Social Prescribing | Buffering Loneliness and Nurturing Well-being Through the Arts, Humanities, and Community

“Good morning Paula, how are you today? What can I help you with in the here and now?” I had become accustomed to Nicole’s questions. For eight weeks, she had become an important fixture in our lives. Through her curiosity, compassion, and skills as a social worker, Nicole enacted the kind of psychological support that I needed after losing my husband.

Unsure of how to care for my postpartum body, my newborn, and a two-year-old who had just lost his father and gained a little brother, I reached out to a local community health practitioner. Upon assessing that I was grieving and lonely, and not clinically depressed, my physician referred me to Nicole. Nicole visited me in my home and helped me refocus my attention away from my pain and suffering and to things that mattered to me. She inquired about the things that once made me happy. Most importantly, she listened attentively to all my needs.

The trauma that accompanied childbirth and the sudden loss of my husband physically impacted me. My body felt seized-up, and I knew that the first step to rebuilding my life and community involved me reclaiming my physical strength and energy. Nicole made note of this. She also made note of the things that brought me joy, like playing with my two-year-old son and playing my guitar. She became curious about my experiences as a singer-songwriter and encouraged me to continue singing, writing songs, and nudged me to rekindle relationships with people in my musical community.

By understanding my strengths, interests, and needs, Nicole worked with me to co-design a healthcare plan to help me buffer the adverse effects of loneliness and grief. By accessing her resources in the community, Nicole was able to signpost me to free weekly yoga passes. She also secured a community volunteer to care for my children and do light housekeeping so that I could socialize, attend yoga, and find the time and space to venture into the world of music once again.

A Strength-Based Approach to Accessing Self-Determination

At the time, I was doubtful that a few hours a week of music and yoga could significantly impact my well-being. However, thirteen years later, I now realize this intervention was a very impactful “person-activity fit” (Schueller, 2010) positive intervention. By design, it was customized to address my personal needs and interests to enhance my well-being.

Over the eight-week period, Nicole became my ally. She used cognitive behavior strategies to cultivate healthier mindsets and taught me specific habits that would eventually help me to flourish. She stoked my self-efficacy, which psychologist Albert Bandura and colleagues (1999) define as an individual’s belief that they have the skills and abilities to produce a positive outcome. Somehow the grief had cast a dark shadow on this belief. As I started to feel physically and psychologically stronger through yoga, music, and social connection, I rediscovered my self-determination. Psychologists Ryan and Deci (2020) describe self-determination as psychological needs that consist of autonomy, competence, and relatedness. These needs propel an individual’s motivation and well-being. Increasingly, I felt a sense of autonomy and more inclined to exert control over my life. I felt drawn to express my own competence, to demonstrate the various ways I could use my skills and talents to achieve the things that were important to me. I was compelled to experience a sense of relatedness and do these things with people who mattered to me. I became curious about this process and how play, the arts, and meaningful connections were important building blocks to my own happiness. I felt a calling to study this unique healthcare model and the psychological underpinnings behind the positive humanities. I was convinced that the methods Nicole used to help me transform my life could be scaled to help other people experiencing loneliness and other similar conditions. Ultimately, this curiosity was what led me to enroll in the Master of Applied Positive Psychology (MAPP) program at the University of Pennsylvania.

Social Prescribing, An Emerging Health Care Model

The story I share about my own personal experiences within the Canadian healthcare system describes the early stages of what is now known as social prescribing.

Social Prescribing emerged out of the United Kingdom in the mid-1990s upon an investigation of a loneliness epidemic that reported that 9 million adult British citizens always felt lonely. In addition, 75% of general practitioners reported they saw up to five people a day who sought medical attention because they were lonely (Jo Cox Commission, 2017). With these findings, a new holistic healthcare model emerged. General practitioners were able to refer non-clinical patients experiencing feelings of loneliness, anxiety, depression, or ill-being (due to a variety of social determinants of health), to community programming through museums, music, dance classes, jogging clubs, and nature parks (Cunningham et al, 2022).

In some social prescribing models, doctors refer patients to link workers, who fulfill the role of social care coordinators. Through motivational interviewing, goal setting, and health coaching, link workers help patients develop a personalized well-being plan and ‘signpost’ them to community-based activities based on their interests (Sandu et al, 2022).

Similar to how Nicole supported me, social prescribing has the power to shift a person’s narrative from ‘what is the matter with me?’ to ‘what matters to me’ (Mulligan, 2023). Research highlights the latter point and illustrates how social prescribing is rooted in self-determination theory (Bhatti et al, 2021).

The potential of this healthcare model is evident. As of 2021, social prescribing now spans 17 countries worldwide. Various models are taking shape, some with and some without link workers (Morse, 2022). In the United Kingdom, the National Health Services' long-term plan is to have link workers in primary care networks so that social prescribing is accessible to everyone through their general practitioners (NHS England, n.d). In Canada, a newly appointed Canadian Institute of Social Prescribing (CISP) is working on a pan-Canadian framework to implement the link worker model into primary care (Mulligan, 2023). In the United States, over forty stakeholders from government, academia, health care, and government came together last year to participate in a design lab for social prescribing (Core 77, 2023).

The SocialWell Collective

As social prescribing is gaining popularity, future initiatives may increase the demand for link workers. Currently, there are requests for greater evaluation and measurement of outcomes, as well as curriculum and training for link workers. Social prescribing frameworks are calling for asset mapping of community resources and collaborations between important stakeholders within the arts, community, and healthcare sectors. Research from an Arts on Prescription program in the United Kingdom demonstrated that creative activity offered through Arts on Prescription enhanced “mental health,” tied into “self-expression and self-esteem,” established potential for “social contact and participation,” brought “purpose,” “meaning,” and “improved quality of life.” Participants of Arts on Prescription programs indicated that they felt “empowered and confident, and experienced reduced feelings of social exclusion and isolation” (Chatterjee et al, 2018, p. 98).

Within our own alumni community of business people, coaches, athletes, artists, researchers, and educators, there is an opportunity for positive psychology practitioners to embed the positive humanities and evidence-based theories and practices into social prescriptions. This way, recipients can learn ways to flourish beyond the issuance of a social prescription. They can be guided along pathways to well-being that can potentially lead to longer-term sustainable outcomes.

In 2023, I received a MAPP Alumni Grant to expand the SocialWell Collective—a community of people and organizations looking to buffer the effects of loneliness and nurture individual and collective well-being through social connection and belonging—to include alumni as potential strategic advisors in designing and developing social prescribing frameworks within their communities. Plans are to develop a positive psychology curriculum for link workers within a train-the-trainer model, to launch art-based and nature wonder gatherings, to potentially evaluate social prescriptions, and to raise awareness for alumni offering their own social prescriptions or coaching services.

As an example, fellow alum Tricia Fox Ransom (C’10) and I designed an evidence-based workshop and social prescription that uses music, wonder, and character-strength spotting as a way for people to connect with one another. As part of the SocialWell Collective offering, we plan to develop curricula that educate link workers and their clients about the positive psychology theories and practices that cultivate their well-being. In his book, Awe: The New Science of Everyday Wonder and How It Can Transform Your Life, researcher Dacher Keltner (2023) shares how music naturally evokes wonder. This mental state of openness, questioning, curiosity, and embracing mystery derived from wonder is not self-serving, but rather oriented towards a collective. Connecting through music and wonder can serve as icebreakers or catalysts for social bonding and provide a potential means to mitigate loneliness.

In May 2023, The United States Surgeon General, Vivek Murthy, issued an advisory on the epidemic of loneliness and isolation. The SocialWell Collective aligns with his recommended framework and National Strategy to Advance Social Connection. The public health crisis arising out of loneliness and isolation is a priority given that studies indicate that loneliness and lacking social connection constitute a risk that surpasses mortality risk factors of smoking 15 cigarettes a day, obesity, and physical inactivity (Holt-Lunstad et al, 2010).

Social connection is a health determinant, and rich and satisfying relationships are important pillars of a happier and more meaningful life. We are at an important juncture. Worldwide, fragile healthcare systems require additional resources and reinforcement. Social prescribing has the potential to not only alleviate the dire effects and risks associated with loneliness, but also to create opportunities for the arts and humanities and community to lead the way to human flourishing.

References

Bandura, A., Freeman, W. H., & Lightsey, R (1999). Self-efficacy: The exercise of control. Journal of Psychotherapy, 13,158–166. https://doi.org/10.1891/0889-8391.13.2.158

Bhatti, S., Rayner, J., Pinto, A. D., Mulligan, K., & Cole, D. C. (2021). Using self-determination theory to understand the social prescribing process: a qualitative study. BJGP Open, 5(2). https://doi.org/10.3399/BJGPO.2020.0153

Chatterjee, H. J., Camic, P. M., Lockyer, B., & Thomson, L. J. (2018). Non-clinical community interventions: a systematised review of social prescribing schemes. Arts & Health, 10(2), 97-123.

Core 77. (2023). Design for social prescribing: bridging silos for health promotion. https://designawards.core77.com/health-wellness/121296/Design-for-Social-Prescribing-Bridging-Silos-for-Health-Promotion

Cunningham, K. B., Rogowsky, R. H., Carstairs, S. A., Sullivan, F., & Ozakinci, G. (2022). Social prescribing and behaviour change: proposal of a new behaviour change technique concerning the ‘connection’ step. Health Psychology and Behavioral Medicine, 10(1), 121-123.

Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A meta-analytic review. PLoS Medicine, 7(7), e1000316. https//doi.org/10.1371/journal.pmed.1000316.

Jo Cox Commission on Loneliness. (2017). Combatting loneliness one conversation at a time. https://www.ageuk.org.uk/globalassets/age-uk/documents/reports-and-publications/reports-and-briefings/active-communities/rb_dec17_jocox_commission_finalreport.pdf

Keltner, D. (2023). Awe: the new science of everyday wonder and how it can transform your life. Penguin.

Morse, D. F., Sandhu, S., Mulligan, K., Tierney, S., Polley, M., Giurca, B.C.,...& Husk, K. (2022). Global developments in social prescribing. BMJ Global Health, 7(5), e008524. https://doi.org/10.1136/bmjgh-2022-008524.

Pearce, E., Launay, J., & Dunbar, R. I. (2015). The ice-breaker effect: Singing mediates fast social bonding. Royal Society Open Science, 2(10), 150221.

Ryan, R. M., & Deci, E. L. (2020). Intrinsic and extrinsic motivation from a self-determination theory perspective: Definitions, theory, practices, and future directions. Contemporary Educational Psychology, 61, 101860. https://doi.org/10.1016/j.cedpsych.2020.101860

Sandhu, S., Lian, T., Drake, C., Moffatt, S., Wildman, J., & Wildman, J. (2022). Intervention components of link worker social prescribing programmes: a scoping review. Health & Social Care in the Community, 30(6), e3761–e3774. https://doi.org/10.1111/hsc.14056

Schueller, S. M. (2010). Preferences for positive psychology exercises. The Journal of Positive Psychology, 5, 192–203. https://doi.org/10.1080/17439761003790948

Social Prescribing (n.d.). NHS England. https://www.england.nhs.uk/personalisedcare/social-prescribing/

About the Author | Paula Toledo (C’22) is a social entrepreneur and founder of the SocialWell Collective. She is also a singer-songwriter, TEDx speaker, and well-being consultant. She advises leaders and organizations on ways to use wonder and art to enhance social connection and promote individual and collective flourishing. As a Canadian Mental Health Association Advisor for Psychological Health and Safety in the Workplace, she also facilitates well-being practices in the workplace. She has recently been appointed as Strategic Marketing and Development Specialist for EntreThrive, a learning platform and community that supports entrepreneurial well-being.