Prescribing for mental well-being

1. Prescribing for mental well-being Dr Lynne Friedli Fit for Purpose 2010 4th National Conference on Social Enterprise and Health Improvement Thursday 23rd April 2010 Perth

2. I did not hear the bird sounds They had left I did not see the speechless clouds I saw only the little white dish of my faith, breaking in the crater. I kept saying: I’ve got to have something to hold on to. Anne Sexton lynne.friedli@btopenworld.com

3. Summary To value the contribution of those whom the market excludes or devalues and whose genuine work is not acknowledged or rewarded Edgar Cahn • Social prescribing in context: the value of mental health and wellbeing • Social prescribing in action • Making it happen • Making the most of the opportunities lynne.friedli@btopenworld.com

4. What’s in a name..... Quality of life Mental health Positivementalhealth Mental capital happiness flourishing Mental wellbeing Emotionalwellbeing wellbeing lynne.friedli@btopenworld.com

5. Dimensions of mental health ‘Generally, associating with other people is good for you, and associating with people outside your own household is even better’Hennell 2008 Emotional resources e.g. coping style, mood, empathy, emotional intelligence Cognitive resources e.g. learning style, knowledge, flexibility, innovation, creativity Mental health (capital) Meaning and purpose e.g. vision, goals, spirituality, connectedness Social skills e.g. listening, relating, communicating, co operating lynne.friedli@btopenworld.com

6. Beyond diagnosis: mental distress “It gets so lonely around here that I phone myself seven or eight times a day, just to see how I am” (Phantom Tolbooth) • pain • alienation: excluded and misunderstood • guilt: inadequacy or self blame • anxiety: fear of loss, panic, chronic worry • anger: blaming self and others • loss: of identity, purpose, faith • despair: loss of hope • loneliness and isolation individuals families, schools and communities lynne.friedli@btopenworld.com

7. Mental health: why bother.....? Tend to the social and the individual will flourish Jonathon Rutherford • Mental wellbeing influences wide range of outcomes • Improving mental wellbeing saves (a lot of) money • Improving mwb delivers social (as well as economic) returns • Improving mental health reduces health inequalities lynne.friedli@btopenworld.com

8. Outcomes associated with positive mental health A worthwhile goal in itself and leads to better outcomes: • reduces prevalence of mental illness • physical health: mortality/morbidity • health behaviour • employability, productivity, earnings • educational performance • crime / violence reduction • pro-social behaviour/social integration/relationships • quality of life lynne.friedli@btopenworld.com

9. Contribution of mental health to inequalities Key domains: education/employment/behaviour /health/ consequences of illness /services (Whitehead & Dahlgren 2006)  Mental health is a significant determinant in each case, influencing: • readiness for school/learning • employability • capacity, motivation and rationale for healthy behaviours • risk for physical health (e.g. coronary heart disease), • chronic disease outcomes (e.g. diabetes) • relationship to health services, including uptake/treatment lynne.friedli@btopenworld.com

10. Social prescribing or Community referral: a way of linking people with non medical sources of support within the community - usually via primary care lynne.friedli@btopenworld.com

11. Rationale for social prescribing From why don’t they to why don’t we: communities as a source of solutions • Addressing the wider determinants of mental health • Expanding treatment/support options • Strengthening social networks/support • A route to reducing social exclusion • Increasing access to mainstream opportunities for people with mental health problems • Activities which are open to anyone lynne.friedli@btopenworld.com

12. Who is it for? • Vulnerable and at risk groups • People with mild to moderate depression and anxiety • Frequent attenders (attend GP more than 12 times per year) • People with long term mental health problems • General population lynne.friedli@btopenworld.com

13. Social prescribing and the determinants of mental health Relationships Increasing social support, networks, collective efficacy Material resources Increasing access to resources/assets that support mental wellbeing Prescribing for mental wellbeing Activities Opportunities to do things that support wellbeing: art, learning, walking, growing food Inner resources Strengthening psycho-social, life skills and resilience lynne.friedli@btopenworld.com

14. Examples of prescribing for mental health • Computerised therapies/CCBT • Self-help/support groups • Bibliotherapy/books on prescription • Exercise on prescription • Arts on prescription • Green activity/ecotherapy • Learning/education on prescription • Volunteering • Supported employment • Timebanks lynne.friedli@btopenworld.com

15. Five ways to well-being Commissioned by the Foresight Project to summarise the evidence from the Mental Capital and Wellbeing Project into 5 key messages lynne.friedli@btopenworld.com

16. Positive steps Individuals • Valuing yourself and others • Talking about your feelings • Keeping physically active • Eating well • Drinking in moderation • Keeping in touch with friends/loved ones • Caring for others • Getting involved/making a contribution • Learning new skills • Doing something creative • Getting in touch with your spiritual side • Contact with nature • Seeking Help Communities Policy lynne.friedli@btopenworld.com

17. Social prescribing: the evidence arts and creativity; physical activity; learning; time banks • human capital (knowledge and skills) • social capital (trust and interdependency) • identity capital (self image, efficacy & confidence) • economic capital (jobs, inward investment, enterprise) • environmental capital (green, blue, wild space) lynne.friedli@btopenworld.com

18. From community referral to mental wellbeing: possible pathways activity Economic capital Human capital Identity capital Social capital Environmental capital Mental health and well-being Adapted from research from the Centre for Research on the Wider Benefits of Learning (http://www.learningbenefits.net/) lynne.friedli@btopenworld.com

19. Bradford South & West PCT CHAT “Personally I’ve made twenty-one referrals into it, a lot of older, isolated, people who have just moved into the area and don’t know the area, one lady who got bereaved two or three years ago and hasn’t quite got over it…a few younger ones, depressed but perhaps just need some advice about benefits or courses in reading or writing or computers.” Community health advice scheme for • patients with non-clinical needs • to facilitate links between primary care and the community and voluntary sector. lynne.friedli@btopenworld.com

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21. Social Prescribing: Referral Form http://www.bolton.nhs.uk/your-health/socialprescribing/sp_refform.asp lynne.friedli@btopenworld.com

22. Commissioning and Referral Pathways Local Government Wild swimming club NHS Health Boards Food Train Primary Care SLA Community Referral Hub Time bank • Referral criteria • Feedback loop Community Garden Healthy Living Centre Citizen’s advocacy You can Cook! Art Alley Reading for pleasure Workers Education Institute lynne.friedli@btopenworld.com

23. Pathways and Protocols • Referral routes: how do people access activities? • Primary care/’hub’/self/liaison worker • Referral criteria: who ‘qualifies’? • Referral feedback: who records impact/outcomes? • Level of support people receive • Signposting: website, directory, open days • Prescription • Supported referral: practical support, liaison, buddying lynne.friedli@btopenworld.com

24. Linking social prescribing to wider goals inCommunity Plans, Health Improvement & Council Corporate Plans, Prescription for learning Time banks Working and learning Successful and inclusive Supported employment Volunteering Bibliotherapy Equalities Debt, benefits welfare advocacy Health improvement Arts on prescription Exercise on prescription Regeneration/environment Ecotherapy/ growing for health Green gyms lynne.friedli@btopenworld.com

25. Single Outcome Agreements The Single Outcome Agreement is the means by which Community Planning Partnerships agree their strategic priorities for their local area and express those priorities as outcomes to be delivered by the partners, either individually or jointly, while showing how those outcomes should contribute to the Scottish Government's relevant National Outcomes lynne.friedli@btopenworld.com

26. Scottish Government, Local Government, NHS: Concordat, Outcomes and Local Delivery Scottish Government Community Planning Partners North Lanarkshire Community Health Partnerships South Lanarkshire Community Health Partnerships NHS Lanarkshire VCS South Lanarkshire 4 localities MHI Local Delivery Plan North Lanarkshire 6 localities Community referral activities lynne.friedli@btopenworld.com

27. STRATEGIC OBJECTIVES NATIONAL OUTCOMES NATIONALINDICATORS AND TARGETS Wealthier & Fairer Wealthier & Fairer Smarter Smarter Healthier Healthier Safer & Stronger Safer & Stronger Greener We have strong, resilient and supportive communities We give children the best start in life Scotland performs: National Outcomes We live longer, healthier lives We have tackled the significant inequalities in Scottish society Increase the average score of adults on WEMWBS by 2011 Plus non-health indicators Reduce the number of psychiatric hospital readmissions Employment Education Safe from crime etc Reduce suicide rate by 20% by 2013 (plus enhanced education and training) Reduce rate of increase of use of anti-depressants to zero by 2009/10

28. Outcomes triangle Mental Health & Wellbeing Resilient communities Children have best start Tackled inequalities Longer healthier lives Improved life chances National outcomes Improved healthy life expectancy Increase quality of life High level outcomes Reduce mental illness Reduce suicide Improve mental wellbeing (WEMWBS) Increased Healthy behaviour Increased General health Increased learning & development Increased emotional intelligence Increased meaning & purpose Individual behaviours Intermediate outcomes Increased Equality Increased Social inclusion Increased Participation Increased Safety Social, economic & physical environments Increased Trust Stronger social networks Decreased Discrimination Increased Financial security & less debt Better Working life Greater social support Better Physical environment Deceased Violence Service delivery outcomes Short-term outcomes related to service delivery Activities

29. Making the most of the opportunities Place shaping: the creative use of powers and influence to promote the general wellbeing of a community and its citizens Lyons Enquiry • Commissioning for outcomes • Commissioning for social value & social return • Co production & core economy: redefining ‘provider’ • Power of Well-being , Duty to Involve & ‘Total Place’ lynne.friedli@btopenworld.com

30. How community referral responds to the determinants of mental health Resources, relationships, meaning, respect • Reducing inequalities in access to valued assets • Including social outcomes: the quality of relationships matters • Increasing opportunities for valued roles, meaning and purpose • Treating people experiencing problems with respect: vulnerability and dependency are part of the human condition, not a mark of moral failure lynne.friedli@btopenworld.com

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33. What if? http://www.what-if.info/SIT_IN_part1.html lynne.friedli@btopenworld.com

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35. Select bibliography • Friedli L et al (2008) Social prescribing for mental health: a guide for commissioning and delivery CSIP North West Development Centre • Friedli L (2008) Mental health, resilience and inequalities WHO http://www.euro.who.int/mentalhealth/topics/20090309_1 • Scottish Development Centre for Mental Health (2007) Developing social prescribing and community referrals for mental health in Scotland • Woodall J an d South J (2005) The Evaluation of the CHAT Social Prescribing Scheme in Bradford South & West PCT http://www.lmu.ac.uk/health/healthpromotion/chpr/reports/chat.pdf lynne.friedli@btopenworld.com