Roy’s social prescribing story : Avoiding over dependency

Roy takes us through his experience of working with clients living with dementia and the issues of overdependency on the support that he provides.

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    Roy’s social prescribing story : Avoiding over dependency of clients on social prescribers

    Roy is a Health and Wellbeing coach working across different GP surgeries in North London. He shares his experience of discontinuing support and terminating rapport with his clients, the challenges that he faces and some strategies he finds helpful.
    Roy is aware that when working with client with dementia, issues of overdependency on the support that he provides can easily develop:

    “Suddenly the social prescriber comes in, they listen, they try to put things in place. They’ve just been given somebody who’s there for them. So, sometimes those people do hang on and then you get to the end of the service time, and you’ve met all their needs and then they suddenly think of something else”.

    In fact, for some clients who live alone and who have limited support from family or friends, the separation can be quite traumatic. Therefore, discontinuing support is a very sensitive process, requiring tact and skills on the part of the social prescriber.

    “Sometimes it may seem like it is a little bit brutal”. So having that gradual kind of transition is very, very important”.

    However difficult, terminating rapport is a key stage of social prescribing. As Roy explains, social prescribing is not about long-term support, but rather about empowering clients by connecting them with specialised support in the community:

    “My job is to help them in to engage with the services that are specialised and other professionals in that field, so I’ll be doing them a disservice if I just keep them on long term because they get used to me and that’s not my job”.

    So, how does Roy address issues of overdependency and ensure the emotional safety of his clients when terminating rapport? Roy suggests that this is a process that takes time, and that it cannot happen suddenly. It starts by establishing honest conversations with clients from the inception of support, in which the social prescriber sets realistic expectations and professional boundaries:

    “I think for me it’s just being really honest and upfront with the individual that we’re not here for long term support. That’s not what we are. We’re not mental health professionals, we’re not counsellors, we’re not the befriending service. And that’s really harsh to say to somebody who is isolated, perhaps, but actually that boundary is really important”.

    When the time of discontinuing support is nearing, the social prescriber invites the client to co-design a continuing support plan, which outlines steps and systems in place to support the client once the social prescriber is gone:

    “I had one closure where the person was living alone, and they didn’t have many visitors. So, we devised a plan for continuing support. There was a local organisation who offered to go to people’s homes, spend some time with them, take them out. And we were able to collaborate together. I sent them the resources I created for the client, the client’s information with his consent, of course, along with details of everything that we’d done. And they took over”.

    This type of infrastructure also ensures that in future times of need, the client can easily be referred back to social prescribing services, avoiding that they “falls into the cracks of the system”:

    “It was agreed that if they identified that the person needs more social prescribing, they would get in touch with us directly and I could just step back in”.

    This, Roy explains, tremendously reduce the client’s anxiety, because he knew that he would not be left completely unsupported and that the supporters taking over knew the social prescriber. It is important to clarify to clients that they can get referred to social prescribing multiple times if they need it.
    Leaving contact details/information and refraining from closing the referral altogether are ways of reassuring clients that the social prescribing team is within reach, should they need it again:

    “I generally don’t discharge. I say to people, you have my mobile number, you have my e-mail address, so if you want you can call me. But I don’t have that many patients that actually do it. I think it’s about the reassurance for them”.

    Leaving the referral open, even for a set period of time, involves making a post-discharge follow up call down the line to check how the client is doing. It is important, Roy emphasises, to avoid giving out personal numbers, as professional boundaries may become blurred, and clients may feel entitled to call social prescribers unannounced.
    Roy’s team has developed strategies to minimise this risk:

    “It is important to give people that warning that I’m not on tap and that I’m not just gonna pick up the phone. So, we try not to give our work mobile phone numbers out. Everybody has to come through the switchboard Team, who are instructed to say – Oh, sorry, Mrs. Smith, you’re not currently working with J. Is there anything I can help you with? That case is currently closed. I can open a case up for you with one of our other team. We also tend to rotate to just avoid working with the same clients over and over”.

    All of the above discussed strategies are in place not only to benefit the clients, but also to ensure safeguarding, quality of work and emotional wellbeing of social prescribers.


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