The happiness prescription
GPs are recognising that at least half their patients need far more than a pill for every ill. For one woman, singing in a choir proved life-changing. Sarah Stacey reports
Listening to the lightness and warmth in her voice, it’s hard to believe Arabella Tresilian, 44, has experienced such serious mental health problems that she once feared she was not well enough to look after her two young children. Treatment with medication and talking therapies was at best a BandAid. What finally transformed Arabella’s life was singing in a choir, a panacea enabled by the social prescribing initiative at her GP practice in Bath. GP Dr. Michael Dixon describes social prescribing as ‘a radical rethink of medicine, planting health and healing in the heart of the community’.
Social prescribing aims to improve patients’ health holistically by referrals to link workers who spend time with them exploring different non-medical interventions, often provided by voluntary or charity organisations based in the local community. Activities might include music, art, sports, dancing, knitting, walking, group learning, yoga, fishing and cookery among many others. Link workers may also help patients address housing, legal and financial problems.
According to Dr. Dixon, who is NHS England clinical champion for social prescribing, ‘we can’t treat everything with tablets or procedures. Health and happiness are multi-factorial. As doctors, we need to stop over-medicalising patients’ issues and harness the assets in the community. Most conditions have some social component – loneliness is endemic, for instance - and we can improve patients’ lives immeasurably by addressing that.’
The key role of link worker combines handholding with compassion and encouragement, plus an in depth knowledge of local resources. Until recently, only about 20 per cent of GP practices have had access to funding for this linchpin but that is changing with NHS England’s recent commitment to fund 1,000 link workers in primary care networks by April 2021, increasing to 3,000 over the next five years.
Arabella’s fragile mental health first became apparent at boarding school. ‘I was depressed and self-harming as well as physically unwell.’ The underlying problems erupted when Arabella gave birth to her first child and found herself in the grip of postnatal depression (PND).
‘I had a wonderful relationship with my baby but also this deep sense of fear because she seemed so fragile. Every morning when she woke up healthy I was astonished and relieved.’ Filling in a checklist for PND, Arabella ticked every box. Her GP prescribed antidepressants, which cleared her ‘darkest clouds’ and allowed her to function but triggered frightening side effects: ‘I had feelings of fading in and out of reality, my brain wobbled and I had vertigo.’
Arabella’s second child was born three years later when she was 25. ‘I became very distraught and unbalanced soon after. I was overcome with such a sense of dread I felt on the verge of exploding and simultaneously aware I was responsible for these beautiful vulnerable children.’ At that point, she was referred for house calls by a community psychiatric nurse for 12 months, which she found very helpful.
Over the next 15 years, Arabella focussed on bringing up her children. She took antidepressants but over the winter of 2013/14, she decided to stop, which led to ‘absolutely horrific’ withdrawals. (Prescribed drug dependency and the consequent withdrawal problems are now the subject of a government review.)
In 2015, Arabella realised her teenage children didn't need her as much as before. Shifting from intensive parenting to being more hands-off was the trip switch for a severe breakdown. ‘I was more unwell than I’d ever been. One day I drove to the wrong office, got back in the car to go to the right one and drove past it. I just went on driving until I was on the seashore.’ Returning home somehow, she took two days off work, which became ‘weeks, months and then two years’.
Her GP confirmed a constellation of problems: severe anxiety and depression, post-traumatic stress disorder and chronic fatigue. Additionally, Arabella learnt she fulfilled the criteria for Asperger’s syndrome, a neurobiological disorder related to autism. ‘I choose to see it as a gift in many ways but Asperger’s can make it hard to communicate my needs and feelings, and sometimes the simplest tasks and choices seem complex and overwhelming.’
Unsurprisingly, Arabella felt suicidal at times. But she was adamant she did not want to take more medication. ‘My GP and I agreed we would work together on “Project Mental Health Recovery Without Drugs”, but I promised I would flag up immediately if I felt in danger.’ The first step was a referral to the practice’s link worker for social prescribing, Diane Girling.
Initially, Arabella found it hard to communicate with Diane. ‘I wasn't well enough to talk on the phone so she sent a very gentle email. She really met me at my level, squirreling into the dark spaces.’ At their first session, Diane encouraged Arabella to talk about the whole picture of her life including debts and legal issues. (Citizen’s Advice Bureau helped with these.)
‘Diane also asked me about things I might enjoy doing, which I hadn’t thought about for years. She helped me understand we could look at both my current crisis state and my future wellbeing.’ Tentatively, Arabella admitted she used to like singing in a choir. ‘My head was so muddled I didn't know where to start but Diane kept pursuing it. She found five local choirs and I chose one.’
The next hurdle was to help Arabella overcome her fears of how to make ‘this enormous mission’ actually happen. ‘By that stage I had no thinking power or confidence. So we went through how I would sign up – email or phone – how I would get there – bus or car and if the latter where to park – and even what I would say to people when I walked through the door.’
On the evening, Arabella turned up ‘shaking and trembling, thinking this is awful. But I got through the door and everyone was so friendly that it was lovely to be around them. When I sang I found it was really good to be in my body. It was all very therapeutic and very heartening.’
Arabella is still a member of that choir. ‘It’s become part of who I am and it makes me feel embedded in my community - unlike talking therapies, which left no legacy.’ Diane also prescribed yoga classes (free for six weeks), which Arabella still goes to.
Further sessions with Diane helped Arabella get back into work, firstly as a volunteer at Bath City farm, where she became a trustee and then Chair. Later, with her professional confidence restored, she trained in mediation and now supports people with mental health difficulties to stay in work.
‘Social prescribing is a way of connecting people with themselves, helping you understand who you are and where you belong,’ says Arabella. ‘It is life changing and very simple. It must be the future of health care.’
This feature was first published in Psychologies magazine.