Social prescribing: coffee mornings, singing groups, and dance lessons on the NHSBMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4857 (Published 19 November 2018) Cite this as: BMJ 2018;363:k4857
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The separation of medicine from spirituality is wrong. Various belief systems can be respected while medical care would still be evidence based. What’s in vogue now is practitioners advancing their own spiritual biases, ignoring their patient’s faith. We are in a new era of medicine and spirituality. The drive for social prescribing is undergirded by overwhelming research validating the value of social relationships in almost all aspects of health.1 At the same time the advances in technology, including social media, is the major driver in furthering the social benefits of spirituality. Western medicine in particular separated from religion to the detriment of both. Humans are social creatures with only 7% of the world’s population being atheist2 and only 16% are not affiliated with any religion.3 Historically medicine can easily count numerous instances where religious beliefs have resisted, interfered with, and harmed the advancement of medical care along with harming medical professionals personally.4 With that said, the lumping of all religions and beliefs together would be as erroneous as lumping quackery and evidence based treatments together. The reality and necessity of social prescribing forces the recognition of the relationship between spirituality and medicine.5
Prior to prescribing, social groups can be rated based upon their effects.
1. History and stability of organization
2. Patient’s prior relationship with organization
3. Physical and mental safety of organization
4. Level of encouragement of mental and physical health
5. Organization’s ability to offer various programs as opposed to accessing multiple organizations to meet various needs.
6. Openness of group to outsiders of different cultures, races, socioeconomic levels and beliefs
7. Empowerment for youth, women and elderly
8. Safety from sexual abuse and corporal punishment
9. Organization’s desire to access tools and information to enhance their ability to help members achieve health objectives
10. Freedom of members to leave the organization for any reason
The physician particularly does not have control of the patient’s life but their impact can be intimidating. White coat hypertension is one example.6 The physician carries the most dominate advice and the use of that weapon to create relationships with other individuals could create life changing effects. Relationships affect behavior which is why social prescribing works so well. Religions shape beliefs which establishes the framework for relationships.7 Injecting the power of the physician’s advice into those relationships could unravel social systems that have existed for decades. In the cases of abuse and bondage, this would be excellent, but for nurturing, positive relationships the results could be damaging.8 Social prescribing may even lead to strong friendships and love.9
Historically health professionals comfortably engaged in social prescribing but compartmentalization of medicine and separation of spirituality has left a huge void in medicine. Only within the last 200-300 years have the two been clearly separate.10 This current advance of social prescribing reflects the separation in that it isn’t even mentioned.
In the article Ms. Kingston points out that social prescribing is “more about active listening, understanding what is most important to the individual, and working together to consider a broad range of options to enhance connectedness and community.” This is an excellent way to view the practice but the health professional should be equipped to see the patient in the context of that person’s life. If a physician suggests a hospital choir as mentioned in the article to aid lung function, the patient could already have a choir at their worship center singing songs associated with their faith. The hospital choir more than likely would sing songs not associated with their faith and could be totally opposite. Relationships would develop which is the actual point of social prescribing but they could end up being attached to someone who would detach them from their other relationships and value systems. Dance, meditation and other activities all have a theological nature to them which influence people’s beliefs and subsequently their behavior.
Health Professionals statistically are less religious, belonging to a higher income segment of the population and also are flocking more to eastern types of spirituality.11 Yoga, mindfulness and meditation are on the rise which will easily infiltrate recommendations, forming implicit and possibly explicit biases. Professionals are trained to conceal explicit biases but since social prescribing enters a person’s belief system, implicit or explicit biases should be openly disclosed. How could a wealthy Buddhist physician discuss with a pentecostal patient the joining of a choir without recognizing the challenges to the patient’s faith? The patient may feel embarrassed by her faith thinking it seems unintelligent. Of course an open discussion should occur with the suggested criteria in mind.The discussion of social prescribing without discussing religion is like discussing football but not disclosing that you will get tackled.
In summary, social prescribing should be standard for health professionals but it is time to rejoin religion to medicine. Nutrition is now finally moving past compartmentalization to recognize the context by which nutrition recommendations affect patient’s lives.12 It is truly not by accident that social prescribing is advancing at this time because nutrition’s cultural awareness appears to lead the way. Nutrition is the bridge of medicine to the true life of a patient. Drugs, devices and surgeries reside in the physician’s domain but food belongs to the patient. For years medicine attempted to prescribe caloric intake recommendations with exchange lists, and diet plans, then macronutrient combinations to now discussing food quality within the context of a person’s life.12 The next phase would be integrating nutrition and social prescribing recommendations within the context of person’s belief system. Many hospitals are still affiliated with religions but their doctrinal beliefs are hidden from most patients.13 A better system would be to bring together all of the resources to lead patients to live their best lives. It would be extracting the best practices of the past onto an evidenced based foundation, transparently and honestly recognizing each individual patient as a living, whole human being.
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Owner - Best Life Pharmacy and Restaurant
Adjunct Assistant Professor
Xavier University College of Pharmacy
Pastor - Faith Full Gospel Baptist Church
New Orleans, Louisiana 70119
Competing interests: No competing interests
Social prescribing of coffee mornings, singing and dance have been around for half a century or more, certainly in social psychiatric settings.
Anyone lucky enough to have seen the life enhancing effects of these initiatives, in wards for chronic and elderly patients, at Dingleton Hospital, Melrose, inspired by Maxwell Jones, needs no convincing of the benefits. (1)
Others, like David Clark at Fulbourn Hospital, Cambridge, continued his good work. (2)
Children and adults from the local communities sometimes added to the jollity.
Perhaps the benefits of two other pillars of effective therapeutic communities -- namely, multiple leadership, and group meetings which encourage horizontal and vertical communication -- may also be in need of rediscovery.
1 Maxwell Jones, Beyond the Therapeutic Community, Yale, 1962.
2 David Clark , Social Therapy in Psychiatry, Penguin, 1974.
Competing interests: No competing interests