SBB Spotlight: Daniel Hayes

"Social prescribing is about finding out a young persons unique values, gifts and talents and providing support to help them improve their mental health and wellbeing via addressing the social determinants of health"

24 July 2023

This month we’re featuring our Senior Research Fellow Dr Daniel Hayes. Daniel is an interdisciplinary mixed-methods researcher, specialising in mental health and social prescribing for young people. He is currently leading our Wellbeing While Waiting project. Read on to learn more about the phases and aims of the project as well as the barriers children and young people face in accessing social prescribing and the role of a link worker.

Q: Can you tell me about Wellbeing While Waiting and what the aims of this project are?

D: The aims of Wellbeing While Waiting are to understand if social prescribing can help young people whilst they wait for treatment within child and adolescent mental health services (CAMHS).

We know that social prescribing can help with mental health and wellbeing, there’s good evidence of that in adult populations and promising evidence of that in youth populations. But, to date, it’s been mainly based in primary care (GP surgeries). At the same time, what we also know is that whilst young people are waiting for treatment within CAMHS, particularly post the Covid-19 pandemic, wait times for treatment are getting longer. So, with Wellbeing While Waiting we want to understand if social prescribing can be used in secondary care for young people whilst they wait for treatment and what benefits, if any, this has for this group. For example, stopping deterioration or whether some young people come off the waiting lists as they feel they no longer need treatment.

Q: What phase is the project in at the moment? 

D: The project is split into 3 phases: the first is the pathway co-development phase. We have completed that with the majority of the 10 CAMHS sites involved. We’re just moving into phase 2 (the research phase) where we are recruiting the control group prior to the social prescribing pathways being rolled out and used in CAMHS.

Q: Why is social prescribing an important pathway for children and young people?

D: The prevalence of mental ill health for children and young people is sky-rocketing in the UK (as well as internationally) and we need novel up and down-stream approaches to help address this. Importantly, social prescribing can be used as both an up and downstream intervention (i.e. early intervention or as part of treatment). However, it’s important to understand that social prescribing is just one potential tool to help address the social determinants of health and help with mental health and wellbeing.

Social prescribing, like other concepts such as self-management, and shared decision making, are all very much about the personalisation of care for patients, in this case, young people. It’s not just about trying to find something else for young people to do, it’s much more about understanding what the young person wants and needs and how this would fit with them and their lifestyle. Maybe some young people don’t feel comfortable with certain types of support or treatment or would prefer to explore other avenues. Social prescribing is about finding out a young persons unique values, gifts and talents and providing support to help them improve their mental health and wellbeing via addressing the social determinants of health.

Q: What are the most significant barriers children and young people face when accessing social prescribing?

D: For certain populations social prescribing is not that well known or understood. If you use the term ‘social prescribing’ with young people it doesn’t necessarily resonate with all of them. For some young people it can feel quite pathologising in terms of language. But for others it can legitimise support by framing it more within a healthcare system.

Another barrier is accessibility, both in terms of where social prescribing is taking place, as well as the activity or support being prescribed. Social prescribing should be taking place in locations where young people feel comfortable talking to a Link Worker and this may not always be in a healthcare setting. In terms of accessibility of the activity, if a person is in a very rural location, they might have difficulty getting to a certain type of support or activity. Or there may not be as many different types of activities available, so these individuals are choosing between a much smaller set compared with somebody in a major city. Therefore, you’re tailoring a service with limited options.

Finally, there is cost – are there pots of funding available for young people to participate in activities or to get the equipment needed to access these activities. This is really needed if we are serious about health inequalities and addressing the social determinants of health.

Q: What is the role of the Link Worker in the context of social prescribing?

D: A Link Worker is an individual that works with a patient over a number of sessions, usually between 6 and 12, and explores with them what they believe they’re presenting difficulties are and what is causing them, as well as their unique values, preferences, and talents. This can be done in a variety of formats, for example, texting, video calls, or face-to-face sessions, to build up a relationship with the young person.  Based on these conversations a social prescription will be co-developed between the young person and the Link Worker, where the young person is connected to forms of support within their communities. The Link Worker may also accompany the young person to their activities to start with, to help ease the transition into the activity or support – this is one of the big differences between social prescribing and signposting.

Link Workers also have an excellent knowledge of the local resources available and communities that these young people live in. Other professionals might not have the time to gain this knowledge given the rapidly changing landscape when it comes to community assets and the cost of living crisis, where keeping track of which services open or close can be difficult. Therefore, it’s important to have someone who is well attuned to these community resources and connections.

Q: What is your background in the field of arts and health and how did your journey lead you to this role in the Social Biobehavioural Research Group?

D: My research sits within what I would call ‘personalised care’ with a particular emphasis on young people. My PhD was about shared decision making, looking at ways we can include young people in decisions about their care and treatment, specifically within CAMHS. As part of this, I identified a number of barriers, such as a lack of knowledge on what different options were available, and complex medical language being used during appointments by healthcare staff.  As a result of this, one of the outputs from my PhD was the development of decision aids for young people to use with their parents and clinicians to make informed decisions about their care and treatment. Specifically, I developed two decision aids per presenting difficulty: one for help and support within the NHS; and another for help and support outside the NHS. The former pertained to medications, psychotherapy, watchful waiting, whilst the latter was for more creative non-medical interventions.

This was before social prescribing had been properly developed and rolled out for young people and was more embedded within adult settings. So I decided with some colleagues to conduct a review into social prescribing for children and young peoples mental health and wellbeing in 2020. Disappointingly, we  found no studies to include, however, this meant that we had a great opportunity to start making an impact on an underdeveloped field. At the end of the review, we posed questions as to why social prescribing wasn’t being used with young people. Was it that the dominant Link Worker model, which is based in primary care, was not accessible for young people? We also considered what implementation difficulties there might be in order to adapt this service to young people and whether these had been properly considered in terms of the nuances and complexities (e.g. the role of the parent in social prescribing).

I then gained successful funding to explore the barriers and facilitators to social prescribing for children and young people’s mental health via the Emerging Minds network. Following this, Daisy invited me to join her as a co-applicant on the Wellbeing While Waiting bid to the Prudence Trust which was successful and led to my role within the team.

Q: Have you noticed a big increase in the amount of research being done on social prescribing for young people?

D: Definitely there has been a massive gear shift in the last two years. There are a lot of conversations happening around social prescribing and how to implement it with children and young people. However research is still in it’s infancy. I’d estimate that social prescribing research with young people is five years behind where studies are with adults at the moment.

Q: How do you see social prescribing being implemented within health care systems?

D: Healthcare systems are constantly evolving, so I suppose I would think of healthcare systems in the broadest terms, involving local authorities, public health, education. Social prescribing is already being incorporated or adapted into these systems to help address the social determinants of health, often as upstream or early intervention programmes, prior to health difficulties emerging or becoming embedded. However, it can also be used as a downstream intervention, as part of the healthcare systems arsenal to help treat patient complaints in primary and secondary care. To use it as a downstream intervention, it has to be incorporated into the biopsychosocial approach of health. Traditionally the social aspect of this model has been neglected or overlooked by healthcare systems, so only the biological or psychosocial elements are treated. This is problematic when the individual is then placed back within the same social environments and structures as before with no acknowledgement of this which leads to them becoming unwell again. There needs to be a more holistic integrated approach.

Q: What are your personal arts-based hobbies and interests?

D: I like giving things a go, but in terms of art-based hobbies, I’m afraid I have two left hands, so my creative attempts often look like they were done by a five-year-old. However, I would say I’m creative with food, I like cooking from scratch and attempting new dishes. I have also started learning Italian.

Daniel is on Twitter and LinkedIn.