What Is Social Prescribing and Why Can't We Have It In America?

Social prescribing is when doctors refer patients to support in the community. But we don't need doctors for that!

First, a little preface, as a treat.

I wrote this piece because I’ve dealt with clinical depression for nearly three decades(oy vey). In that time, I’ve read hundreds of self-help and mental health books.

Most of these books have been useless to me, in my quest to manage and treat my own depression.

Even the ones that everyone seems to universally love, like The Body Keeps the Score, seem to me to be mostly a collection theory and anecdotes, rather than a guidebook of proven techniques for taking ownership of treating one’s own clinical depression.

In a previous post, I said that Johann Hari’s book about depression, Lost Connections, has been the only book that has helped me with my own depression.

When I say helped, I don’t mean that Lost Connections has fixed, or even alleviated, my depression. Personally, I feel I still have a long way to go, and have been experiencing an intermittent-but deep-depression these last few months. Only recently, since landing back in NYC, have I started to emerge from it.

The greatest value of Lost Connections, to me, is that it contextualizes depression in a real and honest way. Hari writes the book as a depression-haver, and that, combined with his journalistic skills, make for a book about depression that’s actually worth reading.

First, the book contextualizes depression by debunking the myth that depression being caused by a chemical imbalance.

The thought has crossed my mind to get back on antidepressant medication a few times. The two times I’ve tried it in the last decade, it has been ineffective. I’m glad to learn that the myth of “a chemical imbalance” was created by an advertising agency.

Second, Lost Connections convincingly ties depression to loneliness. The research is clear–as the Industrial Age reconfigured and then atomized the family, mental health has consistently declined. Loneliness is a big part of that.

This Harvard report found that 36% of Americans feel “serious loneliness”. Another report found that half of Americans are lonely.

The Harvard report found that “those who are isolated are at increased risk for depression, cognitive decline, and dementia”, and that, “Social isolation and loneliness also adversely influence activities of daily living that influence functional status among older adults”.

These things seem obvious to those of us that experience loneliness and depression.

I would even go as far as saying that my depression is caused by loneliness.

This seems like a common experience these days, from conversations I have with friends and acquaintances IRL, and online.

It seems clear that Americans are not ok.

Imagine Smoking 15 Cigarettes Per Day, Forever

Medical research has shown that loneliness not only breeds mental health challenges and cognitive decline, it also kills. Being chronically lonely is just as bad for you as smoking a pack of cigarettes a day, says this study by The Indian Journal of Psychiatry. Loneliness is also a factor in increasing suicide rates in the US.

The social fabric that used to sustain Americans is now largely gone. 70 years ago there were social clubs, bowling leagues, unions, and so on. The cost-of-living was much more manageable. People could afford to have more kids, to gather more often, travel more frequently. This culture has been by trend towards increased social atomization and alienation in Western societies, caused by cost-of-living increases across the board.

In fact, there’s research to support the claim that we are lonelier than we’ve ever been. Boys and men certainly are.

Cheers Has Been Closed for a While Now

So if we’re more tired, more alienated, and more broke than ever, where can a lonely soul go to find camaraderie and the comforts of sociality?

A place that you can go where, like the song, everybody knows your name(ed: this is a millennial reference to the 1980’s sitcom, Cheers)?

If Cheers were remade today it would probably be set in a co-working space.

Bars still exist, sure but if you want to be around people, and don’t feel like being at a bar, what else is there nowadays?

Some obvious answers are concerts, movies, dinner, etc. These all cost money. For many people, discretionary income is at an all-time low.

Many of us tend to stay home, self-isolate, scroll social media endlessly, order takeout if we can afford it, and binge-watch streaming shows.

As Twitter says:

m @ohmakeda

it costs $100 to go outside.

Infrastructures of Care, and Social Prescribing

Instead of a binary of either: 1) going out and spending $100+ or 2) self-isolating, what if there was another secret third thing for lonely people to tap into and meet their need for social connection.

Turns out there are at least two secret third things.

One thing that I’ve been kind of lolling in my brain for a while are Anne Helen Petersen’s posts on Infrastructures of Care.

What are Infrastructures of Care? I’ll quote AHP here:

“I really do believe that the only way to make caregiving sustainable — particularly as boomers and older Gen-Xers begin to age, and stay alive longer, and need more complex forms of care — is to treat care as infrastructure, and fund and subsidize and arrange it as such….even that’s not enough. Not if you don’t have communities of care to interlock with those larger systems of care. People get this, at least on a conceptual level. But a lot of us who’ve found themselves without those sorts of communities don’t know where to start.”

In this paid-subscriber post, AHP gives a few examples of Infrastructures of Care. Some of here examples include:

• CHILDCARE: “The Multi-Prong Auntie Strategy”: This consists of creating an infrastructure for childcare by enlisting single friends, and creating reciprocal shared care arrangements. Enlisting single friends can be as simple as trading a couple of Uber rides and takeout for a night of childcare. Reciprocal share care looks like finding other parents and agreeing to trade a morning or a night of watching each others’ kids every month.
  

• SENIOR CARE: “The Peers Strategy”: AHP tells a story about a woman named Rebecca, who created a system of care for her aging father, who also has Parkinson’s. Rebecca’s father Zooms daily with his siblings, and is checked on regularly by Rebecca, and Rebecca’s babysitter, who also cleans Rebecca’s dad’s house. Rebecca is also in regular contact with one of her dad’s old colleagues and friends of his that live in the same town. In the event that her dad misses an appointment and Rebecca can’t be there, one of the other folks in this “web of care” can check in on her dad and make sure he’s ok.

That’s just two of five strategies described in the piece. If you think about these things, I encourage you to check out Petersen’s work.

This free piece about Infrastructures of Care is a great place to read more about the concept.

What Does an Infrastructure of Care Actually Look Like?

Social Prescribing

I see social prescribing is another infrastructure of care. Or at least it could be.

I mentioned social prescribing in this previous post, in the context of Hari’s book.

The concept of social prescribing emerged in the UK in the 1990’s, after similar “community care” programs that were practiced in isolated pockets(such as those practiced at the Bromley by Bow Centre) formalized. The NHS rolled out a nationwide version of social prescribing shortly thereafter.

Here’s the best definition for social prescribing that I’ve found so far.

“Social prescribing enables GPs, nurses and other primary care professionals to refer people to a range of local, non-clinical services to support their health and wellbeing.”

Social prescribing is based on the idea that peoples’ health and well-being are shaped largely by social determinants, that is, social, economic, and environmental factors.

Here’s how social prescribing works. First, you go to a doctor. Then, the doctor connects you with what’s called a “link worker”. A link worker can help you with finding the resources you need for:

• Housing, benefits, financial and advice

• Employment, training and volunteering

• Education and learning

• Healthy lifestyle advice and physical activity

• Arts, gardening, creative activities

• Befriending, counselling and groups

I should mention that this text is lifted from the Bromley by Bow Centre’s home page. Although I have yet to participate in one, social prescribing programs really do seem to try to meet the whole spectrum of a person’s social needs.

Imagine having a sort-of social worker, who can connect you to all sorts of cool social activities, volunteer groups, and so on, and connect you with those groups. Often, the link-worker may have preexisting relationships with the people that lead the groups, easing the anxiety of the lonely person(you or me) in braving to leave the house and find groups of humans to join, interact with, and form meaningful connections to.

Now, join me in wishing that we had this in America.

Alas, social prescribing, as administered through healthcare system, seems to only exist in countries with single-payer healthcare systems.

America’d again.

We Don’t Need Doctors for That!

As previously mentioned, I learned about the term from Lost Connections. In the book, Hari tries social prescribing after exhausting all of the other standard depression treatments first: meds, talk therapy, etc.

Since my last post–the one where I mentioned I was taking a break because I’m depressed–I’ve been thinking more about the concept.

More accurately, I have been wishing for it.

I feel like I’ve been wishing for a long time. Sometimes I feel like I was born lonely.

I believe that there’s an aspect of my loneliness that’s congenital. I’ve heard from family that my Grandma Pat had six kids because she “didn’t want to be lonely ever again”.

I’m not sure if she got her wish, but she certainly had a lot of people that loved her, and cared for her, until she died in 2020, at 93 years old.

I did some research/googling and can reasonably conclude that social prescribing does not exist in America. There are government-funded programs for vets, seniors, the homeless, and the formerly imprisoned, but nothing for lonely and/or depressed people, in the United States.

Why Not a P2P Social Prescribing Network?

I talked about starting what I called “a lonely hearts club” in this post. I had a few kind folks express interest but I have kind of just sat on the idea and haven’t done much about it.

Bringing Back Social Clubs(but for Weirdos)

The idea was a meet-up for lonely people, that could eventually evolve into a free online platform for administering community care.

Just like social prescribing, I was drawn to the idea because I was lonely. Reading about the heyday of American social clubs suggests there was something rich and vibrant there. I wonder if we can recapture some of that in the age of TikTok, ChatGPT, the on-demand economy, etc.

Things like meet up groups, the network state, and DAO social clubs seek to fill this gap in the digital age, but all of these tech-driven solutions seem either over-engineered or are hard to discover and missing context. The web3 stuff (network state, DAO social clubs like FWB), is not accessible to 95% of people.

So I’m thinking, why shouldn’t there be a peer-to-peer Social Prescribing network?

We don’t have community healthcare in the states, except for the most vulnerable parts of the population: the homeless, seniors, veterans, orphans.

There’s considerable overlap among these groups, but each of these is only accessible through opaque and labyrinthine bureaucratic layers, like the VFW, healthcare providers, and other government-run or corporate-run services.

This Social Prescribing platform wouldn’t replace community healthcare, but it would be an experiment in building another “infrastructure of care”.

I’m thinking that, in the beginning it would start out as a group chat on Signal or Whatsapp. With time, there could be an email digest, a Discord channel, and maybe eventually a webapp or mobile app.

With good documentation, this platform could be replicable so that anyone could start their own Social Prescribing network based off of a “Social Prescribing How-To” guide.

It’s just an idea at this point. I’m thinking about hosting a virtual meet up and an irl one in NYC. The idea would be to gather folks who are interested in this idea and providing this kind of care to each other and to other folks who need it.

I did find this “Social Prescribing Network”, which is based in the UK, and claims to be a free network for people interested in social prescribing. It seems to point to an email sign-up, but I signed up, and maybe this will be a good resource.

If you’re interested in talking more about this idea, or even funding it, send me an email or leave a comment!

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