Doctors Are Writing 'Social Prescriptions' For Depression, Anxiety

TORONTO — When Tammy McEvoy was asked to share her time and crafting talents to engage with other patients at her local health centre, she ended up getting back as much as she gave — maybe more.

McEvoy is one of 15 “health champions” at the Belleville and Quinte West Community Health Centre taking part in an innovative Ontario pilot project in which doctors or other practitioners write out a “social prescription” for patients experiencing depression, anxiety or loneliness that affects their sense of well-being.

The concept — prescribing a social activity like taking a yoga class, visiting an art gallery or joining a knitting circle — has proven to be an effective tool in the U.K., where research has shown that not only do patients benefit from a mental-health boost, but many also end up with reduced medications and find less need to visit their doctors.

Since the pilot project began in October, McEvoy has taught classes on wreath-making, and cooked an evening meal for an addiction group meeting at the centre’s Quinte West site in Trenton, Ont.

The wreath-making classes brought together 16 participants. “The first one I did, I watched magic happen because they all started helping each other,” says the 52-year-old self-described empty-nester who’s often alone while her husband works long hours.

“I’ve spent the last six years not working and not being out because of health reasons,” says McEvoy, who has a heart condition. “But now I can go there, I’m comfortable there.

“It helps me just as much as it helps them.”

Meghan Shanahan Thain, a social worker at the Trenton health centre, says the program is based on a U.K. collaborative practice model called Altogether Better.

“So people come up with their own ideas based on their own talents and skills, but they also have a lens that we don’t see in terms of what the community needs and what our clients need,” she says of the health champions, who included a singing circle in the social activities on offer.

On one occasion, “we had two people who are widowed who connected to each other and just sang,” she says. “A girl from the community showed up with a guitar.

“Music really brings people together, but it also taps into the socially isolated folks as well … Just having a social connection has a lot of health benefits. Being socially isolated can make us sick in a lot of different ways.”

The 18-month pilot project, supported by a $600,000 Ontario Health Ministry grant, is being spearheaded by the Alliance for Healthier Communities, which represents more than 100 primary health-care organizations across the province.

The grant allowed the Alliance to trial social prescribing in 10 of the centres, with a goal of evaluating benefits to patients, says Kate Mulligan, director of policy and communications.

“One example from Thunder Bay that really resonates is there’s a long-haul trucker who was experiencing social isolation and he started up a knitting group at the community health centre,” she says, adding that it’s especially satisfying to see a person in need become a volunteer to help others form social connections.

“They start to recognize their own value and self-worth when they’re participating and contributing to the community,” Mulligan says. “So you’re not just seen as a patient with deficits and problems, but you’re a person who has something to offer.”

Another of the pilot sites is the Rexdale Community Health Centre in Toronto. A large proportion of patients are recent immigrants or refugees, who are at risk of social isolation that can lead to depression and anxiety, says Dr. Sonali Srivastava, a primary-care physician on staff.

“Really, the research is showing us that social integration is a major part of people’s level of happiness and health,” she says. “If there’s a social component in there that is missing, we need to address it.”

That could mean writing a prescription for a patient to join a tai chi class, for example, or to tour a museum or art gallery.

Indeed, the Montreal Museum of Fine Arts (MMFA) and the Royal Ontario Museum (ROM) are two cultural institutions in Canada that have embraced the idea of coupling social activities with health and well-being.

A recent study conducted by the MMFA, McGill University and the Jewish General Hospital found that seniors who participated in drawing and painting workshops reported an improved sense of well-being, health and quality of life.

Starting in January, the ROM will begin providing 5,000 sets of free passes to patients with social prescriptions for a tour of its exhibits for themselves and three companions, working with 20 of its ROMCAN (Community Access Network) partners in the Greater Toronto Area, including the Alliance for Healthier Communities. The program will then be rolled out to the other 80 partners in the network.

Jennifer Czajkowski, deputy director for engagement at the Toronto museum, says research has shown that museums can be restorative environments for visitors.

“They’re with other people, also people are able to see objects that might be from their own heritage, things that help them connect to their own culture or to the cultures of others, other times and places,” she says.

“These things can all help to alleviate a sense of loneliness.”

Srivastava says social prescribing reflects a change in how the medical community views health and wellness and the role that doctors and allied practitioners can play.

“If I just tell somebody verbally ‘I want you to go for a walk for 30 minutes, three times a week,’ they’re less likely to do it than if I were to write it down on a prescription pad,” she says.

“Usually we write down medications, right? But when it’s put on a pad of paper and a doctor writes it down and signs it, all of a sudden it means it’s serious.

“And I believe the reason why it’s important is because we forget that health is not only about physical well-being and mental well-being, it’s also about social well-being.”