Research on Arts & Mental Health
In 2007 the Department of Health and Arts Council England published a joint Prospectus for Arts and Health that highlighted the positive benefits of arts participation for health and advocated the use of arts in the NHS and in community settings. Similarly Cayton (2007) concluded in the Report of the Review of Arts and Health Working Party that there was ample evidence that participation in the arts led to real and measurable health benefits and that the arts should be firmly recognised as being integral to healthcare provision. A separate Arts Council England (2007) report suggested that arts participation was important in its impact on the wider determinants of health, such as living environments, educational attainment, and social capital and agreed that arts should be integrated into mainstream health policy and that funding and resources for arts and health initiatives should be increased. Staricoff (2004), furthermore, cited nearly 400 peer reviewed papers showing the benefits of arts participation on a wide range of health outcomes and Windsor (2005) found an association between self reported general health and arts participation in a survey of 12,262 participants Despite this Clift et al. (2009) concluded that the extent of action on arts and health initiatives by both Arts Council England and the Department of Health has been disappointing, despite the extensive evidence for a broad range of health benefits.
More specifically there is a growing body of evidence that arts participation can be beneficial for users of mental health services, particularly in the context of reducing the stigma and social exclusion that exacerbates problems for individuals and families with mental health issues (e.g. Byrne, 1999). Staricoff’s (2004) extensive review of the medical literature concluded that the use of arts in mental healthcare improved communication between service users and their families and service providers, stimulates creative skills and enhances self-esteem and aids self-expression. Other research concurs, leading to a view that art has personal benefits to self esteem and expression (Dissanyake, 1995; Creek, 2002; Schmid, 2005) as well as improving social engagement (Parr, 2006).
More recently, there have been numerous qualitative studies citing the benefits of arts participation to individuals. For instance, Heenan (2006) interviewed twenty participants and conducted two focus groups comprising ten participants each in Northern Ireland. She concluded that arts projects characterised as supportive and positive in a non-clinical environment led to improvements in self-esteem and confidence, allowed reflection on mental health issues and promoted empowerment and recovery.
Stickley, Hui, Morgan, & Bertram (2007) interviewed eleven service users about their experiences of art and found that participatory arts promoted self-worth and gave participants an opportunity to develop a social role and identity as ‘an artist’ and recognition for the work they produce in a society that denies service users any recognition or role in society (Barker 1998). Stickley et al. (2007) also highlight the hope for the future that artistic expression gives participants, particularly in non-institutionalised community settings that foster a sense of social integration. Such feelings of hopefulness, purpose and meaning as well as social support, and the rebuilding of identity have been well identified as key parts of the recovery process (Repper & Perkins, 2003).
Spandler, Secker, Kent, Hacking, and Shenton (2007) interviewed 34 participants from six arts and mental health projects across the U.K. They found that arts participation facilitated an escape from a cycle of hopelessness and despair, added purpose and meaning for participants that motivated them to engage in other aspects of their lives and helped them to develop adaptive coping mechanisms. Many participants also reported that the focus that arts participation had given them allowed them to avoid self-harm and cope better with distress, such as that caused by auditory hallucinations. It also gave people a sense of control as opposed to being controlled by others or circumstances, and completing and displaying artwork made them feel valuable and worthwhile as members of a wider community and gave people the confidence to claim and develop an identity as an artist. Community arts groups in non-institutionalised settings were also seen as places where participants could offer and receive mutual support from people in similar circumstances and fostered a sense of working together. This is consistent with Stacey and Stickley’s (2010) conclusions: that arts provide a means for recovery away from the perceived oppression of statutory service providers and Howells and Zelnik’s (2010) finding that arts groups facilitated identity formation and a sense of community among participants and a bridge to the wider community.
In general these studies demonstrate that participation in community arts groups leads to outcomes consistent with a recovery model for mental health (Repper & Perkins, 2003; Spandler et al., 2007) in encouraging hope for the future, increasing participants’ self esteem, confidence, purpose, social support and integration, and motivation as well as creating social groups of mutually supportive people with similar difficulties. Whilst this is compelling in itself many might argue that such studies are highly subjective as a result of their reliance on individual testimony that may not generalise to larger groups and the analysis of researchers who may be biased in their interpretation and selective in their presentation of quotes from participants.
Larger scale quantitative studies that employ more objective measures of health, well being, and social inclusion have, however, derived similar results. For instance Eades and Ager (2008) found that of 59 participants completing a community arts course of 12 weekly two hour sessions 64% reported lower depression and anxiety, 69% improvements to social health, 64% greater self-confidence & self esteem, 63% improvements in general health and self esteem, and 74% that they would include creativity in their long term lifestyle. Hacking, Secker, Spandler, Kent, and Shenton (2008) assessed 61 participants at entry to 22 arts projects across the UK and six months later on a battery of standardised and validated measures of Empowerment (Individual Empowerment Assessment, Schafer, 2000), mental health needs (Clinical Outcomes in Routine Evaluation, CORE System Group, 1998), and Social Inclusion (Secker, Hacking, Kent, Shenton, & Spandler, 2009) and found statistically significant improvements in all three measures, with greatest improvements for those with no new stress in their lives and a positive impression of the arts. Participants with more severe mental health difficulties were also more likely to show improvements in empowerment and mental health over the six month study period.
One problem that is characteristic of the field, however, is that evaluation of projects is often retrospective, inconsistent and neglects validated assessments of health, wellbeing, and social inclusion (Hacking, Shecker, Kent, Shenton, & Spandler, 2006). Researchers suggest that community projects should include a rigorous process of evaluation in their plans in order to provide a wider evidence base for the use of arts to promote good mental health and recovery and use triangulation of quantitative standardised outcome measures and qualitative analysis of interviews with participants to provide broad based and rigorous support for their activities (Hacking et al., 2006; Staricoff, 2006). Eades and Ager (2008) lay some of the blame on lack of guidance from funding bodies to community groups (in this case New Opportunities Lottery Fund) for the weakness and inconsistency of evaluation. They conclude that arts projects can lead to real health gains, but that there is a need for consistency and rigour in evaluation, including long term assessments of cost-benefit and quantified health gain, in order to allow integration with mainstream National Health Service healthcare delivery. The work of Hacking et al. (2006, 2008; Spandler et al., 2007); Secker et al., 2009) has, however, gone some way to providing a framework for outcome research that could provide a model for future project evaluation in the field of arts and mental health.
Overall, though, results from all studies are encouraging and support the claim that participatory arts, particularly in a non-institutionalised setting, can benefit health in general (e.g..Staricoff, 2004; Windsor (2005) and mental health in particular (e.g. Stickley et al., 2007; Hacking et al., 2008) and that the outcomes of such interventions are consistent with a recovery model for mental health issues (Repper & Perkins, 2003).
Arts Council England (2007). The arts, health and well-being. London: Arts Council England. Available from: http://www.artscouncil.org.uk/publications/
Arts Council England/Department of Health (2007). A prospectus for arts and health. London: Arts Council England / Department of Health. Available from: http://www.artscouncil.org.uk/publications/
Barker, P. (1998). Creativity and psychic distress in artists, writers, and scientists: implications for emergent models of psychiatric nursing practice. Journal of Psychiatric and Mental Health Nursing, 21, 297-308.
Broadway, G. (2008). Arts and Wellbeing Evaluation Report. Available from: http://towersabove.co.uk/Evaluation%20Report%201.pdf
Broadway, G. (2009). Arts and Wellbeing Pilot 2 October 2008 – April 2009 Evaluation Report. Arts and Wellbeing Evaluation Report. Available from: http://towersabove.co.uk/Evaluation%20Report%202.pdf
Byrne, P. (1999). Stigma of mental illness: Changing minds, changing behaviour. British Journal of Psychiatry, 174, 1-2.
Cayton, H. (2007). The report of the review of arts and health working group. London: Department of Health. Available from: http://www.dh.gov.uk/en/Home
Clift, S., Camic, P.M., Chapman, B., Clayton, G., Daykin, N., Eades, G., Parkinson, G., Parkinson, C., Secker, J., Stickley, T., & White, M. (2009). The state of arts and health in England. Arts and Health, 1(1), 6-35.
CORE System Group (1998). CORE System (Information Management) Handbook. Leeds: University of Leeds.
Creek J. (2002). Occupational Therapy and Mental Health. London: Churchill Livingstone.
Dissanayake E. (1995). Homo Aestheticus: Where Art Comes from and Why. London: University of Washington Press.
Eades, G., & Ager, J. (2008). Time Being: difficulties in integrating arts in health. The Journal of the Royal Society for the Promotion of Health, 128(2), 62-67.
Hacking, S., Secker, J., Kent, L., Shenton, J., & Spandler, H. (2006) Mental health and arts participation: the state of the art in England. The Journal of the Royal Society for the Promotion of Health, 126(3), 121-127.
Hacking, S., Secker, J., Spandler, H., Kent, L., & Shenton, J. (2008). Evaluating the impact of participatory art projects for people with mental health needs. Health and Social Care in the Community, 16(6), 638-648.
Heenan, D. (2006). Art as therapy: an effective way of promoting positive mental health? Disability & Society, 21(2), 179-191.
Howells, V., & Zelnik, T. (2009). Making Art: A Qualitative Study of Personal and Group Transformation in a Community Arts Studio. Psychiatric Rehabilitation Journal, 32(3), 215-222.
Parr H. (2006) Arts and social capital. Mental Health Today. June, 23–25.
Repper, J., & Perkins, R. (2003). Social Inclusion and Recovery: A Model for Mental Health Practice. London: Bailliere Tindall.
Schafer T. (2000). Empowerment: towards a participatory model for the evaluation of the empowering therapeutic environment. Mental Health Care, 3(7), 233 –237.
Schmid T. (2005). Promoting Health through Creativity. London: Whurr.
Secker, J., Hacking, S., Kenti, L., Shentoni, J., & Spandler, H. (2009). Development of a measure of social inclusion for arts and mental health project participants. Journal of Mental Health, 18(1), 65–72.
Spandler, H., Secker, J., Kent, L., Hacking, S., & Shenton, J. (2007). Catching life: the contribution of arts initiatives to recovery approaches in mental health. Journal of Psychiatric and Mental Health Nursing, 14, 791-799.
Stacey, G., & Stickley, T. (2010). The meaning of art to people who use mental health services. Perspectives in Public Health, 130(2), 70-77.
Staricoff RL. (2004). Arts in Health: a Review of the Medical Literature. London: Arts Council England.
Staricoff, R.L. (2006). Arts in health: the value of evaluation. The Journal of the Royal Society for the Promotion of Health, 126(3), 116-120.
Stickley T., Hui, A., Morgan, J. & Bertram, G. (2007). Experiences and constructions of art: a narrative discourse analysis. Journal of Psychiatric and Mental Health Nursing, 14, 783–790
Windsor, J. (2005). Your health and the arts: A study of the association between arts engagement and health. Research report 37. London: Arts Council England. Available at http://www.artscouncil.org.uk/publications/
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