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Five steps to offering books on prescription

Dr Liz England and Dr David Paynton offer a step-by-step guide to an alternative to medication for common mental health problems

Reading Well Books on Prescription is an opportunity for GPs to work with public libraries. The scheme is being delivered by the independent charity The Reading Agency working with the Society of Chief Librarians, local library services and health partners such as The Royal College of General Practitioners.

Reading Well is the first national scheme for England and offers a consistent national model based on an original scheme developed in Cardiff by Professor Neil Frude. The scheme is evidence based with books selected using a rigorous process of consultation and expert advice.

The scheme is based on cognitive behavioural therapy (CBT) and offers a range of treatments for common mental health conditions and other disorders including anger, anxiety, binge eating, chronic fatigue, chronic pain, depression, health, anxiety, obsessions and compulsions, panic, phobias, relationship problems, self-esteem, sleep problems, social phobia, stress and worry.

Books, available free of charge from local libraries, can be recommended by a range of health professionals including general practitioners, mental health nurses, practice nurses, counsellors, therapists, psychiatrists, psychologists.

Reading Well Books on Prescription is intended to integrate into the NICE guidelines-recommended Stepped Care model for common mental health problems. NICE guidelines particularly recommend non-facilitated self-help for anxiety and panic disorder. Books on Prescription is an early intervention treatment, self help treatment and so can be considered before more formal referrals to Improving Access to Psychological Therapies (IAPT) services or prescribing medication. However, it can also be used alongside medication and psychological approaches.

Evidence is growing that self-help books based on the principles of CBT can be effective. Reading Well Books on Prescription also helps people discover other library wellbeing services, including mood-boosting novels and poetry, and social reading activities such as reading groups. There is a small but increasing evidence base supporting the use of literature based interventions in mental health (see references).

While this is a national scheme available to GPs, it may be useful to discuss this scheme with your CCG mental health clinical lead to see how this scheme fits into wider approaches to mental health and psychological support.

The following five-step guide offers an overview of how you can prescribe a book.

1 Get to know the scheme and which books are available

There are 30 recommended titles on the core booklist. These are listed under the conditions covered by the scheme. The core booklist is available as part of the user leaflet and on the electronic recommended reading form.

It might also be useful to contact your local library and check that they are offering the scheme. You can email readingwell@readingagency.org.ukfor further information about your local library contact

2 Identify whether a patient is suitable for the Books on Prescription scheme

Book-based therapy will not be suitable for everyone. Reading Well is aimed at competent adult readers who can read the material and follow any suggested activities.

Some of the titles are available in other formats including audio, e-book, braille and large print, though this will depend on individual library collections. Again, it may be useful to have a discussion with your librarian to find out about this.

The scheme is generally aimed at common mental health problems and behavioural and emotional disorders commonly seen in general practice.

3 Recommend a book

Where a health professional feels that Books on Prescription could be effective, they should discuss the scheme with the patient as a treatment option.

If the patient agrees, the prescriber should then refer to the core booklist and consider with the patient which book is most relevant to their condition. There is a guide to the core bookssummarising the contents of each title to help prescribers make the right recommendation and text and audio excerpts of books are also available.

A book can be recommended by ticking the relevant circle on the reading list in the user leaflet or by completing the online recommended reading form.

It is important to complete the prescriber details on the form, as this will help the patient to join the library - if they are not already a member. There is space on the recommendation form for any notes the prescriber may wish to make about other resources or treatment. The patient then takes the recommended reading form to the local library.

Books can also be borrowed without a recommended reading form and some people may prefer to borrow the title without handing in the form.

4 Explain why you’re offering books on prescription

It is recommended that patients receive a user leaflet as part of the consultation as this tells them about the scheme and how it works. There is also a useful short guide on how to make the most of self-help reading that the patient might find useful.

5 Reviewing the patient and evaluation

Patients should be reviewed as per the NICE guidelines and the Stepped Care Model.

Prescribers can read code the prescription.

For systems using SNOMED CT, CTV3 and Read v2, the following codes should be used to record ‘referral for mental health literature’:

System                                                 Code                     Coding

Systmone (TPP)                                   CTV3                     XaLOs

Emis, Isoft, Vision                                 Read v2                 8HHr

Other systems                                      SNOMED CT       199121000000106

Patients will be asked to complete an anonymous feedback form after they have borrowed a book, supplied by the librarian.

Whilst there is increasing evidence to support schemes using literature interventions using a CBT based approach, there is still a lack of research available to guide implementation. A national evaluation scheme will take place to explore this.

Dr Liz England is a GPSI in mental health in Birmingham and the RCGP mental health commissioning lead and Dr David Paynton is RCGP national clinical commissioning champion and a GP in Southampton.

References

Billington J, Carroll J, Davis P, Healey C, Kinderman P A literature-based intervention for older people living with dementia. Perspect Public Health. 2013 May;133(3):165-73. doi: 10.1177/1757913912470052. Epub 2013 Jan 4.

Fanner D, Urquhart C. Bibliotherapy for mental health service users Part 1: a systematic review. Health Info Libr J. 2008 Dec;25(4):237-52. doi: 10.1111/j.1471-1842.2008.00821.x

Dowrick C, Billington J, Robinson J, Hamer A, Williams C. Get into Reading as an intervention for common mental health problems: exploring catalysts for change. Med Humanit. 2012 Jun; 38(1):15-20. doi: 10.1136/medhum-2011-010083. Epub 2012 Feb 18.

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