February 24, 2009


Prescribing exercise is part of an alternative, holistic approach which recognises that it can boost mental health and wellbeing.
Prescribing exercise is part of an alternative, holistic approach which recognises that it can boost mental health and wellbeing.
ANTIDEPRESSANTS are not only expensive, according to the clinical standards watchdog National Institute for Health and Clinical Excellence (Nice), they are for many people no more helpful than a placebo, and should not be used as a first recourse for mild to moderate depression.

Yet at the last count, 31 million prescriptions for antidepressants were dispensed in Britain and Northern Ireland alone, in just one year.

Four years ago Britain’s Mental Health Foundation asked GPs if they would consider prescribing exercise – which evidence shows is an effective treatment for low mood – instead of antidepressants.

Only 5 per cent said they would even though 78 per cent admitted that they had prescribed an antidepressant even though they felt an alternative would have been more appropriate, while two-thirds had done so because they did not think there was a suitable alternative.

Since then the foundation has been working with GPs to promote awareness of the benefits of exercise for depression. In a follow-up survey, released this month, the proportion of those now willing to prescribe it has risen to 22 per cent, reflecting a clear shift in attitudes and beliefs.

Such practices are all part of an alternative, holistic approach to mental health which recognises that exercise, education, leisure and creative activities can boost mental health and wellbeing.

Studies have long shown that taking part in a group activity can improve confidence, self-esteem and the ability to relate to other people in a social setting. It can also break down isolation – both a cause and a result of depression – and give people a purpose.

Yet, while national policy on mental health has moved from a medical model of diagnosis and cure towards a social model that values recovery and inclusion, it is only relatively recently that GPs have recognised the benefits of what is termed “social prescribing”, or community referrals, for people with mental health problems.

For the past five years London’s Camden council has offered physical activities on prescription to people suffering from a range of physical and mental disorders – from heart problems, osteoporosis, obesity and diabetes to anxiety, depression and schizophrenia.

Patients are referred to the Camden Active Health Team by healthcare professionals, and assessed to see what activity could best help them. The choice is extensive: t’ai chi, pilates, aqua aerobics, badminton, football and more.

Patients are offered an initial three sessions a week over an eight-week period, with the option to continue if they find it helpful.

“We know exercise can help lift mood. The support that patients can get from others in a group activity can help with confidence and really lift spirits,” says Stephan von Schilling, manager of Camden council’s clinical referral for physical activity scheme.

Another approach is “time banking”, which is a form of mutual volunteering where people exchange skills to help others and themselves at the same time. Almost 200 time banks have been set up in the UK, with more than 7,000 people offering their skills in return for time credits, which they can then use to “buy” someone else’s skills or services.

It is part of an emerging community-building approach to health and social care, called “co-production”.

The model has been adopted by Rushey Green surgery, in Lewisham, south London, one of the most deprived areas in Britain. People can be referred to the time bank by their GP or health professional, or self-refer.

“Time banking is open to everyone, but is particularly good for people with mental health problems,” says Lucie Stephens, head of co-production at the New Economics Foundation thinktank, which has played a key role in promoting this community-building initiative.

She works with the South London and Maudsley foundation NHS trust, the main mental health service provider covering southeast London, helping the trust set up time banks for people with mental health problems using its services.

Time banking has been shown to hit all five of the buttons that contribute to mental wellbeing, she says: “There is no doubt that time banks can improve wellbeing by helping people connect, be active, notice what’s around them, keep learning and giving.”

(Guardian Service)

In Ireland, ‘we do not have the option to prescribe exercise’

Dr Niall O’Cléirigh, spokesman for the Irish College of General Practitioners, says doctors in the public health system do not have the option to prescribe exercise. “I would agree that we are far too pharmacologically focused when it comes to depression and we would welcome any initiatives that would offer alternatives. “There has been no emphasis from the HSE or any other agency on using exercise as an adjunct to other therapy options. We are envious of our colleagues in the UK who have a number of treatment options available to them when treating mental health issues. They can formally prescribe gym time, for example, so that a patient can go to a local gym and get a slot. In Ireland that is only open to you if you can pay for it and afford it.”

Suggesting exercise can replace antidepressants as a treatment for depression is unhelpful and may serve to deepen the stigma attached to taking medication for mental illness, says Aware chief executive Geraldine Clare.

“The concern I would have is when the debate is framed as one versus the other,” she says. “Certainly exercise is a great support for people with depression and very useful in promoting and improving mental health. However, when someone is in a depressive episode, it might well be beyond their capacity to engage in exercise.”

Michael Kelly


This article appears in the print edition of the Irish Times