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'recovery' for common but chronic mental health problemsGetting back to normal': theadded value of an art-based programme in promoting

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2/13

Article

Getting back to normal:the added value of anart-based programme inpromoting recovery forcommon but chronic mentalhealth problems

Sally Makin1 and Linda Gask2

Abstract

Objectives. The aim of this project was to explore the added value of participation in an Arts onPrescription(AoP) programme to aid the process of recoveryin people with common but chronicmental health problems that have already undergone a psychological talking-based therapy.Methods. The study utilized qualitative in-depth interviews with 15 clients with persistent anxiety

and depression who had attended an AoP service and had previously received psychologicaltherapy. Results and discussion. Attending AoP aided the process of recovery, which was perceivedby participants as returning to normality through enjoying life again, returning to previousactivities, setting goals and stopping dwelling on the past. Most were positive about the benefits theyhad previously gained from talking therapies. However, these alone were not perceived as havingbeen sufficient to achieve recovery. The AoP offered some specific opportunities in this regard,mediated by the therapeutic and effect of absorption in an activity, the specific creative potential of art,and the social aspects of attending the programme. Conclusions. For some people who experiencepersistent or relapsing common mental health problems, participation in an arts-based programmeprovides added value in aiding recovery in ways not facilitated by talking therapies alone.

Keywords

Anxiety, depression, creative therapies, social inclusion, recovery

Received 14 August 2011; accepted: 15 August 2011

Chronic Illness

8(1) 6475

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1Old Age Psychiatry, Manchester Mental Health and Social

Care Trust, Manchester Royal Infirmary, Manchester, UK2

Primary Care Psychiatry, Health Services Research Group,Manchester Academic Health Sciences Centre, University

of Manchester, Manchester, UK

Corresponding author:

Linda Gask, Primary Care Psychiatry, Health Services

Research Group, Manchester Academic Health Sciences

Centre, University of Manchester, Manchester, M13 9PL,UK

Email: [email protected]

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Background

There is a developing evidence base for the

impact of creative arts in healthcare.1 Arts in

healthhave been described as:creative activities that aim to improve indi-

vidual/community health and healthcare

delivery using arts-based approaches, and

that seek to enhance the healthcare environ-

ment through the provision of artworks or

performances.2 (p. 11)

This includes literature and writing, the-

atre and drama, dance, music and visual

arts3 and is therefore a broad umbrella

covering active participation in creative

activities (such as drawing and painting)

and more passive audience or viewer activ-

ities (such as paintings hung on clinic and

hospital walls).The relationship between art

and health has a rich and complex history2

and a broad scope incorporating two key

dimensions, whether the focus is primarily

on engagement with the arts (with an

assumption that this carries benefits for

well-being) or more specifically on health

improvement (with the assumption that the

arts can help to achieve health outcomes).3

The intervention evaluated in this article is

concerned with the latter dimension.

Arts, health and mental health

In 2006, the Review of Arts and Health

Working Group3 concluded that:

Arts and health are and should be firmly

recognised as being, integral to health,

healthcare provision and healthcare environ-

ments(p. 16).

The last decade saw a rapid development

of arts and health projects across the United

Kingdom, supported by policy develop-

ments.4 However, this was not without its

critics citing inadequate evidence and exag-

gerated claims for the benefits of art.5 There

have been calls for a more systematic

approach to evaluation6 in an arena in

which there has been only limited peer-

reviewed and published research.7 Com-

mentators on the evidence base for arts inhealth have also noted that there is a

pressure for quantitative positivist evaluation

in the healthcare field,8 particularly in the

evaluation of newer focused psychological

interventions, which may particularly clash

with the ideological stance of those involved

in creative therapies.9

The practice of an art, such as painting,

has the potential for therapeutic power,

enabling the expression of cognitive, emo-

tional and spiritual ideas to which people

may otherwise have no access. The arts can

be soothing and calming, distract from pain

and anxiety, and increase self-confidence

and motivation.6,10 Particularly promoted

for people with mental health problems are

community-based arts for health projects.

These differ from more traditional forms of

art therapy, which requires therapists with

specialist training, in that they are focused

on processactually doing and experienc-

ing the creation of art. There is some

evidence that they may have a positive

impact on sense of well-being, psychological

symptoms, quality of life and recovery from

illness.3,11 Arts may be especially helpful for

those who find it hard to express their

feelings verbally,8 and can offer ways of

dealing with social exclusion.12,13

Arts on Prescription (AoP) is a type of

social prescribing in which there is a referral

process, whereby health or social care pro-

viders refer people to a service or source of

support.14 The first AoP scheme was

founded in Stockport in North West

England in 1994. In AoP settings, working

artists, rather than trained art therapists,

engage groups of people in a community

setting. There is limited published empirical

research specifically on AoP,15 but Bungay

and Clift have reviewed the available evi-

Makin and Gask 65



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dence, much of which, they note, is qualita-

tive, indicating that participation raises self-

esteem, provides a sense of purpose, helps

people engage in social relationships and

increases sense of empowerment and socialinclusion.15,16 A large, multi-project evalua-

tion Invest to Save, which included evalua-

tion of AoP projects, utilizing both

qualitative and quantitative methods and

conducted in the North West of England has

also reported its findings.17

Promoting recovery

There is also growing interest in the link

between recovery and involvement in crea-

tive activities. Recovery is understood to

mean something different from sustained

remission of symptoms or cure and has

been defined by Anthony as a way of living

a satisfying, hopeful and contributing life,

even with the limitations caused by illness.18

There has been only limited exploration of

the utility of the recovery model for people

with common mental health problems

(though there is increasing evidence of the

chronic nature of some common mental

health problems19); and little work has

been done to fully characterize the process

of recovery from these problems, despite the

success of this concept in changing the

culture in the field of severe and enduring

mental illness (which does not generally

include within its definition anxiety and

depression), particularly schizophrenia.20

In recent years, recovery has been redefined

from the traditional sense of cure or

absence of symptoms21 to something less

quantifiable and more attainable for those

with persistent mental health problems,

encapsulating the return of the ability to

function effectively to some degree and the

return to activities that would normally be

taken for granted.

Although some qualitative work has been

carried out to characterize the process of

recovery from depression,22 in the field of

common mental health problems notions of

recovery remain remarkably biomedical. In

pharmacological trials, recovery is defined

in terms of reduction in symptoms ratherthan improvement in social functioning.23

Allied to this is the view that recovery,

although defined in social terms but from

the rather narrow economic perspective only

of ability to work, can be achieved with a

quick fix of psychological therapy alone.24

The present study

The call for evidence to inform the quality

and cost-effectiveness of services funded

from a diminishing healthcare budget is

strident. Indeed it seems likely that, in a

period of more limited funding in mental

health, with a more specific focus on

outcomes (usually measured quantita-

tively),15,25 there will be tight competition

for funding between community-based

services utilising an artistic medium and

healthcare services utilising psychological

therapies in the non-pharmacological treat-

ment of common mental health problems.

The art-based and psychological therapy

literatures have developed in parallel. In

practice, some clients will have been in receipt

of both of these approaches. How do these

differ and potentially complement each

other? The aim of this project was to explore

the added value of participation in an AoP

programme to aid the process ofrecoveryin

people with common but chronic mental

health problems who have already undergone

a psychological talking-based therapy. In

order to answer this question, we need to

understand how recovery might be concep-

tualized by those attending the programme.

What part did attending the sessions play in

the process of recovery? And, how did this

process differ from the clients previous expe-

rience of treatmentspecifically, in this case,

psychological or talking therapies?

66 Chronic Illness 8(1)



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Method

Qualitative in-depth interviews with 15

clients who attended the Time Out

AoP service run by START in Salford.Permission to carry out this study was

obtained from the University of Manchester

Research Ethics Committee.

Setting

The START in Salford project (a charitable

organisation that provides arts training

and opportunities for people of all ages

experiencing mental ill health or social

exclusion) is based in Pendleton, Salford,

Greater Manchester, and was set up in 1993,

where it primarily worked with people with

severe mental health problems and psycho-

sis. For the last 5 years, it has been providing

a service for people with mild to moderate

anxiety and depression, referred (as a form

of social prescribing) by their general practi-

tioner (see Box 1)

Recruitment of sample

A list of 28 clients of the project who had

recently completed (or almost completed)

the 6-month AoP programme, and whom

had also been in receipt of some form of

psychological therapy within the previous

5 years (and thus were experiencing or

had experienced either persistent or recur-rent symptoms anxiety and/or depression

during that period), was compiled by the

mental health worker attached to the proj-

ect. A total of 16 potential interviewees were

approached from this list by the researchers,

based upon their gender (in order to achieve a

balance of male and female interviewees)

and the type of psychological treatment

receivedcognitive-behaviourtherapy,coun-

selling, guided self-help and/or brief psycho-

logical input from a Graduate Mental Health

Worker or psychodynamic psychotherapy (or

a combination of these)in order to include

as wide a range as possible of different expe-

riences of talking therapies. Further, inter-

viewees were approached from the remaining

clients when two of the original 16 who had

initially expressed interest in the study were

not willing to participate and one person

withdrew permission after the interview, leav-

ing a total of 15 (see Table 1).

The interviewees were between the ages of

22 and 62 and all were of White British

ethnicity. START gets few ethnic minority

Box 1

TheTime Out project at START in SALFORD

Start Time Out Arts on Prescription service offers up to two sessions weekly, each lasting 2 hours

with all materials and equipment provided. Professional artists are there to help as much as members

need and will guide them through a series of activities which could include: drawing and painting,pottery, gardening, photography and more. They can try a variety of activities and choose what they

like best. Beginners are especially welcome.

The project is flexible and can last up to 6 months. Members can explore opportunities in

volunteering, leisure interests, employment and education. Or, having enjoyed their 6 months of art

sessions they may then decide to join the member-led art group.

A mental health worker carries out the initial assessment, and is available for one-to-one

counselling when needed. She also runs workshops to promote mental well-being such as relaxation

sessions.

Additional out-reach art sessions are also organized in local primary care settings, which have also

welcomed exhibitions of members work.

http://www.startinsalford.org.uk

Makin and Gask 67



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referrals, which reflect the ethnic mix of

Salford (predominantly White British).

Generally, they were no longer in receipt of

any form of psychological therapy although

in a minority of cases contact with the psy-

chological therapist was ongoing. All those

interviewed described experience of persis-

tent mental health problems, which had only

partially, if at all, responded to earlier ther-

apy. All participants provided written con-

sent to be interviewed and every effort was

made to ensure that interviewees did not feel

coerced in any way to participate.

Data collectionInterviews were carried out during the

period of May to July 2008 by a medical

student researcher trained and supervised by

the second author. Interviews were specifi-

cally concerned with the following topics:

the nature of the problems that resulted in

referral to the project, views about the

project, how the process helped with specific

symptoms of anxiety and depression and

with the process of recoveryincluding

how that was understood by the

participants, and how this approach differed

from their experience in talking therapies.

The interviews lasted between half an hour

and an hour and a half and were all audio-

recorded and transcribed. The topic guide

can be found in Box 2.

Analysis

All participants were sent copies of their

interview transcripts for editing and correc-

tion so they could be sure that their ano-

nymity had not been compromised in any

way. Data was analysed thematically.26 The

lead author began coding each interview as it

was carried out, with the assistance of

MAXQDA2 qualitative software to assist

in data handling. Emergent themes were

discussed and developing hypotheses

explored in subsequent interviews with mod-

ification of the interview schedule. All inter-

views were repeatedly read by both authors.

As the project progressed, they met regularly

to clarify meaning and to characterize the

nature of the experiences that were described

by participants, in order to develop a con-

ceptual understanding of emergent themes.

Table 1. Demographic characteristics of participants and experiences of talking therapies

Interview number Gender Age Ethnicity Type of previous treatment

01 F 56 White British Cognitivebehaviour therapy

02 F 46 White British Cognitivebehaviour therapy03 F 59 White British Cognitivebehaviour therapy

04 M 37 White British Graduate mental health worker*

05 F 22 White British Perinatal service-counselling

06 F 59 White British Graduate mental health worker*

07 F 62 White British Counselling

09 M 39 White British Counselling


11 F 52 White British Psychodynamic psychotherapy

12 M 40 White British Graduate mental health worker* alcohol team


14 M 54 White British Cognitive-behaviour therapy, inpatient care15 M 45 White British Counselling, inpatient care

16 F 56 White British Counselling

*Graduate mental health worker is trained in and provides brief psychological therapy utilising guided self-help.




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Results

The findings are presented here, in accor-

dance with the key themes that emerged

from the analysis. Through an understand-

ing of how participants conceptualized

recovery, it was possible to develop an

understanding of how attendance at AoP

had contributed to this, and then to discern

how this experience differed from and/or

complimented their previous experience of

psychological therapy.

Returning to normality

It was particularly striking how many partic-

ipants described persistent problems with

social functioning, in terms of an inability to

go out and re-engage with everyday life

prior to beginning to attend the programme.

Many described long-standing difficulties

with making relationships and coming to

terms with loss, particularly through bereave-

ment. The concept of recovery as used in the

literature referred to above was not at all

familiar to any of the participants in the

early interviews, so it was necessary to trans-

late this in subsequent interviews into an

equivalent concept; to this end getting better

was found to be the simplest explanation of

the term.

Some participants said that getting

better for them meant getting on with life;

to stop dwelling on past experiences and to

Box 2

1. Nature of problem that resulted in attending the project?(prompts)

. Nature of problem

.

Duration. How affects everyday life

2. Other types of treatment that he/she has received for this?

Who from? (prompts)

. GP

. From Primary Care Mental Health Team

. Mental Health Services

. Other?

What type of treatment? (prompts)

. Talking treatment- psychotherapy, counselling, cognitive-behaviour therapy

. Medication?

. Other?

3. Views about Arts on Prescription?

. What have you been doing on programme?

. How has this helped- if at all- with symptoms?

. How has this helped- if at all- with functioning in everyday life?

. How has it helped- if at all- with getting back into work?

. What else is involved in recovery?

. How else has it helped or definitely not helped?

4. Comparison with previous experience of talking treatments?

. How does this approach differ from talking treatment?

. What is different? What is Arts on Prescription better for? What is talking

treatment better for?

Makin and Gask 69



8/13

move forward, enabling them to do things

for themselves:

What does getting better mean? Getting

back to what we used to be like. Getting back

to what we used to do. I mean, when I was[depressed] I didnt watch TV, DVDs, play

computer games, read. . . I never did

anything, I didnt even date . . . I lost all

them and thats all the stuff I used to do

(participant 4).

For others, it was important to be able to

set goals and to be able to reach them, with a

sense of moving forward:

looking as though I can go out and I can setgoals and I can make them goals . . . me being

happy rather than just stuck in a rut (par-

ticipant 5).

And it was quite simply feeling normal:

I know it sounds daft, but feeling nor-

mal. . . its not feeling tired, achy, sad. . . .

So feeling normal is getting up in the morn-

ing going, Oh, right, yes, new day. Get

ready, have a shower, brush your teeth, cleanup quick so you can get out(participant 16).

Thus, there was a sense of wanting to get

back to a life where it was possible to achieve

things that had previously been taken for

granted, but which was also enjoyable,

hopeful and productive. For some, but not

all, this also meant being hopeful about

returning to work but this was only one

aspect of normality and seen as an ultimate

rather than a more immediate goal, which

was unsurprising given the chronicity of

some problems that were described.

The specific benefits of talking therapy

Most of the participants were positive about

the benefits they had previously gained from

talking therapies. Some particularly like the

non-judgemental stance taken by the thera-

pist and the reassurance received from them.

Cognitive approaches were helpful for

enabling them to understand their own

thoughts and to change the way they were

thinking about things:

It was good for making me focus on things I

was doing that were negative, and how tofocus on things that were positive and how to

maintain a consistent routine as well. I mean

just to see where I was going wrong with

things, see how I was looking at things in

negative ways (participant 2cognitive-

behaviour therapy).

A sense of achieving insight from talking

about the past was perceived as an important

benefit from counselling and more insight-

oriented therapies:

There was a lot of things that I discovered

about myself, masses of things that I discov-

ered about myself which I should have

learned when I was younger (participant

11dynamic psychotherapy).

The confidentiality of the one-to-one ther-

apeutic relationship was particularly valued:

Its good because youre speaking one to one,andits confidential. When theres other people

it can be, you know if they are going to say

anything outside, or if you bump into them

again and they hold it against you and things

like that(participant 15counselling, also

inpatient care).

However, these alone were not perceived

as having being sufficient to always help

participants to achieve what they considered

to be returning to normality.

The contribution of AoP to returning to

normality

Three themes emerged from the data in

relation to how attending AoP specifically

contributed to a sense of being able to return

to a sense of normality: the therapeutic and

effect of absorption in an activity, the specific

creative potential of art and the social

aspects of attending the programme.




9/13

Absorption in activity. Most participantstalked about how the arts helped to keep

their mind busy. This helped people by

keeping them occupied and preventing bore-

dom and by taking their mind off thingsand getting you doing things. Participating

in the classes gave them something to focus

on, giving them a way of dealing with

distress and helping to stop ruminating on

negative thoughts and also to relax:

Well its a few hours where your mind is

occupied and absorbed by what youre doing

at the Arts centre, so it takes your mind off

reality for a while(participant 14).

This feeling might carry over into every-

day life:

it takes you away from yourself, youre

thinking about something else . . . Theres

many a morning after Ive left here when

its finished, at 12.30 . . .youre going home

with a buzz, that was alright, that felt good,

that lasted all day(participant 13).

In addition to providing distraction to

them and allowing relaxation, doing some-

thing also gave participants a purpose, a

structure for their day and a reason to get up

in the morning and leave their home, helping

to increase their motivation.

Well its something to get up for, isnt it?

Oh yes, Im going to go there and do that

today(participant 1).

It made me more focused on what I wasdoing. I started to organise myself better.

Create a routine, rather than just drifting

through the day(participant 2).

Creativity. Creating art was seen to be ther-apeutic and relaxing, providing some partic-

ipants with a way of expressing themselves

and reflecting their state of mind:

How does it feel to paint a nice

picture?Cause Im doing something thatsnice and its beautiful. Im not doing

something thats sad and depressing. I

mean, if I drew you a picture now of a dark

castle on a stormy night, what does that tell

you about my state of mind? It means Im

depressed. If I draw something like a nice,

sunny landscape with sheep and cows andthat . . .you know, thats basically what it is

(participant 4).

But for most, it was important in terms of

its contribution to a sense of tangible

achievement, producing a product of a

piece of art and thus resulted in increase in

confidence and self-esteem.

Many participants reported how partici-

pation in the arts sessions had increased

their confidence. Achievement played an

important partparticipants often surprised

themselves with what they were able to

achieve artistically, creating and producing

something tangible, which led to increased

confidence in their own abilities and self-

worth.

it started out just doing a little bit of art but

the confidence spreads to other areas in your

life, like I say, doing things, talking topeople, not being frightened to have a go.

Like I say its affected quite a wide range,

I think(participant 16).

Company and support. The social aspectof the programme appears to be very impor-

tant for all of the participants. Almost

everyone said they had made friends, and

highlighted this as an important part of the

programme. A number of these people saw

the friends they had made in the classes

outside of START.

Meeting other people was a very impor-

tant aspect of the sessions, allowing partic-

ipants to have someone to talk to and

someone to listen to their problems, which

was seen as being very helpful. These people

might be the mental health worker, others

who were experiencing similar problems:

I think being able to come here and speak topeople who obviously have probably been

Makin and Gask 71



10/13

through the same thing as what Ive been

through . . . And I think if you make friends

with people and you chat to them and you

listen to them and they listen to you, I think

youre helping each other along, you know

(participant 6).

A number of participants talked about

how being in the classes allowed them to be

themselves. Sessions provided a non-threa-

tening and non-competitive environment

where people felt they were accepted and

could relax, something which may not be

possible at home. It seemed important,

however, that talking was something that

participants did not feel obliged to do:I come in here and if I choose to talk to

somebody I can(participant 11).

Unless you wanted to speak to her, [mental

health worker] she wouldnt dig (partici-

pant 12).

So, being able to relax and enjoy life

again, a sense of achievement resulting in

increased confidence and self-esteem, and anopportunity to re-engage with the social

world again can be seen as the mediating

factors by which attending AoP contributed

to a sense of getting back to normal.

Doing not talking: Added value

of attending AoP

A recurring theme was the need to build on

what had been gained in psychological ther-apy, by having an opportunity to (and being

motivated to) re-engage with life.

My psychologist referred me, because I was

stuck in the house really for quite long

(participant 15).

However, talking therapy did not specifi-

cally facilitate social interaction or necessar-

ily focus on the future:

it was just like Right sit here and spill your

life out, really. Its like; I dont want to do

that. . . . I just wanted the more social side

and nobody to sit there and say You need to

think about your past or anything like that.

I just wanted more to focus more on

what was coming rather than whats been

(participant 5perinatal service andcounselling).

Participants commented on how they

liked that the programme was practical and

constructive providing participants with new

interests and skills and aiding them to return

to activities. This made them feel that they

were doing something worthwhile that was

actively helping them move forward in their

lives, thus restoring more sense of hope:

I think also with talking therapies, particu-

larly with counsellingyou could talk about

the man in the moon if you wanted to . . . its

something to get up for, isnt it?. Oh yes,

Im going to go there and do that today and

Yes I want to finish that painting so Ill do a

bit now(participant 1).

Indeed, an important aspect of the pro-

gramme appeared to be its role as a stepping

stone to other activities. Most participants

discussed how it had helped them to get back

into education, voluntary work or even, for a

few, eventually paid work, giving them a

greater sense of meaning and direction in

their lives. Thus, talking therapy and attend-

ing AoP could be seen as complementary,

playing a different role. Indeed, AoP did not

seem to be seen as therapy in quite the same

way as psychological treatment. It was per-

ceived as action or doing rather than

talking:

discussing and talking about your condition,

gives you a bit more understanding. And as I

said she [psychologist] came up with sug-

gestions that helped and the Arts on

Prescription isnt to do with your illness,

its to do with an activity. So as long as

youve got the ability to do the activity thats

all the tutors are interested in, theyre not

interested in what your condition is, whereas

youre talking about yourself and your




11/13

condition with psychotherapy . . . theyre

both valuable in their own rights, and

theres not one better than the other (par-

ticipant 14).

Discussion

Summary of key findings

For people with common and chronic

mental health problems of depression and

anxiety, an arts-based therapeutic pro-

gramme aided the process of recovery,

characterized as returning to normality,

through enjoying life again, returning to

previous activities, setting goals and stop-

ping dwelling on the past. Most of the

participants were positive about the benefits

they had previously gained from talking

therapies. However, these alone were insuf-

ficient to help them to achieve recovery.

Attendance at the AoP Programme was seen

as offering some specific opportunities in this

regard, mediated by the therapeutic and

effect of absorption in an activity, the specific

creative potential of art and the social

aspects of attending the programme.

Relevance to the published literature

The meaning of recovery in thiscontext. As we discussed earlier, the mean-ing of recovery remains unclear in relation

to people with common mental health prob-

lems given that the literature has thus far

focused on the experience of people with

more chronic and severe mental health

problems.20,21 Our findings clearly echo

those of Ridge and Ziebland22 who found

that some of the people with depression who

they interviewed wanted to feel normal or

human again and enjoy life . . . .They also

noted, however, that others wanted more

than this, and grappled with narratives

about their longer term prognosis. They

describe a process of insight into unknown

qualities of self that potentially lie beyond

depressionwhich is echoed in the discoveries

that our participants described in their

achievement in acquiring or developing

artistic skills that they had never known

they might possess, leading them to imaginea different narrative for their future lives.

However, it is interesting that several of our

participants also emphasized their goal as

being a return to employment, echoing the

narrower way in which recovery has been

viewed in recent policy on psychological

therapy.24

The contribution of art to the recovery

process.The role of arts in enhancing self-

esteem has been recognised in many areas of

mental healthcare8: by creating something

individuals can boost their own self-esteem,

which may in turn help to improve their

mood. Additionally, being able to express

ones state of feeling in paintings may not

only be calming and relaxing but also help an

individual to understand themselves and

their state of minda finding also supported

by previous research in this field.6,10 Our

themes are very similar to those of Spandler

and her colleagues11 and those benefits

described for other evaluations of AoP

programmes.15

The perceived importance of social inter-

action also raises the question of whether it

was the art classes that participants were

involved in, the engagement with a class

regardless of the art content or just the

opportunity to have time out from their

everyday lives and meeting with others in a

similar situation that were the primary fac-

tors in bringing about a positive experience.

Could this have been achieved in a day

centre environment without specific engage-

ment in creative work? There are indications

that the art played an important role in terms

of supporting people. Firstly, the impor-

tance of the end products that were pro-

duced in the sessions, the visible art works,

was emphasized in terms of the feelings of

pride in their achievementswhich is also

Makin and Gask 73



12/13

supported by a recent study of the meaning

of art to people who use mental health

services.10 Learning new skills and the

achievement of producing something

appeared to be important steps towardsrebuilding confidence and belief in partici-

pants own abilities.

The added value of an arts programme.Our study adds to the published literature by

delineating the specific ways in which an

AoP can add value by aiding recovery for

people with chronic common mental health

problems who have previously experienced

psychological therapies. This has not, to our

knowledge, been previously explored and

was not considered by Spandler et al.11

Previous research specifically evaluating

AoP programmes15 has also not considered

this question, yet, as we have noted earlier, it

seems important to ask questions about the

specific role of such programmes in the light

of the current emphasis on targeting

psychological therapy for funding through

the Improving Access to Psychological

Therapies initiative27 and the changing

policy context in the United Kingdom,

with the potential risk to funding for both

Arts and Social Prescribing initiatives.15,28

Many participants were continuing to strug-

gle with social isolation and exclusion. They

described a sense of building on what had

been gained in psychological therapy, by

having an opportunity to (and being moti-

vated to) re-engage with life. Part of the

social aspect of attending the programme

was having someone to talk tobut this

was very much under the control of the

participant with no sense of any obligation

to talk, either to fellow attendees or the

mental health worker. Making friends and

creating a social network is clearly impos-

sible to directly achieve from a one-to-one

intervention (although it may be a goal of

the therapy)and is not generally encour-

aged in group psychotherapy. Talking

therapy and attending AoP could be seen

as complementary, and for many, AoP did

not seem to be seen as therapy in quite

the same way as psychological treatment.

There was no relationship with a specific

therapist. The emphasis was on activityand enjoyment, with opportunity for

improving social interaction. It was per-

ceived quite simply as action or doing

rather than talking.

Limitations of the study

Due to time constraints, the sample size was

relatively small. It was only possible to

interview participants who found the project

helpful in some waypeople who do not

find the AoP useful did not continue to

attend the sessions and could therefore not

be interviewed. The sample from which the

interviewees were selected was drawn up by

the project mental health worker and those

people who were approached and were will-

ing to talk may have particularly positive

experiences. This may have led to an under-

representation of the negative aspects of

AoP.

We were also unable to specifically report

in detail here on other treatment received as

this was not the focus of our study, but it

does seem likely from our interviews that

additional treatments such as medication

also played a part, for some participants,

in achieving recovery.

It is also possible that people who did not

attend the arts programme had recovered as

a result of talking therapy alone, such that

they did not need to attend an additional

treatment programme such as this one; but

for those who attended there did appear to

be an added benefit in terms of recovery.

Completing 15 interviews was enough to

reach a saturation of themes in relation to

the arts programme but not for the very

varied experiences of talking therapy (which

we did not report in detail here) as there are

many different types of talking treatments

available.




13/13

Conclusion

For some people who experience persistent

or relapsing common mental health prob-

lems, participation in an arts-based pro-gramme may provide added value in

aiding recovery in ways not facilitated by

talking therapies alone.

Funding

This research received no specific grant from any

funding agency in the public, commercial, or not-

for-profit sectors.

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