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!

Mobilising healthy communities: Bromley by Bow Health Partnership

Ian Jackson of the Bromley by Bow Health Partnership was the guest speaker at the first Glasgow Centre for Population Health (GCPH) seminar series of the year.

The Bromley by Bow Health Partnership (BBBHP) is a collaboration between three health centres and other non-primary care partners in the Tower Hamlets area of London. The aim of the partnership and the new primary care delivery model which comes with it is to transform the relationship between the public and primary health care. This means considering the wider determinants of health when the partners plan and deliver care, rather than treating healthcare in a purely biomedical way.

Edited image by Rebecca Jackson. Map via Google Earth

Edited image by Rebecca Jackson map via Google Earth

Effect of social determinants on health

In the 1890s Charles Booth created a map of London which categorized areas of the city of London depending on their levels of deprivation. The most recent Indices of Multiple Deprivation Report showed that those same areas considered deprived in the1890s are still facing the highest levels of multiple social deprivation and health inequality today. It is no secret that disadvantage has a negative impact on people’s ability to make the best choices when it comes to health. And disadvantage at a social level can have a significant influence on poor physical and mental health across a range of conditions.

More recent research conducted by Michael Marmot looked more closely at what determines health outcomes in populations, and the extent to which other factors influence people’s health, or rather their ability to be well.

He produced what is known as the 30/70 model: 30% of what determines your health is your genetics and improvements in pharmacology, the other 70% is related to other “external factors” including poverty, environment, culture, employment and housing. BBBHP has used this as the foundation for their primary care model, arguing that primary care providers are not just dispensers of medical products, but have a responsibility to contribute to people living healthier lives in their community.homeless

Social prescribing

One issue highlighted by the BBBHP was the significant number of people presenting at GP surgeries with “non-medical” ailments, or medical ailments triggered by “non-medical stimulus”. People were arriving at the practices and booking appointments because they were lonely and it gave them somewhere to go. Others were presenting with symptoms of depression, which on further investigation were found to have stemmed from issues around debt or domestic violence. A social prescribing service was set up by the partnership to try to tackle some of these non-medical conditions and improve the health of the general population by non-pharmacological means.

The social prescribing service, where GPs refer people to other local services for help, can be used as a replacement for pharmaceutical interventions, or be supplementary to them. GPs, or other primary care staff, may refer any adults over the age of 18 to one of over 40 partnership organisations. These range from walking groups to formal sessions with advisors in debt or domestic violence agencies, as well as art classes, community gardens and companionship services to combat loneliness. The organisations can provide help and advice on issues such as employment and training, emotional well being and mental health.Ölfarbe

The challenges of quality and funding

Maintaining quality in the provision of social prescribing is a particular challenge for BBBHP. They work regularly with trusted partners, particularly the Bromley by Bow Centre. However, there is no consistent quality check for many of the services from the health partners themselves. Evaluative studies and feedback sessions are used to assess quality and impact, and consider the scale of demand. And while it is acknowledged that more formal frameworks for assessing quality and impact of social prescribing services are preferred in formal assessments, in reality, word of mouth, participant feedback and uptake rates are used as a standard for quality as much as official feedback in a localised community setting.

A second issue is funding. BBBHP identified that finding long term funding was their main issue in providing security for providers and service users, as well as for GPs referring to services. Funding is vital not only to ensure the survival of the community groups who provide some of the referred services, but also to allow them to develop longer term partnerships and build capacity within the social prescribing service. The BBBHP works closely with the Bromley by Bow Centre, a key provider of support services for the local community, but like many services which rely on funding, they increasingly have to plan for tighter budgets.

blue toned, focus point on metal part of stethoscope

A final challenge for the staff at BBBHP was changing people’s expectations of primary care, and what it means to live well. Some patients were suspicious and reluctant to be recipients of “social prescription”, as this did not fit with the traditional expectation of what GPs should do to make people well. This can be a big change in mindset for some people, according to Ian Jackson, when people come expecting to be prescribed antidepressants but are instead “prescribed” a walking club or a debt advice service. He noted that the reaction from patients can sometimes be confused or hostile, and some patients do not even turn up for referrals.

Improving patients’ understanding of the benefits of social prescription, ensuring people attend referral appointments, and that social prescriptions have a long term impact is something which BBBHP are hoping to research further. They feel that looking at the long term impact of non-pharmaceutical interventions and how these feed back into the wider agenda of tackling inequalities is important to allow the partnership to continue to build healthy communities and save on primary care costs in the long term.

category-picture-community-development

Creating positive social connections to improve community health

Social prescribing and other associated projects have sparked new social connections. Members of the community have come together to form their own support groups. The Children’s Eczema support group run by local GPs and the DIY health scheme, which sought to educate and support parents who were anxious about minor ailments in children, have helped parents in the area to set up WhatsApp groups, organise coffee mornings and go to one another for support. Such initiatives are regarded by BBBHP as important in tackling wider, systemic social inequality in the area.

Currently, primary health care in communities is focused on illness. This needs to change, according to BBBHP, with local community-based health delivery based as much around social health as biomedical issues. Through its social prescribing and other services BBBHP has aimed to focus on supporting people in a holistic way, tackling health inequalities as well as biomedical illness, to allow them to make good choices to improve their health.


If you’ve enjoyed this article, you might also like more of our blogs on health and wellbeing:

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!

Social prescribing – just what the doctor ordered?

blue toned, focus point on metal part of stethoscope

By Heather Cameron

It is widely acknowledged that wider social, economic and environmental factors have a significant influence on health and wellbeing. According to recent research only 20% of health outcomes are attributable to clinical care and the quality of care while socioeconomic factors account for 40%.

With increasing pressures on GPs and lengthy waiting times a real issue for many, particularly those with mental health conditions, social prescribing could represent a real way forward.

The government clearly recognised the importance of social prescribing in its new deal for GPs announced earlier this year, which made a commitment to make social prescribing a normal part of the job.

In response to a recent Ask-a-Researcher request for information on different approaches in social prescribing and evidence of what works in the UK, it was interesting to find that despite the recognition of potential value, there has been little evaluation of social prescribing schemes to date.

Much of the material found focused on specific interventions and small-scale pilots and discussion around implementation. A new review of community referral schemes published by University College London (UCL) is therefore a welcome addition to the evidence base as it provides definitions, models and notable examples of social prescribing schemes and assesses the means by which and the extent to which these schemes have been evaluated.

So what is social prescribing?

Social prescribing means linking patients with non-medical treatment, whether it is social or physical, within their community.

A number of schemes already exist and have included a variety of prescribed activities such as arts and creative activities, physical activity, learning and volunteering opportunities, self-care and support with finance, benefits, housing and employment.

Often these schemes are delivered by voluntary, community and faith sector organisations with detailed knowledge of local communities and how best to meet the needs of certain groups.

Social and economic benefits

Despite a lack of robust evidence, our investigation uncovered a number of documents looking at the social prescribing model and the outcomes it can lead to. Positive outcomes repeatedly highlighted include:

  • improved health and wellbeing;
  • reduced demand on hospital resources;
  • cost savings; and
  • reduced social isolation.

According to the UCL report, the benefits have been particularly pronounced for marginalised groups such as mental health service-users and older adults at risk of social isolation.

A recent evaluation of the social and economic impact of the Rotherham Social Prescribing Pilot found that after 3-4 months, 83% of patients had experienced positive change in at least one outcome area. These outcomes included improved mental and physical health, feeling less lonely and socially isolated, becoming more independent, and accessing a wider range of welfare benefit entitlements.

The evaluation also reported that there were reductions in patients’ use of hospital services, including reductions of up to a fifth in the number of outpatient stays, accident and emergency attendances and outpatient appointments. The return on investment for the NHS was 50 pence for each pound invested.

Similarly, the Institute for Public Policy Research (IPPR) has recently argued that empowering patients improves their health outcomes and could save money by supporting them to manage their condition themselves.

IPPR suggests that if empowering care models such as social prescribing were adopted much more widely throughout the NHS we would have a system that focused on the social determinants of health not just the symptoms, providing people with personalised and integrated care, that focused on capabilities not just needs, and that strengthened people’s relationships with one another.

Partnership working

With a continued policy focus on integrated services and increased personalisation, social prescribing would seem to make sense. In addition to providing a means to alternative support, it could also be instrumental in strengthening community-professional partnerships and cross-collaboration among health, social and other services.

The New Local Government Network (NLGN) recently examined good practice in collaboration between local authorities, housing associations and the health sector, with Doncaster Social Prescribing highlighted as an example of successful partnership working. Of the 200 referrals made through this project, only 3 were known to local authority and health and wellbeing officers, showing that the work of social prescribing identified individuals who had otherwise slipped through the net.

And with the prospect of an ageing population and the health challenges this brings, a growing number of people could benefit from community-based support.

As Chair of Arts Council England, Sir Peter Bazalgette, notes “social prescribing is an idea whose time has come”.

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

Further reading: if you liked this blog post, you might also want to read Heather’s earlier post on the health and wellbeing benefits of investing in public art.