With social prescription, art and volunteering can become medicine

Last spring, Tia Washington, 52, a mother of three in Dublin, California, received a stern warning from her doctor: If she didn't quickly get her high blood pressure back under control, she would likely end up in the emergency room. .

He wrote her a prescription for blood pressure medication and urged her to also see a health coach. Mrs. Washington reluctantly agreed.

“I didn't want to die,” he said.

To his surprise, the health coach wanted to talk about more than just vital signs. Ms. Washington found herself admitting that she didn't like doctors (and medications). How she tended to address work or family needs before her own. How her job had created “tremendous stress”.

Together, they decided that Ms. Washington would attend two weekly exercise classes, consult regularly with a nurse practitioner, and receive free fruits and vegetables from a government “food as medicine” program.

By the end of the conversation with the health coach, Ms. Washington said, the message was clear: “Tia, pay attention to yourself. You exist.”

Ms. Washington's experience is just one example of how a practice called social prescribing is being explored in the United States, after being adopted in more than 20 other countries. The term “social prescribing” was first popularized in Britain after it had been practiced there in various forms for decades. While there is no universally accepted definition, social prescribing generally aims to improve health and well-being by connecting people to non-clinical activities that address underlying problems, such as isolation, social stress and lack of nutritious food, which have proven to play a crucial role in influencing who is well and for how long.

For Ms. Washington, who is among thousands of patients who have received social prescriptions from the nonprofit Open Source Wellness, the experience has been transformative. She found a less stressful job, started eating healthier and learned simple ways to move more during the day. About a year later, she was able to stop taking blood pressure medications altogether.

Elsewhere in the United States, similar programs are underway: At the Cleveland Clinic, doctors prescribe nature walks, volunteering and ballroom dancing to geriatric patients. In Newark, an insurance company partnered with the New Jersey Performing Arts Center to offer patients glass-blowing workshops, concerts and museum exhibits. A nonprofit organization in Utah is connecting mental health patients with community gardens and helping them participate in other activities that give them meaning. And universities have begun directing students to arts and cultural activities such as comedy shows and concerts as part of their mental health initiatives.

The approach has also caught the attention of the Federal Reserve Bank of New York's community development team, which will bring together experts over the next year to discuss how social prescribing can help improve well-being in low-income neighborhoods.

The referral process is not new among community health professionals and social workers. Social prescribing differs in that it provides a kind of accountability coach, called a liaison worker in Britain, who assesses clients' needs and interests and then puts them in touch with local organisations, including voluntary groups and cultural institutions.

In recent years, England's NHS has recruited 1,000 new liaison workers, with the aim of making social prescribing available to 900,000 people by 2024. But implementing such a plan in the US, which does not have of a socialized healthcare system would be much more complicated, experts say.

“There is reason to be skeptical about how far it will go,” said Daniel Eisenberg, a professor of health policy and management at the Fielding School of Public Health at the University of California, Los Angeles. “Our healthcare system tends to only make very incremental changes, and I think all the biases built into the system favor more acute medical care and intensive care.”

If social prescribing can help keep people out of emergency rooms for routine complaints, which could save billions of dollars, that could provide further incentive for health insurers to help cover costs, experts say.

Horizon Blue Cross Blue Shield, New Jersey's largest health insurer, is participating in a study examining whether an arts prescription program will improve patients' quality of life and reduce health disparities. Later, the company will find out whether prescriptions can also save money by decreasing patients' reliance on emergency rooms for routine health care needs.

While previous research on social prescribing suggests that it can improve mental health and quality of life, and that it may reduce doctor visits and hospital admissions, many of the studies have been small, based on patient self-reports, and conducted without a panel of check.

The potential benefits have made social prescribing “a really hot topic,” said Jill Sonke, director of research at the University of Florida's Center for Arts in Medicine. She is working with British researchers to identify all the social prescribing programs in the United States – the number now exceeds 30 – and find out what has worked and what hasn't.

The programs are not a panacea, Dr. Sonke said, and there are many possible pitfalls in implementing them on a larger scale in America. If social prescriptions are not accessible to uninsured or underinsured people, for example, or if people do not feel welcome in the places they are referred to, then “the system is not doing what it is supposed to do.” she said. “It's really about everyone having access to wellness and prevention,” she added.

In January, Stanford University and Rutgers University-Newark began prescribing arts and cultural activities for students as an expansion of the schools' mental health services. At Rutgers, students can attend cultural events in Newark for free, thanks to a partnership with the New Jersey Performing Arts Center. At Stanford, students are referred to campus events such as concerts, art shows or specialized classes, and prescriptions are handled by Art Pharmacy, an Atlanta start-up that also provides art prescriptions in Georgia and Massachusetts.

At both schools, any student, including those without mental health issues, can request a referral from a trained member of staff. Rutgers student leaders can also make references.

Kristi Maisha, a Stanford graduate student studying civil engineering, said she decided to participate because she wanted to take a break from the intensity of her academic schedule.

“It's not very beneficial to stay in that headspace all the time,” he said. “So I was definitely looking for something to get me out of all that.”

Ms. Maisha chose to attend an improvisational dance class led by a choreographer, although she showed up with some trepidation. “What am I doing?” she thought as class began.

But he followed the instructor's lead, contorting his torso, limbs and even his face into new shapes, using his body rather than his brain. The class became symbolic of simply living in the moment, she said, and she felt freed from the “planned, predetermined thoughts” that often limited her.

“Now that I know it's actually a good time, I'm more likely to do it, whether they prescribe it or not,” she said.

Audio produced by Kate Winslett.

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