SOCIAL PRESCRIBING FOR DEPRESSION
Welcome to the Social Prescribing program developed by CASPER, New Zealand. We are an organization that has been successfully working to reduce the high rate of suicides in New Zealand for over five years. This is your own personal program for treating mild to moderate depression. Information is provided on a wide range of tested, evidence-based depression interventions which studies have found to be as effective, or more effective, than antidepressants.
Within each category there are references for the evidence-based activities to be undertaken with practical advice and resources for accessing and implementing them. The references are categorized at the end.
You may be surprised at the large number of non-drug alternatives to managing moods and behaviors that are getting in the way of you living the life you want to live. With these benefits and without the risks of drugs, many people feel they are worth trying before they go down the medication path. You should consult with your doctor on whether to try a non-drug therapy regimen.
Included in this information pack is a Social Prescription Pad. It’s like the prescribing pad your doctor uses but instead of providing a drug based treatment plan, it provides a range of evidence based activities to help you regain the happiness, nse of hope and confidence in your ability to change your circumstances that depression has taken from you.
Maria Bradshaw, CEO, CASPER New Zealand
How to Use the Social Prescription Pad
There are a number of categories on the social prescription pad covering a wide range of intervention types. Initially it is useful to prescribe yourself at least one activity within each category as a way of providing yourself with a chance to identify what you find most beneficial. Over time you may find that this broad treatment plan works best for you or you may drop some categories in favor of focusing on others that provide you with the greatest benefit.
Some people use the prescription pad as something personal and an opportunity to take some ‘me time’ and plan their day, week or month. Others choose to involve their families or friends in writing the prescriptions as a way of engaging their Significant Others in their treatment and starting the conversation about how they are feeling and what steps they are taking to care of themselves and re-engage with the world. For some people, the social prescription pad is shared with their doctor or developed with their counselor. How you use it will depend on your personality, preferences and how supportive those around you are. There are no right or wrong choices as long as it is working for you.
How often you write yourself a prescription or review your prescription is also a matter of personal preference. Initially, many people start their week writing or reviewing their prescription. Other may do this every couple of weeks, or monthly. They may do it when they feel things are not going well as a way of making changes in their lives with a view to improving things, or when things are going well and they want to maintain and extend those activities which are contributing to their progress. Some people review their prescription at regular counselling sessions and others at times they arrange with friends and family. Taking some time on a Sunday night or Monday morning to write or review your prescription may help you feel you have a plan to manage the coming week. You may try a number of approaches until you find the one that works best for you or you may have no set routine. Whatever works for you is fine, as long as it providing you with the help you want.
How to Write A Social Prescription
There are ten categories in the social prescription
- art and culture
- basic needs
- social connection
- nature / pet therapy
- reading / movies / music
- peer support
A brief description of the evidence that each works and the kinds of activities that can be included is provided below:
Arts and Culture
There is strong evidence that involvement in the arts promotes strong mental health. A recent study found that
Arts engagement increases happiness, confidence, self-esteem and reduces stress and social isolation. It results in the creation of good memories and has an impact on a person’s knowledge and skills. People need to give themselves permission to be creative and to make time for the arts activities and events that they enjoy. The results showed a relatively small amount of arts activity could make a very big difference to mental health.
Involvement in arts covers a wide range of activities either creating or observing art. These include traditional art activities such as painting, drawing, sculpting, photography, singing, dancing, acting, attending the theater, cinema or galleries and exhibitions. They also include cake decorating, sewing, knitting, jewelry making, graphic design, custom painting cars, cartooning, landscape design, song-writing, making music…the possibilities are endless.
YouTube and Pinterest are wonderful sources of inspiration. Start a search on something within the art and craft fields that interests you or you have always wanted to try and we guarantee you will find an artistic/creative pursuit that captures your interest.
Play / Fun
When was the last time you did something for the pure joy of it? Not to earn money or fulfill a duty or for any reason than it makes you happy. Research tells us that play can relieve stress, boost creativity, improve brain function, and improve our relationships with other people by fostering trust with others. Experts tell us that play matters, no matter how old you are.
When we play, we do things that have no purpose but to bring us joy. This means that what adult play looks like varies hugely from one person to another. It may involve making a snowman, dressing up for Halloween, popping bubble wrap, having a water fight, being ‘silly’ with your partner, or sister or best friend. It can involve adult coloring books, hide and seek with the dog, doing a puzzle or whatever makes you happy.
Professor of psychology Abraham Maslow developed the following model showing our needs as human beings. Maslow believed higher needs such as self esteem and self actualization (achieving our potential) could not be achieved until our basic physical, safety and belonging needs had been met.
If you have needs that are not being met on any level of this model, you may want to include meeting those needs on your social prescription. If your needs for a warm, dry home or adequate food or sleep are not being met, then a focus on getting those needs met will be necessary before you can concentrate on needs further up the hierarchy. Similarly, if your need to be loved and accepted is not being met, this will need to be addressed before you are able to fulfill your need for self esteem.
Sometimes your needs are not being met because you struggle to find the motivation to take actions that would improve your situation. While you could improve your diet or sleep or move to a better house, you are overwhelmed by the effort involved in doing so. Generally, though, getting your basic needs met either involves learning new skills or engaging with individuals or agencies who can help you. Your social prescription therefore would involve making contact with those who can help you acquire the skills you need or help you change your circumstances.
Exercise / Nutrition / Sleep
Studies have shown that exercise is one of the best antidepressants available and that nutrition strongly affects our moods. Ensuring we are active and eat well is critical to our mental health. Perhaps, though, the strongest contributor to emotional well-being is the quality of our sleep. Too much or too little sleep or sleep which does not leave us feeling refreshed, a poor diet and inactivity are strong contributors to depression.
Eating well and exercising regularly do not have to involve spending money on expensive gym memberships and buying expensive foods. Your local library, your doctor and the internet are good sources of information and advice on how to improve your diet and sleep. Opportunities for exercise include sport, walking, housework, playing with children or pets, dancing and lots of others. Find an activity you enjoy and prescribe yourself a daily dose.
Connection with others and a sense of belonging are primary needs for all human beings. Many of us are socially isolated and even those with extensive social networks can feel very lonely. Research has shown it is not the number of groups we belong to but the feeling of being accepted and valued and of belonging to a group that improves our mental health.
Spending time with people who love and accept us without judgment and despite our problems or failings is important to our emotional well-being.
Prescribing yourself a daily dose of connection with friends or family, people who enjoy the same activities you do or share your culture or interests, can make a big difference to the way you feel.
This may involve making plans with people, organizing a shared meal, taking up a hobby within a group, joining an internet based group or skyping with someone you are not able to be with physically.
Helping others has been shown to be one of the best ways we can help ourselves. Volunteering can help us find a sense of purpose, remind us that we are worthwhile and make a positive difference in the lives of others, help us make connections with others and open up social networks and develop or learn new skills. The research has found that volunteering has the greatest health benefits for people who do it in order to help others, rather than to help themselves so it’s important to pick a cause you really care about.
There are many opportunities for volunteering in every community. An internet search will find a list of local charities from animal welfare to hospice, children’s hospitals to food banks who will value your skills and welcome your contribution.
Nature / Pet Therapy
A Stanford University study compared two groups of people who walked for 90 minutes, one in a grassland area scattered with trees and shrubs, the other along a traffic-heavy four-lane roadway. The researchers found marked differences in the two groups in the part of the brain focused on rumination – repetitive thought focused on what is wrong with us and our lives. Those who walked in nature had far less activity in the area of the brain associated with rumination and were happier.
Regularly strolling through a park, woodland area or on a beach is something your social prescription could include so that you are able to harness the benefits of connection with nature.
While our relationships with people can be stressful and difficult, those with animals are uncomplicated and provide many of the things we need for good mental health. Pets provide unconditional love, they don’t blame or shame us or offer unwanted advice. They give us someone to cuddle and care for and encourage us to play and to exercise. Research has shown our relationships with animals have positive effects on our physical and mental health.
Those who don’t have a pet can still have contact with animals by offering to walk someone else’s dog, volunteering at an animal center or scheduling regular time with a friend or family members pet.
Your social prescription could involve taking advantage of the health benefits associated with contact with animals in your home or community.
Reading can help us better understand ourselves and our situation. It can give us insight into the problems we face, remind us that others feel as we do, and show us how others have overcome the difficulties we are experiencing. It can also give us some much needed time out from our lives, a few hours in which to forget our problems and fears and enter someone else’s life. Studies suggest reading fiction may have greater benefits than reading self help books.
Movies provide us with similar benefits to reading. In December 2015 Buzzfeed asked their members what movies had helped them through depression. Amongst the many comments were the following:
“Watching them work through their problems and accept their faults made me feel like I could make it through okay too. And all the adorable dance scenes got me up out of bed and wanting to be moving and active again.”
“I was too tired to reread the books when I was at the peak of my depression, so I watched the movies and escaped to a world where I didn’t have to worry about my problems.”
“I first saw it almost five years ago. After that my life was completely changed for the better. I had depression so bad, I turned to self-harm. 127 Hours made me realize how valuable life is, how important your loved ones really are, and to never, ever, give up.”
“It’s my happy place – I’m seven again and nothing is wrong with the world.”
Music too can help us through the hardest times of our lives. Song lyrics often describe our thoughts and feelings better than we can ourselves. Music can take us back to a time we were happy and remind us we can be again. Music can soothe our pain, give us an excuse to cry and connect us to a community of people who share our musical taste.
Your social prescription could include making time to read, watch movies and listen to music.
Often depression springs from a sense that we have no control over the bad things happening in our lives and our negative feelings. When we feel that we have the ability to change our lives, that we won’t always be stuck in our current circumstances and with our current feelings, our depression can ease.
Regularly learning new skills and mastering new tasks – no matter how small – increases our belief in our ability to change our lives.
You may want to start small with a goal to clean out your closet, try a new recipe, learn to change the oil in your car or calculate percentages. Or you may want to sign up to something more challenging. Whatever their size, learning new skills and mastering tasks encourages our belief in ourselves and our hope that we have the power to change our lives.
Your social prescription could include regular opportunities for achievement.
Connecting with others who share our experiences doesn’t stop the pain we feel but it can help us feel less alone and give us an opportunity to learn about managing depression from others and share our learning with them.
Peer support may come in the form of support groups or internet based groups. Local community service directories, your GP, counselor or citizen’s advice bureau can provide contact details for support groups while searches of the internet or Facebook can provide access to virtual peer support communities.
Your social prescription could include finding and regularly interacting with peer support networks.