Dr Hannah Steedman
Picture reproduced from A Handbook for Nature on Prescription to Promote Mental Health with full permission from the authors.
What is social prescribing?
Social prescribing is a non-medical intervention – healthcare professionals refer patients to a link worker who can connect them with appropriate support. It’s all about connecting people with a variety of community groups and services.
Green social prescribing gets people involved with nature-based interventions to improve their physical and mental health. This can range from green activities (e.g. gardening clubs, nature walks) to creative activities (e.g. art and dance).
As part of the NHS Long Term Plan, the UK government earmarked £5.77 million to see how green social prescribing could be rolled out, aiming to reduce health inequalities and improve mental health.
Why is social prescribing important for young people with SEND?
There are 1.7 million children in the UK with special educational needs (SEN) – that’s about 18% of all school pupils and of those, about 1.2 million receive SEN support.
There’s been a lot of research into how green social prescribing schemes can benefit those with mental health issues and improve general well-being, but there are far fewer publications regarding the benefit for those who have a disability and, in particular, the paediatric population. Children and young people with special educational needs and disabilities (SEND) often have unmet needs and are therefore highly likely to benefit from green social prescribing if they can access local schemes.
In this article, we’ll be focusing on how nature-based interventions impact this group of young people.
How is green social prescribing relevant?
As paediatricians, we care for children with special educational needs and disabilities every day. We’re in a key position to refer them to a social prescribing link worker, as well as being in regular communication with other professionals who can also refer, for example GPs, health visitors and social workers.
Being aware of the impact that green social prescribing could have on a patient, as well as the possible challenges, makes us more likely to identify those who could benefit from such schemes, particularly whilst they are still in hospital, for example during multidisciplinary team meetings or discharge planning. Another way would be to include social prescribing in annual health reviews, making it easier for paediatricians to identify patients within the outpatient setting.
From the literature, it’s clear that there’s a real need for social prescribing in the paediatric population. One study found that children with neurodisabilities often struggle with social participation and have lots of unmet non-medical needs. However, when these needs are met their mental well-being improves. Although there isn’t much literature on starting social prescribing schemes within hospitals, this study suggests that such initiatives could be really beneficial for children with neurodisability.
There’s a well-established link between neurodisability and mental health. Up to 57% of young people with cerebral palsy meet criteria for a mental illness, with a further 40% at high risk of poor mental well-being. Young people with neurodisability often have lower levels of mental well-being – but social participation can act as a protective factor. This makes social prescribing even more important.
So… How do we do it?
What are the challenges?
Accessibility
Young people with additional needs can face extra hurdles if taking part in nature-based interventions. They might need 1:1 support, special risk assessments or a carer to do a pre-visit. For those with physical disabilities or sensory processing disorders, they may face accessibility issues – noisy environments, unsuitable care facilities – or transport might be a deal-breaker. The SEND Code of Practice says that all primary school teachers need to meet the needs of all of their pupils by using inclusive practices – this will apply to green social prescribing activities too.
Feeling safe
Young people with neurodisability have made it clear that feeling physically and mentally safe is a top priority for when they join social prescribing activities. Sadly, some have previously struggled to find suitable social activities and have felt judged or even bullied, especially in mainstream groups. Parents have also said that they want a safe space for their children where they can participate fully without being defined by their disability.
Changes in routine
Going to a new place can be stressful. Disruption in routines can cause anxiety or distress and lead to sensory overload or behaviours which are seen as challenging to others. Plus, it’s important to remember that two children with the same diagnosis will have totally different experiences and challenges.
Money and finances…
Social prescribing schemes usually get funding from the NHS, local authorities or charities, but the current cost of living crisis is making things tougher. Families of children with neurodisability often face pressure with household finances and can have a difficult time accessing community services.
The Sutton Trust (in 2023) found that 50% of senior leaders had to cut back on school trips and outings, making it even more crucial than ever that green social prescribing schemes get the funding they need. This study highlights the need for investing in sustainable health and well-being activities, especially when there are ongoing health and social inequalities. It’s all about making sure that as we expand social prescribing, it’s fair for everyone.
What are the benefits?
Better engagement and motivation
Think back to a time when someone has asked you for directions… It’s much easier if you’ve been there yourself! If you learn how to do something through an experience, you remember it and that’s the same for young people with additional needs. If they are given the opportunity to learn outside the classroom, they are more likely to get involved and stay motivated.
In fact, one study asked UK primary school teachers about how school trips can enhance learning for pupils with SEND. Teachers said that school trips (and leaning outside the classroom) helped children with things like road safety and patience, as well as social skills, learning from their peers and forming relationships.
Lifelong learning and social skills
Children with additional needs or disabilities often struggle interacting with others, especially if they have difficulties with their emotions or communication. That’s why outdoor learning opportunities where they can interact and work with their peers are so important. Plus, being outside can really help to reduce anxiety, which means they are more engaged with learning and this can improve their overall school attendance.
Developing fun, new friendships
Social prescribing is a perfect fit for interventions led by the voluntary, social enterprise and community sectors. The key to its success is that people feel safe in whatever activity they are doing, so that they can benefit from the experience. All children want the friendship and fun that come with social interaction.
Final thoughts…
- Green social prescribing can be incredibly beneficial – but it’s essential to make sure that the scheme is accessible, inclusive and has a family-centered approach.
- Link workers must have a clear understanding of the child’s and family’s needs.
- Link workers must build trust with families and help them navigate the support system, particularly if they are worried about social services involvement.
- For children who have specific communication difficulties or are non-verbal, getting information from parents and carers about their needs and preferences is essential.
- Identifying children and young people who could benefit from social prescribing schemes whilst they are in hospital is a great idea – as these families often find it difficult to access services in the community.
- Gaps in community provision will become more obvious as social prescribing schemes continue to expand. Once identified, the process of filling those gaps can begin.
Key learning points:
- Think about referring your patients to local green social prescribing schemes. Multidisciplinary and discharge planning meetings are good opportunities for this, as well as at annual health reviews.
- Some of the challenges include accessibility barriers, funding and finding appropriate social activities – unfamiliar environments can be stressful to navigate.
- Young people with special educational needs and disabilities who benefit from social prescribing feel more motivated, are more engaged with their learning and improvements are seen in their mental health.
Dr Hannah Steedman, Paediatric Registrar, Wessex Deanery