Article
Care
Change
Mental Health
4 min read

Social prescribing for whole person care

Responding to an anxiety epidemic, there’s a growth in social prescribing with a spiritual wellbeing element. Esther Platt explores how it's working out locally.

Esther works as a Senior Consultant for the Good Faith Partnership. She sits in the secretariat for the ChurchWorks Commission.

Two people sit at a table with their hands resting on top of it. One speaks to the other
Photo by Christina @ wocintechchat.com on Unsplash

Since 2001, Mental Health Awareness Week has been marked once a year in May. This year, the theme was anxiety - an increasingly relevant topic in a country that has endured three years of world-changing crises and the soaring cost of living. Research from the Mental Health Foundation has found that 1 in 10 UK adults feel hopeless about financial circumstances and more than one-third feel anxious. 

For centuries, it has been recognised that spiritual well-being is closely tied to mental well-being. By spiritual wellbeing, I don’t mean organised religion. I mean our sense of relationship to a higher-power or reality beyond our own, and our sense of purpose and meaning in life, as Craig Ellison outlines it as in his paper Spiritual Well-Being: Conceptualization and Measurement. 

In Man’s Search for Meaning holocaust survivor Victor Frankl compellingly makes the case that in a world of suffering, our survival depends on our sense of purpose, meaning and hope. Frankl coined the term ‘the self-transcendence of human existence’ by which he explained that human beings look for meaning beyond themselves, either in a cause, a person to love, or a higher power.

With an increased understanding of the holistic nature of wellbeing, and the value of spirituality, a new way of looking at health is emerging. 

While modern psychologists are still building a clinical-grade evidence base on the value of spirituality, there is clear agreement that spiritual wellbeing is crucial for a good quality of life, especially for those who are facing adverse life events, as you can read on the US National Library of Medicine web site. Traditionally, health provision in the UK has focused exclusively on the physical, and more recently the mental. However, with an increased understanding of the holistic nature of wellbeing, and the value of spirituality, a new way of looking at health is emerging.  

Social prescribing is one way in which this is being done, and across the country. 

In social prescribing, local agencies such as charities, social care and health services refer people to a social prescribing link worker. Social prescribing link workers give people time, focusing on ‘what matters to me?’ to coproduce a simple personalised care and support plan. This involves ‘prescribing’ individuals to local community groups such as walking clubs, art classes, gardening groups and many other activities. 

Churches are playing a crucial role making social prescribing happen. St Mary’s Church in Andover, offer a wellbeing course to members of the community who have been directed to them through the local GP surgery.  

Members of Revival Fires Church in Dudley have been trained to offer Listening and Guidance support to those who are referred by a GP.  

Beyond social prescribing, St John’s Hoxton in London offer the Sanctuary Mental Health course to their community which gives people an opportunity to share their experiences and find solidarity in their struggles.  

Church provides a space where the breadth of our wellbeing, our desire for purpose, community and hope can be supported in a way that the NHS does not have capacity or experience to deliver. As the Archbishop of Canterbury, Justin Welby, writes  

"The issue of mental health is one that requires a holistic approach on an individual basis, incorporating as appropriate psychiatric, medical and religious support’.  

Olivia Amartey, Executive Director for Elim, an international movement of Pentecostal churches adds,  

‘I am convinced that there is no other organisation on earth that cares for the whole person, as well as the church. Its engagement with the statutory authorities, focussed on individuals’ well-being, provides an invaluable opportunity for a synchronised partnership to the benefit of all our communities.’ 

Jesus told his followers, ‘I have come so that you can have life and have it to the full’. This is the hope that animates churches. Christians find meaning and purpose in the hope of life, peace and justice that Jesus gives. Church can be a space where the complexity of hurt and suffering is acknowledged, and where we can find solidarity and support in the presence of those who can help us find purpose and meaning.  

At ChurchWorks, a commission of leaders from the 15 biggest church denominations in the UK, we are excited by the prospect of more churches providing this space. On 18th May we held ChurchWorks for Wellbeing, in which we gathered over 300 church leaders to explore how the church can bring hope to our communities in this time. We shared stories of small and simple conversations, where offering a listening service, an art class or a food pantry enabled churches to give people in their community space to be, to grieve, to process and to grow. From the conference, it is our hope that we will see hundreds more churches start to engage in social prescribing and welcome their communities to access holistic wellbeing support.  

At a time when anxiety is rife, and it is so easy to feel despair and hopelessness, the church offers a vital resource to us: a place where our spiritual wellbeing can be nurtured, where we can find purpose, where we can find community, where we can find hope. 

Article
Assisted dying
Care
Comment
Politics
4 min read

Assisted dying is not a medical procedure; it is a social one

Another vote, and an age-related amendment, highlight the complex community of care.
Graffiti reads 'I miss me' with u crossed out under the 'mem'
Sidd Inban on Unsplash.

Scottish Parliament’s Assisted Dying bill will go to a stage one vote on Tuesday 13th May, with some amendments having been made in response to public and political consultation. This includes the age of eligibility, originally proposed as 16 years. In the new draft of the bill, those requesting assistance to die must be at least 18.  

MSPs have been given a free vote on this bill, which means they can follow their consciences. Clearly, amongst those who support it, there is a hope that raising the age threshold will calm the troubled consciences of some who are threatening to oppose. When asked if this age amendment was a response to weakening support, The Times reports that one “seasoned parliamentarian” (unnamed) agreed, and commented: 

“The age thing was always there to be traded, a tactical retreat.”  

The callousness of this language chills me. Whilst it is well known that politics is more of an art than a science, there are moments when our parliamentarians literally hold matters of life and death in their hands. How can someone speak of such matters as if they are bargaining chips or military manoeuvres? But my discomfort aside, there is a certain truth in what this unnamed strategist says.  

When Liam McArthur MSP was first proposed the bill, he already suggested that the age limit would be a point of debate, accepting that there were “persuasive” arguments for raising it to 18. Fortunately, McArthur’s language choices were more appropriate to the subject matter. “The rationale for opting for 16 was because of that being the age of capacity for making medical decisions,” he said, but at the same time he acknowledged that in other countries where similar assisted dying laws are already in operation, the age limit is typically 18.  

McArthur correctly observes that at 16 years old young people are considered legally competent to consent to medical procedures without needing the permission of a parent or guardian. But surely there is a difference, at a fundamental level, between consenting to a medical procedure that is designed to improve or extend one’s life and consenting to a medical procedure that will end it?  

Viewed philosophically, it would seem to me that Assisted Dying is actually not a medical procedure at all, but a social one. This claim is best illustrated by considering one of the key arguments given for protecting 16- and 17- year-olds from being allowed to make this decision, which is the risk of coercion. The adolescent brain is highly social; therefore, some argue, a young person might be particularly sensitive to the burden that their terminal illness is placing on loved ones. Or worse, socially motivated young people may be particularly vulnerable to pressure from exhausted care givers, applied subtly and behind closed doors.  

Whilst 16- and 17- year-olds are considered to have legal capacity, guidance for medical staff already indicates that under 18s should be strongly advised to seek parent or guardian advice before consenting to any decision that would have major consequences. Nothing gets more major than consenting to die, but sadly, some observe, we cannot be sure that a parent or guardian’s advice in that moment will be always in the young person’s best interests. All of this discussion implies that we know we are not asking young people to make just a medical decision that impacts their own body, but a social one that impacts multiple people in their wider networks.  

For me, this further raises the question of why 18 is even considered to be a suitable age threshold. If anything, the more ‘adult’ one gets, the more one realises one’s place in the world is part of a complex web of relationships with friends and family, in which one is not the centre. Typically, the more we grow up, the more we respect our parents, because we begin to learn that other people’s care of us has come at a cost to themselves. This is bound to affect how we feel about needing other people’s care in the case of disabling and degenerative illness. Could it even be argued that the risk of feeling socially pressured to end one’s life early actually increases with age? Indeed, there is as much concern about this bill leaving the elderly vulnerable to coercion as there is for young people, not to mention disabled adults. As MSP Pam Duncan-Glancey (a wheelchair-user) observes, “Many people with disabilities feel that they don’t get the right to live, never mind the right to die.” 

There is just a fundamental flawed logic to equating Assisted Dying with a medical procedure; one is about the mode of one’s existence in this world, but the other is about the very fact of it. The more we grow, the more we learn that we exist in communities – communities in which sometimes we are the care giver and sometimes we are the cared for. The legalisation of Assisted Dying will impact our communities in ways which cannot be undone, but none of that is accounted for if Assisted Dying is construed as nothing more than a medical choice.  

As our parliamentarians prepare to vote, I pray that they really will listen to their consciences. This is one of those moments when our elected leaders literally hold matters of life and death in their hands. Now is not the time for ‘tactical’ moves that might simply sweep the cared-for off of the table, like so many discarded bargaining chips. As MSPs consider making this very fundamental change to the way our communities in Scotland are constituted, they are not debating over the mode of the cared-for’s existence, they are debating their very right to it.