The star fish and the link worker

To mark Social Prescribing Day, a co-ordinator of social prescribing link workers in Bristol talks about how they help people deal with the circumstances of their lives and not just with their medical symptoms:

In the interview for my job as Social Prescribing Coordinator a few years ago I told a story that I felt reflected the idea of the way in which social prescribing would support people.

That it was about the individuals that we were helping, rather than about saving the world. The story goes:

A man was walking along a beach, and he saw someone dancing in the distance. As he got closer, he saw it was a young boy and that he wasn’t dancing – he was eagerly throwing starfish back into the sea, one by one, as they had become stranded on the beach.

“What are you doing?” he asked the young boy. Without looking up, the boy replied “I’m saving these starfish. If they aren’t thrown back into the sea then they’ll die.”

The man laughed. “But there are thousands of starfish on this beach, and only one of you! What difference can you possible make?!”

The boy picked up a starfish, tossed it into the water and, turning to the man replied: “I made a difference to that one”.

And this is how a lot of people see social prescribing. Someone is struggling with something visible, they go to their GP who suggests a non-medical activity to that person – gardening, for example. And they merrily attend with no barriers, feel their life has purpose once more, feel able to self-care and reduce their use of NHS resources. But, as I began to design our holistic social prescribing model, and actually began to support people in a truly person-centred way, I realised just how far away from holistic social prescribing this analogy was.

It’s not about just throwing starfish back into the ocean. It’s about finding out why they’ve become stranded in the first place, and equipping them with tools to reduce the likelihood of them getting stranded again.

It’s about building resilience, increasing knowledge of self-care, and exploring and addressing the underlying reasons for the individuals’ struggles. Only then can steps be made towards accessing wider groups, activities and support.

For many of the people we work with, if we just throw them back into the ocean they would drown. Or in a few weeks’ time they would be back on the beach, waiting to be rescued again. So, this isn’t about rescuing people. It’s about building skills and resilience within people to help themselves. And it’s about building a community so that it’s ultimately that community looking out for one another, rather than ‘service providers’.

Wouldn’t it be great if people just came to us wanting to know where a local ‘knit and natter’ group was and then went along to it regularly, declaring that all of their long-standing needs were now met? But, as you can probably imagine, it doesn’t quite happen like this.

The majority of people who access our project need what we call a ‘supported referral’ – invariably due to them being negatively affected by the social determinants of health. When people have massive ‘fires’ burning in their lives – welfare benefits, debt, caring responsibilities, lack of education – just giving them a leaflet for an art group and arguing that this will have a positive benefit on them long-term won’t have much impact.

So, this supported referral involves us working with the individual to help address the issues that matter to them, often the ‘social determinants’ of their health – be it form-filling, access to education, housing support and additional barriers that are preventing them from taking steps towards self-care. It is only when these blocks are addressed by walking alongside the individual that a relationship of trust starts to build and real and lasting change begins to happen.

Perhaps the draw for individuals is the truly holistic, person-centred approach that all our link workers take. The most important thing link workers have is time to spend with people – to listen to them, to hear what they truly want and need. For us, it’s not about sticking diagnoses on people; nor is it about fitting people into the neat boxes that society has constructed. Because this invariably means reducing people to a set of problems that match a service offer. Inevitably those bits that don’t fit the service tend to be the very parts that make up the essence of their being – their individuality, their spark.

So, by all means, let’s throw starfish back if they’re stranded. But for any sort of prevention and long-term change we need also an understanding of why they got stranded in the first place so we can make sure they don’t get stranded again – through the building of relationships that are central to a strong, person-centred, holistic social prescribing model.

Colette Brown

Colette Brown is the Social Prescribing Coordinator for Southmead Development Trust in Bristol and for SPEAR (Social Prescribing for Equality and Resilience).

SPEAR is a partnership of community anchor organisations in Bristol working together to address the health inequalities in low-income areas of the city. Together they use an assets-based approach to health and wellbeing, using social prescribing link workers based in GP practices.

Each SPEAR partner (Knowle West Healthy Living Centre, Southmead Development Trust, Wellspring Healthy Living Centre and The Care Forum) is embedded in and trusted by their local community.


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