For many, the emotional impact of the COVID-19 pandemic will be considerable. Feelings of stress, confusion and uncertainty will be unsettling and worrying. Concern about people’s physical and mental health will extend into their determinants, such as social connections that have been lost, restrictive environments, and the economic challenges that many will face. Receiving continuous news and opinions through social media, television, and radio about the disastrous state of the nation is likely to fuel feelings of fear, helplessness, and uncertainty, which may have repercussions on people’s physical and psychological well-being. In the longer term, these feelings are likely to exacerbate the worsening mental health of the UK population.
Fortunately, the NHS Long Term Plan had already begun recognising the wider determinants of our health through social prescribing - a response to the range of factors – not just physiological – that can affect people’s health and well-being. For example, individuals may feel low in mood because they are socially isolated, or anxious because of debt or housing problems. Social prescribing involves linking people to ‘community assets’ that can alleviate challenges stemming from the wider determinants of our health. These community-based assets, often delivered by the voluntary-community sector, incorporate (but are not limited to) organisations that offer advice on housing or debt, luncheon clubs, charities (e.g. MIND), or gardening groups.
Cultural and heritage sectors (e.g. public gardens and open spaces, galleries, museums, heritage sites, theatres, and libraries) can also play a role, and many of them already offer activities and events that support individuals in making connections, developing self-confidence, feeling calmer, and living more healthily. This is reflected in reports from the Heritage Alliance and the All-Party Parliamentary Group on Arts, Health and Wellbeing.
At the University of Oxford, in the Centre for Evidence Based Medicine and the Gardens, Libraries and Museums division, we have been working together exploring how to deliver and evaluate social prescribing activities hosted by the cultural and heritage sectors. We held a public engagement event on this topic last year. Those attending thought that places like museums were suitable venues for: a) helping people to feel less isolated, b) offering a distraction from concerns and worries, c) enabling them to see that life has meaning or purpose. These benefits might come from attending alone, joining group activities, or volunteering. Potential barriers to such gains identified at this engagement event included: a) failure of individuals to regard themselves as those likely to use a museum, b) finding the quietness of the setting off-putting, c) unclear signage, d) limited parking, e) a lack of seating. As part of this work, we produced a review of the benefits that the cultural and heritage sectors can bring to people’s well-being. It highlighted that potential benefits are produced through the provision of: a) therapeutic spaces (being places where people feel safe, calm, relaxed); b) flow (becoming immersed in an activity, diverting people from other concerns in life); c) social capital (resources that individuals accrue from connecting with others, including a sense of belonging, trust, and access to practical advice). Our work highlighted various mechanisms, through which these spaces may improve our health and wellbeing (shown below).
We are taking this work forward, with funding from the UKRI Arts and Humanities Research Council, as an interdisciplinary team composed of colleagues from health and cultural/heritage sectors and digital humanities. For 12 months, we shall conduct a study to address the following question: Cultural institutions as social prescribing venues to improve older people’s well-being in the context of the COVID-19 pandemic: What works, for whom, in what circumstances and why?
The COVID-19 pandemic is affecting what the cultural sector can offer, at a time when significant physical, mental and/or social consequences of the pandemic are anticipated (e.g. fear, loneliness, money worries), especially among older people. From the outset this population was identified as being at risk of suffering the condition itself, its complications and responses to it, including extreme isolation, especially if unfamiliar with online communication. Our research will explore how the cultural sector adapts to support older people’s well-being. This will allow us to provide recommendations to the cultural sector about being 'referral-ready' for social prescribing for older people, in the context of the current pandemic and future ones.
If you would like to know more about our project, or have any comments you would like to share, we very much look forward to hearing from you.
Stephanie Tierney is a Departmental Lecturer and Senior Researcher at the Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford. She co-leads a network of academics, clinicians, providers, policy makers and members of the public with an interest in social prescribing.
Kamal R. Mahtani is a GP and Associate Professor at the Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford. He co-leads a programme of work to build the evidence base to support the redesign of primary care services including building the evidence base for social prescribing.
Acknowledgements We thank Jeff Aronson for comments on an earlier draft. This research is funded by UKRI/AHRC (AH/V008781/1).
Disclaimer: The views expressed in this commentary are those of the authors and not necessarily those of the host institution, organisations mentioned or funding bodies.