Social prescribing for patients with severe mental illnesses: an English primary care longitudinal observational study
This longitudinal observational study using UK primary care data reveals that while social prescribing consultations for patients with severe mental illnesses increased significantly from 2019 to 2023 and disproportionately reached older, female, and more deprived populations with comorbidities, strategies are still needed to improve access for younger adults and males.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of a preprint that has not been peer-reviewed. It is not medical advice. Do not make health decisions based on this content. Read full disclaimer
People living with severe mental illnesses, such as schizophrenia or bipolar disorder, face a unique and often harsh reality. Beyond the challenges of their diagnosis, they frequently encounter a web of social difficulties—financial strain, isolation, and a lack of community support—that can worsen their physical health and shorten their lives. For decades, medical systems have focused primarily on treating the mind with medication and therapy, but a growing understanding suggests that health is also shaped by where a person lives, who they know, and what they do every day. In response, the National Health Service in England introduced a practice called social prescribing. This approach does not involve handing out pills or scheduling clinical appointments. Instead, it connects patients with non-medical community resources, such as local art groups, nature walks, volunteering opportunities, or support networks. The idea is that by addressing these social roots of poor health, doctors can help patients build a more stable and fulfilling life. However, a critical question remained unanswered: are these community connections actually reaching the people with the most severe mental health needs, or are they bypassing those who might benefit most?
To find the answer, researchers turned to a massive digital record of patient visits across England, looking at the medical histories of over one hundred thousand adults diagnosed with severe mental illness. They focused on the period starting in 2019, the year social prescribing was formally rolled out as a standard service, through to 2023. The team examined whether these patients had ever been offered a conversation about social prescribing with their general practitioner. The results revealed a story of rapid growth mixed with persistent gaps. In 2019, when the service was new, fewer than one percent of patients with severe mental illness had received such a consultation. By 2023, that number had climbed steadily to nearly ten percent. This upward trend suggests that the system is slowly waking up to the potential of this approach, with more doctors beginning to discuss community options with their patients.
Yet, the data also painted a picture of who is being reached and who is being left behind. The study found that older patients, women, and those living in the most economically deprived areas were the most likely to be offered these connections. In contrast, younger adults and men with severe mental illness were significantly less likely to receive an offer. This is a notable disparity, given that conditions like schizophrenia often first appear in young men, meaning the very group that might need early support to prevent long-term decline is the one seeing the least engagement. Furthermore, the researchers discovered that patients who had recently been diagnosed with a severe mental illness were more likely to be offered social prescribing than those who had lived with the condition for many years. This suggests that doctors may be viewing social prescribing as a tool for early intervention, helping to establish healthy habits and social ties before physical health problems take hold.
The study also looked at the physical health conditions that often accompany severe mental illness, such as diabetes, obesity, and depression. Patients with these co-existing conditions were more frequently offered social prescribing, which aligns with the service's goal of tackling complex health needs. However, the researchers noted that while the number of people being offered these services is rising, the number of people actually declining the offer has also been tracked. The rate of refusal fluctuated over the five-year period, starting at 16.1% in 2019, dropping to 14.0% in 2020, then 9.4% in 2021, rising slightly to 10.1% in 2022, and settling at 10.8% in 2023. This overall decline suggests that as the concept becomes more familiar, patients may be more open to the idea. Despite this progress, the study highlighted a stubborn barrier: older patients, particularly those over fifty, were much more likely to turn down the offer than their younger counterparts. This refusal may stem from practical hurdles like mobility issues, a lack of transport, or anxiety about new environments, challenges that are often compounded by living with a severe mental illness.
Ultimately, this research provides a clear snapshot of a system in transition. It confirms that social prescribing is moving from a rare experiment to a more common part of primary care for people with severe mental illness, and it is successfully reaching those in the most deprived areas. However, the data also serves as a warning that the reach is not yet universal. The groups that are currently missing out—younger adults, men, and those who have lived with their diagnosis for a long time—require specific attention. The study does not claim that social prescribing is a cure-all, nor does it measure whether these connections directly improved health outcomes, as that requires further investigation. Instead, it establishes a baseline: the door is opening, but for the service to truly fulfill its promise of equity, the path must be widened to ensure no one is left standing outside.
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