LOTUS LI

Dr Rachel Quinn – Executive Director of Strategy and Partnerships at National Academy for Social Prescribing

Southbank Centre,

Belvedere Road,

London, SE1 8XX

1 April 2026

Dear Dr Quinn,

A recent study by the Mental Health Foundation and the London School of Economics estimates the annual economic burden of mental ill health in the UK at £117.9 billion, demonstrating the urgency of investing in evidence-based preventive approaches as both a public health and economic imperative (McDaid et al. 2022). Concurrently, a growing disjuncture exists between the nature of distress and the predominantly individualised models through which it is addressed. Demand for mental health services continues to rise within an overstretched NHS, resulting in extended waiting times and workforce strain, leading to the displacement of responsibility onto communities (Care Quality Commission 2025). As a concerned citizen and student in the UCL Medical Anthropology programme, I encountered social prescribing as a promising model that offers more tailored, non-medical pathways of support. I write this letter to advocate that in risking to become a compensatory role within a strained system, this framework ought to be recognised for its potential as a catalyst within a wider paradigm shift in mental healthcare, one that signals a substantive reconfiguration of how distress is conceptualised and hence addressed.

As the central body for social prescribing in England, the National Academy for Social Prescribing occupies a decisive position in shaping its future trajectory. Stakeholder research highlights both its expanding influence and the persistent lack of robust evidence regarding which approaches are most effective (Sewel 2026). In response, this letter advances three interrelated recommendations aligned with NASP’s strategic priorities (NASP 2023). First, if mental health care is to move toward more socially grounded and less medicalised forms of support, social prescribing must be developed as a mechanism for structural transformation, with user- and survivor-led organisations positioned as central agents and supported through dedicated funding. Second, social prescribing should extend beyond referral pathways to actively engage with diverse cultural and community-based forms of healing, recognising that distress and recovery are often embedded in collective and relational contexts. Third, to innovate and scale such approaches, there is a need for expanded investment in participatory and community-based research, particularly with marginalised populations, to generate context-sensitive evidence and support more equitable and effective practice. Taken together, these recommendations position social prescribing as a central component of a broader reconfiguration towards a more equitable and sustainable mental health care system, one that, given your strategic and partnership leadership, you are uniquely positioned to advance.

Where Social Prescribing and Psychiatry Meet: Post-psychiatry Will Be Social

A growing body of psychiatric and interdisciplinary scholarship suggests that mental health care is at a critical juncture. Building on the first recommendation, I argue that social prescribing can move beyond its current function as an adjunct to clinical care and operate instead as a vehicle for operationalising a broader epistemological shift: implanting care within social environments and the textures of everyday life. Since deinstitutionalisation, psychiatry has increasingly aligned with a ‘biomedical idiom’ (Bracken et al. 2012, 430), privileging neurobiological explanations and psychopharmacological interventions, often at the expense of social and experiential dimensions of distress (Bracken et al. 2012). This has contributed to the ‘medicalisation of everyday life’ (Bracken et al. 2012, 431). In response, leading voices have called for a paradigm shift toward approaches grounded in evidence-based non-technical dimensions of health such as relationships, meaning, and values, and integrated within broader public health and social care systems (Bhugra et al. 2017). Empirical evidence supports this reorientation toward a more ‘social psychiatry’ (Ventriglio et al. 2016, 1): relational factors such as interpersonal connection and the therapeutic alliance consistently exert greater influence on outcomes than technical interventions (Bracken et al. 2012). This has informed recovery-oriented and community-based approaches that emphasise dignity, empowerment, and peer support. Social prescribing, in this context, offers a practical means of interrogating individualised, psychopathological clinical models and of re-centring service users into a broader ecosystem of participatory, pluralistic, community-based, and co-produced ‘post-psychiatry’ (Bracken and Thomas 2001).

Anthropological research further indicates that what they term public psychiatry, is in practice a sprawling, de facto network spanning healthcare, welfare, education, and criminal justice institutions, which collectively manage distress without constituting a holistic, population-based system of care (Myers et al. 2016). Within this fragmented assemblage, social prescribing offers a means of reintroducing coherence through the cultivation of relational and community-based support (Priebe et al. 2013). By engaging with socio-cultural contexts, it can address dimensions of distress that institutional care alone currently cannot capture, effectively re-‘socialising’ healing (Gone 2013, 688). In doing so, it reanimates the liberatory conception of psychiatry: through alleviating suffering, enabling critical scrutiny of the cultural and socio-political conditions that render such suffering endemic (Cohen and Timimi 2001).

Investment in Community: Liberation Psychology and Politicised Healing

As you have recognised, without sustained investment in community organisations addressing the social determinants of health, social prescribing risks devolving responsibility onto communities without commensurate resourcing, thereby exacerbating existing pressures on both voluntary organisations and statutory health systems. Despite their centrality to provision, as acknowledged by NASP through initiatives such as the Thriving Communities Fund, Voluntary, Community and Social Enterprise (VCSE) organisations remain structurally underfunded. If social prescribing is to fulfil its radical potential, I suggest this imbalance to be rectified through dedicated funding streams for user- and survivor-led VCSEs, whose contributions, as I will elaborate below,extend beyond service delivery to the reconfiguration of mental health care itself.

Insights from community and liberation psychology provide a rationale for this investment. Contemporary articulations under the rubric of ‘politicised healing’ posit that where suffering is socially produced, processes of healing are inherently political, entailing shifts in power relations and collective transformation (Patterson-Markowitz 2025). By integrating psycho-therapeutical and political education programs at the meso-level, vulnerable communities would beempowered to gain critical consciousness, enact social change, and develop collective support (Montero et al. 2017). User- and survivor-led organisations in the UK exemplify these principles in practice. Since the 1980s, the service user movement has expanded significantly, now comprising over 700 groups, foregrounding lived experience, peer support, and collective meaning-making (National Survivor User Network 2025). Initiatives such as the Hearing Voices Network with over 180 user-led groups nationwide, substantiate how distress can be engaged outside strictly medical frameworks through non-pathologising, community-based approaches (Bracken et al. 2012). These models contest today’s hierarchical and deficit-oriented paradigms in which large numbers of service users report rigid, insufficiently personalised care in their mental health trajectory (Care Quality Commission 2025), enabling participants to exercise agency over the goals and processes of care, an approach associated with both improved individual outcomes and addressing its structural determinants (Prilleltensky et al. 2001). As such, there is growing consensus that service users and survivors should be treated as primary stakeholders in the design and delivery of mental health services, with meaningful involvement at all levels of decision-making (Bracken and Thomas 2001; Rose 2019).

Investment in community-led infrastructures would address a critical lacuna within contemporary psychiatry: the limited engagement with social cohesion and collective life as a determinant of mental health. While clinical services remain essential, they rarely cultivate the relational networks that sustain wellbeing. Social prescribing offers a mechanism to mediate this gap; however, without sustained institutional support, it risks replicating the failures of earlier community mental health movements, where chronic underfunding and lack of a coherent value-framework precipitated their decline (Kenig 1986). Absent such investment, responsibility is likely to be disproportionately displaced onto already overextended community organisations, thereby undermining effectiveness and sustainability (Priebe et al. 2013). It is therefore imperative that NASP consolidates the emancipatory potential of social prescribing through targeted, long-term investment in meso-level user- and survivor-led community infrastructures and partnerships.

Innovative Partnerships and Approaches: Culture and Healing

As argued, traditional psychiatry is increasingly untenable within a plural, postmodern context characterised by epistemic diversity and the growing authority of informed service users (Bracken and Thomas 2001). Social inequalities translate directly into health inequalities, disproportionately affecting ethnically minoritised communities in the UK, who experience higher burdens of long-term conditions (Harriss and Salway 2008), face syndemics (Singer et al. 2017, 941) – the clustering of health conditions – alongside reduced access to primary care in already overstretched systems (Care Quality Commission 2023). These dynamics are further reflected in patterns of social prescribing uptake, which are higher in socioeconomically disadvantaged and ethnically diverse areas. Evidence suggests that culturally competent care enhances trust, that strengthening local community infrastructures improves engagement, and that more robust, inclusive research is required to refine practice (Race Equality Foundation 2024). In line with NASP’s strategic focus on innovation and partnerships, I argue with my second recommendation for the need for sustained collaboration with diverse cultural and community contexts in which healing may take place. Social prescribing, in this sense, should not function solely as a conduit into pre-existing services, but as a platform for engaging with, legitimising, and co-producing care that is culturally resonant and structurally attentive.

Medical anthropological scholarship provides a critical framework for this reorientation. Illness and ‘social suffering’ are fundamentally intertwined, subverting rigid distinctions between the pathological and the normal by situating distress within collective and structural conditions (Kleinman et al. 1997). Biomedical models, particularly as codified in diagnostic frameworks, risk medicalising what are, in many cases, ‘social problems’ (Kleinman 2012, 181), while obscuring their syndemic nature (Kleinman, 2012). Cross-cultural research illustrates that experiences of distress are not universal; for example, depression may be expressed somatically in some communities (Kleinman et al. 1997). Kleinman distinguishes between ‘disease’, referring to biological dysfunction, and ‘illness’, the culturally mediated experience of being unwell; while biomedicine prioritises ‘cure’ through technical intervention, it frequently neglects ‘healing’, understood as the restoration of certain meanings and social belonging. This disjunction contributes to dissatisfaction and disengagement, and helps explain the persistence of alternative and community-based forms of care that more adequately address these dimensions. As such, the regnant psychiatric model, shaped by culturally specific assumptions (Gaines 1992), may inadequately serve ethnically minoritised populations in the UK who frequently recognise dimensions of human interaction that are absent from traditional psychiatric approaches (Castillo 1997). Non-western healing challenges biomedicine not (only) by offering alternative techniques, but by questioning its fundamental assumptions about what healing and illness are (Csordas 2023). So, when anthropological perspectives stress that healing is frequently integrated in collective and relational life, regarding ‘culture as treatment’ (Brady 1995, 1487), then social prescribing can be understood as a mechanism for reorienting care toward these neglected social and cultural dimensions of suffering, thereby addressing limits internal to the biomedical model itself.

Research and Evidence for Policy and Practice: Participatory Approaches

Medical anthropologist Kleinman (2012) anticipates that processes of psychiatrisation will become progressively entangled with social suffering, with many conditions better understood as biosocial rather than strictly pathological. This repositioning requires interdisciplinary research approaches that can hold the complexity of human distress. In line with NASP’s objective to strengthen evidence for policy and practice, I provide my last recommendation to invest in research conducted both for and with marginalised and minoritised communities as seeds for innovation and to further the emancipatory potential in these communities towards systemic transformation.

On the one hand, continuing from the anthropological understanding that illness is experienced culturally, engaging with non-western healing practices as culturally embedded systems of care could counteract the limitations and inequalities of individualised models that fail to address collective conditions of distress (Ting et al. 2025). On the other hand, there is a need to re-centre community concerns within clinical research, through collaboration with communities and their leaders and practitioners.

I humbly assert that anthropology’s phenomenological focus on local moral worlds and ethnography accommodating to human complexity can reveal how patients experience identity and treatment, and can hold the social prescription system accountable for the agency it affords or denies and thus, as a discipline developing in applied anthropology, would be a crucial part of multidisciplinary innovation research and evaluation assessments. However, anthropological contributions remain marginalised within dominant research paradigms, with funding structures which continue to privilege biomedical methodologies. Applied medical anthropology, particularly with methodologies such as community-based participatory action research, could generate practice-based evidence attuned to lived realities (Beck and Maida 2015). Such a reorientation would support a more reflexive, inclusive, and socially grounded evidence base for mental health care. After all, ‘the mental life of humans is discursive in nature’ (Bracken et al. 2012, 432).

To Conclude

Taken together, I advance recommendations to avert social prescribing to become an auxiliary response to systemic strain, and envision it as a constitutive element in the reorientation of mental health care itself. The current mental health crisis, with a persistent misalignment between socially produced distress and individualised models of intervention, cannot be resolved through incremental expansion of existing clinical frameworks alone. As argued in the Lancet Commission on global mental health, what is required is nothing less than a revolution in how mental health is conceptualised and delivered (Bhugra et al. 2017).

In this context, social prescribing and the broader transformation of mental health care must evolve in concert. England, having pioneered the integration of social prescribing into healthcare systems since 2019 and supported over two million individuals, is uniquely positioned to set a precedent for the dozens of countries now adopting similar approaches. Yet, if social prescribing remains confined to a compensatory role within an otherwise unchanged system, it risks reproducing the very limitations it seeks to address: the displacement of responsibility onto under-resourced communities, the marginalisation of alternative forms of knowledge, and the persistence of structural inequalities in access and outcomes.

Anthropological critique underscores the limits of prevailing approaches. As argued, biotechnical mental health interventions risk becoming ‘mindless and uncultured’ (Kirmayer and Gold 2011, 307) when severed from the social and moral worlds in which suffering is experienced. At the same time, a dominant preoccupation with risk management and standardised evidence hierarchies has constrained innovation, fostering defensive practices that prioritise institutional protection over relational and ethical care. The result is a system that maintains the appearance of control while inhibiting the experimentation and creativity required to address complex, socially embedded forms of distress (Double 2001).

It is precisely here that a different model of social prescribing becomes necessary, as a qualitative shift rather than an expansion at scale already on its way. The three recommendations outlined, targeted investment in user- and survivor-led infrastructures, the cultivation of innovative and culturally responsive partnerships, and the expansion of participatory, community-based research, are mutually reinforcing components of this transformation. Together, they reposition service users and communities as epistemic agents, while generating the forms of evidence necessary to sustain long-term change. In a context of growing institutional distrust and the proliferation of alternative pathways of care, the risk lies not in innovation, but in the continuation of business-as-usual under conditions of crisis (Stoller 2025). Social prescribing, if fully realised, offers a rare opportunity to reconfigure mental health care to a post-psychiatry with  the social, relational, and cultural conditions that make healing possible.

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