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Catching life: The contribution of arts initiatives to recovery approaches in mental health

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Abstract

This paper draws on a qualitative study that was undertaken as part of a national research study to assess the impact of participatory arts provision for people with mental health needs. It explores how arts and mental health projects may facilitate some of the key elements of what has been termed a ‘recovery approach’ in mental health. It is argued that it is precisely these elements – the fostering of hope, creating a sense of meaning and purpose, developing new coping mechanisms and rebuilding identities – which are hard to standardize and measure, yet may be the most profound and significant outcomes of participation in such projects. Therefore, in the context of a growing emphasis on recovery-orientated mental health services, while not necessarily being appropriate for all service users, arts and mental health initiatives could make an essential contribution to the future of mental health and social care provision.
Catching life: the contribution of arts initiatives to
recovery approaches in mental health
H. SPANDLER1phdmaba, J. SECKER2phdbarmndipsw,
L. KENT3cert.ed, S. HACKING4phdmaba& J. SHENTON5
1Research Fellow, 4Senior Research Fellow, Department of Social Work, University of Central Lancashire (Uclan),
Preston, and 2Professor of Mental Health, 3Research Administrator, 5Service User/Artist Researcher, Faculty of
Health and Social Care, Anglia Ruskin University, Chelmsford Essex, UK
SPANDLER H., SECKER J., KENT L., HACKING S. & SHENTON J. (2007) Journal of
Psychiatric and Mental Health Nursing 14, 791–799
Catching life: the contribution of arts initiatives to recovery approaches in mental
health
This paper draws on a qualitative study that was undertaken as part of a national research
study to assess the impact of participatory arts provision for people with mental health
needs. It explores how arts and mental health projects may facilitate some of the key
elements of what has been termed a ‘recovery approach’ in mental health. It is argued that
it is precisely these elements – the fostering of hope, creating a sense of meaning and
purpose, developing new coping mechanisms and rebuilding identities – which are hard to
standardize and measure, yet may be the most profound and significant outcomes of
participation in such projects. Therefore, in the context of a growing emphasis on recovery-
orientated mental health services, while not necessarily being appropriate for all service
users, arts and mental health initiatives could make an essential contribution to the future
of mental health and social care provision.
Keywords: arts participation, creativity, hope, identity, recovery
Accepted for publication: 8 August 2007
Correspondence:
H. Spandler
Department of Social Work
University of Central Lancashire
Preston
PR1 2HE
UK
E-mail: hspandler@uclan.ac.uk
Introduction: recovery and mental health
It is increasingly recognized that with appropriate
support, people with even the most severe and enduring
mental health problems can recover, in some cases in the
clinical sense of the absence of symptoms, and in others
in the social sense of recovering a fulfilling life in their
communities regardless of mental health diagnosis
(Harding et al. 1987, Secker et al. 2002). Indeed, the
so-called chronicity of mental health problems is not nec-
essarily connected to the inherent course of a defined cat-
egory of illness, but rather with the quality of a person’s
life in society (Topor 2001). Thus, ‘recovery’ is not nec-
essarily predicated on a biomedical notion of ‘recovery
from illness’ or ‘remission of symptoms’ (although this is
often how it is interpreted; Anthony 2000). Notions of
recovery have been inspired by services users’ accounts of
their own recovery journeys that have occurred with,
without or sometimes despite, specific mental health inter-
vention (Deegan 1990, Coleman 1999).
In this context, we have seen the emergence in the last
10 years of what has been called a recovery approach to
mental health in the UK, North America, Australia and
New Zealand (Ralph 2000, Jacobson & Greenley 2001,
Turner-Crowson & Wallcraft 2002, Repper & Perkins
2003, Ralph & Corrigan 2005). Recovery approaches are
increasingly being embraced by both the user movement
and, to some degree, practitioners and policy drivers
(NIMHE 2004). However, the term ‘recovery’ is an increas-
ingly contested notion in mental health and the study of
Journal of Psychiatric and Mental Health Nursing, 2007, 14, 791–799
©2007 The Authors. Journal compilation ©2007 Blackwell Publishing Ltd 791
recovery can be problematic because there is no agreed-on
conceptual model to guide research design and methodol-
ogy. In addition, there is no clear consensus within the
mental health community about what people are recover-
ing from, what the process of recovery is, or what the
outcomes of recovery should be (Ralph & Corrigan 2005).
Notwithstanding these difficulties, we use the notion of
recovery to refer to a user-centred and social notion of
recovery which may, or may not, involve symptom reduc-
tion, use of services, diagnosis or medication, but does
involve the individual moving towards being able to live
the kind of life he or she wants to live. In this sense,
‘recovery’ can be seen as the long-overdue emergence of a
social model of disability within mental health (Beresford
2000, Ramon 2003) because it challenges the traditional
way of providing mental health support and focuses on
social conditions and the importance of having the neces-
sary assistance to be able to pursue one’s own self-defined
goals and aims, rather than individual ‘illness’. A recovery
approach is viewed as circumventing sterile arguments
between competing intervention and treatment models by
working within the service user’s own frameworks, defini-
tions and understandings of their difficulties and aspira-
tions (Repper & Perkins 2003).
Key components of recovery
User-centred notions of recovery, by definition, should not
seek to impose particular essentials of what ‘recovery’ may
mean for people, preferring individually defined accounts
and goals. However, there are a number of commonly
agreed components which seem to be necessary for pro-
cesses of recovery and which are subjective enough to keep
this individuated notion at its core. There are a number of
key interrelated elements which can be identified across the
literature on recovery. The importance of having a sense of
hope for the future is seen as an essential or critical factor
(Lovejoy 1982, Dufault & Martocchio 1985, Deegan
1988, Leete 1988, Farran et al. 1995, Adams & Partree
1998, Repper & Perkins 2003, Pitt et al. 2007).
For people with mental health problems, hope lies at the
heart of the individual’s ability and willingness to take
on the challenge of rebuilding and recovery (Repper &
Perkins 2003, p. 52).
Yet feelings of despair and hopelessness are often key
features of long-term mental health difficulties and use of
mental health services. Hopelessness is a predictor of poor
long-term outcomes (Aguilar et al. 1997) and suicide
(Drake & Cotton 1986, Beck et al. 1990). This hopeless-
ness is often exacerbated by the low expectations and
therapeutic pessimism of services (Repper & Perkins 2003)
as well as by the stigma and discrimination frequently
associated with mental health difficulties (Dunn 1999).
In this context, hope is viewed as a ‘life saving force’
(Russinova 1999, in Repper & Perkins 2003, p. 52) and
recovery can be viewed as a reawakening of hope after
despair (Ridgway 2001).
Hope is often seen to involve the anticipation of a future
based upon mutuality, a sense of personal competence,
coping ability, psychological well-being, purpose and
meaning in life, as well as a sense of ‘the possible’ (Landeen
& Seeman 2000). In this way, the notion of ‘hope’ could
unite concepts of recovery as these all relate to other com-
ponents commonly referred to in the recovery literature.
Having a sense of purpose and meaning are frequently
considered central to recovery (Turner-Crowson &
Wallcraft 2002, Repper & Perkins 2003). In addition, the
development of coping strategies and self-management of
mental health problems are also viewed as important
(Ridgway 2001, Onken et al. 2002) as well as social
support and the rebuilding of identities beyond mental ill
health (Repper & Perkins 2003).
Art and creativity often feature in anecdotal and indi-
vidual recovery journeys, and research suggests that par-
ticipatory art does have a range of positive therapeutic
benefits for people with mental health needs (Heenan
2006). However, there has been little research which
explores the importance of arts activities as contributing to
notions of a social model of recovery, at least in the sense
described above. While previous research has described
how other innovations may contribute to a socially orien-
tated recovery approach to mental health, e.g. direct pay-
ments (Spandler & Vick 2006) and employment support
(Secker et al. 2002), the rest of this paper draws on our
national research study to explore how arts and mental
health projects can facilitate some of these key elements in
a recovery approach to mental health.
Arts and mental health study
The case studies were undertaken as part of a national
study to assess the impact of participatory arts provision
for people with mental health needs, which was jointly
funded by two government bodies in England, the Depart-
ment for Culture Media and Sport and the Department of
Health. The study comprised a number of strands of
research, including a survey of arts projects that resulted in
a ‘mapping’ of arts and mental health activity in England
(Hacking et al. 2006); a 6-month follow-up survey of arts
participants using standardized outcomes measures relat-
ing to mental health, social inclusion and empowerment;
and a series of qualitative case studies, which are our focus
here.
H. Spandler et al.
792 ©2007 The Authors. Journal compilation ©2007 Blackwell Publishing Ltd
For the case studies, we selected six diverse arts and
mental health projects with which to explore the processes
though which arts projects achieved benefits for partici-
pants. These included an ‘arts on prescription’ project,
which offers short art courses to people experiencing
mainly depression and anxiety associated with distressing
life events or pressures (project 1); a studio-based project in
which people with severe and enduring needs, often related
to experiences of abuse, are able to work together to
develop their creativity and develop and exhibit their
artwork (project 2); a rural community organization facili-
tating workshops and projects for vulnerable, isolated
groups, including people with a range of mental health
needs (project 3); an arts project which is part of an Asian
women’s mental health organization providing culturally
relevant opportunities, including arts and crafts, through
which women can gain support from each other (project 4);
a Mind day centre offering art as part of a range of activi-
ties aimed at providing a structure for developing social
interaction with others for people with severe mental
health needs (project 5); and a college-based project offer-
ing flexible arts-based courses for people with mental
health needs at the college and in local mental health facili-
ties (project 6).
As part of the case studies, we carried out individual
in-depth interviews with 34 arts project participants. The
interviewees were between the ages of 35 and 78 years and
had been involved with the projects for between 4 months
and 5 years. Twenty-nine were of white British ethnicity
and five were South Asian women. The interview questions
focused on participants’ expectations of their project, what
they saw as the benefits, how they thought any benefits had
come about and specifically whether participation in arts
(rather than other activities) was important in achieving
them. The interviews lasted between an hour and an hour
and a half and were all recorded and transcribed. Interview
data were analysed by two members of the research team
working independently and then comparing notes in an
iterative process to agree and refine an account of ‘what
worked’ for participants, how this happened and the out-
comes that resulted (see Secker et al. 2007). The data were
then reviewed and subjected to a further thematic content
analysis to identify key themes from participants’ accounts
of the impact of arts participation on the key features of
‘recovery’ as defined above.
Themes from the case studies
Most participants across all six projects reported how
arts participation had increased their motivation by
enabling them to gain inspiration to engage with their
artwork. It was clear that this process, alongside devel-
oping their artistic abilities and belief in themselves,
helped participants to gain a sense of purpose and
meaning in their lives:
Eventually over time doing a little bit and a little bit and
being able to come in here and getting that little bit
better, there’s a slow progression of being able to do
things and it gives you some kind of positive purpose in
life . . . that little something has a positive effect on me,
mentally ...it presses my creative button I suppose
(project 5, participant 5).
Before I didn’t think I could do it, whereas now I
know I can, I’m a completely different person . . . now I
want to go and do things . . . Focusing on creativity
means you’ve got like a little reason for doing things
(project 6, participant 3).
This sense of purpose was not confined to their artwork
but often enabled participants to have more purpose and
direction in the rest of their lives:
I feel when I come that I have got some purpose . . .
Coming here gives me impetus to make the rest of my
time more important...Itgives me something to look
forward to (project 6, participant 1).
For participants who did not have a background in
art, this was often related to arts participation enabling
them to becoming aware of their latent abilities, espe-
cially around their awareness and sensory perception.
Some of these participants reported being able to use their
new artistic abilities to find meaning in the local and
natural environment:
It was a nice spring day and I picked up my pad and I
took my little fold up garden chair and I just...went
down with a drink and a sandwich and I drew. I was on
my own and I did it and that was just brilliant so I think
I will do more of that now ...I amgetting more con-
fident now to actually sit on my own and do this because
and this is where it is helping me ...I am going to
actually take it out of what I am doing in the class
(project 1, participant 4).
For the following participant, having a greater sense of
purpose and meaning in her life was especially important in
the context of having taken early retirement as a result of
her mental health difficulties:
Feeling and doing these small things, [I get a] a kind of
excitement that my life at whatever level can have mean-
ing . . . and it’s important as you get older that you feel
you have value (project 1, participant 2).
It is perhaps not surprising that art has the potential to
enable people to find purpose and meaning in their lives
because of the way that arts projects are often able to
support participants to discover individual sources of
meaning and value through their artwork and through the
active creation of something unique and new:
Role of arts in mental health recovery
©2007 The Authors. Journal compilation ©2007 Blackwell Publishing Ltd 793
It doesn’t matter if your leaf or a flower doesn’t look like
a leaf or a flower, it’s your leaf and your flower and it’s
your expression of what’s inside you, and I think that’s
a good thing, because all of us can only get better by
facing ourselves and what’s inside and working on our
own stuff, and not judging ourselves either and truly
saying to ourselves, ‘well this is where I am, this is what
I’ve been through, this is where I’ll start’. And I can do
something with my life (project 1, participant 2).
Having a sense of purpose and meaning also enhanced
participants’ ability to engage in other aspects of their lives.
For many participants, art had become an activity that they
were able to pursue elsewhere, usually at home. For some,
increased motivation had led to an expansion of their cre-
ative repertoire though the taking up of additional new
interests outside the project, such as music lessons, creative
writing or computers. Several participants also reported
taking their art with them on holiday or doing creative
activities at home with their family. Many participants
made an explicit link between the growing hope and aspi-
rations inspired by their creative activities and decreased
levels of hopelessness, which, as we have seen, is an impor-
tant factor in ‘recovery’:
It gives me a destination ...Without it I would be very
depressed, it gives something to aim for and stay in
touch and keep going on for ...Itenthuses me where I
wouldn’t otherwise have, I know I wouldn’t (project 6,
participant 6).
It’s an ignition, it’s a spark ...Whathappens is when
they’ve ignited me a little bit here I go home and I stay
on that creation. If you are creating things you don’t get
depressed (project 3, participant 2).
Many participants referred to their engagement in arts
activities as improving their motivation and inspiration. At
one of the projects, all six participants reported having
increased the days they attended the project, even though it
meant having to pay for themselves. They explicitly related
this to their growing motivation to develop their artwork,
which was particularly striking as all had clearly described
how unmotivated and pessimistic they had been, both
about the project and the future, before they started attend-
ing the project.
It’s actually given me back in my life some ambition to
do something. Which is something that had been absent
for a very long time (project 2, participant 3).
Only a minority of participants actually reported
taking up new formal opportunities in the world (what
may be seen as ‘hard outcomes’ in relation to, for
example, social inclusion or employment). However, most
participants did describe often quite profound increases in
their personal aspirations. Widening aspirations should
not be underestimated because a broadening of the hori-
zons of people’s lives beyond the world of mental health
services is such an important aspect of the journey
towards recovery. The aspirations described by partici-
pants revolved around the world of art, work and
education:
It does spur you on to consider that, either it’s a hobby
that you take up and you can use that in a positive way,
or you can decide that perhaps you’re good enough to
want to go and work in that sort of field . . . This art
project I must admit has inspired me to think that
perhaps I could do something in textiles and things like
that (project 5, participant 5).
Gradually, it’s through this, gradually I’m starting to
get back into the big wide world again. I don’t find it so
scary ...Idon’t know what it is, it gives you something.
It gives you a reason to get up on the morning, it makes
you think, ‘well if I can do this two days a week, maybe
I can do a job’ (project 2, participant 2).
Another important aspect of recovery is often the devel-
opment of coping strategies. There were three different
ways in which arts participants reported being able to use
art projects to help them develop new or alternative coping
strategies. These related to three processes we identified as
being important for individuals in gaining benefits from the
projects. First, most of the participants reported how arts
activities enabled them to relax and ‘ground’ themselves by
focusing on something specific and absorbing. This seemed
to enable them to develop ways of dealing with distress,
by focusing on something outside of themselves. A small
number of participants across different projects described
how concentrating on art helped reduce the distressing
impact of voices or visions:
While I’m painting I’m not listening to the voices I’m
hearing, I’m not trying to reply to them, they’re forced
into the background almost as a distraction because
you’re involved with something . . . and I think also
when I’m painting I find a rhythm to it (project 2,
participant 1).
A number of participants also reported that the focus
and concentration involved in art had a positive impact in
relation to their self-harm. Many people who self-harm
describe this as a need to focus their emotional pain onto
something physical and tangible which gives them a break
from difficult thoughts, feelings and memories. Some par-
ticipants were able to transfer this onto their art, which
gave them an alternative way of dealing with distress:
It was a ‘stop–gap’ in a way but it kept me going, it took
my mind off doing more harmful things [to myself] and
that eased off how bad I felt, the intensity sort of eased
off. So it’s a preventative sort of measure in a way and
it helped me for a period of time (project 2, partici-
pant 5).
H. Spandler et al.
794 ©2007 The Authors. Journal compilation ©2007 Blackwell Publishing Ltd
Another participant recalled how she was able to recre-
ate the memory of the effect gained from focusing on art,
suggesting that the more she was able to achieve this effect
the easier it was to recreate:
You can only do it for so long and you are bound to
come back to it but at least it can give you a break
. . . sometimes it stops it just building up into that, you
know, ‘I can’t escape’ feeling, if you can just break it.
Once you have been there it is easier to get back to it
(project 1, participant 5).
The lasting effect of focusing on art described by par-
ticipants was linked for several people with the ‘portability’
of their art. This was particularly the case for people who
were beginning to use art in the rest of their lives as a way
of deflecting or focusing them away from problems. The
following participant was able to use art at home to help
him cope with the distress of hearing voices, which in the
past he had coped with through self-harm:
Once I’ve lost myself in the artwork the problems in my
head just disappear, they just alleviate and just leave me
feeling better...Icanuseitasagood distraction now
to free me up from my head ...Iused to be distracted
by voices. Even though I was on medication to stop it
sometimes they’d still come through and distract my
days or bring me just right down to the point where I’d
cut [myself]. Now, as a distraction, if I feel I’m getting
like that, I’ll try and draw what I’m feeling on paper so
that I can actually visualise it and see it, and then I’ll set
fire to it and then I’ve got rid of it, I’ve killed it, it’s gone
(project 5, participant 2).
Some of the arts projects enabled participants to find
new ways of coping with distress, through self-expression,
for example by re-creating painful images, creating more
positive images, or expressing difficult feelings directly onto
their artwork and/or through the process of making art.
The art projects enabled them to make their difficulties
more visible to themselves and others, and gave them a way
of relating to their experiences in new and different ways.
This helped to make their difficulties easier to cope with
and also gave them an alternative means of coping with
their distress. Self-expression seemed to be particularly
beneficial for individuals who were struggling with issues
such as self-harm and hearing voices that were related to
past experiences, for example of abuse and bullying.
If you’ve got lots of crap going on in your head and
you’re thinking ‘god I can’t cope with this’, the voices
are strong or something or you just can’t cope. It’s just
good to get it out on paper...thevoices . . . its a way
of saying ‘I’m not going to cope with you today’...It
helps you get shit out of your head when you feel you
can’t cope . . . Even if you chuck it away afterwards you
know at least you’ve got it out on a piece of paper and
you can look at it and say ‘well that’s that piece of shit!’
And then you’ve got it all on a piece of paper and you
can sort it all out in your head and get it in some sort of
order. You can sort it all out in your head seeing it on
paper just makes sense of it (project 3, participant 1).
If I have a vision like that, I can put it straight into my
artwork, so a lot of the things I am seeing or experienc-
ing are coming out in my painting ...SoIhave found it
easier to deal with the things I’m seeing ...Ithasgiven
me an emotional visualistic and creative outlet...It
takes the edge off any bad visions...Sometimes if I find
if I’m in a bit of a state . . . then I find it easier to draw
that out and exorcise my demons so to speak (project 6,
participant 5).
For many participants, the self-expression facilitated
by their arts project contrasted with experiences of
feeling out of control, of being controlled by others or by
circumstances:
I think it’s because my life is so restricted now . . .
Because you know, that’s a good word, control. I feel
like my life is controlled through no fault of my own, so
much that to suddenly have that freedom, it just released
something inside of me (project 1, participant 4).
Arts participation was related for some participants
with the process of rediscovering or rebuilding an identity
within and beyond that of someone with mental health
difficulties, again an important element of recovery.
Because building identities is in large part a social process,
involving internalization of the perceptions of others
(Howarth 2003), the process was especially associated with
opportunities to create and display a finished artwork.
Creating a finished work of art made participants’ achieve-
ments visible to themselves, in turn enabling them to see
themselves as someone who could achieve something. This
was frequently mentioned across all six projects.
Participants often referred to the importance of feeling
valuable and worthwhile, especially in relation to others.
Arts participation helped some participants strengthen or
realign their self-image in relation to others, including
family, friends and the local community, because they felt
people began to see them as having artistic talents and
viewed them differently as a result. Manifestations of this
change included participants’ artwork being welcomed by
their families and friends. Other participants spoke of
requests for artwork to be displayed in community venues,
of being able to teach art skills to others, and of families or
friends making great efforts to support their arts activity.
In addition, eight participants described an even more
profound change, above and beyond being seen as someone
with some artistic ability, in that the production of artwork
enabled them to develop or consolidate a renewed identity
in the world, challenging their identity as being primarily
Role of arts in mental health recovery
©2007 The Authors. Journal compilation ©2007 Blackwell Publishing Ltd 795
defined by their mental ill-health. In turn, this further
widened their aspirations and opened up new possibilities
beyond mental health services. Again, we can see how this
can be seen a crucial aspect of ‘recovery’. These partici-
pants tended to be people who were long-term service users
with a range of complex and serious mental health diffi-
culties, in other words people whose identities were likely
to have been especially compromised by the experience of
mental health difficulties and to whom notions of ‘recov-
ery’ are especially relevant. Importantly, they had usually
had a previous interest and involvement in art before the
significant onset of their mental health difficulties and
through participation in their arts projects were able to
return to those interests and make them central to their
sense of self.
Mental health is not everything if you see what I mean.
Whereas it can be, if you’ve got no focus and if you’ve
got like nothing to do and nothing to keep you busy then
it does become your whole life. And you are your illness
and that’s a hard thing to get away from as well really,
to be able to think ‘no, this isn’t everything, just because
I have got mental health problems, doesn’t mean that is
the end of my life sort of thing’ which is probably how
I viewed it before and so yeah it’s, just good really
(project 6, participant 3).
It’s not just something that someone with mental
health problems has produced it’s something that an
artist has produced and it just so happens that they’ve
got mental problems as well (project 2, participant 1).
Building a new, artistic identity for presentation to
others was especially important for some participants,
given a social context in which we are so often defined by
the work we do:
People always have this conception that you have to
work otherwise you’re lazy or whatever so nowadays
because I do a lot of art if people ask me what I do,
I don’t say ‘oh I’m mentally ill, I go to a day centre’,
I can say ‘well, I do art, I practice art’ (project 5, parti-
cipant 3).
For some participants, involvement with the project had
inspired the confidence to claim an alternative, less tradi-
tional identity as an artist, rather than as someone who had
to do a conventional job:
It gave me confidence to tell people that I am a writer, I
am an artist. Before I used to hide anything I did, just do
it in secret because I used to think well, people think I’m
mad. Who am I? I’m just an ordinary, you know what I
mean? Because I’d had success and that support, I
became more confident, say to people, well, I don’t
really want to go to work, I’ve got to because I’ve got to
pay the bills, but I’m really an artist and I’m a writer
(project 3, participant 6).
For some participants the process of recovery was
closely bound up with their development as an artist. This
highlighted the potency of focusing on artistic development
at some of the projects which facilitated profound changes:
My own means of painting and expression has been
incredibly important...accepting that I do paint in this
style . . . and alongside that has gone my acceptance of
myself, and establishing yeah, I do know who I am and
I’m able to live with that. Which wasn’t always a
forgone conclusion, to say the least...mysense of self
was really quite flimsy really and I didn’t feel that I had
a strong purpose of self...It’s certainly gone side by
side with that and my artwork (project 2, participant 1).
Finally, another common theme in the recovery litera-
ture is the quality of social support available to individuals.
There was considerable evidence from most participants
across all projects that the projects provided an unthreat-
ening and non-competitive environment in which partici-
pants could learn, practise or develop art skills at their own
pace, alongside other people with mental health difficulties,
gaining considerable mutual support from each other. It
was felt that the experience of mental health problems
created a ‘common bond’ and made people more sensitive
to others, even if this was often left unspoken.
I think everyone seems to understand what you’re going
through so if you’re having a particular bad day and
you’ve got flash backs and you’ve got all the crap going
on you can sort of think ‘well I’ll put that on to paper’
and people don’t sort of say ‘oh god what’s that?’ You
know they’ll sort of say ‘oh that’s a really weird image’
or ‘that looks really powerful’ or something and you can
sort of share things with people ...Youcanbeyourself
...You get the benefits of being with people similar
to yourself...Nopressure to fit in (project 2, partici-
pant 1).
A common view was that the projects engendered a
sense of working together where participants could look
out for one another, both emotionally and by helping with
each other’s artwork. For most of the participants, it was
important that the projects had a mental health focus
rather then being ‘mainstream’ arts provision.
There are opportunities to share, two way, to help each
other...Soit feels like a safe group . . . It’s belonging
as well. This is our group . . . and I feel safe coming
here. It’s like you can be in a community and catch a
cold. You can come in here and catch a bit of life. You
actually catch life (project 2, participant 2).
Discussion
While the wider social inclusion agenda prioritizes partici-
pation in ‘mainstream’ settings, participants in this study
H. Spandler et al.
796 ©2007 The Authors. Journal compilation ©2007 Blackwell Publishing Ltd
highly valued their involvement in their mental health-
specific arts projects. If we take a user-centred view of
recovery, it is important to recognize the important part
that the safety and mutual support offered by such projects
can play in individual recovery journeys. As a number of
service users have pointed out, people with mental health
difficulties do not necessarily want to be part of a main-
stream society that has rejected them (Wallcraft 2001).
Indeed, some participants appeared to be in the process of
establishing a confident renewed identity that did not
involve subscribing to mainstream social norms, but
enabled them to accept and value themselves for who they
were. It is important to recognize that social inclusion, in
terms of integration in mainstream society, may not be
lacking for some arts project participants, and may not be
desirable for others.
While the participants in the Asian Women’s project did
report a number of benefits of arts participation, there was
less emphasis on elements that directly related to notions of
recovery as discussed here. In general, we should avoid
drawing any simplistic conclusions from this observation,
but there are a variety of possible interpretations. First, our
interviews with these participants were primarily carried out
with the aid of an interpreter and there may have been some
issues in interpretation of keywords and phrases that did not
resonate with our own understandings of these concepts.
Thus, we may have ‘missed’ references to these themes in
these women’s accounts. Second, it may not have been a key
process for women using this project. Indeed, most of these
participants specifically referred to the importance of their
arts sessions as being ‘time out’ from the stresses and strains
of their everyday lives and familial caring responsibilities.
They often used art as a ‘distraction’ to focus themselves
away from their lives, rather than rebuilding their lives.
While they enjoyed the art sessions, the women often valued
learning something new and gaining mutual support from
each other. Finally, it could mean that these aspects of
recovery are less important to South Asian women, although
we would be especially cautious about this interpretation.
More generally, it raises important issues regarding the
importance of art and creativity in diverse communities, the
applicability of what are currently primarily white Western
notions of recovery to minoritized or diverse ethnic popu-
lations and the specific role and impact of cultural or
gender-specific initiatives.
D. W. Winnicott argued that it is the inability to be
creative and the living of one’s life according to others’
demands and requirements which often results in psychiat-
ric problems as ‘compliance carries with it a sense of futil-
ity...and is associated with the idea that nothing really
matters and that life is not worth living’ (Winnicott 1991,
p. 65).
[T]he link can be made . . . between creative living and
living itself, and the reasons can be studied why it is that
creative living can be lost and why the individual’s
feeling that life is real or meaningful can disappear
(Winnicott 1991, p. 69).
Conversely, he argued that the ability to be creative
instils a greater sense of the meaningfulness of life and this
gives an individual greater individual agency and hope. It
seems to be this sense of ‘life worth living’ that was one of
the most important contributions made by the arts projects
in our study. While we could debate the universality of
creativity, or our understanding of ‘recovery’, the ability to
have some control over one’s actions does seem to be an
important human requirement and was also an important
facet in the reported benefits of arts participation. While
there was less evidence of ‘recovery talk’ among partici-
pants in some of the projects, the sense of freedom and
control offered by their involvement in art was important,
especially for women, whose lives were often dominated by
caring responsibilities and the expectations and demands of
others.
In the context of a growing international recovery move-
ment and increasing interest in the importance of hope and
health (Parse 1999), it may be that arts initiatives have an
important role to play. However, the evidence-based prac-
tice agenda clearly poses a number of challenges for arts
initiatives. For example, despite general agreement about
the common features of ‘recovery’, there remain qualities
that are particularly hard to standardize, define and
measure (Bracken & Thomas 2004, Wallcraft 2005).
Although there have been attempts to measure some of
these components, for example ‘hope’ (see Miller &
Powers 1988, Herth 1991), research has tended to focus on
clinical or ‘hard’ outcomes rather than more on these nebu-
lous and elusive concepts which are highly subjective and
do not in themselves have to relate to specific outcomes in
order to be extremely important and beneficial to the indi-
vidual (Repper & Perkins 2003). In addition, it is clear that
‘recovery’, however defined, should be seen as an ongoing
process, not as an outcome (Ralph & Corrigan 2005). In
this way, the understanding of various aspects of ‘distance
travelled’ towards individual service user-defined outcomes
should be among the criteria in evaluating project impact.
However, these should be flexible enough both to take into
account the individuals’ changing aspirations and to pri-
oritize the aspects of life that they may particularly value.
Conclusion
While creativity might be viewed as an essential human
need, not everyone will find a route to recovery through
arts participation. Despite the importance of arts partici-
Role of arts in mental health recovery
©2007 The Authors. Journal compilation ©2007 Blackwell Publishing Ltd 797
pation for many of the individuals involved in our case
studies, we cannot necessarily assume this is a universal
facet of recovery. Art may be important for some people,
but arts participation (or for that matter involvement in
any other activities) should not be predetermined as ‘good
for’ people with mental health needs and thereby imposed
on them (Repper & Perkins 2003).
However, our study suggests that arts participation may
be one important element of recovery for mental health
service users who have found their lives caught up in a cycle
of hopelessness and despair. For many of our interviewees,
engaging in creative activities helped to reverse an enduring
sense of hopelessness, despair and futility about the future,
which can be common in people who are long-term users of
mental health services. Therefore, we suggest that a recovery
approach to mental health must recognize the potential
contribution of arts and creativity. Moreover, specific arts
and mental health provision may have an important role to
play in the future of mental health and social care provision.
Acknowledgments
The research was jointly commissioned and funded by the
Department for Culture, Media and Sport and the Depart-
ment of Health. The views expressed are the authors’ and
do not necessarily reflect those of the funders.
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