Can social prescribing support the COVID-19 pandemic?

On behalf of the Oxford COVID-19 Evidence Service Team.

BACKGROUND
Much of the world has now implemented social distancing to delay the spread and, it is hoped, impact of the COVID-19 pandemic. The evidence for social distancing suggests that is appropriate for reducing transmission and delaying spread. However, it comes at a cost. Some of this will be economic, with adverse effects on business, trade, and gross domestic product. These may be easier to quantify and possibly manage than other costs from social distancing, such as extended isolation, disrupted mental wellbeing, and loneliness.

Loneliness and the role of social prescribing
Less than two years ago, the government published a strategy for tackling loneliness. It marks the importance of social connections for health, absence of which has been linked to problems such as cardiovascular disease, poor cognitive function, low immune system, and depression. Fast forward to the current situation, in which people are advised to avoid social activities, non-essential travel, and unnecessary visits to relatives or friends. There is a risk that well-being and feelings of connectiveness will plummet and health deteriorate as a consequence. Those living alone may be at particular risk, although loneliness can trouble all members of society, including those in families and younger people.

Under normal circumstances, social prescribing is a key initiative to address loneliness, and other social factors affecting health. Like all areas of life, it has been and will continue to be disrupted by the COVID-19 pandemic. Social prescribing refers to the use of ‘community assets’ (e.g. local organisations, charities, events, groups) to address ‘non-medical’ challenges (e.g. isolation, bereavement) that can affect how people feel physically and psychologically. It is central to the NHS long-term plan and is proposed as a way to ensure that patients receive assistance with their social, economic, or environmental needs. However, it does rely on the use of voluntary services or local activities, many of which will be closed for the near future.

An amended role for link workers
Link workers have been introduced into primary care networks (PCNs) to facilitate implementation of social prescribing. These employees have time to talk to patients, to understand what matters to them in terms of their personal well-being priorities, and to assist them in accessing community assets to reach these goals.

The current COVID-19 pandemic has already altered their role. Community-based activities like Parkrun, luncheon clubs, or volunteering at museums, often proposed as part of social prescribing, have all been put on hold. Link workers can still play key roles during the current pandemic. New guidance from the National Association of Link Workers suggests that its members should hold video or phone appointments with patients and promote existing initiatives that help people feel connected to others.

Virtual connectivity
Ensuring that social prescribing is sustained during this period of uncertainty is going to call for creativity and a search for safe alternatives, which do exist. For example, online singing groups have been developed so that the power of music in bringing people together can be maintained. There are virtual reading groups for book lovers or communal movie watching for those who enjoy films. Individuals can connect with people from the past or with other cultures through online museum collections and those held at National Trust venues. And there is the possibility of learning a new language through a smartphone or tablet.

Social media can also be used to unite communities. Online communication enables people to engage in social interaction, to build social skills, and to develop more positive views about life. And it is not the preserve of younger generations; studies report that social networking (e.g. through WhatsApp) is acceptable to older people as a medium for relieving loneliness. Video-calls, to keep those in care homes connected to family members, have likewise shown promise, although potential barriers have also been identified by researchers (e.g. staff turnover, lack of commitment from relatives).

Advice has been produced about keeping in touch with others during the COVID-19 pandemic. This is where phones come into their own. Befriending services that already exist, or have been established in the light of advice about social distancing, can provide reassurance, enabling people to re-engage with their community and to feel that life has meaning. Investigators exploring telephone befriending have noted that the non-visual element could be advantageous, prompting users to be more open and to express their concerns to the person listening to them.

A report by the organisation NESTA has highlighted the power of technology to be life enhancing. In addition, in a systematic review Hagan and colleagues concluded that technology centred initiatives were effective compared with other approaches when exploring interventions to reduce loneliness. This may provide reassurance about the use of technology-based provision at a time when it is the best available option for keeping people connected.

Drawing on social capital
Social capital refers to the resources and links that can accrue from contacts in society that may be: bonding (close-knit networks that produce feelings of solidarity and reciprocity; links developed with like-minded people, with some form of shared identity) or bridging (weaker ties, with less emotional closeness, that are useful for gaining information or developing a new perspective; entails being part of a heterogeneous grouping). Our recent review on the link worker role has underlined the importance of social capital for implementing social prescribing optimally.

The current need for social distancing does not necessarily negate the ability to draw on social capital, as it may be accessed via online communities. Engagement in such groups increases opportunities for interactions, thus expanding a person’s social network, through which they can receive support and assistance. The Guardian has recently reported that in the UK alone, Facebook has facilitated the formation of an estimated 300 local support groups to help people cope during the COVID-19 pandemic. The combined membership of these groups now totals more than a million people. These online connections are being translated into practical actions (e.g. people volunteering to run errands and check on others). For example, COVID-19 Mutual Aid groups are growing across the country to support older or vulnerable people during self-isolation. Likewise, community care volunteering programmes have been set up to help with a range of activities such as shopping and preparing meals. This can be beneficial to those receiving assistance and to volunteers, as we know that giving back to society in this way, and feeling able to help others, can build individuals’ sense of self-worth, skills, and confidence.

CONCLUSION
An outcome of the COVID-19 pandemic may be persuading people to reflect on what really gives their life meaning. Humans are social creatures, who tend to flourish from a sense of belonging and wane when contact is absent. Hence, social prescribing, link workers, and social capital may be more important now than ever. How social prescribing is to proceed in the months ahead will be a challenge, requiring adjustments and imaginative solutions. It is likely to call for more proactivity (e.g. link workers making regular phone calls to keep in touch with potentially vulnerable people). Link workers should be afforded the space and support necessary to identify alternative ways of helping people to feel less isolated. They may be joined by other members of society, who want to offer community care through volunteering and organised programmes of support. Collectively, this should be seen as essential work, if social isolation and loneliness are not to become severe consequences of the COVID-19 pandemic.

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Disclaimer: the article has not been peer-reviewed; it should not replace individual clinical judgement and the sources cited should be checked. The views expressed in this commentary represent the views of the authors and not necessarily those of the host institution, the NHS, the NIHR, or the Department of Health and Social Care. The views are not a substitute for professional medical advice.