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Social prescribing has gained traction across Canada, integrating healthcare, social services, and community support to benefit patients and lighten clinicians’ loads, according to a new report.

“Clinicians often face constraints on time, resources, or the support needed to fully address nonmedical drivers of health,” Srija Biswas, project manager at the Canadian Institute for Social Prescribing, which produced the report, told Medscape Medical News. “Social prescribing offers a timely, practical response to this growing crisis.”

More than 80% of a patient’s health depends on social determinants like adequate food, housing, income, and relationships with others, according to the report. As a formal referral pathway, social prescribing enables healthcare providers to direct their patients to community-based supports and services with the help of a dedicated liaison.

At its core, Biswas said, social prescribing “reframes care to include questions like ‘What matters to you?’ It links people to resources such as social supports, financial counseling, housing services, and recreational activities that reflect their needs, goals, and values.”

Linking to Community Resources 

Link workers or community connectors are a linchpin of social prescribing. These members of the community have a deep understanding of community resources and undergo specific training that enables them to work with patients who are referred to them.

“Physicians remain the trusted access point, while link workers take on the time-intensive role of walking alongside patients to address their broader life circumstances,” Biswas explained. “Clinicians can embed social prescribing into practice by simply integrating a few key questions about life circumstances into intake or check-ins and making a warm referral to a designated community partner.”

Grace Park, MD, a family physician and regional medical director for Home and Community Care at the Fraser Health Authority in British Columbia, said that when she embarked on her practice, she “learned quickly that family physicians are not well equipped to delve into the social context of an individual to address the social determinants of health.” She gave an example of a patient with diabetes with whom she was working, with little success, to keep the disease under control.

“After many meetings and follow-up bloodwork, the patient finally said to me, ‘I don’t have enough money to buy the healthy diet you recommend.’ That really got to the core of the problem and raised my awareness,” Park said. “If someone can’t afford to buy food you know is good for them or can’t pay for dental work that will enable them to chew their food properly, that will affect how they’re able, or not able, to follow the directions a doctor is giving them.”

In another example, Park recalled a man in his early 60s who was being treated by another practitioner in the health system. The man came into the office because he was feeling “down” and said he didn’t have much social activity. The practitioner ultimately made a referral to social prescribing.

“The community connector met with this patient, and instead of saying, ‘Why are you depressed?’ she asked, ‘What’s the most important thing in your life? What matters to you most?’” It turned out that the man was going to be homeless because his landlord was raising the rent, and he couldn’t find alternative housing.

“None of that came out in the discussion with the primary care practitioner, who was only focused on medication,” Park explained. Once the community connector identified a subsidized housing apartment for the man, he revealed that he used to be a musician, and being able to play the guitar again would bring him joy.

“Together, they created a program where older adults from the community organization where the community connector was working could share their music, poetry, and art,” Park said. The ongoing program is led by the patient, whose depression ultimately subsided.

Yet even when clinicians are sensitive to some of the social issues that make patients vulnerable, many are not aware of the supports in the community and the network that’s available for them, Park noted. For this reason, she worked with Fraser Health Authority to develop a scheme that makes social prescribing easily available to practitioners. She believes that this scheme is the “first in the country where the health system is fully integrated with the community organizations that provide the social prescribing services.”

‘Shift in Outlook’ 

Gary Bloch, MD, a family physician with St. Michael’s Hospital in Toronto, also advocates for social prescribing. The academic hospital and medical center have been addressing social needs alongside physical and mental health needs for more than a decade, he told Medscape Medical News. Members of the healthcare team were referring patients informally until a couple of years ago, when a specific social prescribing program was created.

“Our program targets socially marginalized, low-income older adults who live in our neighborhood,” Bloch said. “It gives us the ability to work in a deep way with those who have high social needs around isolation and other social determinants of health.”

As at Fraser Health Authority, link workers at St. Michael’s are hired from within the community. Generally, those workers “will spend at least an hour sitting and speaking with their clients, trying to get a sense of what their lives are like, and then slowly building out what their needs are and what they would like to focus on as priorities,” Bloch explained. Food insecurity is one of the top issues, he said, though poverty, housing insecurity, and the desire for more access to social programs are also areas of concern.

“The work that is done by our link workers is not something clinicians can do themselves,” he continued. “It requires someone who is specifically focused on that type of relationship building and has that type of expertise on the ground.”

But what clinicians do need to do is “shift their outlook and create space within what they’re doing for patients to think about this realm of healthcare,” he said. “Screening patients about their social needs and then linking them up with community resources needs to be built into the way we practice.”

Way of the Future

Park is convinced that clinicians who aren’t pursuing social prescribing “are missing out on the ability to set their patients up for success in their health journeys and to also take advantage of the rich resources and networks that are available in a person’s community. If you’re able to provide these supports,” she said, “the patients can live normal, healthier lives and reduce some of the barriers that get in the way of doing the right things.”

For example, many older adults who would benefit from exercise programs don’t know how to access them, she explained. Link workers from the community can help by finding nearby programs.

In addition, organizations such as United Way also actively support social prescribing. Its Better at Home program helps older adults stay independent and live in the community by providing services such as grocery shopping, shoveling snow, and transportation to doctor’s appointments.

St. Michael’s is creating a community asset map: A detailed guide to community resources that are available to older adults. “Some resources, such as senior centers, are obvious,” Bloch said. “Others might be much smaller groups or individuals: For example, one or two people running a business that provides cleaning support to seniors. Now everyone on the health team knows about these providers and how to connect with them.

“This is the way of the future for healthcare, certainly for primary care,” he continued. “We’ve known about the link between social health and physical and mental health for eons. We now have ways to address this, and these ways are becoming increasingly popular. I would be surprised if this doesn’t emerge as just a normal part of primary care practice over the next few years.”

Park added, “If we can leverage what’s available in the community and use our community connectors, then we’re increasing the ability to keep our patients well, increasing the reach of health systems, and reducing the burden on those systems to ensure that they are available for people when they really need them.”

The Canadian Institute for Social Prescribing provides resources for clinicians and community members who want to learn more about this model.

Biswas, Park, and Bloch reported having no relevant financial relationships.

Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.