Art for health - the social perspective

Mental Health Nursing, May 2003 by Argyle, Elaine

The therapeutic use of the arts within mental health practice is often associated with Freudian analysis and verbal psychotherapy. However, the benefits to be gained from more socially orientated 'art for health' projects have been relatively neglected. This study by Elaine Argyle seeks to help redress this neglect by examining a project involving the use of art as an intervention tool with groups identified as being at risk of mental health problems

The Acheson Report, 'Inequalities in Health' (Department of Health, 1998) and the government's public health strategy, 'Saving Lives: Our Healthier Nation' (Department of Health, 1999), recognise that solutions to major public health problems require interventions which cut across agency and disciplinary boundaries and which take account of the social, cultural, economic and physical environments which shape people's experiences of health and well-being.

As part of this commitment to holistic approaches in the promotion of health, the use of the arts has been widely adopted to enhance the sense of self-worth, achievement and creativity amongst groups at risk of mental health problems and as a therapeutic activity in its own right (Liebmann, 1990). This growing popularity of art in health promotion has been reflected in the recent proliferation of art for health projects around the country, with the National Network for Arts signing up 350 new members since its launch in the year 2000 (Lewis, 2001).

Despite these developments, most research into the effectiveness of art-based interventions has tended to focus on psychotherapeutically orientated forms of art therapy in which art work is typically coupled with Freudian analysis and verbal therapy (Naumburg, 1966), rather than on socially orientated 'art for health' projects.

Focusing on a one-year project funded by Rotherham Health Authority and organised in collaboration with Rotherham Council helps to redress this neglect. It provided weekly art sessions for a period of around 10 weeks to groups in the local community, which had been identified by the National Service Framework for Mental Health (Department of Health, 1999) as being 'at risk' of developing mental health problems.

The participants

Three 'at risk' groups were identified as eligible and willing to take part in the project. The first was a single parents support group, a long established and close knit group with a stable membership of around 10 women. The second group was a drop-in centre run by a Christian based organisation, serving a large and transient membership of around 600 men and women who experienced a variety of problems including substance abuse, schizophrenia and chronic depression. The third group was a support group targeted at teenage parents. It had six regular female attenders and a few more transient members.

Despite the diverse characteristics of the groups involved, many participants shared common concerns. Financial problems were one concern with the majority of project participants reliant on state benefits. Even the minority with jobs experienced money problems due to low pay. Previous research has highlighted the close relationship between ill health, disability and material deprivation (Department of Health, 1998). In accordance with this, a significant number of participants claimed to suffer from a disability, others experienced long-term physical health problems with subsequent implications for their quality of life. Mental health problems were also an issue for participants. For example the single parent group members felt that they were vulnerable to such problems primarily because of the stress, which they experienced as a result of their childcare role.

The presence of social support has been identified as being an important aspect of 'social capital' and an important factor in reducing the risk of mental ill health. For example, while the occurrence of adverse life events have been closely associated with the incidence of depression (Paykel, 1978), the impact of these adverse life events is likely to be felt less keenly if the individual has access to supportive social networks (Brown and Harris, 1978). This is due, not only to the I practical support provided by such networks but also to their provision of emotional support and 'fund of sociability' (Mangen, 1982). However, contrary to the mutually supportive portrayals of working class life traditionally espoused by sociologists, (Young and Willmott, 1962) recent research has suggested that relatively deprived social groups may be less well endowed with such support than their better-off counterparts (Oakley and Rajan, 1991). In accordance with this suggestion, many participants claimed to lack this support, thus increasing their vulnerability to mental health problems. The single parents felt that this was due to the fact that they lacked a partner. They also felt themselves to be ostracised and stigmatised by the wider community, an experience which was shared by the teenage parents. More overt forms of social marginality were apparent among drop-in centre members, many of whom were homeless.