This scheme was set up in early 2005 and launched later that year. It followed as a model the Books on Prescription work of Dr. Neil Frude in Cardiff. His approach was based on sound clinical research and reflects the professional guidelines issued by NICE (the National Institute for Clinical Excellence) which recommends the use of self-help books to treat common psychological problems, particularly depression and anxiety. These disorders affect large numbers of the UK population, estimated at 10% or 15% at any one time. There is very limited specialist help available and front-line health services are unable to meet the demand for access to psychological therapy.

There were 3 drivers for the development of the service:

• Portsmouth Libraries were keen to explore ways of addressing the health agenda within the City Council
• The Cardiff experience seemed to be a useful model and provided a starting point e.g. an existing book list
• The City’s Clinical Psychologist had contacted the library service with the same aims

The project relates directly to the theme of Improving Health and Wellbeing.

Health and Social Well Being is a key theme of ‘Proud of our past: Ambitious for our future’ the Portsmouth Community Strategy 2004-2009. Promoting safe and healthy communities is a key theme in the Portsmouth City Council Corporate Plan 2007-2010.

Following meetings between Portsmouth Libraries and the Primary Care Trust (PCT), there was consultation with health practitioners during which the Cardiff book list was discussed with a view to adapting it to local need. Some books were no longer easily available; other titles were suggested to fit with the usual pattern of prescribing. 40 titles were chosen and sets of books were distributed to each branch library, with 2 sets to the Central Library.

Funding for the setting up of the scheme was obtained from Museums Libraries and Archives South East and from the PCT; it was established as a joint project. The PCT provided funding for the leaflets and “prescription pads” and also facilitated Mental Health Awareness training for library staff, prior to the launch of the scheme.

The launch was part of a monthly training afternoon for medical practitioners in the city, held at a large conference style hotel. It gave the scheme a very positive start and cultivated some advocates within the PCT straight away. By having a 'slot' in such a big event it was possible to reach more than 50% of the health practitioners on one occasion, to deliver their starting packs and answer any questions.

The scheme was set up with a monitoring system in place: although the selected titles are also available on open shelves, the Books on Prescription collections are “closed”, enabling library staff to track their use. Evaluation has shown that 97% of prescriptions issued are brought into the libraries – far higher than expected. From the prescriptions redeemed it is possible to gather data about which GP practices are making most use of the service, which branch libraries are lending most and the titles and subject areas that are most used. The subject areas involved have always been well used within Portsmouth libraries (key titles relate to anxiety, depression and self esteem) but the impact on the scheme can also be seen on the number of issues of particular books from open shelves. Anecdotal evidence suggests that people who found a prescribed title helpful have recommended it to others.

A brief feedback form is included as a bookmark with these titles and results are currently being analysed. Feedback from practitioners has been very positive. The PCT is also running a small clinical trial to test the effectiveness of the service.

The funding needed to set up this project were relatively small, with book resource costs amounting to less than £5,000 and the PCT covering print costs and training. However the costs in terms of staff time were high, for both partners, reflecting their commitment to win “hearts and minds” before launching the scheme.

The partners were:

• Portsmouth City Council Libraries
• Portsmouth City Teaching Primary Care Trust
• Portsmouth Psychological Therapies Service

For the PCT, this service adds an extra dimension to the treatment a GP or other front-line health worker can offer, particularly at an early stage of the consultation process. It may delay or relieve the need for medication or further referral to psychological services. The patient does not leave the surgery empty-handed.

The Psychological Therapies Service can benefit from the knowledge that GPs are prescribing from a list of agreed titles and that these are currently available and accessible.

For the Library Service, the scheme gives it a greater clarity of role in the health outcomes of their users. Through partnership, it can play a direct part in patient treatment and also attract new users to libraries, strengthening links to their communities.

Some difficulties were encountered and some changes have been made in response. There are issues relating to the book stock:

• Availability of titles cannot be ensured as books go out of print. If there was a consistent national scheme, this might have influence over publishers.
• Some titles and subject areas are much more used than others. It has been necessary to purchase more copies of the titles most in demand.
• There are also challenges in terms of the users’ needs:
• If a book is not available at the time it is requested, a library will access it (free of charge) and contact the person who was prescribed it. However, when this happens, they often fail to return to pick it up. The response to this is a combination of improving stock control and continuing to provide a welcoming and professional service.
• The need for specific mental health awareness training is linked to this as it has proved useful in building staff confidence and understanding of the personal importance of the service to users.

Although libraries have provided health information and self-help books in the past, the recommendation by psychology professionals has given staff more confidence in promoting the specific titles.

The partnership is crucial: both partners saw equal benefit in the scheme and therefore have the motivation to overcome any difficulties and develop its potential. It was important that there was financial commitment on both sides as this underlines the shared nature and provides sustainability.

The success can be seen in the recent reprint of leaflets, funded by the PCT and in a new initiative: Children’s Books on Prescription, a development based on the positive response of practitioners to the original scheme

The methods used seem to have been successful, but some timings could perhaps have been better:

• The need to agree changes to working practices and win over some health practitioners to the programme might have lengthened the early planning stages.
• Staff training should ideally start to happen as soon as possible as there may be some apprehensiveness among library staff unused to dealing with mental health issues.
• This kind of complex partnership needs time to establish and impact cannot be realistically measured within the first few months.