Social Prescribing Nomenclature, Occupational Therapy and the Theory of Institutional Work: Creating, Maintaining and Disrupting Medical Dominance

Abstract

Social prescribing is a process of helping people to access non-medical activities and services which address health and wellbeing needs. The process is frequently (although not exclusively) initiated by primary health care professionals and often involves prescribing activities or initiatives provided by community and voluntary organizations. To occupational therapy, the links between activity, social-connectedness and health are clearly not new, although there are emerging international examples of social prescribing initiatives, and examples of newly developed roles, processes and funding opportunities, all of which are creating momentum behind the agenda.In this commentary, we draw upon the theory of Institutional Work to examine how the language of 'prescription', and the purposive action of policy-makers and practitioners, is shaping thinking and action in relation to activity and health. Arguably, this language has helped to translate the recommendation of activity to meet a range of health needs in to an accessible and implementable concept. However, it has also potentially contributed to positioning the concept within a medical model of health, upholding medical dominance, and leaving occupational therapy on the margins of the debate. * NHS England reportedly plan to co-design these measurement tools ** NHS England are reportedly currently obtaining feedback on the use of these measurement tools. *** No further detail provided

Effectiveness and active ingredients of social prescribing interventions targeting mental health: a systematic review

“…Consistent with previous research,75–77 two studies38 41 in the current review reported reductions in primary healthcare use (consultation rates and medication prescribed) However, these findings should be interpreted with caution. Consistent with previous reviews of social prescribing interventions,4 8 9 75 the majority (15 out of 17) of the included studies were uncontrolled before-and-after studies (with a range of methodological shortcomings). Attrition rates were generally high (mean of 38%) and there was substantial variability in outcome measures.…”

“…This has been supported by purposive action, particularly influenced by the language of prescribing in primary care, to enhance the implementation of social prescribing in primary care. 9 Approximately one in six adults in the UK are living with mental health conditions 10 and social prescribing has the potential to improve outcomes for this population. Mental health has a devasting impact on individuals, their families and society, with depression and anxiety disorders affecting 16% of the UK population at any one time.…”

“…This has been supported by purposive action, particularly influenced by the language of prescribing in primary care, to enhance the implementation of social prescribing in primary care. 9 …”

“…Kimberlee7 and Husk et al ,8 describe four models of social prescribing (referral pathways): signposting service users to appropriate services or groups; direct referral from primary care to an activity or service; a link worker (based within or externally to primary care) who receives referrals and in turn conducts a needs assessment and refers the service user onto an activity or service; and the latter model with the addition of feedback and a support loop between the link worker and the service user. This has been supported by purposive action, particularly influenced by the language of prescribing in primary care, to enhance the implementation of social prescribing in primary care 9…”

Professional Perspectives on Children’s Health Assets: A Delphi Study

“…There is an association between social prescription (HA recommendation) and occupational therapy, as this discipline has a long history of recommending activities to improve the health and well-being of individuals, groups, and communities [ 14 ]. Therefore, in this paper, special emphasis is placed on occupations as understood by occupational therapy.…”