Testing the reality of arts-led interventions in the NHS

Find out how and why a series of arts-led ‘proof of concept’ projects happened in three NHS children’s mental health services in Greater Manchester, through formal partnerships between local arts and cultural organisations and NHS teams.

All projects are now completed and we are so grateful, in a challenging year, to everyone involved for their dedication – and creativity!

Header image by Odd Arts.

Who are we?

Three teams have in 2020 – 2021 delivered a series of arts-led interventions to children and young people accessing NHS Child & Adolescent Mental Health Services, (CAMHS) or Healthy Young Minds, across two NHS Trusts: Pennine Care Foundation Trust and Greater Manchester Mental Health Foundation Trust. The projects were enabled by funding and support from GM i-THRIVE and Great Place.

The children and young people were either open to the service or on the waiting list, and consented to participating in creative and arts-led approaches. Sessions were co-delivered by NHS mental health and arts professionals in various settings, including NHS premises, off site at arts provider’s sites, and online.

The three projects were:

Bolton CAMHS with Odd Arts and Bolton Lads and Girls Club: Wellbeing Theatre

Tameside & Glossop Healthy Young Minds with GAP: Glossop Arts Project

Stockport Healthy Young Minds with Arc: ArtSpace

Why did we do this?

There is promising evidence that arts engagement can support wellbeing in young people. There is strong evidence that music supports speech and language in infants, while wider arts and reading can support the further development of language in children.

There is currently some evidence, but little of it conclusive, that the arts can support in the management of poor mental health for young people and in clinical populations. However it is widely acknowledged that this lack of certainty appears to be driven by a lack of research, rather than null findings, and the wider literature indicates a range of roles for the arts and culture in health.

With growing interest in social prescribing, and the strengths-based model of THRIVE which attends to the whole system around a child, it is important to develop innovative ways to broaden the mental health offer in an evidence-based way, and with the expertise of everyone involved.

What do children and young people say about the arts and health?

Watch this five minute film Well? by Modify Productions to hear from young people in Greater Manchester.

How: Developing partnerships

To begin, we sought Expressions of Interest from NHS providers to work collaboratively with local cultural organisations to develop and deliver arts-led interventions for children seeking mental health support. The terms required that all sessions included a mental health professional, and secured expectations for supervision and Governance of the project using a Service Level Agreement. We also required that each project team make use of the new GM Youth Mental Health Arts and Culture Evaluation Kit so that the feasibility of this tool could also be tested.

The teams met prior to beginning to help prepare and manage expectations, and together as a group at various points for support and troubleshooting.

Aims of the proof of concepts

• To develop a process for partnering arts and cultural providers with NHS children’s mental health services:
  – develop shared language and procedures acceptable to all parties
  – develop and agree formal service level agreements
– identify what works well, as well as challenges and solutions

• To deliver arts-led interventions using the expertise of all partners:
– Increase knowledge of cultural options within NHS teams
– Manage processes such as recruitment and attendance together
– Co-deliver sessions that utilise mental health and creative support

• To evaluate, articulate value and share learning
  – Use of shared language and understanding to facilitate evaluation
– Make use of the evaluation method using standardised & qualitative tools
  – Encourage reflection and learning for future projects and programmes

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How do we know if these types of sessions are effective?

The purpose of these projects was to test the feasibility of partnerships between clinical services and cultural and arts partners, in order to support larger-scale work on effectiveness.

We can say such partnerships come with challenges but are possible, and we have a rich set of materials from across the three projects to inform further work. One unexpected outcome is that some teams will continue post-completion date, which is one good indicator of their value.

Experientially, all partners gave positive reports about the process and the impact on young people. We did see increases in wellbeing across time, and feedback from the participants themselves was positive, but the numbers of participants were not enough to give the statistical power needed to draw any conclusions.

Of course we were also testing the practicalities and user experience of the new GM Youth Mental Health Arts and Culture Evaluation Kit. The Kit was co-designed (with arts providers and Arts Council England, and I’ve posted about this process previously) to support organisations to understand and apply the common metrics used in the NHS, and by commissioners to make decisions. The kit also supports collection of qualitative and creative outcomes. In addition teams used reflection tools and recorded issues managed along the way.

Similar work

If you’d like to understand more about these types of approaches, Hampshire CAMHS with Hampshire Cultural Trust have concluded a three-year programme of brilliant cultural options for children and young people. Find out more here.

Closer to home for me, More Music have been running a singing group with mental health support, Sing it Out, to which we can refer from Lancaster and Morecambe CAMHS. I’ve seen anxious and shy young people transform to give striking public performances through this group!

Ludas Dance in Lancaster engage young people through the medium of dance and have just recieved a BBC Children in Need grant to continue State of Flux, which uses the arts to support soft and hard skills development, reduce social isolation and develop self -worth and aspirations in young people in inpatient services in Lancashire.

What next?

On the GM i-THRIVE website the implementation story of these proof of concepts will soon be available. You can already read implementation stories on arts-led options outside the NHS there. We are working across our team, wider colleagues in GM, and nationwide to share and build on this learning in a variety of ways. I’ll keep you posted!

I like to acknowledge that cognitively, a key feature of creativity is problem-solving. As a member of the NHS I firmly believe that culture and the arts, and artists, have roles beyond delivering sessions in system transformation and that their expert and different approach can help us think creatively about some of the challenges we are facing. These projects are just one part of the broader Arts, Culture and Mental Health Programme which is developing the ways in whcih we see and make use of the myriad roles the arts should – and do – play in our health and wellbeing, and the systems that support that.

Become an Arts, Culture and Mental Health Ambassador:

If you would like to receive free monthly resources on arts and health, access to training in collaboration with 42nd Street (whether you’re a health professional or an artist), and support to embed thinking, evidence and practice where you work, join us! Become an Arts, Culture and Mental Health Ambassador.