A radical plan to address the fallout from Covid on mental health
FOR MOST his life, Frank Frost would go to the doctor and leave feeling worse. When the now retired truck driver asked GPs to help him manage his diabetes and obesity, most – as Frost recalls – “blamed” him for not eating healthier. Often, they suggested that his problems were permanent. “They told me I would be on insulin for the rest of my life,” he says.
Discouraged, he didn’t think he could improve his health and for many years he didn’t try. Her divorce didn’t help, nor did her lifestyle still on the go. “For 30 years, I had 12- to 3-hour days, living on take-out and sandwiches six days a week, and then on the weekends I just wanted to get drunk,” he says.
But five years ago, Frost had an encounter that would change the way he handled his health. When he moved to Sheffield and found Ollie Hart – a tall, chiseled-jawed GP much younger than him – he also discovered a new understanding of what healthcare could be like. Instead of reciting clinical answers, Hart asked Frost personal questions. Instead of suggesting a prescription drug, he talked about the local park’s upcoming run.
Frost always had reservations about the doctors; when he started a controversial diet that – according to a book he had read – could reverse his diabetes, he was nervous to tell Hart about it. “I didn’t want him to say, ‘Oh, you can’t do that, you don’t know what you’re doing,'” he said. But Hart offered non-judgmental support. “He even read the same book as I did,” Frost said, smiling through the hairs of his gray beard.
After spending a few sessions on Frost’s interests, Hart began to reveal some of his own, like cycling. And when he got a hunch that Frost was “sort of bored and fed up with his life,” he offered him an unusual prescription: a bike class in his neighborhood. “It wasn’t so much about controlling his diabetes as it was about helping him get out and do something,” he says.
Frost found Hart’s enthusiasm contagious, but he still had doubts. He was new to the area, did not know the roads and feared his fellow cyclists were too far advanced for him. But he quickly found refuge in his cycling prescription, run by Pedal Ready, an organization that caters largely to adults who are just starting to cycle again. Over time, beyond cycling skills and making new friends, Frost has seen tangible health benefits as well. He lost 20 kg and got to a point where he could do what other GPs once considered impossible: he stopped taking his insulin.
There is a term for the kind of prescription Hart offered Frost: a social order. Social prescribing not only serves patients with clearly “social” problems, such as loneliness or social anxiety, but can also help those with physical problems, such as dementia or cancer. The name comes from basic research by Michael Marmot and Richard Wilkinson which suggests that a person’s health is largely determined by social factors, such as their work, environment, and relationships. Social prescribing aims to address these factors, called “social determinants,” by offering people prescriptions not in the form of a pill bottle, but as activities in their local community. These can include exercise groups like Frost’s cycling class, but also music lessons, gardening projects, nature walks, or even help finding a job or housing.
Although the idea of social prescribing has been around in the UK for some 20 years, the cascading health consequences of a year of isolation have spurred interest in the practice. And, as Covid-19 quickly burns both ends of the health care candle – more patients in need of care and a health service at full capacity – more and more health workers, policymakers and patients see social prescribing as part of the answer.