Sreewichian, P. (2024) – Download PDF – pp. 38-50

 

Pulaporn Sreewichian

Glasgow Caledonian University

Email: Pulaporn.Sreewichian@gcu.ac.uk

 

Abstract:

Music activities have been increasingly prescribed, alongside traditional healthcare practices, to improve health and wellbeing as part of social prescribing. Despite the growing demand for music in social prescribing, there is still a dearth of in-depth discussion on the social prescribing of music activities, especially specific challenges and limitations hindering the link between healthcare practices and community music activities. Reflecting upon a study done as part of PhD research on the social prescribing of music activities and the potential of music technology, this article aims to discuss identified challenges and limitations of the current social prescribing of music activities. The paper begins with a review of models and practices of socially prescribed music activities, drawing from existing literature and the stakeholder study. The paper then discusses identified challenges and limitations, including stakeholders’ buy-in and perception toward music activities, availability of music activities and funding, and a lack of shared information. Reflection on these challenges informs a discussion on potential improvements to optimise the social prescribing of music activities and bridge the gap between healthcare and music activities to support health and wellbeing within the social prescribing mechanism.

Keywords: Social prescribing; Arts on prescription; Community music; Health and wellbeing.

Introduction

Social prescribing is a mechanism of enabling a link between healthcare practices and non-medical resources in communities to holistically support individuals’ health and wellbeing (Buck & Ewbank 2020). The aims of social prescribing are to address non-medical factors that influence health quality and to tackle wider determinants of health by connecting individuals to various types of supports and resources that match their needs, for instance, financial advice services, nutrition advice, sports, and creative activities (Buck & Ewbank 2020; Husk et al. 2019).

Among various resources in communities, music activities have received increased attention as socially prescribed support resources (National Academy of Social Prescribing [NASP] 2023a). Community music, in particular, offers opportunities and inclusive spaces where individuals can actively engage in music activities. Evidence suggests that taking part in community music enhances wellbeing and strengthens social cohesion (Millar et al. 2020; Vougioukalou et al. 2019). These outcomes align with the objectives of social prescribing, which emphasise empowering individuals and strengthening community resources (Davis-Hall 2018). While the use of music activities to support health has long existed (Bradt 2006; Fancourt 2017), the growing recognition of social prescribing has led to increased attention on enhancing a formal link from medical settings to music activities in communities (NASP 2023a). This is with the expectation that music activities will provide support alongside primary care practices (All Party Parliamentary Group on Arts, Health and Wellbeing [APPGAHW] 2017; Vaizey 2017).

Despite the growing interests around the potential impacts of music activities and community music, there remains a need to address existing challenges and limitations to optimise the link between social prescribing and music activities and community music moving forward. This article reviews the current challenges and limitations of the social prescribing of music activities by examining existing academic and grey literature. The discussion begins with a background on social prescribing, followed by an overview of the current scene of music activities in social prescribing, identified challenges and limitations, and concludes with a reflection and recommendations for future improvement.

What is Social Prescribing?

Various factors such as lifestyles, community networks, socioeconomic status, living conditions, and cultural background, collectively known as the wider determinants of health, play a significant role in determining individuals’ health and wellbeing outcomes (Marmot & Wilkinson 2005). In response to growing concerns about health inequities and the sustainability of healthcare strategies, the World Health Organization (WHO) and regional public health sectors have highlighted the importance of addressing the wider determinants of health in health strategy and policy to move forward sustainably (Diderichsen et al. 2012; World Health Assembly 2009). One proposed strategy for improving focus on the wider determinants of health is to foster collaboration with non-medical resources outside of healthcare practices (Phillips et al. 2020). Social prescribing aligned with the proposed strategy as a structured mechanism for healthcare providers to connect people with non-medical resources in their communities that influence health and wellbeing (Buck & Ewbank 2020). As such, social prescribing serves as a health intervention aimed at addressing the wider determinants of health (Nowak & Mulligan 2021).

Social prescribing, sometimes also called community referrals, is a term that originated in the United Kingdom (UK) referring to a mechanism of enabling healthcare practice to link with non-medical resources (Buck & Ewbank 2020; Morse et al. 2022). The earliest report of a formal social prescribing initiative in the UK is evidenced back to the 1990s at the Bromley by Bow Centre, East London(Davis-Hall 2018). Bromley by Bow Centre provided support to people in a deprived area of East London by integrating community and healthcare services, providing support around the wider determinants of health, connecting people to non-medical services, and empowering them to take control of their health decisions (Buck & Ewbank 2020; Davis-Hall 2018). Similar programmes subsequently emerged across the UK, though they did not gain widespread recognition until evidence supporting social prescribing began to accumulate in the 2000s (Friedli & Watson 2004; Popay et al. 2007; South et al. 2008). Over the following decade, social prescribing gained increased attention, as evidenced by the growth of literature and discussions among policymakers (Department of Health and Social Care 2018; National Health Service [NHS] Health Scotland 2016). Social prescribing has currently been included in healthcare strategy agenda of the NHS boards across the UK (Buck & Ewbank 2020), with funding support for the implementation of social prescribing across the nation (Department of Health and Social Care 2022). Outside of the UK, social prescribing has also received increased attention and become widely publicised internationally. Recent evidence of social prescribing development can be found in several countries globally, including Japan, Singapore, India, Iran, New Zealand, Australia, Portugal, Spain, Finland, Austria, and Canada (Khan et al. 2023; World Health Organization 2022).

Social prescribing models range from the simple provision of information about available resources to more formal referral pathways involving experts in community resources, often referred to as “link workers” (Oster et al. 2023). The link worker model is the most recognisable form of social prescribing in the UK, which has a link worker as a key person in bridging between traditional healthcare and community resources (Fixsen et al. 2022). In the link worker model, an initial referral to a link worker is made, often through a primary care setting, once a client is identified as potentially benefiting from non-medical resources (Buck & Ewbank 2020). The link worker then works with the referred individual to identify and help facilitate access to the non-medical sources of support for the individual’s needs (Buck & Ewbank 2020). The role is sometimes called social prescribing coordinator, community navigator, community connector, or health advisor (Buck & Ewbank 2020; NASP 2023b). The success of the link worker model is often attributed to the trust and rapport developed between the link worker and the individual, which can help reduce social isolation and improve engagement with community resources (Husk et al. 2020; Moffatt et al. 2017). Economically, implementing a link worker model is expected to reduce healthcare costs (Wildman & Wildman 2023). With its promising potential, health boards in England and Scotland have invested in employing more link workers in primary care practices (NHS England 2019; Scottish Government 2023). However, link workers are also employed outside primary care practices in community settings, such as community connector programs (e.g., Your Voice n.d.). This shows that the linking mechanism of social prescribing is not only limited to referrals from healthcare professionals but can also come from community members or self-referrals (Oster et al. 2023; Your Voice n.d.).

Activities and support interventions being socially prescribed are varied and tailored based on each individual’s needs. According to NASP (2022), socially prescribed activities and sources of support can be categorised into five main groups. The first category involves the prescription of advice and information related to social welfare, debt management, legal issues, employment, and housing, aimed at providing practical assistance with issues that could negatively impact wellbeing and health behaviours (Kitmitto et al. 2022; NASP 2022). The second category involves prescribing nature-based activities, such as gardening, outdoor swimming, or creative activities in green spaces, which foster connections with nature and can yield psychological and physiological health benefits (Mughal et al. 2022a; NASP 2022). The third category includes the prescription of physical activities, such as sports, dancing, and walking in nature, designed to promote physical activity, reduce frailty, and alleviate social isolation (NASP 2022; Polley & Sabey 2022). The fourth category involves the prescription of arts and cultural activities, which offer individuals opportunities to engage creatively and connect with their communities through activities such as art classes, music, singing, discovering hobbies, or visiting galleries (NASP 2022; NASP 2023c). Lastly, the fifth category includes heritage-based activities, such as visiting museums and historical sites, which help individuals explore their sense of self and belonging within their community (NASP 2023d).

 

Music Activities in Social Prescribing

A vast body of evidence suggests that prescribing of music activities has promising benefits on both the individual and community levels. Listening to preferred music reduces heartbeat rate and blood pressure (Wu et al. 2017), lowers cortisol levels (the stress hormone), and increases dopamine production (the pleasure hormone) (Koelsch et al. 2011; Salimpoor et al. 2011), indicating that music listening can reduce stress and anxiety. Participating in active music-making has been shown to impact neuroplasticity in young people and facilitate neurorehabilitation in adults (Baker & Roth 2004; Schlaug et al. 2009). Psychologically, engaging with music activities is strongly linked to an individual’s sense of self and identity (Hesmondhalgh 2008). Additionally, participating in group music activities has been reported to facilitate improvement in sense of belonging, self-awareness, and enforcing development of healthy relationships with peers (Camlin et al. 2020). These combined holistic impacts suggest that music activities can be an effective, low-cost intervention that not only improves health outcomes but also reduces pressure on the current healthcare and social care systems (APPGAHW 2017; Crealey et al. 2023; UK Music & Music for Dementia 2022).

In the context of social prescribing, music activities have often been included in discussions on arts and cultural prescriptions (Bungay & Clift 2010). The potential for music to improve health and well-being has gained increasing attention in the recent decade, particularly during the COVID-19 pandemic, when music helped to mitigate social isolation and support mental health (APPGAHW 2017; UK Music & Music for Dementia 2022b; Vaizey 2017). A significant milestone in the social prescribing of music activities in the UK is the launch of The Power of Music Fund in 2023. Managed by the NASP, the funding body provides multi-year funding to grassroot choirs and singing groups targeting people living with dementia and families and helps the music groups develop links with health sectors (NASP 2023a). This significant funding initiative, a collaboration between NASP, local authorities, national music organisations, and multiple other funders, demonstrates the recognised potential of community music activities to support the health and social care system (NASP 2023a).

While there are various types of music activities being socially prescribed, singing may be one of the most common socially prescribed music activities. As mentioned in the previous section, there is currently an increasing attention on singing to support people living with dementia. Nonetheless, many other singing groups are also being socially prescribed with targeting to provide support for people with respiratory conditions, cancer patients, mental health clients, or individuals who are interested in improving general wellbeing(Chapman 2022; Scotland’s Singing For Health Network n.d.). Singing groups and choirs for health and wellbeing has grown as socially prescribed music activities throughout the UK as it requires fewer resources and a higher level of musical expertise to participate (Bhanshaly 2022).

Apart from singing, a wide range of other music activities in communities are also being socially prescribed. Music production and one-to-one music lessons are evidenced to be socially prescribed to promote a safe space for teenagers to develop resilience, self-esteem, and improve their wellbeing (Mooney & Poole 2019; Music for Good 2021; National Children’s Bureau 2022). Songwriting, instrumental groups, jamming sessions, and music appreciation activities are being prescribed in communities to support people with mental health difficulties, refugees and asylum seekers to provide opportunities to explore new interests and forge a sense of community (Action Foundation 2024; Chapman & Barbara 2022; Davenport 2022). Additionally, there are also music activities designed for remote or personal-led support being prescribed through social prescribing. For instance, resources for personal playlist making by Playlist for Life (2019) and Music for My Mind (2021), and The Music Hot Line provide opportunities for an individual to explore their creativity with professional musicians through a phone call (String of Heart 2023).

Challenges and Limitations

While music activities in communities are gaining more recognition and support as part of social prescribing, there are challenges and limitations that may hinder the social prescription of music activities moving forward.

Availability and accessibility seem to be major challenges as music activities are not always available in wider communities. Reports by UK Music and Music for Dementia (2022) and AMP (2023) pointed out a current issue regarding a lack of music activities in rural and remote areas. As most music activities are located in urban and metropolitan areas, people living in rural areas may have to commute to a certain location to participate in music activities (UK Music & Music for Dementia 2022). For individuals living in rural areas, commuting to access music activities can be difficult, as public transportation is often infrequent and in decline, which poses a barrier to accessing essential health services and prescribed activities (AMP 2023; Department of Transport 2023). Moreover, in the case if individuals are willing to travel, the cost of transportation can sometimes be a barrier. This is especially problematic in the context of social prescribing, as individuals being prescribed an activity may face multiple issues related to low socioeconomic status, making the cost of travelling to an activity a limiting factor (Gates et al. 2019).

Ensuring the availability and accessibility of music activities requires monetary support, but funding is another significant challenge. Funding is essential in supporting the operation and continuity of music activities in communities, as many activities are community-led and run by volunteers and/or in collaboration with a charity organisation (Yi & Kim 2023). Funding challenges have long been reported, and the issue has worsened due to the recent cost-of-living crisis in the UK (Health and Social Care Alliance Scotland 2023; Stewart 2024). A recent report gathering responses from creative health sectors reveals that while there is a positive attitude toward arts and cultural activities to support health, the issues of strained and reduced funding have been worsening (Tang 2024). Unstable and insufficient funding can lead to existing organisations being unable to maintain their music activities and volunteer workforces (AMP 2023; Tang 2024). To support the continuity of music activities, some providers have resorted to crowdfunding and charging small participation fees (Youth Music 2023). However, these strategies are not seen as sustainable long-term solutions, particularly given the financial constraints of many social prescribing service users (Evans et al. 2013). Therefore, it is suggested that improvements be made in strategising investment partnerships with existing funders (e.g., government, industry, and philanthropy) and securing long-term funding investments from healthcare sectors to support the continuity of existing music activities and expand opportunities in areas lacking such activities (UK Music & Music for Dementia 2022).

Lastly, there is a need to improve the quality of evidence and increase stakeholders’ awareness of the potential impacts of the social prescribing of music activities. While there is vast scientific evidence on the impact of music on health and wellbeing, evidence of music and other arts activities in the context of social prescribing is inconsistent in terms of validity, quality, and reliability (Mughal et al. 2022b; Tang 2024). Quality evidence is needed to enhance buy-in and support for the prescription of music activities and for music activity providers to secure continuing funding support (Boyd & Robertson-Kirkland 2023). However, evaluation can sometimes be challenging and burdensome for activity providers due to a lack of time and resources (Boyd & Robertson-Kirkland 2023). Collaboration could help provide evaluation resources to music activity providers and foster the quality of evaluation practices (Boyd & Robertson-Kirkland 2023).

Reflection and Future Direction

With rich evidence of the benefits of music activities on health and wellbeing, the social prescribing of music activities holds a promising future to support the health and social care system in the UK. However, the identified challenges and limitations indicate that the current state of music activities on prescription is not yet stable and is at risk of unsustainable financial support. These challenges are intertwined, with issues of accessibility and availability partly attributable to a lack of funding. Concurrently, to inform sustainable funding strategies moving forward, there is a need for more robust evidence on the impacts of music on prescription.

All Party Parliamentary Group on Arts, Health and Wellbeing has recommended that arts on prescription should involve stronger partnerships between sectors to expand evidence and strategies for creative activities in social prescribing (APPGAHW Contemporary Music Review 2017). One recently established example of such a partnership in music on prescription is The Power of Music Fund by NASP. This fund is the first to provide substantial support to the social prescribing of music activities for a five-year period, setting a hopeful precedent (NASP 2023a). However, this opportunity is currently limited to activities for people living with dementia and their families. While it is understandable, as dementia affects nearly a million people in the UK (NHS 2023), there are broader demographic groups that could benefit from music activities but are currently unable to access them (AMP 2023). Therefore, more partnerships and collaborations are needed to strategise the sustainable development of links between health and social care and music activities that can support a wider population.

Developing such partnerships and collaborations may not happen without raising stakeholder awareness of the potential impacts of music on prescription. As mentioned earlier, this highlights the need for more evidence and communication to raise awareness among stakeholders. Compared to The Power of Music Fund, evidence of music in dementia care is well established (e.g., Pedersen et al. 2017; Van de Winckel et al. 2004), including the cost-effectiveness potential of singing interventions (e.g., Coulton et al. 2015; Skingley et al. 2011). Thus, future evaluation evidence should clearly discuss the theoretical mechanisms contributing to the measured impacts of music activities on prescription (Mughal et al. 2022b). To effectively communicate the potential of music activities to healthcare professionals, evidence must clearly explain how music activities can support the treatment and/or management of conditions (Boyd & Robertson-Kirkland 2023). With the growth of the arts and health research field, evaluation resources and theoretical frameworks are available to improve understanding of the impacts of music activities on different demographics (e.g., Warran et al. 2022; Warran et al. 2023). Additionally, future research and evaluation should investigate the effectiveness and return on investment to support funders’ strategies towards funding music and other creative activities as part of social prescribing (APPGAHW 2017).

Conclusion

Music activities hold promising potential to support health and wellbeing as part of social prescribing, with impacts expected at both the individual and community levels. Music activities and community music, alongside other arts on prescription, could help reduce the pressure on health and social care systems. Initiatives like The Power of Music Fund highlight the growing recognition and support for music in social prescribing. However, challenges persist. Accessibility and availability issues hinder wider population benefits, and funding constraints limit the sustainability and reach of existing programs, as well as the development of new initiatives. Additionally, more robust evidence is needed to support the efficacy and impact of music activities and community music in social prescribing. To advance the practices of music on prescription, improved partnerships and collaborations between sectors are essential for developing strategies and evidence on the social prescribing of music activities.

 

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