A prescription for life

GP Dr Sara Nairn and Catherine Cotching photographed at Deer Park IPC on July 29, 2019 in Melbourne, Australia. (John Donegan/1826)

A new ‘social prescribing’ program is providing personalised solutions to the growing problem of social isolations and loneliness in our community.

Emily* had always been capable, active and independent, even as she reached 80 years old. But when her husband died, she started to withdraw, slowly cutting herself off from her community.

Victoria* loved losing herself in a good book. But as the years went on and her arthritis got worse, she started to become truly lost, stuck in her house most of the day with only her books for company.

Robert* was confident and outgoing, but had become increasingly isolated, unable to connect with people who shared his interests and experiences. He spent most of his days at his local shopping centre, having coffee with a group of older men. He wanted to meet new people and experience new things, but he didn’t know where to start.

There is nothing particularly remarkable about the stories of Emily, Victoria and Robert. Their quiet struggles to maintain meaning and connections in their lives would resonate with millions of Australians, if not all of us. But what is remarkable is just how widespread loneliness and isolation has become in our community – and how damaging it is to our health and wellbeing.

A recent study from Swinburne University and the Australian Psychological Society showed depression and social anxiety were 15 and 13 per cent more likely respectively among people experiencing loneliness. The same is also true in reverse – people experiencing depression and anxiety are also more likely to be lonely.

He sees the impact of loneliness and isolation on his patients every day, many of whom are older people who are losing touch with family and friends.

The impact that loneliness and social isolation can have isn’t limited to mental health. Studies going back at least 30 years highlight loneliness as a predictor for developing illness and early death, but more recent work has also identified it as a direct cause of physical symptoms like chronic inflammation, which is linked to heart disease, arthritis and Type 2 diabetes.

This comes as no surprise to GP Dr Michael Oladiran, who works at IPC Health in Deer Park, Melbourne. He sees the impact of loneliness and isolation on his patients every day, many of whom are older people who are losing touch with family and friends.

“We see a lot of patients with social isolation and social issues, and medically we cannot really set up for that,” Dr Oladiran said. “When that happens, it’s always good to have that social linkage for them, so that their social needs are met, and at the same time we meet their clinical needs as well.”

Meeting those social needs is now easier for Dr Oladiran, thanks to a new ‘social prescribing’ program funded by North Western Melbourne Primary Health Network and being trialed at his practice. The program funds Community Coordinator Catherine Cotching, who is able to assess a patient’s social, financial and life-management needs and support them to connect to appropriate services and groups in their community.

Dr Oladiran gave the example of a patient in his mid-50s with poorly controlled diabetes, who was unable to afford his medications.

“His sugars were just up in the roof,” Dr Oladiran said. “I was seeing him as regularly as I could, the diabetic educator was seeing him, it got to a time we were giving him samples [from medical representatives] just to keep this sugar a little low. And that’s as much as we could do.”

“When he came before, he was just bitter about everything. And now when he comes, he’s happy, smiling.”

Once the patient was referred to the social prescribing program, the community coordinator was able to contact his local MP to help process his application for the Disability Support Pension, which meant he could now afford to buy his medication.

“He’s using his medication now and his blood sugars are down. But then his overall mental health and thinking as well is much better. When he came before, he was just bitter about everything. And now when he comes, he’s happy, smiling.”

“I wouldn’t have been able to do that clearly. So that gives me more time to do my clinical work while you have other people doing the social prescription part.”

While the program is still in its early stages, Ms Cotching has been getting a steady stream of referrals from all three IPC Health sites in Brimbank, including from GPs, counselling services, allied health and nurses.

“Some of the clients have come here because they are just socially isolated and the want to be involved in some sort of social program or group activity,” Ms Cotching said. “Others are needing support with some legal issues, and housing issues and financial issues sometimes.”

A big part of Ms Cotching’s role is simply knowing what programs, services and groups are available in the community and how to access them for her clients.

“A GP probably doesn’t have the time to actually know what’s there. They only consult for 15 minutes or 10 minutes and their focus is on the clinical side of things.”

Working in the program has reinforced just how much a person’s ability to be healthy is impacted by their personal and social circumstances.

“… sometimes I think people don’t see their medications as being essential.”

“Particularly when it comes to financial issues, there’s a direct relationship. If people can’t afford to buy their medications, they can’t afford to buy good food, then obviously their health will deteriorate.

“People will prioritise the essentials and sometimes I think people don’t see their medications as being essential.”

IPC Health GP Sara Nairn says people need to be aware that anyone, no matter their age or background, can become lonely or socially isolated.

“It is cutting across all groups, including younger patients with complex disabilities or acquired brain injuries and things like that,” Dr Nairn said. “Of the patients being referred the majority are older, but it’s certainly not limited to just older people.”

While social isolation and loneliness are pervasive and growing issues, Dr Nairn says innovative programs like social prescribing and a growing move to a more holistic model of healthcare give her reasons to be optimistic about the future of social health.

“It took me a while to understand exactly what the program was offering because it’s so novel. And I think once we all get our head around what the program is offering, I think we will recognize what an incredible hole it is filling in what we can offer to our patients and their lives.

“It’s just a great, great program and a great idea.”

*Names have been changed.