Community-based theater and adults with psychiatric disabilities: social activism, performance and community engagement

Coproduced, arts interventions for nurturing care (0-5 years) in low-income and middle-income countries (LMICs): a realist review

OBJECTIVES

Community-based arts interventions have the potential to support contextually relevant nurturing care programmes and policies that adapt to different settings. Understanding the distinctive features of using the arts in local, culturally specific ways in low/middle-income countries (LMICs); how this varies by context; and gaining a better understanding of the perspectives on desirable outcomes for communities is important evidence that this review generates.

DESIGN

We conducted a realist review of papers that covered outcomes related to child health or development (0-5 years) AND arts-based approaches AND community-based, participatory approaches AND based in LMICs using a range of databases and other networks. A coding framework was developed covering context, intervention, outcomes, mechanisms, study, sustainability, transferability and scalability.

RESULTS

The included papers reported 18 unique interventions. Interventions covered 14 countries, with evidence lacking for South America, Arab countries and parts of Africa. Lead authors came from mostly clinical science-based disciplines and from institutions in a different country to the country/countries studied. Intended outcomes from interventions included clinical, health systems/organisation, changes in practices/behaviours/knowledge/attitudes, and wider social and educational goals. We identified three demi-regularities (semi-predictable patterns or pathways of programme functioning): participatory design based on valuing different sources of expertise; dynamic adaptation of intervention to context; and community participation in arts-based approaches.

CONCLUSIONS

Our findings suggest that arts-based, nurturing care interventions have greater potential when they include local knowledge, embed into existing infrastructures and there is a clear plan for ongoing resourcing of the intervention. Studies with better documentation of the lessons learnt, regarding the intervention delivery process and the power dynamics involved, are needed to better understand what works, for whom and in which contexts.

The Performative is Political: Using Counter-Storytelling through Theater to Create Spaces for Implicated Witnessing

Performative counter-storytelling can be a powerful experience for both the artists who create these stories and the audiences who witness them. This study examined audience responses to a counter-narrative (entitled "AMKA") performed by Africans in Australia which intended to present more complex, holistic, and strengths-based representations of their communities than those currently circulated by dominant discourses. Guided by a critical whiteness lens, the study explored how 34 self-identifying white audience members interpreted the performance and how they questioned whiteness by assuming the role of implicated witnesses. Following thematic analysis of mixed closed- and open-ended post-performance survey responses, audience members made connections between the content of AMKA and the contemporary political and cultural contexts in which it was performed and began to examine their positions of privilege and power. This study has provided evidence for the potential of political theater in creating spaces of encounter whereby responsible listening positions can be nurtured in the journey toward dismantling personal, and potentially structural, racially-based injustices.

"We're All in the Same Boat" - The Experience of People With Mental Health Conditions and Non-clinical Community Members in Integrated Arts-Based Groups

In recent decades there has been a significant increase in community rehabilitation programs for people with mental health conditions. One such nationwide programs is Amitim in Israel whose mission is to foster the psychosocial rehabilitation of people with mental health conditions in the community. Amitim’s flagship program consists of arts-based groups that integrate participants with mental health conditions and non-clinical community members. To better understand the experiences of participants in these arts-based groups, five focus groups were conducted with participants from 15 integrated arts-based groups. In total, 17 people with mental health conditions and 21 non-clinical community members were interviewed for this qualitative study. Three main themes emerged from the thematic analysis: creation and expression through the arts promote well-being, self-disclosure in a safe space encourages a sense of belonging, and “we are all in the same boat.” The participants underscored the role of creation and expression through the arts in facilitating emotional expression, self-discovery, interpersonal communication, and spiritual elevation. The findings suggest that the facilitators should instill a sense of equality by enabling intergroup acquaintances without labeling participants’ mental health status. Integrated arts-based groups should be accompanied by a mental health professional who can contain and work through complex emotional situations when needed. Arts therapists who specialize in both arts and mental health are particularly suitable for this role. Overall, the interviewees reported that participation in the integrated arts-based groups positively impacted their personal recovery processes by providing a corrective experience of equality as well as enhancing a sense of belonging to the community and social relationships. The participants also reported being empowered by the final artistic event that not only enhanced their sense of visibility, competence, and aspirations for future development in personal, interpersonal, and artistic realms, but also helped to combat both self- and public stigma.

Stigma correlates in individuals with mental health conditions versus community members enrolled in a nationwide integrated arts-based community rehabilitation program in Israel

Two of the most prominent challenges faced by people with mental health conditions (MHCs) are experiencing stigma and personal recovery. This study focused on the analysis of baseline data from registrants for integrated arts-based groups in a nationwide psychosocial rehabilitation program in Israel. The aim of the study was to examine the possible associations between self-stigma, personal recovery and creative self-efficacy (CSE) in people with MHCs, and the associations between public stigma, desire for social distance, familiarity with mental illness and CSE in community members. Cross-sectional data were collected by online survey software in October-November 2017 from 114 people with MHCs and 117 community members who enrolled in 15 integrated arts-based groups, and 68 people with MHCs who were not enrolled in integrated groups. The main findings suggest that individuals with MHCs who reported high self-stigma also reported a low sense of personal recovery and low CSE. The CSE of those with MHCs correlated positively with their personal recovery. Among community members, high public stigma was associated with a greater desire for social distance in women, but less contact with MHCs in men. Individuals with MHCs who had previously participated in integrated arts-based groups reported greater personal recovery than those who had not. Community members reported higher CSE and public stigma than the CSE and self-stigma of individuals with MHCs. The findings help characterise both individuals with MHCs and non-clinical community members who decide to enrol in integrated groups, as well as individuals with MHCs who chose not to enrol, enabling similar community-based programs to better identify their conditions and meet their needs. Future research should examine the contribution of integrated arts-based groups to promoting recovery and reducing stigma.