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Arts & Health: An International Journal
for Research, Policy and Practice
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The transformative potential of the
arts in mental health recovery – an Irish
research project
Lydia Sapounaa & Elisabeth (Rudie) Pamera
a School of Applied Social Studies, University College Cork Ireland,
Cork, Ireland
Published online: 11 Sep 2014.
To cite this article: Lydia Sapouna & Elisabeth (Rudie) Pamer (2014): The transformative potential
of the arts in mental health recovery – an Irish research project, Arts & Health: An International
Journal for Research, Policy and Practice
To link to this article: http://dx.doi.org/10.1080/17533015.2014.957329
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The transformative potential of the arts in mental health recovery –
an Irish research project
Lydia Sapouna*and Elisabeth (Rudie) Pamer
School of Applied Social Studies, University College Cork Ireland, Cork, Ireland
(Received 15 April 2014; accepted 19 August 2014)
Background: This article is based on the Arts þMinds research project which
investigated the experience of arts participation for mental health service users in Cork,
Ireland, and the potential of integrating the arts into mental health care. Methods:
Based on the principle of user-controlled definitions of recovery, the voice of service
users was central in this research. The authors used participatory observation methods
and conducted qualitative interviews with project participants (service users, artists and
mental health staff) to explore the impact of arts participation on service users and
service structure and culture. Results: The research demonstrated the transformative
potential of the arts to create environments conducive to recovery through
empowerment, connection-making, confidence-building, hope, story-telling and
story-making. Conclusions: Moving beyond the general agreement on the positive
contribution of the arts in mental health care, this article highlights some of the
challenges of introducing creative forms of engagement and expression in traditional
biomedical settings. It is argued that a meaningful partnership between the arts sector
and mental health services is not just a technical measure but requires a radical shift in
the way we understand, respond to and engage with human distress.
Keywords: arts; mental health; recovery; creativity; cultural change
Introduction
It is increasingly recognised that arts participation by people experiencing emotional
distress can offer a range of therapeutic benefits and facilitate the process of recovery
through community inclusion and stigma reduction. This paper draws on qualitative
findings from a research project conducted by Sapouna and Pamer (2012), aiming to
provide evidence of the value of the arts in mental health. Paticular emphasis is given to
the potential of the arts to transform the current narrow focus of biomedical mental health
care. The contribution of user-defined evidence of recovery in researching and capturing
the changes that can be achieved through creative interventions is also highlighted.
Arts þMinds (A þM) was established in 2007 by Health Service Executive (HSE)
mental health staff in Cork, Ireland, with funding and support from the HSE Cork Arts and
Health Programme. It works across mental health settings in Cork City and County
including acute, special care, continuing care, day care and community. A þM
1
seeks to
facilitate service users to participate more fully in the social and cultural life of the
community, and to challenge the stigma faced by people experiencing emotional distress.
AþM works with professional artists across all art forms including music, creative
writing, visual art, dance and storytelling.
q2014 Taylor & Francis
*Corresponding author. Email: l.sapouna@ucc.ie
Arts and Health, 2014
http://dx.doi.org/10.1080/17533015.2014.957329
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The A þM research project reported in this paper was set up to investigate the impact
and potential of integrating the arts into mental health care. The project involved planning,
delivery and evaluation of art programmes (two music workshops, identified as music
project A and music project B, and one animation workshop) to mental health service users
in three sites in Cork City and County:
.an acute in-patient unit (music project A);
.a day centre (music project B) and
.a city art gallery, with participants from two community mental health services
(animation project).
The research took place throughout 2011. The arts projects were delivered over an 8 –
10-week period between May and September 2011. Beyond Diagnosis, the report based on
the research presented in this paper, was published in 2012 (Sapouna & Pamer, 2012).
The Irish policy and practice context
The integration of arts into Irish mental health services is one element of a broader attempt
to embrace creativity as part of recovery-informed, person-centred practice. A Vision for
Change (Department of Health and Children [DoH&C], 2006), the Irish National Mental
Health Strategy, identified the need for mental health services to adopt a recovery
perspective and considered it a core principle to “ ...inform every aspect of service
delivery” (p. 9).
While the concept of recovery in mental health discourse is not a new one (earliest
articulations go back to Anthony, 1993; Deegan, 1988), during the past two decades there
has been a redefinition involving a shift from a clinical understanding of recovery as
“absence of symptoms” or “recovery to normality” to a process of “recovering what was
lost”: citizenship, rights, meaningful roles, responsibilities, decisions, potential and
support (Bracken & Thomas, 2005; Crowe & Taylor, 2006; Mental Health Commission,
2008). Recovery thus conceived can contribute to a paradigm shift in mental health
towards locating the service user as the central driver of their own life, a life of their own
choosing, in a community in which they are citizens with equal rights to all other citizens
(Ryan, Ramon, & Greacean, 2012). This shift from “the patient” to “a citizen” role can be
a significant challenge to the hegemony of the medical approach by putting individual
choices, social inclusion, citizenship and human rights to the centre of practice. As Roberts
and Wolfson (2004) argue, the current “redefinition of recovery as process of personal
discovery, of how to live (and to live well) with enduring symptoms and vulnerabilities
opens the possibility of recovery to all” (p. 37).
Arts and mental health recovery
There is a growing body of evidence on the benefits of the arts for people experiencing
emotional distress. Staricoff’s (2004) extensive review of medical literature describes how
various art forms can benefit general health and well-being, including mental health. This
review highlights that mental health service users’ involvement with the arts stimulates
creative skills and self-esteem, and improves self-expression and communication between
service users, staff/service providers and family. Studies exploring the benefits of arts
participation have found that, through art, mental health service users have experienced a
sense of empowerment (Hacking, Secker, Spandler, Kent & Shenton, 2008; Parr, 2005),
improved self-esteem, greater confidence, a clearer self-image (Goldie, 2007; Hui &
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Stickley, 2010), motivation and an appreciation of having “time out” from mental health
concerns (Secker, 2011), enhanced general well-being and quality of life (Arts Council
2003; Bungay & Clift, 2010; Hacking et al., 2008; Moloney, 2005,2007; White, 2008).
Arts participation can facilitate people to take greater control of their lives and their
recovery (Van Lith, Fenner, & Schofield, 2011), explore and understand feelings, develop
alternative coping strategies when dealing with distress (Spandler, Secker, Kent, Hacking,
& Shenton, 2007; White, 2008) and feel more hopeful and better able to cope with distress
(Spandler et al., 2007; Stacey & Stickley, 2010). Further studies suggest that arts
participation can lead to a reduction of stigma and social exclusion for people
experiencing distress and their families (Hacking et al., 2008; Parr, 2006b; Stacey &
Stickley, 2010) through expanding social networks, decreasing isolation (Parr, 2006a),
creating a new identity as an artist and challenging the perceived identity of oneself as a
user of a mental health arts project (Spandler et al., 2007). Arts participation offers people
opportunities to give and receive mutual support, collaborate with others, develop a sense
of belonging within the wider community (Secker et al., 2007; Spandler et al., 2007) and to
connect with further opportunities within the community (Hui & Stickley, 2010).
Within the Irish context, Moloney (2005) and White (2008) document the experiences
of services users, staff and artists partaking in music workshops across a diverse range of
mental health settings. Moloney’s (2005) study concluded that the music workshops had a
positive impact on service users’ self-confidence, concentration and perseverance, with
positive experiences such as hope for the future, a sense of community and fun, a newly
developed interest in art, improved communication and listening skills, learning new skills
and realising new abilities. Positive impact has also been reported by staff and artists –
benefiting from professional development, discovering new skills and realising diverse
forms of communication with service users (Moloney, 2005; O’Shanahan & Grehan,
2009).
Concerns have also been highlighted. Connecting with the wider community through
arts is not an unproblematic process. Parr (2006b) argues that being a mental health service
user in mainstream artistic and cultural community settings may reinforce a sense of
“otherness,” as one’s contribution may be less understood or appreciated than in a
protected mental health setting. Furthermore, the instrumental integration of the arts
within mental health services can also be problematic. If the arts become a “commodity”
of mental health systems primarily focused on medication, containment and coercion
(Stickley, 2012a), their creative contribution may be compromised. Overall, however, the
literature on arts participation clearly suggests that arts and creativity can be an important
element of the recovery process for mental health service users.
Methods
The choice of a qualitative methodology reflected the ethos of the A þM project, which
itself is informed by principles of recovery and social inclusion. In a period where
evidence-based practice is central to service development and delivery, the research
methodology highlights the significance of evidence constructed by the narratives of
people who have direct experience of mental health services (Faulkner & Thomas 2002;
Higgins & McGowan, 2014). A qualitative methodology was therefore appropriate as it
can empower individuals to tell stories which can aid our understanding of contexts, such
as agency and community contexts, within which art initiatives have taken place (see
Cresswell, 2007). An interpretive framework was employed to consider the service users’
subjective experiences. This subjective dimension was particularly useful in exploring
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how project participants defined the significance of the arts as a care option within mental
health care. Employing narrative-based methodologies in evaluating the contribution of
the arts in mental health care raises questions about the nature of the evidence produced.
Like other qualitative research on recovery (Wallcraft, 2005) and the arts (Stickley,
2012b), the evidence we (L. Sapouna and E. (R.) Pamer) produced is primarily based on
user-narratives and personal accounts rather than clinical outcomes. Such evidence can
often be dismissed as “unscientific” in the current evidence-based agenda. Furthermore,
we are aware that in researching the integration of the arts into mental health care, the
tensions between art as a form of creative expression and the dominant biomedical model
of care, which has not traditionally encouraged creativity of expression, need to be
considered. Acknowledging these tensions, our paper concentrates on research findings
that highlight the potential of creativity and the arts to transform the often coercive nature
of mental health services and to help people engage with life-enhancing activities within
and beyond mental health structures.
Participant observation and semi-structured face-to-face individual and group
interviews with service users, participating staff and contributing artists were the main
methods of data collection in this study. The two researchers (L. Sapouna and E. (R.)
Pamer) actively participated in the music and animation workshops. All service-user
participants were informed in advance by staff about the study and about the researchers’
participation in the workshops. All were invited to participate in the study. The researchers
explained the research aims, interview recording methods and confidentiality issues to all
participants in the workshops and before the interviews. A total of 35 service users were
interviewed. Music project A was set in an in-patient unit which had a high turnover of
user-participants (approximately 40) over the 8 weekly sessions of the project. In this
setting, individual interviews were held with 21 participants who volunteered to be
interviewed after the music sessions. Music project B was set in a day centre where
individual interviews were held with 5 out of the 10 regular attendees of the facility.
Finally, all nine participants of the animation project were interviewed through three
group interviews. Participating mental health staff and artists were informed about the
study through their ongoing involvement with A þM. Interviews were held with all nine
mental health staff involved in the workshops and the three artists who delivered the
programmes. Prior to the interviews, all interviewees signed a consent form giving
permission to record their experience of the project with the use of a Dictaphone and to use
the interview data for the purpose of the study.
Results
Project participants had diverse experiences of mental health services, ranging from long-
term in-patient engagement and receipt of intense support to first admissions and a
minimum level of support at a community level. For the majority, however, social
isolation, the lack of stimulation, the lack of meaningful activities and boredom were the
common denominators. While this was particularly evident in the in-patient setting,
people who lived in the community (both in hostels and in independent accommodation)
also spoke about isolation and often having “no reason to get out of bed in the morning.” In
that sense, the opportunity to participate in the A þM workshops was particularly
appreciated by service users in both in-patient and community settings.
All 35 service-user participants described the art workshops as a positive choice to
have as part of their care. This does not mean that all participants always enjoyed all the
art sessions. People also spoke about struggling with interactions in a group, or about some
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aspect of music bringing up feelings of sadness and loss. However, they all appreciated the
range of experiences they were offered through the art workshops.
Participants spoke about feeling good, enjoying themselves, experiencing and
expressing emotions, having a sense of worth, developing a sense of collaboration and
camaraderie, working towards an end result, developing concentration and focusing skills,
realising they had skills they never thought they had, feeling respected and heard by both
artists and mental health staff, and connecting with their communities. While only a handful
of participants mentioned the word “recovery,” the majority spoke about arts facilitating the
creation of an environment that is conducive to recovery. Based on the principle of user-
controlled definitions of recovery (Higgins & McGowan, 2014; Sapouna, 2008), the voice
of service-user participants has been central in this research. For the purpose of this paper,
we present a selection of key themes that emerged from the research and highlight the
transformative potential of the arts within and beyond service provision.
Experiencing and expressing emotions
Through singing I express beauty or hope. (Music participant)
Participants spoke about both experiencing and expressing emotions through their
involvement in the art workshops. This was, as one participant observed, not easy to do
within mental health services – “ ...you know my biggest problem is ... I still find it very,
very hard to express myself in here [inpatient unit]” (music participant).
Well over half of the participants appreciated arts as a way of non-verbal expression.
For example, one participant said “it’s a way for quiet people to express themselves ...if
you are quiet and you can play the drums you are expressing yourself, you know what I
mean?” Another participant, making reference to visual arts, said “I suppose it gave one
the freedom to ... express oneself through painting or drawing, and you know what’s nice
is that you get the feedback ...it puts us thinking about why we drew something or ...
what it means for us ....” The therapeutic effect of non-verbal expression was emphasised
by A þM artists: “ ...[P]eople can express themselves without having to put words on it
...when you get to play instruments there’s a great release from it, you just kind of forget
everything, and you nearly get lost in just enjoying playing music” (A þM artist).
Participants spoke about art evoking a range of emotions. While people primarily
described the workshops as uplifting, energising experiences, four people also spoke about
experiencing feelings of sadness, loss and frustration. For example, one person spoke
about music evoking memories of loss, while an animation participant spoke openly about
experiencing mixed feelings by saying that the project made him think about his life and
his feelings and this had mixed results. This finding suggests that arts participation cannot
be evaluated solely on the basis of evoking positive emotions but on the basis of (a)
evoking a range of emotions that are integral to human nature and (b) providing people
with the opportunities to express these emotions in a safe, accepting space.
Connecting with self, others and life
The majority of participants said that the art workshops provided a space to connect with
themselves and their feelings. As one person said, “ ...art is kind of connected with your
soul, your sanity and if you are not connected you’d be like a zombie.” Participating in the
workshops was also a way for people to “get back some reality” in their lives. This was
clearly articulated by one person who said “ ...it was nice to get a beat and ... get
something back, you know some bit of reality back you know” (music participant).
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Relationship-building with others is also a “real-life” situation. The workshops were
experienced as a positive space for participants to connect with each other and to build
relationships in a stress-free environment. As one staff member put it:
...you can share stories like ...this morning [somebody said at the music workshop ] “oh I
met my husband through this song” ...You can tell your story in a sense and not be that big
heavy kind of “tell me about your life” ....
Being part of the music group seemed to motivate participants to “get on” with others
in the in-patient setting. Over half of in-patient care participants commented that, apart
from smoking, there were limited opportunities for people to get together. “It [music ]
helps me to link with other people ... because I am a quiet kind of person” (music
participant). Participants said it was easy to mingle in the music workshops as they felt it
was a friendly, family-like environment. Seeing another side of people was also identified
as a way of building relationships by getting a different perspective on people. Participants
spoke about how having fun, seeing other people having fun and enjoying themselves
enhanced their wellness and helped them connect with others.
All nine participants of the animation project worked intensively in groups towards
developing a story for the final product (animation feature). “We were all on the same
boat ...we are connected through developing a story,” said one participant. Interestingly,
this is not just a metaphor but it was meant literally, as one of the animation features
included a boat journey through Cork city! Animation participants and artists spoke about
developing a sense of camaraderie and co-working skills as “ ...the ability to co-operate is
a skill that makes life easy” (animation participant).
This does not mean that all workshop participants always enjoyed being together and
co-working. People also struggled when being with others, for example one person spoke
about the frustration of being part of a group: “Sometimes it’s hard, frustrating ...trying to
co-operate I am not enjoying it” (animation participant).
Based on the earlier discussion, it can be argued that project participants were given
opportunities to experience the benefits, limitations and challenges of “being with others”
and to connect with “real-life” situations, an essential process in mental health recovery.
Confidence-building – recognising strengths
Participants spoke extensively about getting a boost of morale and a sense of worth
through partaking in the art workshops. Most interviewees said that they surprised
themselves at what they had achieved, saying that they “knew more,” were “able for more”
and “liked more” than what they thought. For example, one person spoke about how her
confidence grew through the animation workshop as she had never taken a photograph in
her life and then realised that she was able to make a short animation film – “ ...these
workshops opened up a creative side I didn’t think I have ....” The staff also spoke about
participants surprising themselves and others – “ ...it’s just amazing to see people with
that ability and you think sometimes you would not see that unless they are in the music
group ...” (staff). Seeing the “finished product” and “your ideas become alive on a screen”
was very important for the animation group. “We had a presentation in the end where we
all watched it in the gallery, you know on the big screens ...it was brilliant” (animation
participant).
Approximately half of the participants spoke about their concentration suffering as a
result of their mental health difficulties and the effect this had on their self-esteem. As a
result, they appreciated the opportunity to work on their concentration through the arts
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projects. This was particularly relevant to the animation group who had to focus on story-
making and film production. As one person put it, “ ... it’s brought out my concentration
...I don’t feel worthless all the time.”
Furthermore, confidence acquired through the art workshops encouraged participants
to make plans and pursue further interests by, for example, “getting back into music and
learn an instrument” or “joining a choir ...” (music participants).
It is important to stress the difference between skills improvement through art and
opportunities provided through art to acknowledge and realise existing skills. In other
words, it is not necessarily the case that participants lacked concentration, focusing and
problem-solving skills, but rather that they lacked opportunities to realise and demonstrate
these skills to themselves and others.
Equalising power relationships
This research identified possibilities to equalise power relationships, through user
involvement in decision-making and planning around the art workshops. Mental health
staff actively engaged in the art workshops and this was appreciated by participants and
artists. “This made workshops an activity for all involved not just something for
‘patients’” (A þM artist). All staff spoke about service user and staff relationships
becoming more equal in the context of a joined activity where there is an opportunity to
move beyond professional boundaries and just be members of the same group. This was
also identified by about a third of user-participants. As one person observed, “ ...the
nurses got involved as well ... just like us, they weren’t like standing over there and just
supervising, you know ...there was no difference between [us ] I didn’t feel like a client.”
Participants also said that they found it easier to approach staff in the context of the art
workshops. As one person said, “I don’t know ... the people here, the nurses and things
like that – you can talk more to them.” This can have a positive effect on staff-user
interactions outside the workshops. For example, one staff member said that after co-
participating in A þM workshops, service users have “de-stigmatised us.”
Seeing service users as participants in art groups rather than “patients” has also been a
way to re-evaluate staff perceptions and practice. As one artist said:
I think their relationships change a lot, especially in places where we would work in for a
while ... staff would have said to us that they see people in a different light or that they kind of
said “how did I not know that before,” things about different members in their group that they
would have never thought of it before.
Changing relationships can also pose challenges to long-established power
differentials between mental health staff and service users. As a sense of powerlessness
is one of the main barriers to the recovery process (Lilja & Hellzen, 2008; Tew, 2011), it is
important that these new interactions can be transferred beyond the boundaries of art
workshops to other areas of mental health care.
Beyond diagnosis
The A þM project provided opportunities for participants to see themselves and to be
seen by others as individuals in different roles rather than as patients with a particular
diagnosis. For example, people in the music workshops saw themselves and other
participants as people having fun, sharing a joke, liking or disliking a particular kind of
music. They also learned a bit more about one another’s lives. Similarly, in the
animation project, participants met each other through different roles such as story-
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tellers and story-makers, through trying new things together, and collaborating towards a
common task.
As already discussed, mental health staff spoke extensively about seeing “people”
rather than “patients” in the art workshops. Project participants also spoke about viewing
themselves differently, as the following quote suggests:
I think it’s kind of different because you are not talking about your illness ... you are not
talking about medication. You are just like any other person when you are in there, and you are
just having a laugh ... just like any other person. (Animation participant)
Artists acknowledged that people were going through hardship but stressed that the
diagnosis is irrelevant when it comes to making art.
... [M]y role is about having the creative environment for people to access, and if I began to
know more about individual clients’ reasons for being there I think it would take away from
what I do.
...[I]t’s not about the condition ...it’s about ... tapping into something that we all have,
tapping into creativity ...spontaneity and fun and ...all of those things that are human.
(A þM artists)
This is quite a significant shift from traditional mental health practice where the
diagnosis is central to professional thinking and provision of care.
Creating accepting and respectful environments
Research findings suggest that the arts can contribute to environments where people
experience a sense of freedom, acceptance and respect. Almost all the participants said
that in the art workshops they felt no pressure to perform, to “be” or to express themselves
in a particular way. As one of the music participants said, “ ... everyone can be a part of it.
So it doesn’t matter if you can sing or can’t sing, you can still have rhythm, and it’s so
relaxed.” Being in a place where people do not constantly doubt themselves is important,
as the following quote suggests:
...I am getting over a hurdle of playing music and seemingly nobody notices that you don’t
sing properly or something. I was very anxious before, anxious what this or this person thinks
and now ...I am over that, I ...just don’t worry if I miss a chord or something. (Music
participant)
The majority of participants said that they felt respected and involved in what was
going on, that their opinions counted and that they were comfortable about making
suggestions to their groups. In the animation group, this involvement was manifested in
the story-making and the production of the animation films. As the animation artist said,
“...[my role ] is just to give the space for people to create their own stories.” In the music
groups, user involvement was manifested in the actual running of the sessions where the
facilitators actively encouraged user-led music sessions.
The significance of feeling respected needs to be seen in the broader context of user
experiences of mental health services. In this project, service users did not speak about feeling
disrespected by mental health staff; however, many expressed concerns about the lack of
choice of activities and the infantilising nature of some of the other activities. One person drew
a comparison between the experience of an arts workshop and another activity in the same
setting where she felt as though she was being treated like a child.
I love the art as well because ...you know ...you could get that feeling ... of warmth.
At [other activity ] sometimes ... – it’s like – you are put in a cage and you have a lot of kids
and you tell them do jig puzzles or give crayons ... I am paranoid that people think because
you have a psychiatric illness that you are stupid.
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Being part of a social community-reducing stigma
Participants, staff and artists spoke about arts being a tool to combat isolation, break down
barriers between service users and the community and reduce stigma. For animation
participants, being located in an art gallery, a “normal space” in Cork city centre, was very
significant. It signified involvement in the community not as a “mental health group,” as
initially feared by some group members, but as an “animation group.” This short
conversation between two members of the animation group highlights this issue:
So it’s not like you’re sitting with a nurse as such, or ...a member of the mental health team –
do you know what I mean ...you’re going to an Art Gallery ....
You’re going somewhere different ... we’ve been bombarded with hospitals, we’ve been
bombarded with medication.
It’s great, I loved being in the gallery.
We’ve been institutionalised and it’s completely the opposite of that is what we need.
Through the arts projects, participants living in the community engaged with facilities
that they did not know about or did not have the confidence to use before. This exposure
has also affected the way mental health service users are now viewed in such facilities.
As one staff member found out, “ ...people who work in the community facilities view
people with mental health issues differently having met them.” Community mental health
staff also stressed the importance of meeting service users in a mainstream community
setting, a welcome shift from home visits and referrals to outpatient services.
Through arts participation, people had the opportunity to be part of the broader
community and not just the mental health community. Four participants said that
becoming involved in too many mental health groups can reinforce stigma and a sense of
“being unwell.” As one animation participant said, “ ...it’s very important that we
actually feel not ...just people that are unwell ...but we’re just part of the social
community.” A similar point was made by a staff member who argued that rather than
becoming part of the service, arts would have to be brought into the community to create a
broader network of people. This is not to deny the value and contribution of diverse groups
within mental health care. Rather, it is about acknowledging that people need
opportunities to engage with the world outside the mental health system rather than the
mental health system becoming their world.
Discussion: Arts as a tool to embrace a cultural change in mental health
The A þM projects were experienced in a very positive way by participants in the three
settings. In line with previous research, this study confirmed that arts in mental health care
can create conditions conducive to recovery through the “discovery of personal
resourcefulness, meaning and growth, within and beyond the limits imposed by the
‘mental illness’” (Mental Health Commission [MHC], 2008, p. 7). Participation in the art
projects also contributed to well-being and social inclusion by enabling participants to take
on meaningful and satisfying social roles in their communities (Hui & Stickley, 2010;
Spandler et al., 2007).
While participation in the art workshops was clearly a way of breaking the monotony of
life in in-patient care and the social isolation experienced by many in their communities, the
transformative and therapeutic nature of creativity was also identified by participants in all
three settings. Along the lines of other studies (Moloney, 2005; Spandler et al., 2007), it was
found that arts in mental health care contribute a valuable space where creative expression is
Arts and Health 9
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encouraged and where service users can be acknowledged as people with potential,
imagination and skills. The possibilities of achieving more egalitarian relationships between
staff and users through art participation were also key aspects of our findings.
It is therefore important to develop strategic partnerships between the arts and the
mental health sector, with arts programmes being another care option for people in
distress. For arts to become a meaningful care option, the appreciation of multidisciplinary
teams is required. Mental health professionals will need to expand their roles to embrace
activities such as community development and fundraising for art-related activities that
have not traditionally been considered part of their brief. Furthermore, the role of
education in preparing mental health professionals is significant. Including modules on
arts and mental health in professional courses can certainly provide professionals with
more tools to work creatively with people in a mental health setting. However, if arts are to
be a meaningful care option, a broader recovery-focused, user-centred approach to mental
health education and research is also essential.
However, integrating the arts into mental health practice is not an unproblematic
process. This study has given a first-hand insight into the tensions between the creativity
and freedom of expression embraced in artistic activities and the rigidity and passivity
associated with the dominant biomedical model. For example, the majority of participants
contrasted the art workshops with the regimental style of in-patient wards where they often
felt “observed,” prevented from expressing themselves and “lacking a say” in their care.
Artists and staff also identified resistance by some multidisciplinary teams to the valuing
of diverse types of engagement, including artistic engagement, as part of mental health
practice. Therefore, if the integration of the arts into mental health care is to be recovery-
enhancing, it cannot be a mere instrumental addition to current services. This integration
requires a more fundamental change in the current medically focused model of care, which
could be a challenging task. In other words, it is important that the contribution of the arts
towards more creative, respectful and egalitarian forms of engagement does not operate in
isolation (i.e. only within art workshops), but affects the overall culture of mental health
care in a way that such care embraces creativity and provides opportunities for people to
be seen beyond the role of the “patient.”
Furthermore, our research has highlighted the risks associated with the assimilation of the
arts into a mental health system which remains primarily focused on clinical rather than
psychosocial interventions. Participant artists stressed the importance of the arts not losing
their creative potential in a system that can often “stop us from being as big as we can be”
(A þM artist). In line with other research, this study identified the distinct value of the arts in
mental health as opposed toart therapy (Levine, Perkins, & Perkins, 2005). The focus of the art
workshops has been on creative expression, which can have a therapeutic effect, but is
differentfrom art therapy where clinical goals areset. This is not suggestingthat art therapy, or
indeed other therapeutic interventions do not play a valid role in the recovery process. It is
recognising the distinct contribution that arts can make in mental health which is about
creativity, expression, experimentation and play rather than treatment. The value of engaging
with activities beyond the boundaries of clinical settings and connecting with a community
beyond the mental health community was also identified as a key aspect ofsocial inclusion and
stigma reduction. In that sense, arts can be a tool to see people beyond their diagnosis, and as
such can provide unique opportunities for recovery.
This qualitative study was informed by the narratives of people with first-hand
experience of arts participation in mental health. The findings of the study have provided
insights into how arts and creativity can contribute to a change of culture towards
recovery-oriented mental health practice. Although this study did not adopt a user-led
10 L. Sapouna and E.(R.) Pamer
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approach, user-led research is important, as this research can itself be a creative medium
for such change to be realised. In addition, research into arts participation in mental health
would benefit from adopting broader sociocultural approaches and utilising creative media
such as video, writing and story-telling (see Stickley, 2012a), which can capture people’s
experiences and emphasise the users’ voice as being central to research and evaluation.
Conclusion
The arts can be a medium for recognising people’s resourcefulness and multiple skills,
which are often lost when they become patients in a mental health service. In a broader
sense, creativity in mental health care can contribute towards recovery, through enabling
people to make connections, expand their experiences, take meaningful roles and
experience a sense of worth and value.
Moving beyond the benign agreement on the positive contribution of arts to mental
health care, this research has highlighted that such a contribution is not a mere matter of
“adding” arts programmes to the current mental health services. The broader conceptual
and ideological framework governing mental health care poses significant challenges to
adopting a more creative approach to practice. This research has found that a meaningful
partnership between the arts sector and mental health services is not just a technical
measure but requires a cultural shift in the way we understand, respond to and engage with
human distress. The arts in mental health care provide opportunities to see people in
distress beyond their diagnosis and can facilitate such a shift towards embracing creativity
of expression, nurturing strengths and facilitating service-user care choices, both inside
and outside mental health structures.
Note
1. For further information about A þM, see http://www.artsandmindscork.com.
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