An investigation into the treatment of patients with mental health disorders using outdoor activity based social prescribing programmes

An investigation into the treatment of patients with mental health disorders using outdoor activity based social prescribing programmes: A social prescribing programme study investigating health outcomes, quality-of-life and cost effectiveness, and a qualitative evaluation of the theoretical model and the long-term/post intervention impact.

"Social prescribing - sometimes referred to as community referral - is a means of enabling GPs, nurses and other health and care professionals to refer people to a range of local, non-clinical services." (Public Health England, 2021). Whilst many social prescribing projects have been completed across the UK, research has been broadly carried out by charities at a small scale and targeting self-reported wellbeing improvements alongside social return on investment studies (Muskett, 2023).

There is currently limited validated evidence on the effectiveness of social prescription, partly because of difficulty in capturing the changes schemes have made in individual's wellbeing in a way that is statistically significant, and also due to the limited information on the long-term impact and behaviour change post programme (Health Action Research, 2022).

We propose two phases of study to better understand health outcomes and cost effectiveness of social prescribing compared with conventional therapy, and to investigate the theoretical model behind the intervention programme. Brief overview of the academic literature in social prescribing

More than 15 million people in the UK live with one or more long-term health condition, and one adult in six in England has a common mental disorder (Naylor et al, 2012; McManus et al, 2016). In 2022/23, the NHS planned to spend £12.8 bn on mental health services (BMA, 2022). Social prescribing has the potential to alleviate pressure on the NHS by working with patients in primary and secondary care settings to deliver better early-stage outcomes by preventing hospital admissions and lowering the number of GP visits (Makanjuola et al., 2023).

Academic literature on social prescribing projects concentrates on relatively small social prescribing interventions. Studies so far suggest improvements in mental and physical health for patients, as well as a positive social return on investment into projects, however, there have been limited studies with control groups and no clinical trials of interventions in the UK (Pescheny et al, 2020).

A 2020 systematic review was critical of the state of the literature, particularly with regards to evaluation methods, although it also stated positive indications that programmes have had a beneficial impact on patients (Pescheny et al, 2020). A qualitative study of service user perceptions found the holistic method used in social prescribing to be useful in tackling complex and long-term health problems (Moffat et al, 2017).

At present, there is mixed evidence as to the effectiveness of social prescribing (Carnes et al, 2017), and differences in evaluation quality might be contributing to some of this mixed evidence. As such, it is unclear whether social prescribing is effective and how.

In our proposed research, we hypothesise that patients who engage with social prescribing programmes alongside routine care will have improved health outcomes and a reduction in the number of GP visits and hospital admissions. Further, we hypothesise that social connectedness and access to green spaces will play an important role in the theoretical model of the intervention programme.