Feel better with a book … why bibliotherapy may be just the medicine we’re looking for

By Morwen Johnson

It’s not just dedicated bookworms or librarians who get excited that Christmas means piles of book-shaped parcels under the Christmas tree (and time to read them too!). Books are the second most popular Christmas gift for adults in the UK, behind chocolate. But now we’re into the New Year it’s worth remembering that books are for life, not just for Christmas. And the benefits of books go much further than keeping your brain active and passing the time.

Reading involves ‘emotional thinking’ and in the words of The Reader, books “are full of the stuff that makes us human”. That means that they can be a powerful resource for improving mental health.

“I felt better than before … I felt understood”

We’ve written a couple of times on our blog about social prescribing – and how the NHS is recognising that non-medical treatments such as arts activities or gardening can improve mental and physical health. The use of bibliotherapy and self-help reading is part of this focus on holistic health and self-management of long-term or chronic health conditions. And a recent systematic review has added to the evidence base, finding that bibliotherapy is effective in reducing adults’ depressive symptoms in the long-term, “providing an affordable prompt treatment that could reduce further medications”.

The Reading Agency’s Books on Prescription scheme has been running nationally in England since 2013 and since it started has been expanded to cover Books on Prescription for common mental health conditions, Books on Prescription for dementia, Reading Well for young people and Reading Well for long term conditions. 635,000 people are estimated to have benefited from the schemes.

Books can be recommended by GPs or other health professionals but are also available on self-referral for anyone to borrow, as part of public libraries’ health offer. Similar schemes can be accessed in other parts of the UK.

And the social enterprise The Reader has many years’ experience of how shared reading groups and reading aloud projects can be used to increase health and wellbeing.

The healing power of imagination and creativity

It’s not just self-help books which can help improve health – reading fiction and poetry can also help. The author Philip Pullman recently said that comfort can be found in books, and the familiar act of reading, in an uncertain world. And Blake Morrison, writing back in 2008 on fledgling bibliotherapy initiatives, quoted Hector, in Alan Bennett’s The History Boys, as saying how, in the presence of great literature, “it’s as if a hand has reached out and taken our own”.

The unique value of fiction is that we can recognise aspects of our own lives in the characters and imaginary worlds of books and in many cases, narratives of change, of transformation, of recovery, can provide comfort or hope. In other situations, books can literally put into words, difficult experiences which people struggle to admit or talk about. They can also promote understanding of other people’s situations, very different to our own.

This is true not just in literary works –acclaimed graphic novels and memoirs have shone a light on topics such as the experience of psychosis (Look Straight Ahead), cancer (When David Lost His Voice; and Probably Nothing); eating disorders (Lighter Than My Shadow); OCD (The Bad Doctor); childhood anxiety (Everything is Teeth) and grief (The End).

And children’s publishing is also a medium for helping children process difficult emotions or experiences –for example Duck, Death and the Tulip is visually beautiful and heartfelt. For anyone interested in how books can help children’s mental health, the Royal College of Psychiatrists has a useful online resource list of books for children and also for teenagers.

A lifeline and a consolation

It’s worth remembering the important role that libraries play in supporting wellbeing. As well as supporting bibliotherapy initiatives, public libraries are safe spaces which people who are isolated, lonely or ill can come to for support and to make connections. Research for the Arts Council estimated that these improvements to health save the NHS around £27.5million a year.

Reading is not just a leisure activity. For many people, the information and stories found in books – whether bought, borrowed from libraries, or shared between friends – can provide a lifeline.

In the words of Daisy Goodwin, introducing her book 101 Poems That Could Save Your Life, “there may not be a cure, but there is always a consolation”.


The Knowledge Exchange are a team of researchers and librarians based in Glasgow, who comment on and curate information on social policy.

You can follow us on Twitter to see what developments in public and social policy are interesting our research team. There may also be a few book-related quotes occasionally!

Hoarding and housing: person-centred approaches to a growing problem

Most people have possessions in their homes that they can’t bring themselves to throw out, from clothes and furniture to photographs, books and ornaments. But the growth of clutter around the house can sometimes escalate to become so severe that it causes significant risks to the health and wellbeing of residents and their neighbours.

For housing providers, problematic hoarding has become a serious and costly issue. In 2014, Inside Housing magazine reported an increase in the number of social housing landlords seeking injunctions to inspect homes where they suspected the resident of hoarding. But a housing management solicitor highlighted underlying difficulties with taking legal action against problematic hoarders.

“Even if the housing association wins and costs are awarded against the tenant, the chances of the tenant paying are slim. It’s a problem because it’s a huge expense.’

The nature of hoarding

A 2012 paper from the Chartered Institute of Environmental Health (CIEH) provided an overview of hoarding, and observed:

“As a behaviour, it is quite common and most people who hoard possessions do not suffer from any psychiatric disorder. However, in some cases the problem may progress to become so severe that it causes significant distress and impairment.”

The CIEH paper noted that three components have been identified with problematic hoarding:

  • acquisition of and failure to discard possessions that appear to be of little use or value
  • living spaces sufficiently cluttered so as to preclude activities for which those spaces were designed
  • significant distress or impairment in functioning caused by the hoarding

The problems and risks for housing providers and their tenants

For housing providers, residents and neighbours, hoarding presents particular problems and risks, including:

  • overcrowding issues
  • health and safety hazards, including fire risks and falling /tripping
  • environmental health concerns, including infestation and vermin
  • properties falling into disrepair

Tackling the problem

Under mental health and environmental legislation, local authorities and health agencies can take action where hoarding constitutes a statutory nuisance or health and safety risk. Social landlords may also resort to legal action against tenants. But taking an enforcement-only approach raises tricky ethical questions, especially if a resident is mentally unwell. And, as the Inside Housing article reported, taking tenants to court can be ineffective and expensive. Housing organisations, therefore, are increasingly developing person-centred approaches to help compulsive hoarders understand and change their behaviour.

Orbit Housing: support and advice

For some years, the Orbit housing group has been collaborating with Coventry University and the Knowledge Transfer Partnership to tackle the growing problem of hoarding.

In 2013, Orbit launched a toolkit designed to support practitioners and organisations working with people who compulsively hoard. The toolkit was developed with input from mental health support organisations, environmental health bodies and service users. It addresses environmental and social isolation issues and includes advice on the assessment process, intervention tools, improvement measures, relapse prevention, and sign-posting.

In 2015, Orbit obtained funding for two specialist case workers, enabling the launch of a new hoarding support and advice service. In addition, Orbit has also developed a hoarding policy setting out the aims, principles and values to be adopted in the housing group’s approach to individuals with hoarding tendencies.

Derbyshire:  Vulnerable Adult at Risk Management

Because problematic hoarding can require responses from different agencies, including social housing providers, environmental health and fire and rescue services, a multi-agency approach is helpful in tackling the issue.

In Derbyshire, this kind of multi-agency policy has been established to develop a risk management plan for people who would not necessarily fall into the responsibility of adult social care direct service provision.

Vulnerable Adult at Risk Management (VARM) is managed by Derbyshire County Council and Derby City Council, with support from the Fire and Rescue Service, police, social housing providers, environmental health and others. The policy aims to support vulnerable adults who are at risk of serious harm through self-neglect and risk-taking behaviour, and it has already been applied in cases of hoarding.

Last year, the Chief Fire Officers’ Association highlighted a case where the VARM policy helped a Derbyshire social housing provider to support an elderly man who was putting himself at risk due to hoarding behaviour.

“His care package was adjusted, to include assistance with household chores; he was visited and helped by health practitioners; his home was cleared allowing his central heating to be repaired. Fire risks were mitigated down to an acceptable level without the need to revisit and upset him.”

Similar approaches have been developed by Circle Housing Association in the London borough of Merton, and by Knightstone Housing in the West of England.

Positive outcomes

Hoarding is one of many resource-intensive problems facing social housing landlords. But, as these examples demonstrate, a collaborative, sensitive and supportive approach to problematic hoarding can achieve positive outcomes for housing organisations and their tenants.


Follow us on Twitter to see what developments in public and social policy are interesting our research team.

Read some of our other housing blogs:

A book for everything that ails us … why bibliotherapy could be just the medicine we’re looking for

platform reading

Image: Moriza (CC BY 2.0)

By Morwen Johnson

Many of us will have received books as Christmas presents last month – and the bestseller lists testify to their continuing popularity despite regular doom-mongering. The benefits of books go much further though than keeping your brain active and passing the time. Reading involves ‘emotional thinking’ and in the words of The Reader, books “are full of the stuff that makes us human”. That means that they can actually be a powerful resource for improving mental health.

“I felt better than before … I felt understood”

Last year we wrote on our blog about social prescribing – and how the NHS is recognising that non-medical treatments such as arts activities or exercise can improve patient’s mental and physical health. This is partly linked to the emphasis on enabling self-management support to be given to people with long-term or chronic health conditions. The use of bibliotherapy and self-help reading is a valuable aspect of social prescribing.

The Reading Agency’s Books on Prescription scheme has been running nationally in England since 2013 and was expanded last year to include a reading list to support people with dementia and their carers. In its first year, an evaluation showed that it had reached 275,000 people with book-based cognitive behavioural therapy. The scheme is evidence-based and works within NICE guidelines. Books can be recommended by GPs or other health professionals but are also available on self-referral for anyone to borrow. Similar schemes can be accessed in other parts of the UK.

The healing power of imagination and creativity

It’s not just self-help books which can help improve health however – reading fiction and poetry can also help. Blake Morrison, writing back in 2008 on fledgling bibliotherapy initiatives, quoted Hector, in Alan Bennett’s The History Boys, as saying how, in the presence of great literature, “it’s as if a hand has reached out and taken our own”. We can recognise aspects of our own lives in the characters and imaginary worlds of books and in many cases, narratives of change, of transformation, of recovery, can provide comfort or hope. In other situations, books can literally put into words, difficult experiences which people struggle to admit or talk about.

This is true not just in literary works –acclaimed graphic novels and memoirs have shone a light on topics such as the experience of psychosis (Look Straight Ahead), cancer (When David Lost His Voice; and Probably Nothing); eating disorders (Lighter Than My Shadow); OCD (The Bad Doctor); childhood anxiety (Everything is Teeth) and grief (The End).

And children’s publishing is also a medium for helping children process difficult emotions or experiences –for example Duck, Death and the Tulip is visually beautiful and heartfelt. For anyone interested in how books can help children’s mental health, the Royal College of Psychiatrists has a useful online resource list of books for children.

Taking the idea of the healing power of reading and providing a creative spin, the Emergency Poet offers prescription poems and poetic pills. Deborah Alma was inspired by her experience using poetry to support dementia patients, to think about how poems could be used as a therapeutic way to encourage people to discuss stress. She now travels in a converted ambulance to festivals, schools and libraries, providing literacy solace on the move.

And the social enterprise The Reader has many years’ experience of how shared reading groups and reading aloud projects can be used to increase health and wellbeing.

Libraries are the best pill

As public libraries come under increased pressure from councils trying to make budget savings, it’s worth remembering during the economic arguments that free access to books does not just help improve literacy. Research for the Arts Council last year found that libraries make a positive contribution to people’s health and wellbeing. In fact they estimated that these improvements to health save the NHS around £27.5million a year. The Carnegie Trust and CILIP also advocate strongly for the wider benefits of public library services in the 21st century.

Public libraries are safe spaces which people who are isolated, lonely or ill can come to for support and to make connections. As mentioned, many libraries are involved in Books on Prescription schemes (in England it is part of the Universal Health Offer), run social reading groups, and benefit both individuals and community wellbeing. Librarians have expanded their professional skills to work on these multi-agency projects and tailor them for their own local communities’ needs. For example, Kirklees Libraries and Information Centres was a finalist in the 2013 CILIP Libraries Change Lives Award for its Reading and You scheme which uses bibliotherapy in libraries, hospitals and community organisations’ premises. And yet libraries continue to be seen as an easy target for cost-cutting.

A lifeline and a consolation

Reading is not just a leisure activity. Libraries are not just buildings which have been superseded by the internet. For many people, the information and stories found in books – whether bought, borrowed from libraries, or shared between friends – can provide a lifeline.

In the words of Daisy Goodwin, introducing her book 101 Poems That Could Save Your Life, “there may not be a cure, but there is always a consolation”.


The Knowledge Exchange are a team of researchers and librarians based in Glasgow, who comment on and curate information on social policy.

You can read more about us in this blog article and on our website.

And of course, you can follow us on Twitter to see what developments in public and social policy are interesting our research team. There may also be a few book-related quotes occasionally!

How does where you live affect your wellbeing?

Over crowded tube platform London

People living in areas with a high population density have higher levels of anxiety

by Alan Gillies

How does the place you live affect your wellbeing? That was the topic of two separate studies we received in the Information Service last week. With the current interest in place-making, the issue is a topical one.

Perhaps unsurprisingly, the main message from both studies is that people’s own individual characteristics, such as physical health problems, socio-economic status, and employment status, had a much larger relationship with personal wellbeing than the characteristics of the places in which they live. However both studies found that place did have an impact on people’s personal wellbeing. Continue reading

Do people think rationally… or do they need a nudge?

brain with nudge ideas

by Alan Gillies

One of the benefits of working in any information service, and in the IDOX Information Service in particular, is the way you tend to find relevant information in unexpected sources. Thus, for example, we recently came across an interesting article on behaviour change, not in a psychology or management journal, but in the most recent issue of Environmental Health News.

“Until the 1970s it was generally accepted that people were rational in their thinking…” claims the article, before going on to outline the development of ‘nudge’ theory which aims to use subtle methods to encourage people to change their behaviour rather than relying on a rational decision Continue reading