Towards an inclusive arts-based mental health service

We know that engaging in arts and creative activity has a positive impact on mental health.

However, mental health services commission very little arts activity.

  • Creative interventions and arts engagement can improve mood, confidence and self-esteem.
  • Of those young people who are seen by current mental health services, around 1 in 2 will reliably recover.

The challenge

Mental health services for children and young people are stretched further than ever. The national system transformation programme known as i-THRIVE is addressing this by broadening the clinical offer, increasing patient choice, and improving access and engagement. Greater Manchester is the only team nationally to include an Arts, Culture and Mental Health Programme as part of their offer to young people.

‘[It was a] very supportive group,
the amount of support and
happiness is incredible’

Young person

 

‘All the love and care is incredible’

Young person

 

‘Thought it was like an art lesson
at first but then really enjoyed it’.

Young person

 

‘We’d love for it to carry on’

Young person

 

GM i-THRIVE’s Arts, Culture and Mental Health Programme was created as a way for mental health and arts professionals to utilise and build on an existing evidence base whilst, at the same time, broadening the arts-based offer for young people. Within the context of evidence- based practice there is promising evidence that arts engagement can support wellbeing in young people and that creative interventions can improve mood, confidence and self- esteem. There is also strong evidence that arts participation supports cognitive development.

Whilst this evidence base is growing, there is currently only inconclusive research into the role of the arts in supporting the management of poor mental health for young people. It is, however, generally acknowledged that a lack of research, rather than null findings, is behind a lack of definitive conclusions and that the wider literature indicates a range of positive outcomes for young people’s mental health when they take part in arts and cultural activity1.

The Arts, Culture and Mental health Programme was established as part of GM i-THRIVE in order to build upon and develop the existing evidence base, to broaden the mental health offer for young people and to create the conditions for mental health and arts professionals to collaborate and co-produce.

At the beginning of the programme, it became evident that arts professionals often lacked the confidence and tools to assess, record and report on the mental health outcomes from their work, so we set about co-designing an evaluation kit that would facilitate this process. Our aim was to facilitate the production of appropriate and rigorous evidence and remove one of the major barriers to the commissioning of arts-based mental health approaches.

Our approach

The project worked with arts organisations, the voluntary sector and commissioners to develop proof of concept projects which would explore the feasibility of embedding arts-led provision within existing care pathways.

We aimed to develop a process for partnering arts and cultural providers with NHS children’s mental health services through:

  • developing a shared language and procedures acceptable to all parties
  • developing and agreeing formal service level agreements
  • identifying what works well, as well as challenges and solutions.

It was imperative that the programme drew on the expertise of all partners so that we could:

  • increase NHS teams’ knowledge about the arts-based options available
  • establish processes such as recruitment and attendance together
  • co-deliver sessions with both arts and mental health professionals present, so that young people were fully supported.
  • To effectively evaluate, articulate value and share learning we:
  • used shared language
  • created and used an evaluation kit with standardised and qualitative tools
  • encouraged reflection and learning and recorded these as part of the evaluation process.

The three 12-week proof of concept projects took place within Pennine Care Foundation Trust and Greater Manchester Mental Health Foundation Trust. Bolton Child and Adolescent Mental Health Service worked with Odd Arts2 and Bolton Lads and Girls Club Wellbeing Theatre Group3. These sessions explored the concept of wellbeing using games, discussion and role play and led to an interactive, Forum Theatre performance. Tameside & Glossop Healthy Young Minds worked with Glossop Arts Project4 and this group created imaginary, fantastical creatures and a virtual exhibition. Stockport Healthy Young Minds (HYM) collaborated with Arts for Recovery in the Community (Arc)5 A range of diverse, creative activities provided participants with opportunities to explore themes through different media, techniques and languages. Participants created a number of physical artworks which they could take home with them and share with family and friends.

To begin the process, GM i-THRIVE sought Expressions of Interest from NHS providers who wanted to collaborate with local cultural organisations to develop and deliver arts-led interventions for young people seeking mental health support.

All sessions had to be staffed by both an arts and a mental health practitioner and expectations around supervision and governance for the project were set out in a service level agreement. The project also required that each team made use of a new GM i-THRIVE Youth Mental Health Arts and Culture Evaluation Kit6 so that the feasibility of this tool could be tested.

The kit was co-designed by arts providers, mental health practitioners, academics, NHS clinicians and representatives from policy makers.

Our aim was to create the conditions for arts organisations to understand and apply common metrics used by the NHS and commissioners. The evaluation kit also supported the recording of qualitative and creative outcomes.

The children and young people who took part in the projects were either already engaged with the service or on waiting lists and had consented to participating in creative and arts- led approaches. Sessions were co-delivered by NHS mental health staff and arts practitioners in a range of settings, including NHS premises, at arts provider’s sites and online.

  • In Bolton 11 young people regularly attended a theatre based intervention
  • In Tameside and Glossop 5 young people took part in visual arts workshops, creating imaginary, fantastical creatures and intricate sculpted pieces which were displayed in an online virtual exhibition. In total more than 20 pieces were created and each participant also took home a personalised calm box
  • In Stockport three young people took part in a visual arts project, creating an online exhibition.

All three projects were well received by the mental health teams who commissioned them. In Bolton, the project continued post-pilot.

In Stockport arts and cultural provision was subsequently commissioned as part of the Early Help offer. In Tameside and Glossop the Healthy Young Minds teams also decided to continue with the partnership and successfully bid to Children in Need to enable this.

What we achieved

We wanted to test the feasibility of partnerships between clinical services and arts and creative partners and whether this could result in improved mental wellbeing outcomes for young people.

‘I feel more motivated and confident in myself.’’

Young person

Unusually for a mental health project structured around groupwork, there was very little drop out and most attended regularly. Participants were overwhelmingly positive about their experience and staff received letters and messages from them detailing how much they had enjoyed and valued the sessions.

All delivery partners including Child and Adolescent Mental Health Service and Healthy Young Minds, reported that they observed positive change in participants. They also indicated that they would like to see a creative offer expanded in their services.

‘A challenging but ultimately fruitful collaborative project.’

Arts Manager

Child and Adolescent Mental Health Service and Healthy Young Minds similarly persisted in their efforts to complete the project working within restrictions. Staff made enormous efforts in very difficult circumstances and their actions demonstrated the value placed on these creative interventions.

There were several redesigns and stop-start implementations of each project in response to the unfolding Covid-19 pandemic. Nonetheless, three of the four cultural providers were able to successfully engage young people albeit in small numbers. Whilst the project was able to evidence increases in wellbeing across time, the number of participants was not statistically significant and so evidence-based conclusions could not be drawn..

‘I’ve been able to express how I feel.’’

Young person

Learning from the projects has informed the wider GM i-THRIVE Arts, Culture and Mental Health programme, including the development and delivery of workforce training.

‘The project was very well received by the young people and had a positive impact on their emotional well-being, with one young person describing it as ‘the highlight’ of their week.’

 

Arts providers

What we learned

  • Preparation and relationships are key, as are clearly defined roles
  • A considerable lead in time is necessary to incorporate the training needs of partners and to define roles and responsibilities
  • Regular debriefs between partners facilitates reflection and the improvement of services
  • Responsibility for follow ups and check-ins with participants should be clearly defined
  • Language is key. The words “art” and “group” can put off some young people
  • Social anxiety and other difficulties can have considerable impact on a young person’s ability to engage with creative activity. Key work can support a young person through this process
  • Cash flow is a vital part of project planning and can be a barrier to commissioning. Many large NHS bodies work to much longer payment schedules than small arts organisations and this should be factored in from the outset.

A fuller implementation story of these proof of concepts is available from Manchester i-THRIVE7.

 

The Evaluation Kit

GM i-THRIVE has further tested the evaluation kit with wider system partners, and begun to roll out a training programme on its use. Over 50 organisations have now requested their Kit and this work continues.

The national lead for THRIVE transformation, The Anna Freud Centre, is working with

GM i-THRIVE to support the uptake of the Evaluation Kit. Further national CYP mental health organisations have also expressed interest in its use. The team is working across health and social care, the cultural sector and with colleagues in GM, and nationwide to continue to share and build on this learning.

The learning from this project has informed a series of training, eLearning and workshop events on implementing arts-based options in children’s services, delivered to the GM workforce via the i-THRIVE Academy.

‘The commitment and perseverance of all parties astonished me. While I was already convinced of the need for this kind of provision, this experience has confirmed that our colleagues also want to offer creative and cultural options alongside and within more conventional mental health service provision.’

GM i-THRIVE Arts, Culture and Mental Health Programme manager Dr Kat Taylor