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engage 30: Arts and Healthcare

Editorial

Penny Jones
Arts Consultant and Guest Editorial Advisor

How willing are those in the medical professions to engage with the arts, and what are the barriers to this? How can we work in partnership? What is the key current research into the benefits of arts and health projects, and what future research is needed in order to have an impact on policy? The contributors to this issue have responded to these questions to address a range of issues facing artists and galleries that seek to implement health projects.

Cite this article

Penny Jones
Editorial
engage 30: Arts and Healthcare
Pages 4-10
Editor: Eileen Daly, Guest Editorial Advisor: Penny Jones
Summer 2012
Published by engage, London
http://www.engage.org/article.aspx?id=38

The role that the arts can play in supporting healthcare delivery and wellbeing has been widely acknowledged and has grown in recent decades in the UK and internationally. This edition of the engage journal explores the contribution that the visual arts can make to the environment of UK hospitals and medical centres and how engagement with the visual arts can impact on the lives of patients, staff and carers. How willing are those in the medical professions to engage with the arts, and what are the barriers to this? How can we work in partnership? What is the key current research into the benefits of arts and health projects, and what future research is needed in order to have an impact on policy? The contributors have responded to these questions to address a range of issues facing artists and galleries that seek to implement health projects in medical environments or to welcome patients, carers and medical professionals into their premises. Others have explored the role of visual arts organisations in the wider world of healthcare or consider how the two sectors can work together better. The success stories all feature open, honest collaborations; the emerging messages are about an urgent need for continued exploration, research and advocacy.

Arts and Healthcare: the challenges of partnership

Despite a growing acceptance of the benefits of engagement across the arts by clinicians, medical staff, carers and patients arts in health remains a contested field. The two sectors do not necessarily share the same values, language, working methods and evaluation techniques. The world of health is very complex. Partnership development can therefore be slow and challenging.

Susan Potter elucidates the current situation. After introducing recent research studies which demonstrate that engagement with the arts has a positive impact on physical and mental health and wellbeing, she analyses the methodologies used to evaluate arts in health programmes. Quantitative, evidence-based assessment, involving the application of standard measures of impact is required by the medical profession, while arts organisations and artists, accustomed to working with risk and unforeseen outcomes, seek personal responses through qualitative methodologies.

The case studies Potter presents apply mixed-method strategies to evaluate the impact of arts interventions on three different patient groups. The studies demonstrate the willingness of arts organisations to accommodate medical evaluation strategies, as do many of the projects described here. Significantly, traffic in the opposite direction, with medical professionals acknowledging the value of alternative strategies for measuring impact, has not, until very recently, been forthcoming.

She also points out that the position of artists who work in health is often ambiguous, that this indeterminacy is often stimulating and motivating; and that the work they do does not necessarily lend itself to standard evaluation methodologies.

Ultimately Potter questions how far the drive for hard evidence is relevant to arts programmes when participant numbers are often small, when outcomes and impact vary according to the individuals involved, and whether it is ethical to impose a clinical framework upon arts practice that is not concerned with clinical outcomes. She argues that a mutual acceptance of the strengths and values of the two sectors, and a shared approach built on an expanded research programme could help to bring about the development of a ‘common language’ to enable exchange between patients, carers, artists and health professionals.

Wendy Gallagher of the Whitworth Gallery also identifies the need for a shared language having faced the challenges of building partnerships between a group of Manchester museums and the large NHS Trusts in the city. The need for reciprocal professional development for all partners was identified after the delivery of a range of projects highlighted the differences in approach between the two sectors. Staff from the museums and galleries ran taster sessions in five hospitals for staff and visitors, to demonstrate their working practices and to invite discussion and engagement. The partnership is now developing courses and workshops for medical professionals delivered in galleries, while a postgraduate certificate course at the University of Lancashire will be soon be on offer to arts professionals seeking a greater understanding of the health sector.

Another way to develop this mutual understanding and common language could be the introduction of the concepts and practices of contemporary art to student doctors as part of their medical training. Doctor Helen Smith of Brighton and Sussex Medical School and artist Anna Dumitriu have worked together for four years delivering a one-term accredited, elective course, Creative Communication: Art and Medicine. It enables student doctors to explore the different approaches of art and medicine to the issues of enquiry and communication by making artwork that references their medical studies. Anna Dumitriu describes how the course sets out to question students’ assumptions about the art versus science paradigm and develops observation and enquiry skills. She points out that these young people could well be the art, science and health collaborators of the future. But Dr Smith, the only medical professional represented here, states that despite the acceptance of the value of the acquisition of clinically relevant skills and experience, and the personal and professional growth achieved through arts and humanities courses, she believes that for the medical establishment ‘further evidence of the impact is needed to ensure their continued inclusion in an increasingly crowded medical curriculum’.

Galleries and museums as sites for healthcare projects

The adoption of a research culture has been central to the delivery of healthcare programmes by galleries and museums, not only to measure efficacy for participants but also to interrogate the contribution of art and galleries. Is there something special or unique that galleries and museums bring to support healthcare?

There is a tendency for the gallery to be represented in health projects as a place of solace and safety, where educators and artists mediate between art, object and participant, and provide opportunities for enrichment and therapy through self expression, discussion and social engagement. However the reality is more nuanced and challenging. How do the multiple identities embodied by galleries impact on the way health programmes are delivered and perceived?

The gallery as a site of safety

Sarah Plumb, while acknowledging that the gallery is not a neutral site in terms of its social and cultural context and agency, describes a programme where Modern Art Oxford functioned as a ‘neutral territory’ allowing two marginalised groups to meet together in an intergenerational project. The gallery, she suggests, was a space where dementia sufferers, their carers and young people not in education, employment or training (NEET) were able to meet, work with artists and art, access support and develop in ways that may not have been possible within the usual social, medical or educational contexts that define them as problematic.

Enabling access to a museum, a public space from which some people, patients and their carers, feel they are excluded, was a key factor in the development of the ‘Beyond Words’ project at the Fitzwilliam Museum. Joanna Holland and her colleagues discuss ways in which training for staff, volunteers and carers enabled dementia sufferers and their care partners to visit the museum with increasing confidence and a sense of belonging. With staff trained to work with the dementia sufferers, carers ‘were able to step away from their normal caring roles and concentrate on their own museum experiences.’ Like the patients they were able to engage with artworks and gain a sense of ownership of the museum that could eventually lead to independent visiting.

But Colette Neal questions some of the assumptions about the value of galleries and museums as sites for healthcare delivery in an analysis of the research relating to a mental health improvement programme delivered in four Welsh museums and galleries. While her research corroborates the findings in the literature that activities in museums have a positive impact on some patients by providing beautiful surroundings, opportunities for heightened observation, artistic activity and a reconnection with their own and a collective past, she points out that other participants had adverse reactions to historic buildings or collections. Creative activity in museums does seem to have a significant beneficial effect on people suffering from mental distress but she questions whether this is a result of the setting, the activities or a combination of the two; and if it is in fact possible to privilege the museum or gallery as a site for this kind of work over the many other possible arts sites.

If it cannot be argued that there is anything intrinsically beneficial about participating in the visual arts above other artforms, what privileges galleries and museums above other arts sites, must be their accessibility, often free to visit, and their active policies to engage with and support patients, their carers and the health service.

The gallery as a site of enquiry

In contrast some galleries or art spaces define themselves as sites for socially and politically engaged activity, enabling artists to work with others in a process of collaborative enquiry to analyse, critique and respond. Louise Shelley describes an ongoing programme, ‘Not Our Class’, at Studio Voltaire which interrogates the work of Jo Spence (1934-92). The patient’s viewpoint, her body image, the ‘medicalisation’ of the individual and her position within medical, social and political hierarchies was the subject of Spence’s later work. The artist, photographer, and self-styled cultural worker, who through her art addressed the cancer and leukaemia she experienced, critiqued the treatment she received in 1980s and early 90s. ‘Not Our Class’ explores these themes in the contemporary context. Three artists are engaging with different groups to explore a range of issues raised by Spence, which continue to resonate at the political, social and personal level today.

To investigate issues of voice and reciprocity, and the ways in which art stimulates communication Michèle Fuirer and Sheila Grandison planned and delivered ‘Drawn to Dialogue’, an enquiry into the nature of conversation in the gallery, as part of Tate Modern’s Community Learning programme. The project brought together two groups of participants with communication difficulties from within the Community Learning programme. It took place over three weeks and used making and words to discuss artworks.

The gallery as a site of research

The gallery as a site in which patients, carers, medical staff and artists cooperate in research is an increasingly familiar scenario with which the arts sector courts the medical sector in its bid to demonstrate the value of partnership working for patient wellbeing, and by which it seeks to influence policy that will lead to a greater involvement by artists and galleries in healthcare. How can two seemingly incompatible practices – the arts which encourage risk taking and a risk averse health sector, work together?

While Angela Rogers and Alice Briggs describe the aims of their work in galleries in Wales with dementia sufferers as enabling creative activity, enhancing self esteem and confidence, and increasing social interaction, the strategies employed to facilitate this involved intellectual and physical challenge for all involved. The achievements of the participants required adjustments in their carers’ perception of dementia sufferers and their potential, and forced a reconsideration of the ways in which patients can be stimulated and supported through the arts. They hope that a legacy of the programme will contribute to policy change effected through further research into the impact of visual arts interventions on dementia. The research is informing a bid to the Arts and Humanities Research Council by three universities to ‘contribute towards the creation of dementia supportive communities through ground breaking arts interventions.’ One of these universities is Newcastle University, where Anna Goulding and Andrew Newman set out to investigate the impact of engaging with contemporary visual art in galleries by older people, not with dementia, but who had a range of cultural engagement histories. Taking a changing sense of identity construction (a process that may contribute to wellbeing) and the development of social capital as evidence of impact, they explore the barriers to, as well as the contribution of, engagement with the arts for wellbeing and suggest ways in which this research could influence healthcare policy and practice. Outcomes of the research include the development of new strategies for engaging with older people by partner galleries and ultimately, training for artists and carers.

Enhancing the environment

The most visible contribution made by artists and designers in healthcare is to the environment in hospitals and health centres. The impact of these works – both temporary and permanent – is long-lasting. To ensure a sense of ownership, commissions are increasingly implemented in new build and refurbishment programmes in consultation with staff, patients and carers.

Guy Noble responds to Grayson Perry’s comment ‘If hospitals want to use art, please can they treat us as adults? Part of healing might be facing up to the realities of being stuck in a fallible body’. He suggests that for the outcomes to be meaningful (rather than the anodyne decorations often associated with hospital art), risk is necessary in the seemingly risk-averse hospital. Noble describes the inclusive process that brought a sense of ownership to patients and staff, of a series of new commissions at University College London Hospital Cancer Centre. An acknowledgement of the sense of the depersonalisation or ‘medicalisation’ experienced by patients and the attempt to collaboratively address it was problematic but eventually enabled bold outcomes. Patients suggested challenging themes including survivorship, journeys, community, fear and hope. Through patients and artists’ dialogue, complex works were made that referenced patients’ lives and their individuality as well as their illnesses.

In her description of the series of commissions at the Royal London Children’s Hospital Sarah Carrington states that as a commissioner she seeks to ‘strike a balance between respecting and listening to clinical concerns for an environment, and surprising expectations of what art might look like within a safe, clinical setting’. She also describes a series of commissions for wards and public circulation spaces that involved collaborations between between artists and young patients, and between artists, for example, poet Lemn Sissay and designer Morag Myerscough. She says that although art and design cannot heal by themselves ‘they can restore a sense of connection to the world through materials, text or by creating alternative views out’.

In a process that extends the idea of connection and collaboration, artists Sue Ridge and John Davies describe the ways in which they interacted with the public to generate responses that were integral to the completion of two commissions for acute hospitals. Exploring narratives about hospital life, the projects reflected the experience of the hospital users who engaged with the artists. A shed placed in public areas acted as a hub that drew people in to interact through conversations, notes, questionnaires, poems and sketches. The completed artworks were assembled from the many voices and experiences accessed through this interaction and validated the component individual, community and historical narratives.

Discussion

The projects described in this journal must be seen in the current political and social context. Health and social services facing reduced funding, in an uncanny echo of the situation experienced by Jo Spence (Shelley) and fewer opportunities to undertake cultural projects independently, may well be increasingly open to partnerships with visual arts organisations that offer supporting or additional services. But the sustainability of much of the work described here is questionable given the short-term nature of project funding and the squeeze on health and arts budgets.

Issues around the standard of the arts involved in healthcare programmes are touched on by Sarah Plumb, Guy Noble and Sarah Carrington. It cannot be assumed that the artistic or social values that inform arts interventions in healthcare settings are artists would question a doctor or nurse’s expertise, many medical professionals and members of the public have opinions about the value of the arts. Arts managers, commissioners and artists have to justify themselves and their work on a regular basis.

Despite the challenges, ongoing research and the emergence of new mixed-method evaluation models applicable across all art forms and in community and medical settings have resulted in a growing recognition of the contribution of the arts to wellbeing and healthcare. The need for balance and reciprocity have been recurring themes in these articles. In order to ensure that the role of the arts in health and wellbeing remains strong, the health services need encouragement to move some way towards an acceptance of the practices and processes involved in the arts. Perhaps the incorporation of the arts in medical training (Gallagher, Smith, Dumitriu), or the collaborative projects described here will increase the dialogue that will enable the arts and health sectors ‘to understand each other, work to their strengths and identify common ground in order to work together effectively.’ (Potter).

 

Penny Jones is a freelance arts consultant with expertise in gallery education and arts in health. She was manager of an Arts in Health programme at a Sussex hospital from 1999-2011.

 

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References

Matarasso, F (1997) Use or Ornament? The Social Impact of Participation in the Arts. Comedia

White, M (2009) Arts development in Community Health: a social tonic. Radcliffe

Wood, C (2009) Museums of the Mind. Culture Unlimited

Five ways to wellbeing: http://neweconomics.org/projects/five-ways-well-being

London Arts in Health Forum: www.lahf.org.uk/

National Alliance for Arts and Wellbeing evaluation
resources: www.artshealthandwellbeing.
org.uk/resources/research/search?keys=evaluation&tid=All

 

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