some time after the period of isolation is over.
A recent survey by the Australian Bureau of Statistics shows that while Australians are taking precautions to prevent spread of the virus, two thirds still remain concerned or very concerned about their health due to the spread of COVID-19.
And according to a separate survey by Essential Research, many thousands of people are experiencing side-effects on their mental health of loneliness and a heightened sense of social isolation wrought by COVID. Twelve per cent of Australians, according to Essential Research, are wrestling with self-isolation, struggling to maintain a daily routine and fears about their mental health. This comes are more of us, 37 per cent, are missing connections with friends and family
Loneliness, depression and anxiety
The reality of isolation is highlighting the widespread and often seemingly intractable problems of loneliness, depression and anxiety for which current services are often pressed to provide the right and timely response..
Modern medicine has no cure for loneliness and our community health systems routinely lack capacity and cohesive supports necessary to counter these conditions because they are so focused on the ‘here and now’ of managing chronic conditions.
However there is persuasive case for social prescribing as a remedy coming from people who have lived with isolation and depression and have reported their lives have been transformed after getting the right support to find fresh interests and activities which put them in touch with their community and give them a sense of purpose.
By providing the right supports social prescribing can address key risk factors for poor health, including social isolation, unstable housing, multimorbidity and mental health problems. These factors are associated with low engagement in preventive activities and low levels of self-management for medical conditions.
Social prescribing report
Social prescribing in Australia received a boost in a recent report which followed a roundtable initiative co-hosted by the RACGP and CHF in partnership with the National Health and Medical Research Council Partnership Centre for Health System Sustainability, and a consultation process.
Surveys commissioned for the initiative indicate that while many patients in Australia would welcome social prescribing, the supports to make it possible are often not available. Doctors also acknowledge the value of social prescribing, but often there are few linkages to support systems or indeed the services available to guide and support people toward non-medical solutions.
The extent to which doctors assist patients to address socioeconomic factors linked to ill-health is variable. Seventy-four per cent of physicians in Germany and 65% in the UK said they frequently coordinated patients with social services or other community providers. In contrast, approximately 40% of physicians in Australia, the USA and Canada reported the same. Further estimates suggest that approximately 20% of patients consult their GP for what are primarily social problems, according to data cited in the Social Prescribing Roundtable Report.
Social determinants
These problems are not best addressed through a clinical or pharmaceutical response; however, these interactions present an opportunity to improve health outcomes if we recognise the breadth of factors that affect a person’s health and wellbeing. Characteristics of a person’s physical and social environment can either facilitate or hinder their engagement with, and management of, their health and care.
The roundtable report says that by recognising the trusted relationship between the patient and their health professional and taking the opportunity to address the socioeconomic determinants as part of these interactions, primary health services can facilitate engagement with community services to help address the underlying causes of poor health.
The flow-on effect is a reduced reliance on health services, improved health outcomes and better value care. The recommendations in this report have been synthesised and derived from expert discussions and reflect our shared desire to see a shift from a focus on illness to wellness in the health system.
A long term approach
The roundtable urged that social prescribing be made part of the Commonwealth’s 10 Year Primary Health Care Plan, with recognition of the need for funding and support for a more comprehensive patient-focused health system.
There needs to be more support for ‘link workers’ to help connect patients to community services, identifying where skills already exist and developing training and qualifications where needed. And the report suggests governments work with local councils and community organisations to identify groups that could contribute to social prescribing scheme and that Primary Health Networks (PHNs) expand Health Pathways to include a social prescribing pathway for patients.
Such support structures can start in quite simple ways, even despite the current difficulties imposed by the coronavirus. Wyndham City Council in Victoria has introduced a Check and Chat phone at service available to anyone in the community, who may be feeling lonely and would benefit from a regular phone check in and friendly chat.
As the service says in a community notice, feeling lonely can affect people of all ages, especially when they are missing those day-to-day social interactions in our neighbourhood and may also be isolated from family and friends.
The free service is an extension of Council’s existing Social Support Service for vulnerable and elderly clients, which provides regular social support and welfare checks. Check in & Chat is a one-on-one phone chat service, where you’ll be paired with a friendly staff member for a regular chat at a scheduled time and day.
Staff can also help direct callers to other resources and organisations for support, including crisis support, counselling, mental health services and family support.
The Canadian experience
A fresh perspective comes from Canada where a pilot project involving 1,100 clients’ experience with social prescribing released just last month found that clients reported overall improvement.
Health practitioners found social prescribing helped client wellbeing and decreased repeat visits. And it enabled deeper integration between clinical care, different health practitioners and social support.
The report was produced by the Alliance for Healthier Communities in Ontario. In an accompanying statement concerning the COVID pandemic, it makes an important if somewhat disturbing point about the impact of isolation. It recalls Canada’s experience with the earlier SARS epidemic, which, even given the relatively short isolation experience, left people with longer term mental health issues.
COVID – as our most contemporary pandemic – also raises the stakes in terms of needing to invest in connected communities through a national social prescribing scheme.
Leanne Wells is CEO of the Consumers Health Forum of Australia.
