HERTFORDSHIRE COUNTY COUNCIL
CULTURE CABINET PANEL
WEDNESDAY 14 JANUARY 2009 AT 2.00p.m.
BOOKS ON PRESCRIPTION - UPDATE
Report of the Director of Children, Schools and Families
Author: Andrew BignellTel: 01707 281584
Executive Member:- Keith Emsall
- Purpose of report
To update the Panel on the take-up of the Books on Prescription scheme since its introduction in June 2007, and on plans for the future development of the scheme.
- Summary
‘Books on Prescription’ aims to encourage and facilitate access to recommended self-help books as part of a care programme for patients with common mental health problems.
Since its launch in June 2007, the Books on Prescription titles in Hertfordshire Libraries have achieved an impressive 13,000 issues, but only 102 ‘prescriptions’ have been handed in to library staff. This suggests that there is a significant demand for these materials, but that patients are sensitive about admitting they have mental health problems, and prefer to borrow the books anonymously.
- Recommendations
The Panel are asked to note the report.
- Background
4.1A quarter of all GP consultations have a significant mental health component. National Institute for Clinical Excellence (NICE) guidelines recommend Cognitive Behaviour Therapy(CBT) and guided self-help as the preferred method of treatment for patients presenting with mild depression and related conditions, but there is a gap between the level of need and the level of health service provision.
4.1.2Various strategies to help bridge this gap have been tried, including directing clients towards high quality self-help materials. Books are by far the best researched of the self-help media and there is now good evidence that promoting their use, through ‘bibliotherapy’, can be highly effective.
4.1.3Cardiff libraries, in partnership with local health professionals, piloted a ‘Books on Prescription’ scheme to encourage and facilitate the use of recommended books as part of a care programme for patients with common mental health problems. Following the success of this pilot, over 100 library authorities in England and Wales have used the Cardiff template to deliver similar schemes.
4.1.4In 2007 Libraries, Culture and Learning (LCL) successfully bid for £25,500 from the Mental Health Supported Capital Expenditure Fund to create. a ‘Books on Prescription’ scheme in Hertfordshire. This was launched during Carer’s Week in June 2007.
4.2How the scheme works
4.2.1Each surgery and health centre has a booklist, and a supply of information leaflets, posters and ‘prescription pads’. The GP or other health professional determines the problem with the patient and uses a ‘prescription pad’ to prescribe a particular book from the list. The patient can then present the prescription at their local library.
4.2.2The 43 titles on the booklist are selected in consultation with mental health professionals. These titles are available in all Hertfordshire libraries, and through the mobile service. The collections are housed on the open shelves in libraries and form part of the library stock. This allows open access for users, who may borrow from the collection without staff intervention if they wish. Reservations for individual titles that are already out on loan may be made free of charge on production of the prescription.
4.2.3Patients who are not members of the library are asked to join when they present their prescription, which provides the necessary identification so that they can borrow items immediately.
4.2.4Library staff are used to dealing with enquiries involving information of a confidential or sensitive nature. Each enquiry is dealt with professionally in a non judgemental way. Staff training on how to support users with mental health problems has been delivered as part of our programme of equalities training.
4.2.5Details of the scheme were mailed to all GP surgeries and health centres, and promoted through ACS (Joint Commissioning Team) and the Community Mental Health Trusts, as well as in the relevant local media. Following recent changes in the structure of mental health provision, the Primary Care Trust has contacted the newly formed Enhanced Primary Mental Health Teams and the mental health leads in GP practices to enhance awareness of the scheme.
4.3Take-up of the scheme
4.3.1Issue figures indicate that the Books on Prescription titles achieved an impressive 13,000 issues in the 18 months from 1 April 2007 to 30 September 2008. Issues of individual titles suggest that the most popular topics are depression, anxiety and self-esteem.
4.3.2Only 102 ‘prescriptions’ were handed into libraries during the first year of the scheme, which may suggest that the popularity of the books is coincidental. However, anecdotal feedback from health professionals suggests that many are writing prescriptions on a regular basis, and there is evidence that the take-up of the books is directly related to promotion of Books on Prescription.
- The books were added to library stock in April 2007, but the scheme was not launched until June. Issues of the titles on the booklist rose from 1095 to 2909 in the quarter following the promotion of the scheme to health professionals.
- Issues are particularly high in St Albans and Hitchin, where there has been strong support for the scheme among local GP practices.
- Several surgeries have requested new supplies of the User Guide and publicity materials.
4.3.3The most likely explanation for the discrepancy between the high number of book issues and the low number of prescriptions presented is that patients are sensitive about admitting that they have a mental health problem. If the books are readily available and easy to find on the shelves, then they prefer to borrow them anonymously rather than presenting the ‘prescription’ to library staff.
4.3.4Feedback on the scheme from health professionals and other partners has been enthusiastic. A review meeting on 4 November 2008 was attended by the partner organisations that contributed to the establishment of the scheme – Hertfordshire Primary Care Trust, Adult Care Services, Hertfordshire Partnership Trust, Carers in Herts and Hertsviewpoint, along with a representative of the newly formed Enhanced Mental Health Teams. All present were keen that Books on Prescription should continue and develop, and a number of suggestions were made for refining and improving the scheme.
4.3.5An Equalities Impact Assessment of Books on Prescription was carried out in 2007, which identified a lack of titles suitable for people with learning difficulties, and a lack of stock in formats suitable for people with visual impairments. The Library service is working with partners to address these gaps.
4.3.6The Books on Prescription scheme has also been used to support and link in with other mental health initiatives. In May 2008, the BBC launched its headroom initiative – a support and information campaign on the subject of mental health and well-being, which will run for 2-3 years. St Albans Library was one of the pilot libraries for this initiative, and ran a Stress-Busting weekend in June, promoting the use of books to support mental wellbeing, and bringing partner organisations and practitioners into the library to offer information and advice.
4.4Sustainability and future developments
4.4.1Hertfordshire libraries will allocate money from the materials fund to maintain and update the book stock. A panel of health professionals will continue to recommend and monitor titles suitable for the scheme, but the overall size of the collections will not increase.
4.4.2The Primary Care Trust will continue to publicise Books on Prescription by mailing GP’s surgeries, health centres, mental health teams
and community and voluntary organisations to maintain the profile of
the scheme. A new press release will be issued in January 2009.
4.4.3HertsViewpoint will work with its members to encourage the collection of user feedback and case studies on the effectiveness of the scheme.
4.4.4Work will continue to explore the viability of extending the Books on Prescription to cover children and young people.
Background papers
Books on Prescription Paper to the Culture Panel 2 April 2008
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