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 Professor Jenny Secker of Anglia Ruskin University was commissioned to review the benefits of the arts to mental health for the Department of Health. The Friends' young-onset dementia project was included in the first part of the research. Below is a summary of the research, published in the second research bulletin of the Cambridgeshire and Peterborough Mental Health Partnership NHS Trust, in December 2007 (available on the Mental Health Trust's website). Professor Secker's full report is available online:
Mental health, social inclusion and arts: full report >
Mental health, social inclusion and arts: developing the evidence baseBy Jenny Secker, Helen Spandler, Sue Hacking, Lyn Kent and Jo ShentonAbstractThis article outlines two strands of the national research study Mental health, social inclusion and arts: developing the evidence base that directly involved arts and mental health project participants. These were an outcomes study providing quantitative evidence of the benefits of arts participation for people with mental health needs and qualitative case studies with six arts and mental health projects. The case studies explored how people benefited from arts participation. The outcome study results provide evidence of empowerment, mental health and social inclusion gains with benefits. The case studies identified eight processes through which benefits were achieved. BackgroundThe study was commissioned by the Department for Culture Media and Sport and the Department of Health in response to the Social Exclusion Units report on mental health and social exclusion (ODPM, 2004). Although arts participation was widely seen as valuable for people with mental health needs, the evidence base was not strong and the study was therefore intended to make a contribution to developing a stronger evidence base. The research was carried out by a team from Anglia Ruskin University and the University of Central Lancashire whose combined experience included evaluating and using mental health services, and creative art work. AimsTo identify appropriate indicators and measures of mental health and social inclusion outcomes, and to develop and implement an evaluation study based on those indicators and measures. MethodologyQuestionnaires included three standardised measures: an empowerment measure, the Clinical Outcomes in Routine Evaluation (CORE) measure and a social inclusion measure. Questionnaires were developed and revised following comments from service users at arts projects and a service user research group who assisted with piloting. Participants were invited to complete questionnaires shortly after joining a project and again six months later. At follow-up participants (62 from 20 projects) rated the impact arts participation had had in relation to the measures. Six diverse arts and mental health projects were selected to take part in case studies. Workshops were held with projects facilitators, and 34 participants, involved in projects for sufficient time to have benefited (usually six months), were interviewed. The workshops explored projects theories of change (Weiss, 1995). The interviews explored participants journeys through their arts project, identifying the benefits and how they thought these had come about. Two members of a service user research group played a major role in organising the project, participant surveys, the case study workshops and interviews. They also assisted with data entry and carried out workshops and interviews with other members of the team. ResultsThe outcome study results showed statistically significant improvements on all three measures after six months arts participation. There were no differences in the extent of improvement relating to participants age, gender, ethnicity or type of mental health problems. Improvements on the empowerment and CORE measures were greater for participants identified by the CORE as having clinically significant mental health problems when they first joined their project and those who reported no recent new stress in their lives at follow up. Analysis of participants impact ratings showed beyond reasonable doubt that the improvement in empowerment was due to arts participation. The evidence was promising, if less secure, for the improvements in mental health and social inclusion. The case studies identified eight distinct but interrelated ways in which participants benefited from arts participation. Three processes were considered important by nearly all participants across projects: getting motivated, focusing on art and connecting with others. It helps that creative bit and that motivation bit, because the motivation with depression is obviously another symptomIts given me something to motivate me, to a better quality of life than just being ill. The one thing I can say about art, as opposed to other things, it starts this mystical, magical quality, or it seems like it has, it draws you into it, it absorbs you like nothing else. It does me anyway. Its taught me a lot that I can interact with peopleIm responding to the world differentlyI wouldnt have touched a course in the community, its still a barrier to me but Im making the circle bigger so its positiveits making the safety zone bigger. A further three processes were very important at particular projects: self expression, connecting with abilities and having time out: Its a good way of expressing yourself. I think it helpssometimes, what you fear in your mind, you can express in your paintings. I think thats a good thing, too. Its opened my eyes to my abilities and the fact that theres more out there to learn and its been very inspiring. We dont do anything for ourselves and here when we did this, its like a different feeling, that I have done something for myself. [Its] like leaving everybody behind, the children, husband, everything, so its just for myself. Participants identified two further ways that arts participation benefited them: rebuilding identities and expanding horizons. Although less common than other processes, they were important to at least some participants in all of the projects and helped in achieving potentially quite profound and wide-ranging benefits. Its not just something thats someone with mental health problems has produced, its something that an artist has produced and it just so happens that theyve got mental problems as well. The case studies demonstrated that arts provision for people with mental health needs is not a case of one size fits all. For example, structured arts provision that participants can readily accommodate in busy lives may be particularly beneficial for women with caring and other family responsibilities, while projects with the capacity to provide high levels of emotional and artistic support may be particularly important for people with long-term experiences of severe distress. One feature that was important for all participants was providing arts activity in a safe, supportive, unthreatening environment. All six projects involved in the case studies provided arts activities specifically for people with mental health problems and this was highly valued for the opportunity it gave to rebuild confidence through contact with peers who were seen as understanding, and for the mental health support available. It appeared to be the support available in a mental health specific project that enabled many participants to develop greater confidence in relating to other people and to expand their horizons beyond the world of mental health. This requires exploration in further research comparing mental health specific and more broadly based projects. Key recommendations and actionsWe believe that our results provide sufficient evidence of empowerment, mental health and social inclusion gains to justify support for arts and mental health work, as advocated by the Department of Health's recent review of arts and health (Department of Health, 2007). Further research is required to assess whether benefits are sustained in the longer term and to recruit larger samples of participants so that more detailed analyses can be carried out. Participants impact ratings were promising as a means of attributing outcomes to arts participation in contexts where control groups are not feasible. Outcome studies should be accompanied by in-depth qualitative work to explore the ways in which benefits are achieved, since outcomes alone tell us little about the best ways of providing arts participation opportunities for different participant groups. Influence on practiceInterim reports and presentations to different interest groups have informed thinking about the development of arts and mental health work. The final report is widely disseminated to continue this process.
Mental health, social inclusion and arts: full report >
Conclusions and next stepsOur research has demonstrated that arts participation has positive outcomes for people with mental health needs and has illuminated the processes through which benefits are achieved. Next steps will depend on funding bodies being able and willing to support the development of arts and mental health work in line with the growing evidence base, and to commission further research aimed at assessing longer term benefits.
Mental health, social inclusion and arts: full report >
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