This was presented at the University of Otago General Staff Conference, "Linked In and Switched On", 29 August 2014. Books on Prescription is a programme designed to provide access to evidence-based self-help resources for those experiencing common mental health problems. It was adopted by the Southern Primary Health Organisation (PHO) in 2011, following in the footsteps of National Health Service (NHS) in the UK. It has found success in Central Otago Public Libraries and has recently been adopted by all public libraries in the regions of Otago and Southland. Books are prescribed to patients by health professionals from a list of recommended titles that have been reviewed by mental health professionals. These titles allow people to independently learn strategies to improve their mental well-being and supplement primary health treatment for common mental health problems. The University of Otago Health Sciences Library saw an opportunity to support the teaching and learning of medical students. By engaging in this collaboration the partners hope to embed the programme into the practice of future health professionals and to improve the well-being of staff and students. This paper reviews the programme in the University setting and Southern PHO catchment to date.

1. Collaborating to enhance opportunities for
teaching and learning, and for the well-being of
staff and students at the University of Otago
Introducing Books on Prescription

2. Introductions
Katie Jahnke | Health Promoter & Projects Coordinator
Southern PHO | Katie.Jahnke@southernpho.health.nz
Jodie Black | Registered Psychologist
Student Health, University of Otago | jodie.black@otago.ac.nz
Sarah Gallagher | Subject Librarian
Health Sciences Library, University of Otago | sarah.gallagher@otago.ac.nz
Richard German | Divisional Librarian
Health Sciences Library, University of Otago | richard.german@otago.ac.nz

3. Overview
Katie - History of BOP and Southern PHO involvement
Richard - How libraries are changing internationally
Sarah - Why and how the Medical Library became involved
Jodie - The role of the programme at Student Health

4. What is BOP?
A community health initiative whereby GPs, mental
health professionals and other health professionals
can offer their patients recommended self-help books
for mild to moderate mental health problems.

5. History
• Developed in Wales in 2002 by psychologist Dr Neil
Frude
• In 2005 the scheme was rolled out across Wales then
throughout the UK following extensive evaluation
• Implemented in Central Otago in 2011 and
progressively rolled out in Otago and Southland

6. Why start a BOP scheme?
• 46.6% of the population will meet the criteria for a mental disorder
during their lives
• 39.5% have already had experience of mental disorder
• 20.7% of the population will have experienced a mental health
disorder within the past 12 months
• There is significant unmet need for people with mental disorders.
Over a 12 month period only 39% of people with a mental
disorder had visited health services

7. Evidence
• Clinical evidence shows that books can be as effective as other forms
of therapy and with the advantage of having no potential side effects
associated with drugs, and often achieve good results more quickly.
• Bibliotherapy is one of the key self-help strategies recommended in the
treatment of depression and anxiety.
• Research suggests that patients benefit from knowing more about their
problems, and learning psychological tactics to deal with them.

8. Southern PHO
• 285,852 enrolled patients in 89 practices
• 40% enrolled pop. live outside the main cities
important to have a rural focus
• Reduced access to mental health services in
rural areas

9. Hearing UK experiences
Watch:
● Reading Well (UK)
● a medical
professional
● a librarian
● a patient

10. University of Otago Libraries
● 7 libraries
o Medical, Dental,
Science, Education,
Law, Central
o Hocken Collections
● Available to all staff
and students

11. What libraries are about
Ranganathan’s five laws of library science:
1. Books are for use
2. Every reader his/her book
3. Every book its reader
4. Save the time of the reader
5. The library is a growing organism

12. Future libraries
Extensions of Ranganathan’s ‘laws’ (Crawford and
Gorman, 1995):
1. Libraries serve humanity
2. Respect all forms by which knowledge is communicated
3. Use technology intelligently to enhance service
4. Protect free access to knowledge
5. Honor the past and create the future

13. More than just books
● Libraries are constantly
evolving to meet the needs
of our communities
● We are trusted places /
people for information
provision
CC-BY-NC-ND Dunedin Public Library
https://www.flickr.com/photos/dunedinp
ubliclibraries/13884121976

14. NZ Public Libraries in 2013
Source: Libraries in Aotearoa 2014, p7

15. Libraries & health information
“Libraries can build on the fact that
many people visit libraries for health
information before or instead of
engaging with health professionals”
- Ingham 2014

16. Libraries <3 their communities
Places of refuge & services
in times of crisis, eg:
● CHCH earthquakes
● Hurricane Sandy
● Ferguson Riots
So libraries are a good fit
for BOP schemes

17. BOP in universities
Otago is one of a few university libraries in the
world that have adopted Books on Prescription
• University College Dublin
• Brunel University London
• Loughborough University

18. Why is Otago involved?
Dual reasons for our involvement:
● Opportunity to support teaching and learning in the
Dunedin School of Medicine
● Opportunity to contribute a resource to improve staff
and student well-being at the University of Otago

19. #1 - Teaching & learning
● Approval of teaching staff
● Ordered books
● Created a guide
● Promotion

20. Our guide
● resource for teaching and learning
● a resource for prescribers
● to illustrate and provide access to the books in the collection
● to present evidence of bibliotherapy & case studies
● to provide access to supplementary material
● www.otago.libguides.com/bop

21. Promotion

22. Interest from others
● Our launch in August 2013
coincided with the roll out of
the scheme across the UK
● Generated interest / RFI from
other libraries in NZ
● Reported in LIBROS and
HEALTH SIG

23. “I personally recommended the service to a patient I met in
General Practice, who was suffering from a relapse of her
depressive illness … she seemed very receptive to the idea …
I really appreciated having something additional to offer her
however- she was already on medication for her depression,
and really responded to the idea of having something that she
could do herself. I think it's a really valuable service, and I
hope that the medical school incorporates it into the general
practice curriculum!”
- 6th year medical student

24. #2 - Well-being
Support the well-being of
staff and students
● Student Health
● Disability Information &
Support
● Employee Assistance
Programme (EAP)
CC http://pixabay.com/en/reading-manual-docs-help-book-man-
99244/

25. Student Health Services
● Largest “enrolled” population in the Southern District
● About 50 staff including: nurses, general practitioners,
counsellors, dietitians, psychiatrist and administrative
staff
● Majority of students access Student Health during term
and return to their family GP over breaks
● 28% of Otago students record their “home area” as the
Southern District

26. Counselling Services
● Unique to have counselling services on site
● Same day appointments with self referral for brief
assessment, advice, counselling and/or further referrals
● Referrals have doubled over the last 5 years
● Peak demand periods towards the end of each
semester

27. Benefits for Student Health
● Part of a stepped care approach to mental health
● Options for those on a waitlist or returning home over
breaks
● Provide options directly accessible by students
● Utilizing library infrastructure

28. Promoting BOP in SHS
● Information session provided to SHS staff
● Books rotate through staff room
● SHS staff have added to scheme - including sexual
health
● Link to BOP on SHS website
● Bookmarks promoting BOP are available from all
clinical rooms

30. Challenges to consider
● Staff familiarisation with the scheme and books
● Client attitudes towards electronic and bibliotherapy self
help are more positive than the clinicians
● Some staff already use electronic resources, including
websites and apps

31. Goals
● Further promotion to staff and students as a well-being
aid
● Further promotion to teaching staff (Medicine)
● Further promotion to health workers on campus

32. Evaluation
The Southern PHO are undertaking an extensive
evaluation in the region, including:
• Surveying prescribers and librarians
• Collating issuing data and user feedback
• Interviews and focus groups with prescribers and
consumers

33. Continuous improvement
Our collaborative practice includes a cycle of review to
ensure we continue to improve this programme.
Four step quality cycle
• plan > act > review > improve
Source: http://www.uow.edu.au/quality/quality/index

34. Indicators of success
● Website / online guide hits
● Books issued and holds placed
● Extra copies requested
● Student and staff feedback
● Prescriptions filled
● Evidence of incorporation into learning programs
● Cross promotion through other well-being projects

35. Fig 1. Example of statistics gathered by Springshare software over 12 months
of the Books on Prescription Guide www.otago.libguides.com/bop

36. “I personally find the books on prescription program to be a
very valuable resource. Dunedin has limited access to
counselling and mental health services, and many of the
services which are available have significant wait times for
patients who are not acutely unwell. This can have a
significant impact on the mental health of patients who are
unable to afford to pay out of pocket for these services.”
- 6th year medical student

37. Next steps
● Develop opportunities to incorporate into Residential
Assistant, peer support and future staff training
● Otago University Student Association (OUSA) Mental
Health Awareness Week
● Review the outcomes and adopt any recommendations
from the PHO evaluation

38. Summary
● Working in collaboration across departments has made
this project possible
● A structure of continuous quality improvement will allow
to project to continue to grow and meet the needs of
staff and students

39. References
Ingham A. Can your public library improve your health and well-being? An investigation of East Sussex Library and
Information Service. Health Information & Libraries Journal. 2014;31(2):156-60.
LIANZA. Libraries in Aotearoa 2014 http://www.lianza.org.nz/resources/lianza-publications/libraries-aotearoa/libraries-aotearoa-
2014 [Accessed 19.08.2014]
NHS Choices. Reading Well Books on Prescription. https://www.youtube.com/watch?v=1H8OpYP0zPg [Accessed
19.08.2014]
New Media Consortium. NMC Horizon Report: 2014 Library Edition http://cdn.nmc.org/media/2014-nmc-horizon-report-library-
EN.pdf [Accessed 19.08.2014]
Pratt RJ. The introduction of a healthy reading scheme for people with mental health problems: usage and experiences
of health professionals and library staff. Mental Health in Family Medicine. 2008;5(4):219-28.

40. Thank you
www.booksonprescription.co.nz
www.otago.libguides.com/bop