Dear Editor

Frais's insightful perspective on seeking an effective treatment for his medication-resistant depressive illness highlights the important place of electroconvulsive therapy (ECT) in management of the condition (1). Not only is ECT the most efficacious treatment for this disorder (2), it retains good effectiveness following pharmacotherapy failure (3). Despite this, Frais's experience of starting the treatment late in the course of his illness only after he had requested it himself (1) is all too common. Many outpatients and families lack his resourcefulness and are never offered ECT despite its potential benefits.

It is vitally important for community and inpatient psychiatrists to offer ECT early, alongside other options, to patients with resistant moderate or severe illness. ECT is not a treatment of last resort.

Yours faithfully

Dr Richard Braithwaite MRCPsych
Consultant Psychiatrist, Sussex Partnership NHS Foundation Trust
Chair, Committee on Electroconvulsive Therapy & Related Treatments, Royal College of Psychiatrists

Mr Neil Kinlay
Expert by Experience, Committee on Electroconvulsive Therapy & Related Treatments, Royal College of Psychiatrists

Prof Julie Langan Martin
Professor of Psychiatry and Honorary Consultant Psychiatrist, University of Glasgow
Chair, Scottish Electroconvulsive Therapy Audit Network

Prof Declan M McLoughlin PhD MRCPsych
Head of Discipline, Dept of Psychiatry, Trinity College Dublin
Member, Committee on Electroconvulsive Therapy & Related Treatments, Royal College of Psychiatrists

Prof George Kirov
Clinical Professor, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University
Member, Committee on Electroconvulsive Therapy & Related Treatments, Royal College of Psychiatrists

References
1. Frais A. Finding the right treatment for severe depression. BMJ 2025;389:r478.
2. UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet. 2003 Mar 8;361(9360):799-808.
3. Heijnen WT, Birkenhäger TK, Wierdsma AI, van den Broek WW. Antidepressant pharmacotherapy failure and response to subsequent electroconvulsive therapy: a meta-analysis. J Clin Psychopharmacol. 2010 Oct;30(5):616-9.

Dear Editor,

At what stage in medical training does one know whether or not they would like to become a surgeon? I have participated in Dissection Room teaching as both a student and an educator, and I have experienced and witnessed moments of inspiration that are unique to the setting.

Having spent a session diligently using a hammer and chisel to open the skull and expose the dura mater, I know one of my students is now contemplating a career in Neurosurgery. I myself was initially drawn to the prospect of becoming an ENT surgeon or an anaesthetist after an especially memorable lesson in which I performed a Cricothyrotomy on a body donor.

Furthermore, we see a different side of some students when in a unique environment. One of my quietest students in the classroom comes out of their shell in the Dissection Room, and has shown skill with surgical tools that would otherwise have lain dormant.

One cannot contemplate such a significant change to a medical curriculum without reflecting on the loss of opportunities.

Dear Editor,

Let’s not get caught up in the terminology “prescribing,” although perhaps the expression “community referral” may be more appropriate in some cases (Napierala et al., 2022). As a clinical pharmacist who has studied and researched health promotion, including community initiatives such as parkrun (Dunne et al., 2024), I would like to apply a health promotion lens rather than the traditional bio-medical model to this issue.

One of the tenets of health promotion is “re-orienting the health services” (WHO, 1986). An important part of this re-orientation is developing and using community initiatives to promote physical and mental health and wellbeing. In my experience, the parkrun practice initiative is so much more than just “prescribing parkrun”. It allows healthcare professionals to model healthy behaviour by attending parkrun themselves. It may also involve referring patients to community initiatives that they may not be aware of and supporting patients who may need that little bit of extra help to attend activities that are available in the local community. Not forgetting that referral may include suggesting that patients can volunteer at parkrun, which has health benefits in it’s own right (Haake et al., 2022).

Whether we refer patients to parkrun, a community choir, gardening group or book club; as healthcare professionals we should look beyond the traditional prescribing model and do whatever we can to support the health and wellbeing of our patients and community members, regardless of what label we use to describe that process.

Dunne, A., Quirk, H., Bullas, A., & Haake, S. (2024). 'My parkrun friends.' A qualitative study of social experiences of men at parkrun in Ireland. Health promotion international, 39(3). https://doi.org/10.1093/heapro/daae045
Haake, S., Quirk, H., & Bullas, A. (2022). The health benefits of volunteering at a free, weekly, 5 km event in the UK: A cross-sectional study of volunteers at parkrun. PLOS global public health, 2(2), e0000138. https://doi.org/10.1371/journal.pgph.0000138
Napierala, H., Krüger, K., Kuschick, D., Heintze, C., Herrmann, W. J., & Holzinger, F. (2022). Social Prescribing: Systematic Review of the Effectiveness of Psychosocial Community Referral Interventions in Primary Care. International journal of integrated care, 22(3), 11. https://doi.org/10.5334/ijic.6472
WHO. (1986). Ottawa Charter for Health Promotion, World Health Organization, Geneva.

Dear Editor

We thank the authors for their thoughtful analysis and welcome the chance to discuss the broader implications of “prescribing parkrun” within the context of social prescribing. We agree that parkrun is a remarkable community‐based initiative that demedicalises health promotion, shifting focus away from traditional, command‐driven models toward an empowering, participatory approach. We address several key points raised in the article.

Demedicalising and Empowering through Social Prescribing

Critics argue that using the term “prescribing” implies a top–down model of authority, yet this view overlooks how social prescribing is practised in clinical discussions about group physical activity such as parkrun. The term “prescribing” is aimed at clinicians, legitimising evidence‐based treatment options beyond medications. There is robust evidence that group physical activity improves health outcomes (1), although many clinicians and patients remain unaware of its efficacy compared to medication. By framing physical activity like parkrun as an added treatment option, clinicians support demedicalisation by avoiding unnecessary prescriptions—a practice preferred by patients. Just as forcing medication would be poor practice, dictating behavior is similarly inappropriate and unlikely.

From a patient’s perspective, calling parkrun a prescription is misleading because the event remains free and accessible to all. The term ‘prescribing’ here is meant solely to encourage clinicians to signpost it as a valid option. Facilitating access to this community‐led opportunity to enhance physical and mental health is sound practice, regardless of semantic debates. This aligns with evidence that community‐focused interventions can transform patient engagement by promoting autonomy and self‐directed improvement, especially among marginalised and deprived groups (2).

Evidence of Impact and Cost-Effectiveness

Recent research, including a study by Haake and colleagues from Sheffield Hallam University (3), shows that parkrun participation is linked with statistically significant improvements in life satisfaction over six months. The study reported a weighted, seasonally adjusted increase of 0.26 points in life satisfaction among new participants, with the greatest gains in those previously inactive. The cost‐effectiveness analysis is compelling; benefit‐cost ratios range from 16.7:1 with a conservative estimate to as high as 98.5:1 when broader wellbeing impacts are included. These figures underscore the economic and public health benefits of incorporating social interventions like parkrun into primary care.

Primary Care Engagement and Adoption

It is important to clarify that over 2000 general practices now participate in parkrun practices, not merely 1800 as previously suggested (4). This level of engagement demonstrates that GPs recognise the value of linking patients to community assets. Primary care professionals are championing a shift toward a holistic and preventative approach that de‐emphasises traditional pharmacological treatments in favour of community participation and self‐care.

Countering the Misconception of “Medicalising” Exercise

Critics claiming that “prescribing” parkrun reinforces a hierarchical framework misinterpret social prescribing. Integrating parkrun into primary care promotes a model where community resources, not medications, take centre stage. This approach does not reduce patient autonomy; it provides a flexible, enjoyable option for self‐directed health improvement supported by professional advice. Rather than undermining community exercise, it legitimises parkrun as a vital component of modern, patient‐centred health promotion.

In Summary

In summary, the evidence affirms that parkrun is a paradigm of demedicalisation rather than an overly medicalised intervention. It embodies social prescribing by connecting patients with their communities while delivering measurable improvements in life satisfaction and wellbeing. With over 2000 general practices involved, ‘prescribing’ parkrun is a justified, cost‐effective public health strategy that merits ongoing support and expansion. These findings and practice insights not only reinforce the validity of social prescribing models but also highlight the transformative potential of community‐based health initiatives in reshaping modern primary care. Overall, parkrun integration into primary care offers significant, measurable, and enduring public health advantages globally.

1) Burke, Shauna M., et al. "Group versus individual approach? A meta-analysis of the effectiveness of interventions to promote physical activity." Journal of sport & exercise psychology 2 (2006): 19-35.
2) What works: Community engagement and empowerment to address health inequalities - Health Equity Evidence Centre
3) HAAKE, Steve, QUIRK, Helen and BULLAS, Alice (2024). The impact of parkrun on life satisfaction and its cost-effectiveness: A six-month study of parkrunners in the United Kingdom. PLOS Global Public Health, 4 (10).
4) Royal college of GPs 2000 GP surgeries in the UK now registered to parkrun practices 28 March 2025 https://www.rcgp.org.uk/News/2000-GP-surgeries-registered-parkrun-practices