NHS Health Scotland
Outcome Indicators

3.3 Community engagement activities, individual and community-based arts programmes and social prescribing will contribute to individuals and communities having increased knowledge and awareness of services and promote motivation and access to services and programmes for all. This, in turn, will increase attendance, participation and engagement therefore contributing to increased trust in the community, increased social support and social networks.



Community Engagement

Social prescribing/community referral

Community engagement
There is limited highly processed evidence in the mental health sector about effective interventions to promote community engagement and participation, build social capital and increase trust. There is some review level evidence that direct and indirect community engagement activities may impact on social capital.[1]

Informed by reviews of effectiveness evidence, NICE public health guidance 09 Community engagement to improve health made 12 action recommendations which together are intended to present 'the ideal scenario for effective community engagement.' These include prerequisites for community engagement, infrastructure, approaches and evaluation of community engagement programmes. The NHS Health Scotland commentary on this guidance supported these action points subject, where appropriate, to adaptation to fit Scottish organisational arrangements.[1]

Evaluations of other community-based projects such as Communities that Care (CtC) suggest that they can result in improvements in family and community relations as well as other behavioural impacts.[2] Long-term evaluations in the UK have not been undertaken to date.

There is no highly processed evidence in the health sector about the effectiveness of individual and community-based arts programmes in increasing social support, social networks and social inclusion. Rowling & Taylor argue that at an individual level, involvement in the arts can contribute to developing supportive social networks, building self-esteem and increasing sense of control and, at a community level, can contribute to a social cohesion and a sense of belonging.[3] A number of small scale studies suggest that engagement in the arts can improve social networks, build self-esteem, and enhance personal motivation, increase optimism and reduce levels of anxiety.[4]

Social prescribing/community referral
There is no highly processed evidence about the effectiveness of social prescribing in relation to increased social support and reduced social isolation. However, social prescribing has the potential to directly and indirectly increase social networks and social support and reduce social isolation. Social prescribing aims to strengthen the provision of, and access to non-medical sources of support within the community, thus providing social solutions to mental health problems. This might include opportunities for arts and creativity, physical activity, learning and volunteering, mutual aid, befriending and self-help, as well as support with, for example, benefits, housing, debt, employment, legal advice or parenting.[5, 6] Where sources of support are communal activities there is potential for social contact and social support if individuals are motivated to participate.

There is some emerging evidence, from small scale projects such as arts on prescriptions, exercise referral and referring to learning advisors, that social prescribing can have a positive impact in terms of enhancing self-esteem, reducing low mood, increasing opportunities for social contact, increasing self-efficacy, increasing transferable skills and increasing greater confidence.[5] The evidence base for social prescribing is, however, limited by wide variations in how the term is used and understood and considerable inconsistency in indicators used to measure success. The small size of pilot trials, lack of independent evaluation and poor methodology, notably in the design of qualitative research, all make it difficult to draw robust conclusions about the mental health impact of social prescribing, particularly in comparison with usual GP care or in terms of cost effectiveness.


  1. NHS Health Scotland (2008). Health Scotland Commentary on NICE Public Health Guidance: Community engagement to improve health. NHS Health Scotland: Edinburgh.

  2. Hosman C & Jané-Llopis E (2005). The Evidence of Effective Interventions for Mental Health Promotion. In H Herman, S Saxena & R Moodie (Eds). Promoting mental health: Concepts, emerging evidence and practice. WHO: Geneva.

  3. Rowling L & Taylor A (2005). Intersectoral approaches to promoting mental health. In H Herrman, S Saxena and R Moodie (Eds). Promoting mental health: Concepts, emerging evidence, practice. WHO: Geneva.

  4. Friedli, L., Oliver, C., Tidyman, M. & Ward, G (2007). Mental health improvement: evidence-based messages to promote mental wellbeing. NHS Health Scotland: Edinburgh.

  5. Freidli L et al. (2007). Developing social prescribing and community referrals for mental health in Scotland. Scottish Development Centre for Mental Health: Edinburgh.

  6. Foresight Mental Capital and Wellbeing Project (2008). Final Report. The Government Office for Science, London.