Hosted by The Australian Commissioner for Children & Young People, I was invited via the legendary Jane Bennett, co-author of About Bloody Time and Founder of Celebration Day for Girls, to present Menstrual Cycle Support on social prescription.
Transcript:
June 2021
Hi. I’m Kate Shepherd Cohen
Thank you for inviting me to be with you today, albeit virtually. It’s a foggy day here in Cornwall on the Atlantic coast and - yep - I am wearing a winter jumper despite it being mid summer here in the UK!
I’m the founder of Menstrual Cycle Support, or MCS.
Almost unbelievably, this is the first non-clinical menstrual health service to be officially offered by the GP through the exciting relatively new channel of social prescribing.
I’m going to talk briefly to you:
about the international social prescribing movement
about the Menstrual Cycle Support course itself, how I set it up and my findings so far and
about how Menstrual Cycle Support might work on social prescription in Australia and beyond.
What is social prescribing?
Social prescribing is defined as the means of enabling GPs and other primary care and allied health professionals to refer patients to a number of non-clinical services.
What does this look like?
If I am suffering from a number of ongoing symptoms, such as low mood, anxiety, aches and pains, fatigue and seek help (usually pharmacological help) my GP might, alongside standard medical tests, refer me on ‘social prescription’ to a local walking or gardening group, where if I attend, I will very likely improve my physical and mental wellbeing and hopefully reduce my need to rely on medication to ‘fix’ my symptoms or the need to keep returning to the GP to report the same problems.
In fact, early reports in the UK suggest that social prescribing has reduced GP appointments by a fifth and it’s benefit is so considerable to unburdening the health service and improving individual wellbeing that the government has made it a key part of its NHS long term strategy for ‘universal personalised care’ so that, as of this year, social prescribing is available in all GP surgeries across the country.
Now Covid has scuppered the opportunity to meet socially and made many social prescribing offers impossible but Covid has also sped up the process of enabling GP surgeries to be run so that all appointments now begin with a telephone triage or e-consultation. This enables patients to be directed to the relevant primary care professionals - for example, I might be encouraged to see the nurse, mental health worker or GP, as well as a social prescribing link worker who can offer me a range of local partnered services.
And social prescribing is very much a movement. It began in the UK, as a grassroots initiative - with a handful of pioneering GPs - and it soon pricked the interest of the department of health and a worldwide network of initiatives so that social prescribing has rapidly become an international movement, supported by the World Health Organisation among others.
Social prescribing is predominantly considered to be a service for tackling so-called social diseases such as loneliness, isolation, low mood and obesity, it’s really caught on in local services that get people outside in nature, learning about nutrition and connecting people with a community through the arts.
We are at the beginning of the social prescribing revolution and there is so much more potential.
I happen to live in an area where the GP surgery has been a pioneer in social prescribing and when I learned the practice of menstrual cycle awareness from Alexandra Pope & Sjanie Hugo Wurlizer at the Red School as a way to heal my own menstrual suffering, I was determined to get GPs on board to alleviate the suffering of others - social prescribing, I could quickly see, was the ticket.
My local GPs could immediately see the benefit of a menstrual cycle and menopause support group - of course they could (!) - since currently they can offer patients only the pharma route alongside secondary appointments for scans, with waiting lists of up to three years in some place. Many of us will have had a personal experience of visiting the doctor with menstrual cycle issues or issues with side effects from contraception and many of us will have felt the burden of menstrual or menopause loneliness as we’re sent away with very little information, a new pack of pills, and a sense that perhaps it’s all in our heads.
One in three women in England are said to suffer with their menstrual cycle. This causes disruption to work, education, social and family life. It is hugely disruptive to relationships (RCGP). We know that they suffer because they have visited their GP.
So, what if, alongside the offer of a new brand of hormonal contraceptives, I am offered a support course that will give me the opportunity to learn about the cycle, understand it and reframe it in the company of my peers. What if I am given a chance to understand what’s happening to my body during perimenopause? This is Menstrual Cycle SUpport on social prescription.
Better still, what if I’m offered a menstrual cycle support course by the nurse who I go to to ask about contraception, or by the patient co-ordinator who takes me through my telephone triage. How about a referral from the school nurse, a psychologist or from an occupational therapist or even the osteopath? This is Menstrual Cycle Support on social prescription
What is Menstrual Cycle Support?
Menstrual Cycle Support is a four month course so that participants can create a three month cycle diary - this is brilliant for taking to the GP, for reporting side effects from medication, for simply understanding our own cyclical patterns the bad, yes, but also - crucially - the good.
Not all Gps in England have received training in gyenecology so the cycle diary is great leveller, helping both patients and doctors better understand the cycle, cyclical patterns and problems.
Menstrual Cycle Support also helps those on medication or contraception, or those wanting to go on contraception, or those wanting to come off contraception.
How did I get the course into the GP surgery?
Following a blessing from the Red School to adapt Menstrual Cycle Awareness for the course, I began to reach out to women’s health specialists, GPs, gynecologists, psychologists as well as period poverty campaigners, menstrual researchers, educators and - of course - women themselves - all of whom were ready and willing to input into this much needed course. Next up I contacted the Royal College of Obstetricians and Gynecologists and NGOs, like Endometriosis Uk, followed by the Department of Health and other political leaders for their endorsement - all supported it and shortly after its launch, I was honoured to receive Innovator of the Year Award 2021 at the INternational Social prescribing Awards - all of which has helped additional GP surgeries to agree to refer patients to my course.
But - for those keen to offer their own ideas through social prescribing - the barrier to entry seems very low: I needed to prove credibility (I've been offering menstrual cycle workshops for the last 7 years), but DBS and insurance were the only prerequisites. I personally decided to take further courses in mental health awareness, counselling skills and safeguarding as I had a strong sense of the kind of trauma that accompanies the menstrual experience and I always signpost participants to professional medical or psychological help - indeed one of the criticisms of social prescribing has been the risk to patients who are left in the hands of someone untrained in mental health, for example. (See University of Oxford, Practical Ethics) so for anyone offering a social prescribing course it is very important to ensure that you offer the very best safeguarding practice so that participants are directed to any further professional help and ensure that patients understand the difference between non-clinical and clinical support.
The other criticism of social prescribing has been, and it feels important to share the pros and cons, that it encourages patients to go back to the doctor in order to be yet again prescribed something - I do feel this is going to take a generation or two to put right - yes we have had, as a society, too much leaning on the health profession, especially for our own menstrual experience: may it be so that girls and women and others who menstruate no longer feel the need to go to the doctor for anything more than severe and debilitating menstrual pain - that journey begins, I believe, with GPs and school nurses referring to Menstrual Cycle Support on social prescription and an encouragement towards self-referrals, which - to address the criticism - I have made available and market through my own channels.
I launched the course in December 2020 with two GP surgeries and was - perhaps not surprisingly - instantly oversubscribed. Six months later I am working with 47 surgeries representing nearly half a million patients. Rolling out - dare I say it - has been relatively straight forward. The GPs don’t need much convincing.They know all too well the need of the service. Menstruators themselves don’t need convincing either. THey know all too well the need of the service. [July 2022: MCS is now offered in every GP surgery in Cornwall]
Patients have the offer of a free or a paid place (paid places pay for the free ones), but all have the option of a free place - indeed, many of the surgeries I work with are in areas of high social and economic deprivation. There are free online resources and access to the private social media community for ongoing support should someone be on a waiting list for a free place.
What were my takeaways from the pilot?
With the pilot completed in March 2021, 100% of participants reported an increase in menstrual wellbeing. My main takeaways from the pilot? First that online - although not possible for some - is fantastic for this work, as participants can show up in their pyjamas, whilst on their period, once children are in bed, with no fear of turning up in a room with people they don’t know to talk about periods and secondly, that the course does not need to be an information overload - simple understanding of the phases of the cycle and ways to live life around it is enough - mostly participants want to share their experience and listen to others and I take much inspiration from the Red Tent women's circle movement for this.
Could this work in Australia? A resounding yes!
Social prescribing is already happening in some pioneering surgeries in Australia and Dr Harry Nespolon, the President of the Royal Australian College of General Practitioners recently stated that Social prescribing may well become part and parcel of every GP’s role as a preventive health advocate. With the statistics demonstrating that One in four Australians now reports now reports feeling lonely and isolated, perhaps it’s only a matter of time before the Australian government back social prescribing nationally. Dr Nespron says that “We will go to the evidence base to ensure that what we decide is backed by the best available research” - in other wods it’s a waiting game to see just how effective social prescribing is in reducing GP workload and General practice over-attendance, ER usage and inpatient admissions -qualitative research - something the menstrual cycle has historically lacked due to pervasive gender bias and something I am addressing with Menstrual Cycle Support in partnership with a fantastic research company, Meaningful Measures. The evidence we collect from offering the same course across the board could pave the way for future menstrual health services - I am hoping to publish my first report next year and while the Australian government waits for such evidence to support social prescribing, this is not to say that your local GPs or school nurses and school counsellors wouldn’t begin to refer patients to a menstrual cycle support course - the Chair of the Board of the same Royal College, estimated she was already using social prescribing techniques in around 60% of her consultations.*
It all starts with just one or two pioneers…
Thank you. I wish I could be with you to share the ongoing discussions.
Please send all questions and comments to kate@kateshepherdcohen.com
You can find out more about the service at www.menstrualcyclesupport.com
Enjoy the rest of your day.
More info:
All questions/comments to
kateshepherdcohen@gmail.com
PLEASE NOTE THIS TRANSCRIPT WAS EDITED FOR REPUBLICATION JAN 2022