Embedding the arts in healthcare

Children’s mental health: the current context

One in ten children in the UK need support with their mental health, and rates of anxiety, self-harm and suicidal behaviour are increasing sharply. Only a quarter of children and young people asking for help receive treatment, yet much of this distress can be relieved using evidence-based options. I work in Child and Adolescent Mental Health Services (CAMHS) as a clinical psychologist, providing psychological interventions as part of a multi-disciplinary team. But I am concerned that only one in two children and young people who access support through CAMHS will reliably recover.

Back in 2014, NHS England and the Department of Health jointly published a policy paper, Improving access to mental health services by 2020, which outlined national waiting time standards and plans to provide better access to mental health services. However, while demand for specialist services is rising, the funds and resources required to address this need remain lacking. Mental health services are stretched and are not always the preferred option for people who wish to improve their wellbeing.

My Fellowship on the arts in healthcare

My Fellowship aimed to explore the myriad roles the arts can, and do, play in the service of mental health - through design of the environment, arts-led service provision and public health messaging. My Fellowship Report recommended ways that participation in culture and the arts can contribute to people’s wellbeing.

As part of the first leg of my Fellowship, I visited Finland to explore the existing links between Manchester’s Arts for Health, where I was working as a lead researcher at the time, and Finland’s TAIKE Centre for Arts Promotion. TAIKE is a nationally funded expert and service agency for promoting the arts. Annually, Taike allocates 40 million euros in awards and grants to professional artists and subsidies to communities in the field of the arts.  I was keen to see Finland’s best-practice examples of the arts in healthcare, including those located beyond the traditional healthcare environments. As part of my Fellowship, the Finnish Government invited me to several symposia which helped me to understand the structural background to several initiatives that embed the arts in health and social care. Their five-year programme, Art and Culture for Wellbeing Action, aimed to embed culture and the arts into healthcare and improve the wellbeing of patients, staff and wider communities.

In New York, the organisations I visited were frequently vibrant and profound, and their arts-led health interventions demonstrated a significant impact on the wellbeing of the people who accessed them. For example, I witnessed poetry act as a catalyst for uncommon and moving interactions between prison officers and young women living in Rikers Island, a large and controversial jail. Using a technique known as black-out poetry, the teen girls chose a single page from a book and selected words that stood out for them. In black-out poetry, the page is then decorated to highlight these words and make a poem. This exercise aids communication and the sharing of personal stories and feelings, and ultimately provides expression, connection and creativity in what is a stark and punishing environment.

Greater Manchester: a new deal to improve health for all

In 2019, the World Health Organization published the Arts and Health Scoping Review, a watershed moment for arts and health, which echoed the recommendations of my Report. Meanwhile the regional authority in Greater Manchester had received devolved central powers which included funding to merge health and social care budgets. To address poor health behaviours and outcomes, and improve mental health, their plan focuses on ‘reaching a new deal’ with the public. This context, alongside the current transformation of children’s services known as THRIVE, has enabled me to begin to implement the findings of my Report at a structural level across all 10 boroughs of Greater Manchester.

A new arts, culture and mental health programme

In March 2019, I joined the Greater Manchester i-THRIVE team, which is leading a system-wide transformation. Together we have developed an arts, culture and mental health programme that is unique to the region. This has helped to increase everyday awareness of the links between culture and wellbeing, formalise collaborations with existing arts organisations, and co-develop criteria for understanding and evaluating good practice. We aim to increase understanding of how creative, cultural and arts-led provision can be used in mental health provision, and to demonstrate that such options are credible and necessary for contemporary approaches to wellbeing in youth. Our programme has completed scoping surveys to understand provision and attitudes around arts-led options for young people, and identified existing good practice in the cultural sector in Greater Manchester.

We have developed links between the health and cultural sectors in two keys ways. Firstly, through a series of ‘proof of concepts’, in partnership with the Greater Manchester Combined Authority. The partnership will fund and promote collaboration between CAMHS and the cultural sector to co-deliver arts-led interventions to engage children, young people and families in services to support mental health and wellbeing.

Secondly, and importantly, this work will be evaluated and developed using the newly launched and freely available Greater Manchester Youth Mental Health Arts & Culture Evaluation Kit. This kit is the product of a series of workshops in partnership with several organisations in Greater Manchester including the Combined Authority and Arts Council England. Artists, clinicians and researchers reached an agreement to co-produce the kit which utilises a minimum set of outcomes, which are appropriate for use by the cultural sector and which also speak directly to commissioners and decision-makers.

My hope is that this work, and similar efforts around the world, will support our rapidly expanding understanding of the fundamental roles that arts play in maintaining and recovering health and wellbeing. In terms of child development and the functions of a family, I hope that the arts will reclaim their traditional place in supporting expression and reflection, emotional regulation and sense-making. I also hope that recognition of these roles will continue as we will continue to see how arts and culture can serve the population, as we have seen during the pandemic, by providing enjoyment and new, absorbing skills that support wellbeing. This will prove useful in helping people and professionals to engage with people and their distress in less medical terms. This is particularly important in dealing with problems in young people, which are commonly socially determined and which can have more positive outcomes through an empowering, collaborative and child-friendly approach.