arts and health practice in healthcare CAMHS Child & Family Psychology iTHRIVE pandemic social prescribing

Lessons from arts-based projects for young people seeking NHS mental health support

The GM i-THRIVE Arts, Culture and Mental Health programme series of proof of concepts are now available as a downloadable case study from Great Place. Great Place GM was a 3 year action research programme led by Greater Manchester Combined Authority from 2018-2021, concluding this month with a series of online events and case studies and the launch of the final report.

Great Place aimed to demonstrate the contribution of culture and creativity to health and wellbeing, community and place. This was achieved through innovative partnerships and new ways of working, under numerous strands of work including aging well, place shaping and diversity and inclusion.

“What we’ve achieved is to demonstrate that culture and creativity contribute to dynamic and healthy communities and can help address social and health inequalities. But culture isn’t just a tool for change, it shapes our places, develops us as humans and is an essential part of the life force of the city region.”

Julie McCarthy
Great Place GM Programme Manager

Children and young peoples’ mental health

Of those young people who are seen by current mental health services, around 1 in 2 will reliably recover. We know that 1 in 10 will worsen. What can we do about these limitations in effectiveness? We do know that creative interventions and arts engagement can improve mood, confidence and self-esteem, and arts engagement as a positive impact on mental health.

However, mental health services commission very little arts activity.

The national system transformation programme known as THRIVE aims to improve outcomes by broadening the clinical offer, increasing patient choice, and improving access and engagement. Towards assets-led and evidence-based approaches, Greater Manchester’s i-THRIVE is the only team nationally to include an Arts, Culture and Mental Health Programme as part of their offer.

Towards an inclusive arts-based mental health service

GM i-THRIVE’s Arts, Culture and Mental Health Programme was established in order to 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.

There exists promising evidence that arts engagement can support wellbeing in young people, and that creative interventions can improve mood, confidence and self-esteem. The wider literature indicates a range of positive outcomes for young people’s mental health when they take part in arts and cultural activity, but there is currently a lack of, and only inconclusive research, into the role of the arts in supporting the management of poor mental health for young people.

Our approach

In partnership with Great Place,we worked with arts organisations, the voluntary sector and commissioners to develop several ‘proof of concepts’ exploring the feasibility of embedding arts-led provision within existing care pathways. 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. You can read about the development of these projects, including Governance and other formal processes, here.

The three 12-week proof of concept projects took place within three services in Greater Manchester. For example, Bolton Child and Adolescent Mental Health Service worked with Odd Arts and Bolton Lads and Girls Club Wellbeing Theatre Group. These sessions explored the concept of wellbeing using games, discussion and role play and led to an interactive Forum Theatre performance.

Photo from Glossop Arts Project

‘[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

Evaluation

At the beginning of the programme, it became evident that some arts professionals felt that they lacked the confidence and tools to assess, record and report on the outcomes of their work. Moreover, many organisations are not aware of the metrics collected by the NHS. We therefore brought together a group to co-design an evaluation kit that would facilitate the evaluation process, and enable providers to transparently work with commissioning frameworks (you can read about the process here). Our aim was to facilitate the co-production of an appropriate evaluation method, and address one of the major barriers to the commissioning of arts-based mental health approaches.

The project required that each team made use of the new GM i-THRIVE Youth Mental Health Arts and Culture Evaluation Kit 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.

Impact and the future

All three projects were well received and continued post-funding. In Bolton, the project was supported by the service manager to continue 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 do this.

What we learned and achieved

We wished to explore the feasibility of partnerships between clinical services and arts and creative partners. We also wished to consider if and how 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 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

NHS colleagues persisted in their efforts to complete the project working within unstable pandemic restrictions. Staff made enormous efforts in very difficult circumstances and their actions demonstrates 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. A total of 21 young people took part. Whilst the project showed increases in wellbeing across time, the number of participants did not allow any statistically significant conclusions to 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, explore expectations, 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, as can the framing of the work as mental health support.
  • 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.

The wider programme

GM i-THRIVE have further tested the evaluation kit with wider system partners, and continue to offer support on its use. Over 50 organisations have now requested their Kit and this work continues.

We work across health and social care, the cultural sector and with colleagues in GM, and nationwide to continue to share and build on this learning. We aim to align this work to the recommendations set out in the recent report, A Social Glue, which sets out how culture and creativity contribute to the health and wellbeing of the people of Greater Manchester.

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

I live in Lancaster and work in Lancaster & Morecambe CAMHS as a senior clinical psychologist, and across Greater Manchester managing the new Arts, Culture and Mental Health programme with GM i-THRIVE, part of the national transformation of children's services. This blog began to help record and share my 2017 Churchill Travelling Fellowship, following a research role at Arts for Health, Manchester Metropolitan University. My work in the field of arts and well-being came about in many converging ways. As a child I was interested in emotional well-being, and worked in mental health research as a graduate. I began clinical psychology training in 2010, and for my thesis studied the role of creativity in bipolar disorder, because of the known links, and partly due to my own experiences of engaging creatively to manage extremes of mood throughout my 20s. I have worked in several university psychology research departments including the Spectrum Centre for Mental Health Research at Lancaster University, notable for its service user involvement, and on the Dementia & Imagination research programme.

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