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‘Book prescriptions’ won’t work without guided support from GPs

The Arts Council-funded project to promote self-help books for mental health conditions was widely reported in the media last week.

From May 2013 libraries will be stocked with a list of 30 self-help books on a range of topics from depression and anxiety to obsessive compulsive disorder, along with a sister list of ‘mood-boosting’ novels and non-fiction titles. GPs are to be encouraged to issue a ‘Reading Prescription’ to patients suffering from mild-moderate mental health problems who will then receive library membership as well as access to the full reading list.

True to form, the Daily Mail’s coverage was accompanied by an image of a bikini-clad woman, apparently reading one of the ‘books on prescription’ whilst sitting on an idyllic beach with her toes resting in the gently lapping water - not exactly the experience of most patients in the throes of an episode of depression. Inappropriate visuals notwithstanding, the scheme was reported in a fair way.

Arguably there is much to be said in favour of the scheme, including the fact it’s backed by the RCGP. The challenge will be to make it really work to the benefit of patients, and to avoid any risk that it will be used as an excuse to cut an existing service.

At first glance it seems odd to use the term prescription - these books will be freely available to anyone who cares to visit the library, after all. But perhaps there is sufficient power in the doctor-patient relationship that a recommendation from your GP could carry significant weight. In fact I already have a small list of self-help books which I encourage my patients to dip into - I am always encouraged by how frequently they take up the suggestion, and the positive results that follow.

There is certainly evidence in favour of the role of self-help books in the management of depression in primary care, including a recently published randomised controlled trial. What this trial and my own experience with self-help books have in common, however, is guided support. In the trial, this consisted of 3-4 face-to-face appointments totalling 2 hours of contact, while my own practice would involve a small number of typical 10-minute GP appointments - either way, the self-help books were not used in isolation.

In my own practice, what seems especially important is to be able to recommend a book which I have read personally - I can choose the right book for the right patient, and explain why I am ‘prescribing’ it. I felt concerned by one quote from the Daily Telegraph coverage of the story from Debbie Hicks, director of research at the Reading Agency. She told the paper: ‘All 30 books could also be picked up by library members who wanted to avoid the perceived “stigma” of visiting their GP for mental health issues.’

If the scheme is to succeed, then GPs will need to have faith in the books we are prescribing. That the list has been carefully compiled and has Royal College approval are both certainly good starting points, and will bring confidence that these titles are a cut above the thousands of mediocre self-help books out there.

But more needs to be done to breathe life into the project. At the very least, GPs should be sent more information about the books on offer - a brief summary and a personalised review, for instance. There is plenty of time until we are due to kick off in May so perhaps someone, somewhere is already penning these helpful hints - let’s hope so.

One thing is certain - the options available to patients with mental health problems who present to their GP are too limited. As Pulse reported recently, waiting times for talking therapies are often too long to be a viable treatment, and medications are sometimes all that is left to fill the void. We should welcome any new alternatives with proven benefits - maybe people will be more prepared to see their GP about mental health concerns if they think they might be given a book rather than a pill.

Dr Martin Brunet is a GP in Guildford and programme director of the Guildford GPVTS. You can tweet him @DocMartin68.

Do you ‘prescribe’ books to your patients? If so, let us know what’s on your list in the comments below.