British Doctors May Soon Prescribe Art, Music, Dance, Singing Lessons | Hacker News Reader

British Doctors May Soon Prescribe Art, Music, Dance, Singing Lessons

smithsonianmag.com

152 pointspseudolus62 comments

People may be dismissive of this but this is one of the best things that most people who suffer from mental health issues can do. Every therapist I've seen over the years has constantly pushed me to exercise and/or maintain a consistent hobby. I was historically very dismissive of this idea and my thinking was that my problems were unique (even romanticizing that idea somewhat when I was younger). As I got older I just felt more alienated, disconnected, and crazy. Certain medications helped but it was difficult to stay on them. It wasn't until I was able to get into a workout routine and be consistent with it for a while that I started to feel mentally "normal" again or at least I stopped thinking that I was crazy and everyone else wasn't. The thing that motivated me into this was pretty much terror and panic. I was convinced I was losing it and everywhere I'd go the walls would close in and I would freak out (pretty bad agoraphobia). Hopefully someone who is struggling with mental health issues reads this and decides to make a change now instead of waiting until it gets worse.

I know all of this sounds like some "wow thanks i'm cured" content and no it will not cure you of your afflictions, but it takes the edge off of them so you can actually focus on and confront your issues rather than barely holding on.

For me working out is incredibly important for normalizing hormones and stabilizing my mood. I imagine it is the same for others.

As an aside; I wonder if you have / had hypothyroidism?

Do you have done interesting readings about normalizing hormones? I didn't think about this aspect when considering how working out improved health.

>(even romanticizing that idea somewhat when I was younger

Hah, me too. Nothing kills that romantic feeling of individualistic poetic suffering like realizing your problems are actually because you are just a glorified biological robot not getting sufficient exercise and nutrients.

I can third that. Though I think we also need to include the social aspect into it as well. Exercise and nutrients are needed, but I do think social interaction is also needed. In fact, I've almost made it a point to never turn down any invite simply because it generally makes me feel better, even when I'm not in a depression period.

My initial skepticism based on the title was overcome by reading the actual article. Basically, it's no good to sit around in a bed popping pills and wasting away. To that end, the UK is allowing GPs to more strongly encourage patients to get out and be active with things like free tickets.

This isn't a terribly new idea, though it's still a very good one.

The best part is if it doesn't work, the side effects are negligible if not beneficial.

Context: in the UK, healthcare is nationalised and seeing the doctor is free; for a prescription you pay only a small, fixed charge (and even that's free if you're under 16, over 60 or disabled).

So if your child has a cough and you get some Calpol from a pharmacist, you pay the regular price, if you can convince your GP (or pharmacist, where supported under the "minor ailments scheme") to prescribe you the same thing, you get it for free. This is one reason why every winter the National Health Service runs campaigns telling people "do you really need to see your doctor?" and poor people in particular go "yes we do". I don't blame them.

(Google "UK Calpol for free" if you want to read up more on this.)

I always feel the need to include the explanation of "Free at the point of delivery" - we all know we pay for it in our taxes. (This is to pre-empt any TANSTAAFL comments).

Also here in Scotland prescriptions are free as well.

Are you this pedantic about the non-marginal costs of all government services?

This public school is free at the point of delivery or calling the police is free at the point of delivery ?

The "free at the point of delivery" part is precisely how NHS services are described:

https://www.nhs.uk/using-the-nhs/about-the-nhs/principles-an...

If you don't make that qualification people will often accuse you of being a crazy socialist that doesn't appreciate where they money is actually coming from.

NB As an aside, a "public school" in the UK isn't what you think it is :-)

https://en.wikipedia.org/wiki/Public_school_(United_Kingdom)

Doh! I had a nagging suspicion about the public school thing. Now I have outed myself as an ignorant American.

> This is one reason why every winter the National Health Service runs campaigns telling people "do you really need to see your doctor?" and poor people in particular go "yes we do".

The other reason (At least in the US and Canada) for why poor/'poor' people go and see their doctor when they have a cold, is because their boss expects a doctor's note for a sick-with-the-cold day.

Such campaigns are as much targeted at the patient, as it is at their employers. Doctors don't want to deal with non-serious seasonal infections, and they don't want patients seeking a doctor's note to get their other patients sick.

yes, thank you. Fortunately I no longer work for employers like that, but as an entry-level low-level employee, you are automatically looked at with suspicion by most employers. If you need a sick day, you have to get a doctor's note, which is an outrageous waste of everybody's resources.

Been there, done that.

Phoned up work to tell them I was on the first day of a bad cold and needed a day off. They say no problem but you MUST get a doctor's note. So I phone the GP and they tell me they can see me in 2 weeks' time, I go along as ordered - the cold's completely better by then of course - and ask for a note to say that I had a cold 2 weeks ago, which I duly get and hand in to my employer. Everyone's happy, free at the point of service etc.

I hope you made a point of asking for two hours off that day, to sit in the waiting room for a note to make HR happy.

Your GP was allowed to charge you for that letter, and if you were inside the self-certification time your employer must pay the charge.

Which country does this apply to?

England. Sorry, I should have said. I don't know what happens in Wales or Scotland or NI.

Employers in the UK aren't supposed to ask for one if it's less than seven days (I don't know if they aren't allowed to, but I and my immediate family have never worked anywhere they have):

> If you're off work sick for seven days or less, your employer shouldn't ask for medical evidence that you've been ill. Instead they can ask you to confirm that you've been ill.

https://www.nhs.uk/common-health-questions/caring-carers-and...

GPs can charge if it is for less than seven days.

The Minor Ailments Scheme does not provide free calpol for all, and you don't need to see your GP to access it.

https://www.nhs.uk/news/medical-practice/minor-ailment-schem...

The reason the NHS keeps pushing the "are you in the right place" message is because they cannot provide the services peple need in the places people go to (eg, providing GPs in A&E departments), and people get better care if they go to the right place.

> because they cannot provide the services peple need in the places people go to (eg, providing GPs in A&E departments), and people get better care if they go to the right place.

Why doesn't the NHS provide services in the places that people want and expect them, instead of the places that suits the NHS? They're thinking backwards.

If you have a lot of people going to A&E who really need the services of a GP, then guess what? Put a GP in the same place as the A&E.

We have a chronic shortage of GPs. Most people who visit A&E with a minor ailment do so because they can't get an appointment with their GP within a reasonable timeframe - they'd rather sit in a waiting room for four hours than wait two weeks for a GP appointment. Putting GPs in A&E is just robbing Peter to pay Paul; we need to fix the GP shortage, but that is a complex issue that will need time and money to resolve.

https://www.economist.com/britain/2018/01/04/the-nhss-latest...

I ahree that GPs should be put in A&E departments.

People think the NHS is one big monolithic organisation, but it isn't.

We have NHS England who don't provide any services, but who commission some specialist services. Then we have 195 Clinical Commissioning Groups. These are regional organisations who again don't provide any services, but who comission services from other provider organisations. We have a bunch of trusts - mental health trusts, acute trusts, community care trusts (and combinations of these), and then we have a bunch of GPs.

In same places you'll have a 24 hour GP walk in centre close to A&E, with plenty of signage telling people of the wait times. (Swindon Hospital does this).

In some places you'll have out of hours GPs located at A&E, but weirdly to access these you have to go via a phone line call to 111.

So, yes, it's something I find frustrating.

Encouragement is not a bad idea, and there’s nothing stopping doctors from doing that today.

But the idea of “prescribing” an activity that is meant to be intrinsically motivated seems misguided.

It reminds me of those kids growing up who’s parents forced them to do every extra-curricular activity. They ended up -hating- everything they were made to do. And from my anecdotal evidence, kind of miserable.

Creative activities require a real intrinsic desire to participate in them in order to be joyful. Forcing them spoils them, and can make the participant feel even more down on themselves (I’m practicing, why don’t I like it?).

I think the better alternative is for the dr to flesh out what things the person really wants to do already, and continuously encourage them to go for it.

Maybe what I’m missing is that by making it a prescription, medical insurance will cover it? I guess that would be pretty great, as long as the person has an intrinsic desire to do the thing.

The proposed better alternative is more the role of a counselor than a doctor IMO which makes me think they should be encouraging the use of counselors instead. That being said, many people find things like counseling as superfluous or taboo so maybe it is in our best interest to delegate this responsibility more towards general practitioners.

Part of the GPs job is to be a general counciler on their health and lifestyle habits. They certainly shouldnt be diagnosing mental health issues if they don't have the expertise but encouraging to have good habits before referring them to an actual therapist is definitely warented in most cases.

Parents do it all the time.

Nobody wakes up wanting to play the oboe.

As a Former high school oboeist I can confirm that the oboe is F*ing hard to play.

Oddly enough, my daughter did. No idea why at all.

The thing about illness is, when you feel crappy you don't want to do anything. Which of course leads to less activity, to exacerbation of associated health problems and then back to not wanting to do zilch.

You can only break that circle by getting your body and brain busy with anything at all.

And with any creative activity, you figure out as you go whether you're any good at it or you prefer to switch to something else. Only you need motivation to do that.

> But the idea of “prescribing” an activity that is meant to be intrinsically motivated seems misguided.

But what if the evidence shows than it works? Because this stuff is evidence-based.

Here's the evidence: https://www.evidence.nhs.uk/search?q=%22%20social%20prescrib...

It may work better in helping to get people to start doing something, rather than keeping their routine.

There's nothing that says people may not start liking the activity that is good for them later, and keep doing it regardless of whether they started doing it on prescription or with encouragement/friend recommendation. But there's usually some initial hurdle to get over, and anything that helps is probably good.

> But the idea of “prescribing” an activity that is meant to be intrinsically motivated seems misguided.

Social prescribing doesn't mean the patient is forced to do something they don't want to do, it means the patient who may struggle (because motivation, health, money) to access something gets some support to access an activity.

That support might be financial. Here's a scheme to give free access to a slimming club for epople with a BMI over 25: https://www.slimmingworld.co.uk/health/swor/how-does-it-work...

It might be motivational, or a stepped approach from a supported activity into a mainstream activity.

I think a lot of these people fall into a pit which they can't get themselves out of. They probably just need a push to get them going again.

Our northern neighbor is doing it too. I hope it catches on in the U.S.

"A similar campaign launched in Canada earlier this month, Brendan Kelly reports for the Montreal Gazette. Beginning on November 1, every member of the Montreal-based medical association Médecins francophones du Canada (MdFC) gained the option of handing out 50 prescriptions allowing patients and a limited number of friends, family and caregivers to tour Quebec’s Montreal Museum of Fine Arts for free. Normally, admission costs up to $23 Canadian dollars (roughly $18 USD). As MdFC vice president Hélène Boyer tells Kelly, the initiative builds on research suggesting museum visits raise serotonin levels to offer a quick mood-boost."

I used to suffer from SEVERE depression in High School / College / Throughout my 20s. I am also diagnosed bipolar.

It's amazing how much of my problems could be traced back to lack of sleep, lack of exercise, smoking too much dope, and drinking too much.

The human body was made to be constantly strained and working out. Working out is a requirement of successful aging. [0][1][2][3]

It sounds like that condescending claptrap you hear over and over again, but hey: Maybe we are being condescending for a reason. Maybe you need condescended to. Maybe we are sick of telling you that you need to get enough sleep and work out to feel better. Even if it does not get you to 100%, it's a start.

0: https://www.nytimes.com/2018/10/31/well/move/being-fit-may-b... 1: https://www.nytimes.com/2018/06/06/well/weight-training-may-... 2: https://well.blogs.nytimes.com/2011/11/09/aging-well-through... 3: https://www.nytimes.com/2017/11/15/well/move/to-maintain-mus...

By "used to", it sounds as though you have navigated to a better place in life, and that is great. When you look back, do you think that it is possible that some of the bad sleep/lack of exercise/smoking too much dope/drinking too much could have been owed to depression, instead of the cause of it?

I might be misreading your wording, but to my interpretation you're attributing depression being caused by those things. I am only asking for clarification because I have experienced some of those things, but also depressive feelings, and I'm wondering - introspectively, and by asking you, trying to learn from others - if it's easy to identify causes, and then learn to address those causes.

(edit: wording was pretty awful)

> ... could have been owed to depression, instead of the cause of it?

It's a viscous cycle, absolutely. For me it was DEFINITELY lack of sleep as one of the primary instigators of my depressive episodes. Lack of sleep was both a symptom and a cause of my depression. But, I know this: Getting more sleep and living well would have solved a LOT of my problems. LACK OF SLEEP was the thing to conquer, not this vague ennui I was dragging around like Christ on the cross.

I went to school at night and worked 40 hours a week through college. I would stay up late so I could have SOME AMOUNT of free time that was not occupied by work or school. This would lead me to getting really behind on my sleep, leading to poor performance at work and at school, and on and on. Graduating and finally going to bed at a decent time is what REALLY helped me get on the right track.

The research is very clear here: Sleep is absolutely an essential part of your life, and you forgo it at your own peril. I know it's "cool" in the hacker world to stay up super late and work on code all night, but in my personal experience: The code they write at 2am will have to be rewritten by your college who got enough sleep that night. And going into work worthless the next day is not an equal trade-off.

Thank you for your response, and candor. It certainly gives me a better understanding and new things to consider.

I'd argue that "poor diet" rounds out that list of "obvious physiological deficits that impair mental health".

And that only covers the physiological aspects of things, not counting other aspects (lack of social interaction, lack of meaningful work, etc)

Makes sense to me. In Germany you sometimes can get a few weeks at a spa ("Kur") to recharge your batteries. We often forget that in order to be healthy we need something to feed our souls and for most of us that work doesn't do this.

It's crazy how far behind the US is on mental healthcare.

I have been battling depression for a long while now. My insurance can only get me to see an in network therapist four times every year!!! I can only see a psychiatrist once every six months.

This is with paying an already ludicrous sum each month for healthcare. I feel like I'm burning money, the most pressing healthcare issue I have, I cannot get help for.

Regardless, I have been working really hard on improving alone.

I think there's two issues contributing to this in the US. The first is, obviously, as you mentioned, health care costs and insurance. But I think the bigger issue is stigma. Everyone talks about how it should be acceptable to go get mental healthcare, but it still isn't. A lot of it has to do with the culture of individuality and consumerism that has been forced down Americans throats since birth. I think it's especially bad for men (and I am not saying it's not bad for women, but I can only comment on my male perspective), as there's the thought that we should be able to hide our emotions and do it alone; that we should be able to overcome everything through sheer willpower. Basically, the Protestant mentality is driving us all insane. Sadly, I don't really know of any good way to go about changing social norms in this regard.

There is a bigger issue in the US than health care cost and stigma. And that’s the kickbacks Doctors get for prescribing drugs to begin with. America has the single largest prescription drug problem in the world.

> I can only see a psychiatrist once every six months.

Most British patients with depression or anxiety have never seen a psychiatrist. The default is to treat in primary care, with only the most severely ill patients being referred to a psychiatrist. Patients often have to wait many months for specialist treatment, even if they have a severe and enduring condition like schizophrenia or bipolar disorder. Access to treatment for eating disorders is frequently rationed on the basis of Body Mass Index - if you're not literally on the brink of death, you're on your own. There are frequently zero beds available in mental health inpatient units in the entire country. Many patients experiencing acute mental health crises have been sent hundreds of miles for treatment, because there are no beds available anywhere near them.

Mental healthcare in the UK is a slow-burning crisis due to a lack of funding, increasing demand on services and a shortage of trained staff. Psychiatrists, psychologists and mental health nurses are leaving the NHS in their thousands. Suicide and homelessness amongst patients with mental health problems have risen sharply, with the police playing an increasing role in managing patients in acute need. All too often, there's simply no help available.

Against this background, I'm extremely sceptical about social prescribing. If it's anything like the Improving Access to Psychological Therapies programme that was supposed to revolutionise mental health care in Britain, it'll be the cheapest possible band-aid rather than a serious effort to provide better care.

https://www.theguardian.com/society/2017/jul/07/nhs-bosses-w...

https://www.nhsconfed.org/news/2016/10/is-mental-health-cris...

https://www.mind.org.uk/media/494424/we-still-need-to-talk_r...

I've read and followed the advice in both "The Depression Cure" and "The Mindful Way Through Depression" and can say both helped quite a bit. I personally did not find that therapy did much of anything for my depression (though I will say CBT for sleep was a life saver for me, so it was worth it just for that).

Depression is a pretty tricky thing to deal with, but I personally find that keeping a daily meditation practice helps a lot. Ultimately, being more mindful throughout the day means you'll ruminate less and dealing with the psychological component of depression is like 90% of the battle. Mindfulness will not improve your life in any of the areas that might have led you to feel depressed in the first place (e.g. feeling alone because you are alone, feeling like you have not accomplished enough, etc), but it will allow you to break away sooner from the rumination associated with these feelings so you can work on improving your life in some measurable way instead of wasting time feeling miserable.

I also think depression can just be a tradeoff for some people with a given mindset. Some people are very hard on themselves when they fail. These people are probably going to have a better chance at being successful since they are always taking responsibility for their failures and trying to improve themselves, but they are also going to have a higher chance of becoming burnt out and depressed as a result of the high expectations they have placed on themselves. The state of being depressed is obviously extremely counterproductive to what they were trying to achieve in the first place - eventually the goals shift from trying to start that business or get that promotion to just trying to get out of bed in the morning, and ruminating on this setback only feeds the depression. Ultimately, cutting out the rumination is how to resolve this in the short term, and mindfulness is the tool for doing that. In the long term, these people need to realize they are only human and have limitations and figure out how to take better care of themselves or learn to not be so hard on themselves in the first place.

Because humans need creativity and self expression in order to be healthy, and not just a job?

> Suppose that humans happen to be so constructed that they desire the opportunity for freely undertaken productive work. Suppose that they want to be free from the meddling of technocrats and commissars, bankers and tycoons, mad bombers who engage in psychological tests of will with peasants defending their homes, behavioral scientists who can't tell a pigeon from a poet, or anyone else who tries to wish freedom and dignity out of existence or beat them into oblivion.

-- Noam Chomsky

So, as a UK resident, I'm torn here. On the one hand, many people would absolutely benefit from these things. It is appalling in our society how many people suffer from something as ostensibly simple as severe loneliness, which can cause significant mental and physical health problems. So yes, this sounds great.

On the flip side... Mental health treatment in the UK is currently dramatically under-funded and under-resourced. Waiting lists are stretched beyond belief, and obtaining treatment is almost impossible for certain conditions. (First hand experience - one fairly significant mental health condition, but - ah! Only one! We only have enough resources to even try and help people with two conditions - co-morbidity. Come back when you're worse!) So two things - how much of this will in reality be pushed in an effort to avoid prescribing more serious therapies that people genuinely need (but the system can't manage), and how much of this would actually be available? It's all very well telling someone with little to no means through ill health to go and take up dance, or learn an instrument, but is that really on offer? Will that really be funded and available in areas where currently there's an 18 month waiting list to see a simple counsellor?

(I thought I should pre-empt a possible reaction of "well, that's what you get with socialist/communist/etc. medicine - <death panels> etc." - there's no inherent reason for this other than poor management, under-funding and structural incompetence. It is definitely possible for the NHS to work well again, but right now, the fact that it doesn't is more political than theoretical. It would be like me pointing to the current shutdown in the US as evidence that governments aren't possible.)

In Canada, our doctors already do this - there's a social prescription that's taken root the last year or thereabouts.

https://www.thestar.com/life/health_wellness/opinion/2018/03...

A BBC article on the same subject:

https://www.bbc.co.uk/news/entertainment-arts-46111595

I'm sure it initially sounds silly - but if it is shown to be clinically effective then I'm all for it.

It does indeed sound silly but given what we know about the real and measurable effects of placebos - why not art?

Indeed, I'm sure ideas like washing your hands and drinking clean water also sounded silly at some point.

[NB In the middle of reading a history of the Crimean war and you realise how many aspects of basic hygiene were completely ignored as recently as the mid 19th century].

More-or-less related: https://youtu.be/IeLGP2dsjME?t=126

Recreation is a drug; it makes perfect sense for a GP to prescribe it.

It's weird that they're suggesting this may soon start: social prescribing isn't new, even in the UK.

Recent announcements are that it is to become more available.

https://www.england.nhs.uk/personalisedcare/social-prescribi...

The big announcement, and something that most commentary is missing, is that this an effort to increase personalisation, and personalisation is a big part of the integration (joining up social care and NHS care) agenda which is being pushed by the current secretary of state.

What of those who already “self-medicate” with these things - will they be subsided too or go on paying full price? What’s sauce for the goose is sauce for the gander after all.

The UK Arts Council does indeed already subsidise such medication

In true tradition of medicine, these things must also be restricted from the average person, who can't be trusted to "self-diagnose," and therefore must be protected behind a prescription, for which you must pay money and convince your lord (another human) that you need it. /s

On a side note, I hate how the government has instituted gate-keepers to keep us from medicine.

A little off topic but interesting reading if you want to understand more about how mental health is covered under health insurance:

https://www.apa.org/helpcenter/parity-guide.aspx

Reply on news.ycombinator.com