Arts on prescription and social prescribing

1. Introduction

Version followed: the NHS England link-worker model of social prescribing (Summary guide, updated June 2020; Workforce development framework for social prescribing link workers, ref. B1569), plus the UK arts-on-prescription (AoP, also called arts on referral) model as described by Holt, Matthews and Elliott and by Jensen et al. (2024). Practice outside England (Scandinavian "culture on prescription", Australian and US schemes) differs and is not covered in detail. [source: NHS England summary guide; NHS England workforce framework; Holt et al.; Jensen et al. 2024]

This is not psychotherapy and not an arts therapy. It is a community, arts-in-health programme. Holt et al. state plainly that art on prescription is neither art therapy nor psychotherapy: participants are not expected to explore psychological problems through their artwork or share them with the group, and it is also not an art class, because skill-building and critique are not the aim. Jensen et al. likewise exclude the expressive arts therapies and describe sessions as led by arts-for-health facilitators, not therapists. Arts therapies, by contrast, are delivered by HCPC-registered arts therapists. [source: Holt et al.; Jensen et al. 2024; Creative Health Quality Framework glossary] Your role as a psychotherapist is therefore to assess fit, refer, liaise, hand over risk information, and follow up, while your own therapy (if it continues) stays separate from the arts activity.

What it is. Social prescribing connects people to community groups, activities and services that meet practical, social and emotional needs affecting health and wellbeing. In England, social prescribing link workers (SPLWs), mostly based in primary care networks (PCNs) or voluntary-sector (VCSE) hosts, give people time to explore "what matters to me?" and co-produce a simple personalised care and support plan, then connect them to community provision. [source: NHS England social prescribing page; workforce framework] Arts on prescription is one such route: a referral, usually from a health professional, to a group programme of arts activity over several weeks, aimed at psychosocial wellbeing. Stockport Arts on Prescription (1994) is reported as the first scheme to use the term (Holt et al., citing Huxley 1997; the 1997 source itself is not drawn on [uncertain]). Later UK schemes named in the literature include City Arts (Nottingham), Arts and Minds (Cambridge), Arts for Health (Milton Keynes), Art Shine (Bristol) and Art Lift (Gloucestershire). [source: Holt et al.]

How change is thought to happen. Mechanisms are described as still debated. Proposed pathways run through aesthetic engagement, emotion, cognitive and sensory stimulation, social interaction and (for some activities) physical activity, framed salutogenically. [source: NASP rapid review, Mughal et al. 2022] Participants value a safe, non-judgemental group, social belonging, relaxation, a sense of positive change and simply getting out of the house; relaxation during sessions predicted wellbeing change in one study. Jensen et al. summarise the focus as "process, play and social community". [source: Holt et al.; Jensen et al. 2024]

Evidence status (as the sources give it).

• Jensen et al. 2024 (systematic review with meta-analysis, 25 studies, no RCTs found): pooled pre–post wellbeing (WEMWBS) improvement of about 5.8 points across 7 studies, above the 3-point minimally important change, with moderate heterogeneity; no comparator-controlled pooled estimate; quality mostly low or medium; participants mainly female, older and White. Authors call for comparator designs and a large pre-registered trial. [source: Jensen et al. 2024]
• Holt et al.: qualitative and uncontrolled pre–post studies are generally positive, but about a quarter of completers in one large evaluation did not improve, lower baseline wellbeing went with more benefit, and economic claims (GP visit reductions, social return on investment) are unpublished and based on poor data. [source: Holt et al.]
• NASP rapid evidence review of arts, heritage and culture in social prescribing (2022): findings overwhelmingly positive but quality inconsistent, much of it anecdotal or unvalidated pre–post data, most sampled pre–post studies at the lowest grade, few RCTs, and weak evidence on reaching underserved groups. [source: NASP rapid review, Mughal et al. 2022]
• Practical meaning: present AoP to clients as a promising wellbeing and connection offer, not as a treatment for a mental disorder or a substitute for indicated psychological or medical care. [synthesis]

Professional frame. Link workers are a non-registered role (the PCN post is pitched at Agenda for Change Band 5) with mandatory safeguarding training, a named GP supervisor and monthly clinical supervision. [source: workforce framework] AoP facilitators are artists or arts-for-health practitioners; no regulated profession covers this work and none of the sources names a required registration [uncertain whether any voluntary register applies]. If a client needs arts therapy, refer to an HCPC-registered art, music or drama therapist instead. [source: Creative Health Quality Framework glossary; synthesis] You remain bound by your own registering or accrediting body for consent, confidentiality and record-sharing. [synthesis]

2. Framework

The pathway below combines the NHS England link-worker sequence with the AoP programme format. Phases A and F are the therapist's own steps and are [synthesis]; B to E are described in the sources.

[source: NHS England summary guide; workforce framework; Holt et al.; Jensen et al. 2024; CultureForHealth entry for Arts and Minds]

One named example: Arts and Minds (Cambridgeshire) runs a 12-week programme of 2-hour workshops with facilitated museum and gallery visits, led by a professional artist supported by a counsellor, for adults with mild to moderate depression or anxiety; GPs, health promotion workers, occupational therapists, social workers, psychologists and counsellors can refer directly with a referral form. [source: CultureForHealth entry for Arts and Minds] Check the current details with the scheme, as funding and formats change. [synthesis]

Who the link-worker route is for: people with long-term conditions, people needing mental health support (described elsewhere as low-level mental health needs), people who are lonely or isolated, and people with complex social needs. Link workers refer on when a need exceeds the role, for example a mental health need requiring a qualified practitioner. [source: NHS England summary guide; NHS England social prescribing page] AoP schemes mainly target low to moderate mental health problems in primary care. [source: Holt et al.] None of the sources gives a formal exclusion list; local schemes set their own criteria [uncertain].

3. Guiding principles

• Not therapy, by design. The group is for creative activity and connection, not for processing psychological material; keep your therapeutic work in your sessions. [source: Holt et al.]
• What matters to the person. The plan is led by the person and recorded in their own words; refer for their goals, not yours. [source: workforce framework]
• Informed choice before referral. People should know what they are being referred to and what to expect, and can decline. [source: NHS England summary guide]
• Process and play, not product. No deadlines, critique or pressure; the artist encourages rather than takes over; activity matched to skill to avoid boredom or stress. Prepare clients who fear "being bad at art" accordingly. [source: Holt et al.; Jensen et al. 2024]
• Optional, low-pressure attendance. Participants can rest, step out or leave early. [source: Holt et al.]
• Safe: do no harm and manage risk. Safeguarding arrangements, risk assessments (environment, activities, materials, group size) and insurance should be in place before work starts. Check this before referring to an unfamiliar scheme. [source: Creative Health Quality Framework; NHS England summary guide]
• Know the limits of each role. Link workers check complex plans with a clinician and refer back when needs exceed their role; artists work within the remit of the activity. Your handover must not push clinical risk management onto non-clinical staff. [source: workforce framework; Creative Health Quality Framework; synthesis for the last point]
• Tell your story once. Share relevant records with consent so the client does not repeat their history to every agency. [source: workforce framework]
• Collaborative and realistic. Work jointly with health, care and community partners; set goals that fit a short, weekly group. [source: Creative Health Quality Framework]
• Equitable. Participants in the evidence are mostly female, older and White; plan for transport, childcare and other access barriers and for under-represented groups. [source: Jensen et al. 2024; NASP briefing]
• Planned endings. Endings and progression routes are planned from the start. [source: Creative Health Quality Framework; Holt et al.]
• Reflective. Review outcomes and feed back; schemes value data from referrers and participants. [source: Creative Health Quality Framework; NASP briefing]

4. Intervention inventory

Because this is a programme rather than a therapy, the inventory has two parts: (A) the therapist's own procedures for referring into and working alongside AoP and social prescribing, and (B) the programme components the sources describe, which you need to know to prepare a client or to co-facilitate. The sources describe the pathway and programme; the step-by-step therapist procedures in Part A are largely [synthesis] built on that description, and each item says which parts are sourced.

Part A. Therapist procedures

A1. Assessment of fit

• Purpose / when: Before suggesting AoP or social prescribing, decide whether a community arts group suits the client's current needs, risk and wishes. Use when loneliness, isolation, low mood, anxiety, low confidence, long-term conditions, a wish for meaningful activity, or a therapy ending suggest community connection would help. [source for target groups: NHS England summary guide; Holt et al.; synthesis for the procedure]
• Steps: (1) Clarify what the client wants from it (connection, structure, creativity, getting out) and whether that is a social or a clinical need. (2) Check that any clinically indicated treatment is in place or being sought; AoP sits alongside treatment, not instead of it. (3) Review current risk (suicidality, self-harm, safeguarding concerns, recent crisis, psychosis, substance misuse) and decide whether an unsupervised community group is safe now. (4) Check group readiness: can the client tolerate a room of strangers for about two hours, manage being asked about their art, and keep personal disclosure contained? (5) Map practical barriers: transport, childcare, cost, mobility, sensory or language needs, digital access, timing. (6) Check preferences: art form (visual arts, crafts, music, singing, dance, writing, museum visits are all reported), venue, group composition. (7) Decide: refer now, refer later, or not suitable (consider an HCPC-registered arts therapist or other clinical service instead). [synthesis; activity range from Jensen et al. 2024]
• Example language (illustrative): "This isn't therapy and it isn't an art class. It's a small group that meets weekly to try creative things, with no pressure to be good at it or to talk about your problems. Does that sound like something you'd want, or would it feel like too much right now?"
• Watch for: The client hearing the suggestion as being "passed on" or discharged; a wish to use the group to work through trauma (better placed in therapy); acute risk that needs a clinical plan first. It is working if the client can say in their own words what they hope to get and has a realistic plan to get there. [synthesis]

A2. Informed choice and preparing the client

• Purpose / when: Once fit looks good. The NHS England guide expects informed decision-making before referral so people can choose and know what to expect. [source: NHS England summary guide]
• Steps: (1) Explain both possible routes (link worker or direct scheme). (2) Describe a typical programme: weekly, about two hours, small group, several weeks, led by an artist, possible museum or gallery visits, ending with move-on options. [source: Holt et al.; Jensen et al. 2024] (3) Explain that they can rest, step out or leave early and that no-one critiques the work. [source: Holt et al.] (4) Agree exactly what information you will share and with whom, and get consent to share; record it. (5) Agree how the arts group will be discussed in therapy (see A6). (6) Offer to help with the first contact if confidence is low. [steps 4–6 synthesis]
• Example language (illustrative): "If you go through a link worker, they'll spend some time with you working out what matters most to you, which might lead to the arts group or to something else. Or I can refer you straight to the scheme. Which would suit you?"
• Watch for: Ambivalence masked as agreement; shame about artistic ability; worries about confidentiality in a group. Working if the client chooses a route and can describe what the first session will be like. [synthesis]

A3. Choosing the referral route

• Purpose / when: Pick the route that matches the client's needs.
• Options (sourced):
  • Via an NHS social prescribing link worker. Referrals come from general practice, pharmacies, local authorities, multidisciplinary teams, hospital discharge teams, allied health professionals, emergency services, job centres, social care, housing associations and VCSE organisations; self-referral is accepted. The link worker offers typically 6–12 contacts over about three months, a "what matters" conversation, a personalised care and support plan, and connection to activities. [source: NHS England summary guide; workforce framework] Best when needs are broad (housing, debt, isolation as well as creativity) or the client is unsure what they want. [synthesis]
  • Direct referral to a local AoP scheme. Some schemes take direct referrals on their own form from named professions; Arts and Minds lists psychologists and counsellors among referrers. [source: CultureForHealth entry for Arts and Minds] Best when the client clearly wants an arts group and the scheme accepts your profession. [synthesis]
  • Self-referral. Encouraged by NHS England for link-worker services and accepted by some AoP schemes. [source: NHS England summary guide; Jensen et al. 2024] Useful for clients who prefer autonomy. [synthesis]
  • Finding local provision. Local authorities and arts-in-health bodies may publish creative health referral frameworks (for example Birmingham City Council's creative public health pages); the National Academy for Social Prescribing (NASP) champions social prescribing, builds partnerships, runs the Thriving Communities programme and publishes evidence briefings, but none of the NASP pages describe it as a referral point for individual clients. [source: Birmingham City Council creative health page; NHS England social prescribing page; NASP briefings] Ask the client's GP practice or PCN who their link workers are. [synthesis]
• Steps: (1) Check the client's GP practice or PCN for link-worker access (PCN-employed or VCSE-hosted). (2) Search for local AoP schemes and check their referral criteria and form. (3) Check the scheme's basic safeguarding, insurance and venue arrangements; link workers are expected to check these before referring and you can ask. [source for check: NHS England summary guide] (4) Choose with the client. [synthesis]
• Example language (illustrative): "I'll ask your GP surgery for their link worker's details, or you can contact them yourself if you'd rather."
• Watch for: Schemes that are paused, oversubscribed or out of area; schemes without clear safeguarding arrangements. [synthesis]

A4. Writing the referral

• Purpose / when: After consent. A good referral gives the receiver enough to welcome and support the person safely without disclosing more than needed. [synthesis]
• Steps: (1) Use the scheme's or service's own form where one exists. (2) Include: identity and contact details, preferred name and pronouns, how the client prefers to be contacted, what the client hopes for (in their words), access needs (mobility, sensory, language, neurodivergence, timing), relevant health conditions only as they affect participation, and your contact details and availability for liaison. (3) Include the risk and safeguarding handover (A5) when relevant and agreed. (4) State that you will continue/are ending therapy and how to contact you. (5) Record the referral in your notes. If you work in or with general practice, NHS England lists SNOMED CT codes for "referral to social prescribing service" and "social prescribing declined". [source for codes: NHS England summary guide; rest synthesis]
• Example language (illustrative), referral wording: "Ms A would like to join a small creative group to rebuild confidence and meet people. She finds new groups daunting and would welcome a phone call before the first session."
• Watch for: Clinical jargon or diagnoses the receiver does not need; missing consent; no named contact for concerns. [synthesis]

A5. Risk and safeguarding handover

• Purpose / when: Whenever there is current or recent risk to self or others, a safeguarding concern, or a vulnerability that staff need to know to keep the person safe. Link workers and community groups are non-clinical; risk management stays with clinical services. [source for non-clinical role and escalation routes: workforce framework; NHS England summary guide; synthesis for the procedure]
• What the receiving side has (sourced): SPLWs must understand duties to safeguard children and adults, identify people at risk and follow local processes; they escalate concerns, including abuse and domestic violence, to a named supervisor and can escalate specific case concerns to the named GP; they have monthly clinical supervision covering patient risk; NHS England expects clinical supervision time to discuss issues such as domestic violence, self-harm and suicidal thoughts, and clear safeguarding procedures. Community groups should have insurance, safeguarding, lone-working, first aid (including mental health first aid), data protection and DBS arrangements. Creative health organisations should have safeguarding arrangements and risk assessments in place before work begins and trained people on hand for first aid and mental health first aid. [source: workforce framework; NHS England summary guide; Creative Health Quality Framework]
• Steps (synthesis): (1) Complete your own risk assessment using your service's standard approach before referral; do not refer someone in acute crisis into a community group as the main response. (2) With consent, give the receiver a short, plain summary: what the risk is in general terms, known early warning signs, what to do if they notice them, and who to call (client's crisis plan contacts, you, the GP, NHS urgent mental health line or emergency services). Do not pass on method detail. (3) Agree in writing who holds clinical responsibility (you or the GP or mental health team), not the link worker or artist. (4) If there is a safeguarding concern about a child or adult at risk, follow your own safeguarding duties now; a referral to an arts group is not a safeguarding action. (5) If the client refuses consent to share risk information, weigh whether the referral is still safe; share without consent only where your professional and legal duties require it. (6) Ask how the scheme will contact you if they are worried and how quickly. (7) Diarise a check-in after the first two or three sessions.
• Example language (illustrative): "If the group leader notices you're withdrawing or not turning up, would it be OK for them to let me know? What would you want them to say or do?"
• Watch for: Handovers that leave an artist holding clinical risk; risk information that is too vague to act on or more detailed than needed; plans with no named clinician. Working if the receiver can say what they would do if worried and whom they would contact. [synthesis]

A6. Working alongside: keeping the therapy–activity boundary

• Purpose / when: When therapy continues during the programme. The group is not for processing psychological material; therapy is. [source for the boundary: Holt et al.; procedure synthesis]
• Steps: (1) Agree with the client that the group is for doing and connecting, and that feelings stirred by it can be brought to therapy. (2) In sessions, ask about the group as you would about any meaningful activity: what they made, how it felt, who they talked to. (3) If the client brings artwork, respond with curiosity about their experience rather than interpreting the image; do not treat community artwork as assessment or diagnostic material. (4) Do not ask the artist to set therapeutic tasks, run exposure exercises or report on the client's emotional content. (5) If the client wants a therapeutic arts process, discuss referral to an HCPC-registered arts therapist. [synthesis]
• Example language (illustrative): "You mentioned the clay session stirred something up. That makes sense to explore here. In the group itself it's fine just to make things."
• Watch for: The client making disclosures in the group they later regret; artists drifting into a counselling role (Holt et al. note facilitators' disclosure and boundary-setting vary and need guidance); you drifting into supervising the artist. [source: Holt et al.; synthesis]

A7. Liaison with link worker and scheme

• Purpose / when: At referral, after the first sessions, at concerns, and at the end.
• Steps: (1) Name one contact person on each side. (2) Agree what will be shared (attendance, broad engagement, concerns) and what will not (session content, artwork, other participants). (3) Respond promptly to concerns raised by the link worker; NHS England expects link workers to give referrers appropriate feedback about the people they referred and to refer back when needs exceed their role. (4) Join an MDT or case discussion if the client is complex and consents. [source for feedback and MDT presentation: NHS England summary guide; workforce framework; steps 1–2 synthesis]
• Example language (illustrative), to link worker: "I'm her therapist and will continue weekly. Please contact me if attendance drops or you're worried about her mood. I won't need details of what happens in the group."
• Watch for: Over-sharing; nobody owning follow-up; data shared without a lawful basis. Working if concerns reach the right person quickly. [synthesis]

A8. Follow-up and outcome review

• Purpose / when: After the first two to three sessions, mid-way, and at the end. [timing synthesis]
• Steps: (1) Check attendance and experience with the client. (2) Revisit the goal set in A1 and A2 in the client's own words. (3) If you use outcome measures, align with what schemes report: the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) is the measure most AoP studies use, and the link-worker framework references the ONS4 personal wellbeing questions; both are licensed or published instruments, so use official versions and do not adapt items. [source for measures: Jensen et al. 2024; workforce framework] Holt et al. note that mood change during sessions predicted wellbeing change, so asking how the client feels at the end of sessions is a reasonable informal check. [source: Holt et al.; NASP briefing; informal check is synthesis] (4) Decide: continue, adjust (different group, art form or venue), or stop. (5) Record the outcome. [synthesis]
• Example language (illustrative): "How have the last three sessions been? Is it giving you what you hoped for?"
• Watch for: Lack of improvement is common (about a quarter of completers did not improve in one large evaluation), so plan alternatives rather than treating it as failure. [source: Holt et al.]

A9. Ending and move-on planning

• Purpose / when: From the start of the programme and in the last few weeks. Endings can leave people with a "void" and need transition support. [source: Holt et al.]
• Steps: (1) Ask early what the scheme offers afterwards: move-on groups, peer-led creative or friendship groups, links to galleries and museums, community signposting, or a possible second referral. [source: Holt et al.; Creative Health Quality Framework] (2) In therapy, anticipate the loss of the group and plan the week structure after it. (3) Involve the client in choosing what comes next. [source for involving participants: Creative Health Quality Framework] (4) If the AoP ending coincides with a therapy ending, consider spacing them. [synthesis]
• Example language (illustrative): "The group finishes in four weeks. What would you like to have in place by then?"
• Watch for: Withdrawal or mood drop after the last session; the client stopping all activity. [synthesis]

A10. Feeding back and reporting gaps

• Purpose / when: At the end and when provision is missing. Link workers escalate gaps in provision through formal feedback routes; schemes and the NASP briefing call for better data from community organisations. [source: workforce framework; NASP briefing]
• Steps: (1) With consent, give the link worker or scheme brief feedback on whether the referral met its aim. (2) Tell the PCN or local social prescribing lead about unmet needs (no provision for a language group, no accessible venue, no evening sessions). [synthesis]
• Example language (illustrative): "Two of my clients couldn't attend because there's no daytime childcare. Is there anything for parents with small children?"
• Watch for: Feedback that identifies other participants. [synthesis]

A11. Children and young people

• Purpose / when: Social prescribing is described as all-age, and Jensen et al. include one school-based AoP programme (with school pastoral staff as referrers), but none of the sources sets out a child-specific AoP pathway. [source: NHS England social prescribing page; Jensen et al. 2024; uncertain for local child pathways]
• Steps (synthesis): (1) Follow your safeguarding and mandatory-reporting duties; an arts referral never replaces a safeguarding referral. (2) Get the young person's assent and, as appropriate to age and competence, parent or carer consent. (3) Check that the provider has child-safeguarding procedures, a designated safeguarding lead and DBS-checked staff (NHS England lists DBS checks among expected group arrangements). (4) Agree who accompanies or collects younger children. (5) Choose age-appropriate groups and venues; school-based or youth-arts provision may fit better than adult schemes.
• Example language (illustrative): "There's an art group after school on Thursdays. Would you like to try it? I'd need to check with your mum too."
• Watch for: Adult schemes taking under-18s without child-safeguarding arrangements. [synthesis; DBS point from NHS England summary guide]

Part B. Programme components (as described in the sources)

Use these to prepare clients or if you co-facilitate (Arts and Minds, for example, pairs a lead artist with a counsellor). [source: CultureForHealth entry for Arts and Minds] If you co-facilitate, your role is support and safety, not running therapy within the group. [synthesis]

B1. Pre-session contact and room preparation

• Purpose / when: Before the first session, to reduce anxiety and barriers.
• Steps: The artist phones each participant before the first session; the room is set up in advance; venues are accessible and adjustments made. [source: Holt et al.]
• Example language (illustrative), artist to participant: "I just wanted to say hello before Tuesday and tell you how the first session works."
• Watch for: Participants who do not answer or sound very anxious; a supported first visit (link workers sometimes accompany) may help. [source for accompaniment: NHS England summary guide]

B2. Group guidelines

• Purpose / when: First session, revisited as needed.
• Steps: Agree guidelines covering confidentiality, kindness and no judgement; the group can adapt them. [source: Holt et al.]
• Example language (illustrative): "What would help this feel like a comfortable place to be?"
• Watch for: Unsupportive interactions and in-groups that exclude members, which can undermine benefit. [source: Holt et al.]

B3. Facilitated creative workshop

• Purpose / when: Each weekly session, usually about two hours.
• Steps: Offer activities across the art form (visual art, crafts, drawing, collage, clay, wirework, music, singing, dance, creative writing are all reported); pitch activities to participants' skill levels; encourage rather than take over; no deadlines, critique or pressure; emphasise playful exploration. [source: Holt et al.; Jensen et al. 2024; CultureForHealth entry for Arts and Minds]
• Example language (illustrative): "There's no right way to do this. Try a few materials and see what you enjoy."
• Watch for: Boredom or stress from a poor skill match; perfectionism. Relaxation in session is associated with benefit. [source: Holt et al.]

B4. Museum, gallery and cultural visits

• Purpose / when: Within some programmes, and as a move-on link. [source: CultureForHealth entry for Arts and Minds; Holt et al.; Jensen et al. 2024]
• Steps: Facilitated group visits; museum-based programmes may include object handling, artmaking or horticulture. [source: NASP rapid review, Mughal et al. 2022]
• Example language (illustrative) [synthesis], to a client: "Next month the group visits the gallery. If the journey or the crowds are a worry, let's plan that part now."
• Watch for: Travel, cost and crowd barriers. [synthesis]

B5. Optional, flexible participation

• Purpose / when: Throughout.
• Steps: Participants may rest, step out or leave early. [source: Holt et al.]
• Example language (illustrative) [synthesis]: "You can take a break, step outside or leave early whenever you need. Nobody will ask why."
• Watch for: Repeated early leaving as a sign that the group is too much; raise gently with the participant and, with consent, the referrer. [synthesis]

B6. Materials and physical safety

• Purpose / when: Planning and every session.
• Steps: Risk-assess the environment, activities, materials and group size before work begins; keep group size within the practitioner's skills; have trained first-aid and mental health first-aid cover; minimise lone working. [source: Creative Health Quality Framework] For the materials named in schemes: control clay and glaze dust (wet cleaning, no dry sweeping), supervise sharp tools and wire cutters and consider the risk for anyone who self-harms, use non-toxic, low-odour paints and adhesives with ventilation, and follow food-hygiene rules for any refreshments; NHS England lists food safety among expected group arrangements. For music and drumming, keep volumes moderate and offer hearing protection. For dance or movement, check floor space and fall risks and invite people to adapt movements. [synthesis; food safety from NHS England summary guide]
• Example language (illustrative) [synthesis], when checking a scheme: "Could you tell me how you risk-assess the room and materials, and who is first-aid and mental-health-first-aid trained at sessions?"
• Watch for: Unsafe venues, loud rooms, crowded tables. [synthesis]

B7. Endings and move-on groups

• Purpose / when: Final weeks.
• Steps: Plan endings with time and resources; offer follow-on groups, peer-led groups, community signposting and links to cultural venues; involve participants in choosing. [source: Creative Health Quality Framework; Holt et al.]
• Example language (illustrative) [synthesis]: "The group ends in three weeks. Which of these follow-on options would you like to try?"
• Watch for: The "void" after the end. [source: Holt et al.]

B8. Practitioner support and supervision

• Purpose / when: Ongoing for artists and link workers.
• Steps: Artist facilitators need clinical supervision, emotional support and training, including safeguarding, confidentiality and data protection. Creative health practitioners should have briefing and debriefing, training, mentoring, reflective practice, peer support and clinical supervision. Link workers have a GP supervisor and monthly clinical supervision. [source: Holt et al.; Creative Health Quality Framework; workforce framework]
• Example language (illustrative) [synthesis], declining informal supervision: "I'm glad to talk about one referral we share. Ongoing supervision of your sessions would need a formal agreement with a clear scope."
• Watch for: A psychotherapist being asked to supervise a scheme informally; agree it formally with clear scope or decline. [synthesis]

5. Handling problems

The sources name a few programme-level problems (unsupportive group dynamics, in-groups, the ending void, non-improvement, access barriers, facilitator boundaries). Most of the therapist-level guidance below is [synthesis].

• Client feels "fobbed off" with a non-clinical offer. Present AoP as an addition, not a replacement; confirm what clinical care continues; let the client decline without consequence (people can decline, and NHS England even has a code for social prescribing declined). [source for declining: NHS England summary guide; rest synthesis]
• Never attends the first session. Explore what stopped them (anxiety, transport, timing, shame about art); offer a supported first visit via the link worker, who can accompany people; or arrange a phone call with the artist. [source for accompaniment and pre-session call: NHS England summary guide; Holt et al.; rest synthesis]
• Drops out mid-programme. Ask what changed; consider a different art form, venue or time, or a gap and later re-referral (a second referral is sometimes possible). Do not frame it as failure. [source for second referral: Holt et al.; rest synthesis]
• Not improving. About a quarter of completers in one large evaluation did not improve. Review goals, check for untreated depression or other clinical need, and adjust the overall plan. [source for figure: Holt et al.; rest synthesis]
• Client uses the group as therapy or discloses heavily. Agree beforehand that personal material belongs in therapy; if disclosure happens, debrief in your next session and help the client decide what to share in the group. Ask the scheme how facilitators handle disclosures. [source for boundary: Holt et al.; rest synthesis]
• Group conflict, exclusion or an unpleasant member. Unsupportive interactions and in-groups can undermine benefit; encourage the client to raise it with the artist; revisit the group guidelines; consider a different group. [source: Holt et al.; rest synthesis]
• Overwhelm or distress triggered by the activity (e.g. a material, music, a theme, a museum object). Remind the client they can step out or leave early; build a short coping plan in therapy; if music is involved, ask about musical associations that may trigger traumatic memories and about noise tolerance. Process the reaction in therapy, not in the group. [source for stepping out: Holt et al.; rest synthesis]
• Risk rises during the programme. If the link worker or artist reports concern, or the client discloses suicidal thoughts, self-harm or safeguarding issues, reassess risk using your standard practice, update the crisis plan, and inform those who need to know under the agreed handover. Link workers escalate to their named supervisor or GP; clinical responsibility should already be named (A5). Consider pausing attendance only if being in the group is itself unsafe; social contact is often protective. [source for link-worker escalation: workforce framework; rest synthesis]
• Artist or link worker out of their depth. If you notice non-clinical staff holding clinical risk or offering counselling, raise it with the scheme lead; artists' disclosure and boundary practices vary and need guidance and supervision. [source: Holt et al.; Creative Health Quality Framework; rest synthesis]
• Rupture with you over the referral. If the client experiences the referral as rejection or a sign therapy is ending, name it, explore it and restate your plan. [synthesis]
• Ending void. Plan move-on early (A9); in therapy, review structure and contact after the group ends. [source: Holt et al.; Creative Health Quality Framework]
• Access and equity barriers. Transport, childcare, housing, benefits and legal problems can block attendance; the evidence base is mostly female, older and White and weak for migrants and underserved groups. Use the link worker for practical barriers and ask for culturally appropriate, language-accessible or community-led provision. [source: NASP briefing; NASP rapid review; Jensen et al. 2024; rest synthesis]
• No local scheme, waiting list or funding has ended. Ask the link worker about other creative, heritage or community options (libraries, museums, choirs, craft groups are all named in the NASP review), or self-directed creative activity while waiting. [source for options: NASP rapid review, Mughal et al. 2022; rest synthesis]
• Client refuses information sharing. Respect it where lawful; refer with minimal information or support self-referral; reconsider if risk makes an unshared referral unsafe. [synthesis]
• Client or referrer overstates the evidence. Say what the reviews say: consistent pre–post wellbeing gains and positive participant accounts, but no RCTs in the 2024 review and mostly low-quality designs. [source: Jensen et al. 2024; NASP rapid review]
• Physical health or disability needs. Check venue access, seating, rest breaks and material adaptations; mention needs in the referral. [synthesis; accessible venues from Holt et al.]

Sources

Sources:

• Social prescribing (NHS England)
• Workforce development framework: social prescribing link workers (NHS England, B1569)
• Social prescribing and community-based support: Summary guide, updated June 2020 (NHS England)
• Social prescribing: Reference guide and technical annex for primary care networks (NHS England) (landing page only; annexes not drawn on [uncertain])
• Holt NJ, Matthews J, Elliott C. Art on prescription: Practice and evidence (UWE repository) (year not stated in the copy opened [uncertain])
• Jensen A, Holt N, Honda S, Bungay H (2024). The impact of arts on prescription on individual health and wellbeing: a systematic review with meta-analysis. Frontiers in Public Health 12:1412306
• Mughal R, Polley M, Sabey A, Chatterjee HJ (2022). How arts, heritage and culture can support health and wellbeing through social prescribing (NASP Academic Collaborative rapid evidence review)
• NASP briefing: Social prescribing, arts, heritage and culture
• Creative Health Quality Framework (Culture, Health & Wellbeing Alliance)
• Arts on Prescription, Cambridge, St Ives and Peterborough (CultureForHealth mapping entry for Arts and Minds)
• Creative public health: referral framework (Birmingham City Council)

Cited second-hand, not drawn on: Huxley P (1997), on Stockport Arts on Prescription, as cited by Holt et al. [uncertain]