Is this the solution to Ireland’s anxiety epidemic?
CAN there be anything more relaxing than sitting on the bank of a river, fishing, watching the water gently flow past, surrounded by wildlife and flowers and with the sun on your face? And might this also be a treatment for depression and anxiety? The idea is not as strange as it sounds. In fact, fishing is being prescribed as a pilot scheme in some parts of England.
It is part of ‘social prescribing’, something which has become a buzzword in medicine. It aims to view patients holistically and encourage doctors to understand there are not just biological or psychological aspects to how someone becomes ill, but social factors too.
We know, for example, that loneliness and isolation contribute to a number of illnesses from depression to heart disease.
The idea is not new. There’s a remarkable story about a young doctor called Sam Everington who in the 1980s was working in a deprived part of East London. He started a fascinating experiment after noticing how many of his patients were depressed.
WHILE training, he’d been taught the medical model of depression — that it was a chemical imbalance and so the treatment was medication which would help rebalance brain chemistry.
But he began to realise that many patients, despite being on antidepressants, weren’t getting better. He realised depression is far more complex than the medical model allows for.
It’s not just a biological phenomenon, but a social one, too. It’s no good dishing out tablets if people still feel unsupported and disconnected from the world. We are, after all, social animals.
To try to help people with this and reconnect them, he took over some unloved scrubland near his medical centre and prescribed gardening to his depressed patients. Over the months a group of them worked on the land, weeding it, tending it and planting flowers. They watched as their efforts paid off and the flowers bloomed.
Passersby would tell them how beautiful the garden looked and in time the patients were talking to each other about their difficulties and found common interests.
They started to provide the support, understanding and care for one another that, for a host of reasons, each of them had lacked in their lives beforehand.
Sam Everington is a highly regarded GP still working in East London and is one of Europe’s main proponent of the idea of social prescribing. I think his work is wonderful as I have always found the biological explanation for depression too simplistic. It doesn’t reflect what I see in my clinic.
It’s true, there are patients who, despite everything going fantastically in their lives are suddenly struck down with depression for no discernible reason. Some sort of chemical imbalance does seem to chime with this group. But for many others, their depression has a clear root in social factors. They are isolated from friends or family for whatever reason, or had a troublesome upbringing which affected their ability to form relationships. They are disconnected in one way or another from other people. They are also often in emotional pain and the only real salve for this is not antidepressants — at least not on their own — but a personal connection with another person. For these patients, giving them a pill and sending them on their way is never going to be the answer. I’ve therefore been practising social prescribing for years in an unofficial way. In an assessment, I spend just as long trying to understand a patient’s social situation and history as their medical or psychiatric history. Of course, it’s important to find out what antidepressants they have been on in the past, but it’s also vital to know what support networks they have and how they spend their time. Before I reach for the prescription pad I always explore what social changes we could make. I encourage people to try things such as volunteering. One patient in his 30s had been on nearly every antidepressant there is. He was too depressed to work, felt stuck and worthless. I suggested volunteering at a homeless shelter, which he did. A psychologist and I, called him a few times a week to encourage him to go. Over time, he needed our prompting less and less. The transformation was remarkable.
‘For the first time I feel needed. I can’t let them down,’ he said.
While previously he’d stay in bed until midday and would go for days without washing or eating properly, it acted as a motivator to get up and get out to the shelter, even if he didn’t feel like it. ‘I’m so busy, I forget I’m depressed,’ he said.
Social prescribing is precisely the kind of approach we should be taking to tackle mental health problems. We need to realise it is a complex mix of biological, social and psychological factors and should tackle it on all fronts.
The interesting lesson from Sam’s group, though, is that it’s no good just sending people out with a spade and some seeds. It needs to be carefully managed, so that, as they struggle in the early days while the dark cloud of depression still hangs over them, they are encouraged, welcomed and chivvied along.
Social prescribing isn’t just about saying people need to go fishing, it’s about ensuring there’s a proper system in place to support those people to fish as they get better.
When done properly, it can have wonderful results.
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