Arts debate

These questions are not easily answered. The point for now is that they are being asked at a national level. Artists are being taken seriously within what has for too many years been a scientifically dominated and dare I say clinically dogmatic and blinkered healthcare system.

So how do we truly embed the arts within healthcare systems and public health and at the same time mitigate against those tired notions of the arts being a ‘frill’ or low on the agenda in relation to clinical medical care?

Some interesting political developments have taken place over the past few years where government policy is influencing both arts and health policies from the top down to be increasingly inclusive, participatory and agenda crossing, whilst artists, service users and healthcare workers are influencing notions of holistic and creative healthcare from the bottom up through imaginative alternatives.

This work is bringing together healthcare communities, professional contemporary artists, local authorities, cultural industries, business, and education to share practice and learn from each other. It is drawing down arts, health and social policy driven funding. It is not about prettying places up or providing musak or nice distractions. Nor is it about selecting prestigious art ‘for’ people. It’s about creating new stakeholders and enabling decision making and learning and new connections. It is about creating opportunities for artists to share their creative language and their artistic medium, with people who are excluded or disadvantaged through illness or exclusion. It is also about engaging the healthcare workforce in exploring new meanings and new solutions to holistic and people centred care. It is also about creating alternative avenues for the arts and new roles for artists.

“The hospital helped with my illness but the arts project changed my life”
Patient- Lime project

Brian Chapman, Director, LIME, Manchester.

I am a Welsh artist who provided 2 years voluntary art tuition in the Wrexham area of North Wales.I have given both group and individual tuition to the Elderly, Mental Health and Special Needs Adults how to draw and paint with watercolor and acrylics.After this period i set up as Art for All in march 2006.

This tool of art is a very powerful medium that deserves recognition for its true values and worth.

All clients that partake in the classes are amazed at what they have produced by themselves in a two hour class. You can see it in their eyes.

Clients are empowered with self accomplishment and they are keen on learning more, new skills.

Art teaches so much but most of all it teaches Communication as this tool is the begining of all sharing,regardless of what form or medium it takes.

Art and its many, many forms that are available are too many too list as are the benefits of art in health.

It is time the goverment opens its eyes and see's the true value of Art in Health and Society.

After so many years working in my field and working with so many adults i have seen the benefits first hand.

If any one would like to see more about Art for All it is listed at The Arts Council of Wales site. Thank you for reading this comment.

It has been well said elsewhere that "you can deliver pizza but you can't 'deliver' health, education or community safety." Enlightened professionals all know that 'users' of services must be invited into a partnership to 'co-produce' these outcomes.

The arts clearly have a powerful role to play in this. GPs and others can refer people with 'activity prescriptions' to artistic activities in which they can reconnect with themselves and others in new relationships.

When their participation is also recognised as 'work' that is crucial to society because it encourages active, creative citizens, we can also think about rewarding such commitments. This can be done creatively through the use of new 'time currencies' that encourage a new mutualism to suit our own age.

Further than this we can underwrite these commitments of time to personal and community health and growth by using existing arts activities. For instance, where there is undercapacity attendance at local or touring arts events that is already funded, people may pay in 'time credits' earned through their earlier participation to enjoy new artistic experiences. This meets the Arts Council's agenda of developing new audiences for the arts at no extra cost. In fact, these new audiences generate secondary income from spending in bars and restaurants.

Not only is the imagination the most powerful ally of the artist but of all who would open up such new spaces in community life that encourage participation, create active and healthy citizens and make life worth living.

John Rogers
Project Coordinator
Wales Institute for Community Currencies

One of the tricky things is to identify who will benefit most from what kinds of art participation, and what are the qualities of artist that are important in this work. I don't think wwe should shy away form asking these questions.

When asking these questions we must be mindful of the raft of methodologies available to us in investigation. One priority in the health field must be to continue to challenge the hegemonic grip that positivism has over acceptable evidence. Different methodolgies will be needed to capture the experiential gains of participating in art.

This is not to say that any old evidence will do. I support a rigourous, reflective approach to researching the field, and have identified the need for artists that work in health to be open to having questions asked about their practice and its impact.

Whilst we might accept the view that any art is enriching, in general, if we are serious about examinig its role in health, I do think we must be ready to ask and attempt to answer difficult questions.

The main value for me is not art as therpy per se, but the exmaination of the therapeutic and social gains of art. Artists, social researchers and health practitioners, must continue to engage in diaglogue to develop new ways of udnerstanding practice, impact and evidence.

A warning - it will not be possible to develop the same evaluative frameworks for different arts practices, arts practitioners or performers as for viewers or audiences as for other participants. But we must begin to develop pictures of how process is related to experience and in what ways.

We have begun to develop some of these frameworks in the research Institute for Health and Social Change at Manchester
Metropolitan Univirsity, where researchers work with artists and health workers in collaborative and active forms of research. (http://www.rihsc.mmu.ac.uk/) We have raised some of these issues in a report of the Pathways - arts for mental health project see http://homepages.poptel.org.uk/mark.burton/listkb.htm .

We are happy to contirbute to ideas for researching in the field and for examining the ways in which such research leads to strentgthening of the projects and roganisations involved.

Two of the main benefits I see in my work running an arts in hospital programme are emphasising the role of the hospital as a public building, open to the whole local community. Many more people will see artwork in hospital than may visit a gallery. Live music in hospital reaches people who may not have been to a concert in years. This gets people thinking and talking about the arts, and gives artists and school and college arts programmes publicity.

Another benefit is that arts events get NHS staff talking to each other and to patients; even small projects can really help to break down the 'silo' mentality betweeen different departments and types of staff.

However, the health service is a huge and complex organisation and artists need a helping hand with accessing areas where they can make a difference, and support while they are doing it from someone who knows the system.

I also often wonder whether is it reasonable or realistic to expect artists to solve entrenched problems which arise from many complex factors. Artists are creative people with many skills but they are not miracle workers.

I'd like to second Patrick Goodall's comment - there are many people working to improve the hospital environment for patients and visitors - Friends' organisations, WRVS, volunteers, patient support groups etc, as well as clinical staff such as therapists, play specialists etc who may use arts techniques - it is important that arts programmes work with these people and try to find common ground (and vice versa).

The clinical effects of art in healthcare are well documented. Clinical research conducted by Chelsea and Westminster Hospital entitled, "A Study of the Effects of the Visual and Performing Arts in Health Care" concluded that placing artworks in a healthcare environment produced the following benefits:

- A noticeable reduction in stress and anxiety levels in patients
- A reduction in length of hospital stays
- A reduction is the use of some medications
- Improved staff morale and better staff retention

One cannot dispute that the arts enliven healthcare spaces. The visual arts stimulate long windowless corridors and can act as way-finding tools in sites which are full of complicated signposting. Artists working in collaboration with patients and staff offer a breath of fresh air in dull, sombre waiting rooms and wards. There can be no dispute that these activities along with music, performance, dance, drama and film, to name but a few, alleviate the oppressive environment in which patients, staff and visitors can often find themselves.

Paintings in Hospitals finds that patients, staff and visitors are extremely receptive to all forms of art practice and, indeed, many find the experience uplifting. Our aim, which has remained unchanged since 1959, is to improve the healthcare environment through the provision of original works of art for the benefit of patients, staff and visitors. Over the years we have seen the arts in health sector mature and, as a result, have been required to develop our services to meet the changing needs of the healthcare sector, their patients and the communities to which they serve.

A patient waiting for a transplant at Taunton and Somerset Hospital summed up the comments of many by saying, "I am allowed to walk along the passage on this floor only and these paintings are the focus of my attention each time. Thank you for giving me greater interest and hope for the future."

Similarly, a volunteer working within a patient discussion group at Tapping House Hospice commented that the paintings being displayed were a talking point, "they lift and soften the atmosphere. The paintings jog the memory and remind us of places we have visited and things we have done in the past. This can facilitate discussion with the group, which often leads to other topics being talked about."

In addition to the visual stimulation of artworks, artist in residency projects can have tangible benefits for the healthcare facilities involved and for those who have an opportunity to participate. It has been our experience that carefully matched activities, in relation to a specific place, alongside an artist in residence during hospital appointments or long monotonous visits, can help countless numbers of people embrace and cope with their anxieties and uncertainties. Arts projects create environments conducive to communication and allow people to think about things other than their condition, such as holidays, hobbies and memories of happier times. This helps remind staff, the patients themselves and their visitors that they aren't "just patients" but intelligent, normal human beings.

In addition to the obvious benefits for patients, artist in residency projects help create a sense of community and togetherness within departments; transcending job descriptions and official departmental structures and allowing individuals who would not normally have the opportunity to work together to understand each other?s roles more clearly. In our experience this leads to improved communication and better staff morale, which is clearly conducive to the provision of better medical care.

As Josie Aston highlights, the National Health Service is a huge and complex organisation. It is our opinion that with no national voice for our sector at present it can be difficult to credibly justify our work and infiltrate this complex system. A sense of cohesion in the sector and a forum in which to share success stories, problems and effective ways of working as well as clear guidelines for those involved in commissioning or facilitating arts in health activities would undoubtedly improve the sector?s image; allowing us to refine our ways of working and improve upon what we are already doing and thus moving forward together.

I agree with Carolyn Kagan?s stance on evaluating the sector?s work. Acquiring funding for clinical research will always be difficult as our work is not profit driven. Regardless of whether the funding for clinical research is forthcoming, we do need to find ways of increasing the evidence base for our work through the employment of methodologies which are as thorough and considered as those employed by the medical and health sector.

Like architecture and interior design, the artwork that we have around us can significantly influence the way we feel on a day to day basis. Whilst not central to the function of a hospital, integrating art, in all its forms, within the healthcare environment has lasting and tangible benefits. We welcome the findings of the "Review of Arts and Health Working Group" published by the Department of Health (DoH) last week. Similarly, we also welcome the launch of the joint prospectus by the DoH and Arts Council England, "A Prospectus for Arts and Health". With arts in health now being recognised as integral to the provision of healthcare and our art programmes delivering real and measurable results, perhaps we should be asking the question "what is the future for arts in health and what challenges does the sector need to overcome in order to move forward?"

(www.paintingsinhospitals.org.uk)

Up until four years ago I was a senior physiotherapist working mainly on the community. Most of the people I came into contact with were demotivated and I knew with 100% certainty that a large proportion would never carry out the exercises I gave them. The reason why they became immobile was that they had no reason to be mobile. What they needed was social contact and a project to get involved and interested in to give them structure and a reason to get out of bed. There are thousands and thousands of people who simply exist behind four walls that only healthcare workers who work on the community see. The normal population going about their day to day activities is unaware of their existence. Patients like these and those who �bounce back� to GP surgeries and treatment centres cost the NHS millions.

One of the big things that getting involved in a knitting and stitching project can do is to encourage people to look forward to tomorrow. They enable people to regain control of their lives. As projects that can be done without moving from an armchair or bed they are ideal for that initial motivation.

I have been researching this for two years and what I�ve uncovered is exciting. Large numbers of knitters and cross stitchers already use these crafts as very effective tools to manage chronic pain (even severe pain), depression, ME, Fibromyalgia, anxiety, panic, stress, self harm, binge eating, PTS, OCD, bereavement, insomnia and other conditions, such as improving concentration and memory. They�re great for carers, too. So we know they work.

We have several theories as to how they are working. They are an effective distractant for those suffering pain and depression but there are other things going on to. For example � is there a link to EMDR therapy � knitters report a feeling of intense calm and being able to process their thoughts? Meditation � knitters who also meditate tell us that knitting induces a similar state of mind � this could open up the benefits of meditation to those who would find it difficult such as children or those with learning disabilities, the very stressed or demotivated. Could the repetitive movement be causing a release of serotonin or perhaps enabling new neural pathways to open up? MS and ME sufferers who knit report not only an improvement in hand function and coordination, but also their thinking becomes clearer.

Since starting this research I have become convinced that the creative process is very important for balancing life. It�s an instinct that we need to fulfill. Our research so far has shown that the beauty of knitting and cross stitching is that everyone can benefit - healthy or ill, young or old. For the healthy they are a wonderful tool for stress management for those who are battling with long term illness they are a life saver in many instances. They are a universal tool because they enable even those who aren't 'artistic' to be creative. They cut across language, age, culture and intelligence.

There is an urgent need to find a home-based therapy that's cheap and easily accessible and I believe knitting and stitching could be the universal tool to achieve this. I found as a community physiotherapist that attitudes needed to change before people could benefit from expensive medical treatments. A person needs to take responsibility for their own health and be prepared to work towards this with the medical teams otherwise treatments such can be ineffective. I believe that using art in healthcare motivates people to want to do other things. And this needs to start in hospital. The ruminating and hypervigilance cycles that lead to downward cycles of depression start here as the only thing unoccupied patients have to do is reflect on their situation. My father was in hospital last year for four months and I observed a ward full of patients left staring into space for months on end. How then can we motivate them to do tasks which require effort or may cause discomfort?

From the anecdotal evidence we�ve collected knitting and stitching change attitudes, behaviour and possibly causes chemical and physical changes in the brain and I see them as a key to motivating people into both taking responsibility for their own health, but also exploring other activities.

They also open up a window for talking, better communication and expression of emotion. Knitters and stitchers who attend groups tell us that conversations become intimate very quickly even when there are strangers in the group. Special schools and groups dealing with disruptive teenagers are already using knitting and cross stitching to successfully change violent, disruptive behaviour.

They are relatively cheap, easily accessible and very importantly produce and end product which raises self esteem and confidence as the creator proudly shows items off or gives them as gifts. Many people who suffer from long term illness have told me that they feel worthless in society � being able to make gifts and stitch for charity makes them feel worthwhile and able to contribute again. Importantly they are completely portable, so can be done in hospital, when out and about (to manage pain spasms or panic for example) or during the lunch break for stress management.

You can find out more about our work at www.stitchlinks.com

I don?t want to repeat all the things that have been said about the proven benefit to patients of the arts and the value for money arts activity can provide. I would though, like to make one or two points which can get overlooked in the debates around this issue.

The first of these is that the NHS is the largest employer in Europe. Everyone in their life will rub up against it and most people will experience life-changing experiences within the walls of a hospital or clinic. If art is not integral to such an institution then this reflects on our society as a whole. Birth, life and death are all in a day's work for a health service which also serves every sector of society. If art doesn't have a place here then where else should we expect to find it? Dr Rigler and others talk of the things the health service can learn from artists and they are right to but there is also a huge amount artists can learn from professionals dealing everyday in the emotions and experiences which are also the currency of great art.

My second point is that Dr Rigler invokes Bromley by Bow as others are wont to do and with some justification. It has proved to be a powerful example to many of us of how this sort of work can work. However, there are now a growing number of innovative artists, hospitals, dance projects, music initiatives and the rest which are effectively using the arts to challenge ideas about wellbeing. Organisations across the country are presenting art and encouraging participation in a range of ways all of which deserve the attention of funders and arts in health practitioners looking for examples of good practice. It?s no disrespect to Bromley by Bow to advocate that we spread the net as wide as possible in looking for ways to move arts in health practice along.

Finally I think Clive Parkinson?s point at the very beginning of this is a good one ? arts in health practitioners are often used to what Josie Aston refers to as the silo mentality of the NHS ? it would be great if Arts Council artform officers could be encouraged to look at arts in health as a natural part of their patch and artists who have yet to work in arts in health should similarly be encouraged to engage with the sector.

What's So Special About Culture?

There are things that the cultural sector can do better than anyone else to stop us sleepwalking into emotional meltdown:
o For most of human history, medicine has been concerned with illness and dysfunction, whereas what led to happiness and well-being was the stuff of philosophy, poetry, and art. Happily, a pedigree in these issues means that well-being is in the bloodstream of the cultural sector. It's about the meaning in life, not the mechanics of it and it reflects it all back at us to make us think. It's crucial if we stand a chance of closing the gap between galloping GDP (doubling roughly each generation) and flat-lining emotional well-being (or happiness if you prefer)...
o In other words, our emotional health is not improving because we've got more stuff. In fact, Lord Layard at the London School of Economics explains that our emotional health is getting worse because: "The rat race is for income and when each of us works more and earns more, this imposes a genuine loss of happiness on others. It is a form of pollution.". This is the emotional pollution that is toxic to 6 million people a year in this country and it's a rat race that poisons your own mental health as well as those people around you. Culture offers an escape route.
o Art and artefacts (the mainstays of the cultural sector) inspire curiosity, communicate in 3-D, and put jump-leads on your emotions and imagination. That marks them out as different. Try sitting someone in a 19th Century electro-therapy chair - suddenly they're ready to discuss mental health. Only the cultural sector can do this.
o If nothing else, the cultural sector can emotionally engage almost everyone, almost everywhere. Take Museums as an example: there are more museums than the big four supermarkets put together, more people through the turnstiles than football, and enough artefacts to stretch the 385,000km from here to the moon. It's a sector that can help underwrite the mental health of a nation. Museums have nothing to sell except understanding and enjoyment. There aren't many institutions left that can say that in a commercial world. That's special. Museums don't want to sell you a personal loan or a gadget. They want you to imagine, to enjoy, to think. And they create sanctuaries for you to escape and hear yourself think; a kind of de-compression chamber to slow (and calm) people down and give them space to find their equilibrium again. They're our collective memory bank too; the collective history, identity, and culture of humanity; an anchor for our emotions; an asset to our mental health.

The cultural sector is not, in my view, primarily about fixing us up when we've gone wrong (that's the job of the health service). But it is outstanding at preventing us going wrong in the first place and improving our well-being beyond the purely functional. It's a job that desperately needs doing and one that the NHS plainly does not do (only 0.1% of the NHS budget is spent on promoting good mental health). That's not a criticism. It's just that the NHS is the answer to a different question.

If we only have a fix-and-mend service, we can't affect the pressures that make us poorly in the first place (and the insatiable demand for healthcare help). If we have the cultural sector, we can.

And prevention makes sense. Not just common sense, financial sense: To save you looking at the national accounts, Derek Wanless (ex chief of Nat West) already did the maths: his two government-commissioned reports in 2002 and 2004 argue that prevention is not only better than cure, it's also cheaper than cure - up to £30 billion a year cheaper. That's more than half the current NHS budget.

So prevention is cheaper than cure and the cultural sector's contribution is prevention not cure.

What was that about a no-brainer?

Adapted from clmg's work: Museums of the Mind. (www.clmg.org.uk) Copyright clmg 2007

The undeniable success of Dr Opher's 'experiment' in referring patients reporting with depression to art therapy, as an 'alternative to Prosac', has highlighted the relationship between creativity and long-term mental health issues, What is important here is that it has highlighted also the context in which this model works. Importantly it has shown that it works well on a 'local' level. There are other examples which follow the same model and which are, withall, 'local' and this is one of the main reasons why they have been a success.

The key words here are 'dedicated', 'focussed', 'local' and 'personal'.

Damian Hebron's observations are also interesting in that he highlights the potential for turgidity once central government becomes obsessed with 'an interaction between Arts Council and NHS'. I think what Damian is also saying is that initiatives such as Dr Opher's and the Bromley-by-Bow Centre have only succeeded because they have been set up and run by a small local team and been relatively free of centralised institutional control.

Remember: the bigger the ship, the longer it takes to change direction and the more it costs in energy, resources and manpower.

We all have seen evidence of the characteristically slow pace of change in such developments where monstrous institutions like the NHS are involved. We should have realised, in an age where publically-funded institiutions just keep getting bigger, that small is beautiful, local is best and the fewer 'cooks', the tastier the broth.

We have seen, particularly those of us working in the education and public health sectors over the past 10 years, just how much time and energy has been wasted in pandering to futile centralised monitoring, targetting and box-ticking. The tragedy is that this is time which should have been spent either delivering teaching or delivering care to the sick.

We seem to have grown into a mindset where, before we 'do' anything remotely helpful, we all have to contribute to covering the government's corporate arse.

I have seen, at first hand over the past 10 years, how this hegemonic, insurance-led thinking hugely depletes the energy, morale and initiative of those who work at the 'coal-face'.

The service-users do not benefit - look at the decline in standards reported in both sectors - despite huge investment. Added legislation, systems and 'fail-safes' mostly achieve only extra work for an ever-growing army of public service administrators and managers.

So I say to the Arts Council and to the NHS: Learn from circumstance and hard evidence; learn from past mistakes; look at what can be done without a lot of centralised interference; strip away the bureaucracy and concentrate on a tight, action and results-led strategy.

Above all give 'local control' over to those who are actually delivering the service and do not weigh them down with mountains of 'reporting and monitoring'. What really counts are the individual and tangible benefits - not statistics.

Give the money to the 'deliverers' and to the 'doers' on the ground; let them get on with it and don't interfere.