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The trouble with social prescribing for mental illness

23 July 2018

2:55 PM

23 July 2018

2:55 PM

It’s a measure of how much the debate around mental health has changed that Matt Hancock’s latest announcement on social prescribing for mental illness isn’t being written up as mere quackery. The Health and Social Care Secretary today pledged a £4.5 million fund for these schemes, which include gardening, arts clubs, running and so on.

Hancock is worried about possible over-prescription of anti-depressants and the associated risk of diagnosis creep, whereby people who are not depressed but quite understandably struggling with life events such as a bereavement are given a medical diagnosis and handed pills that aren’t really going to help them. As I’ve written before, anti-depressants are not without their unpleasant side-effects, and it is extremely hard to come off them, even if your symptoms have improved dramatically, so this is a serious matter.

Social prescribing isn’t just for people who have been wrongly diagnosed, though: it is already recommended for a range of mental illnesses, including ones with far more severe symptoms than depression. Gardening, for instance, is often recommended for patients with schizophrenia.

The problem is that it’s not clear how effective social prescribing actually is. There is plenty of anecdotal evidence that outdoor exercise, gardening, social activities and so on can be good at tackling loneliness and can improve a patient’s symptoms. But a systematic review published in BMJ Open in 2017 found that the research base just isn’t there to show that social prescribing really does what its proponents claim. The researchers examined studies of patients given social prescriptions, and concluded that none of the studies were sufficiently trustworthy because they were biased from the outset, or badly-designed with only a small number of patients taking part in each.

This isn’t to knock social prescribing, by the way: it’s actually a symptom of a wider problem when it comes to treating mental illnesses, which is that there is a paucity of research into all treatments, whether they come in the form of pills or a 5k run. We don’t even know whether anti-depressants really are being over-prescribed, what the right number of prescriptions per year for these drugs would be, or even what causes the majority of mental illnesses. Scientists are leaning towards a theory that depression may have strong links to the immune system and could be akin to a physical inflammatory disease, but we don’t know that for sure either. We don’t yet know what we don’t know about mental illness, which makes it rather hard to know what the best way of treating it is.

One thing we do know, though, is that insufficient amounts of money are being spent on these conditions. Mental health charities are very keen to push the NHS Five Year Forward View given it commits to an increase in availability of some services including psychological therapies. But the fact that we don’t know enough about the causes of and effective treatments for mental illnesses shows the need for more research funding. Otherwise, the NHS risks wasting money on prescriptions of pills or social activities that aren’t actually working.

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