“Removing the thorns”: the role of the arts in recovery for people with mental health challenges

Self-perceived relations between artistic creativity and mental illness: a study into lived experiences

Aim

To explore the self-perceived relationships between experiences of creativity and mental illness and to understand the meanings behind these relationships.

Background

The idea that mental illness and artistic creativity are somehow related dates back to ancient times. There is some evidence for an actual correlation, but many questions remain unanswered on the nature and direction of the relationship. Qualitative contributions to the debate are scarce, and mainly focus on the potential benefits of participation in the arts for people with mental illness.

Design

An explorative, interpretive study.

Methods

Twenty-four professional and semi-professional artists with self-reported experience with mental illness, were recruited purposively. Unstructured in-depth interviews were conducted and transcripts were subjected to interpretive analysis, guided by a hermeneutic phenomenological frame.

Results

Participants experience a range of interactions between artistic creativity and mental illness. Three constitutive patterns describe what these interactions look like: "flow as a powerful force"; "ambiguous self-manifestation"; and "narrating experiences of suffering."

Conclusion

The findings show that both the concept of creativity and the concept of mental illness, as well as their interrelationships, are layered and complex phenomena that can take on different meanings in people's lives. The findings provide starting points for further research that goes beyond the polarized academic debate. Understanding the experiences of artists with mental illness can help shape the role of art in public mental health and mental health care.

Creative activities as intervention: experiences of well-being and satisfaction with daily living in a mental health context

PURPOSE

This study aimed to explore to what extent and in which way people with severe mental illness experience well-being, performance, and satisfaction with daily living when participating in creative activities as intervention.

MATERIALS AND METHODS

A sequential mixed-methods design was applied. Data was obtained at two measurement points two-three weeks apart using the WHO-5 questionnaire and COPM questionnaire from a sample of 33 participants participating in interventions with creative activities. In addition, eight of the participants took part in qualitative semi-structured interviews, and data was analysed using content analysis on a manifest level. The quantitative data was processed using descriptive statistics, paired t-tests and Kendall's tau-b for correlations.

RESULT

Participation resulted in improved self-rated well-being (17. 70. p < 0.0001), self-perceived occupational performance of daily living (1.40, p = 0.001), and satisfaction with occupational performance (2.05, p < 0.0001). The changes in well-being and daily living were explained by a work-like content and structure, positive intrapersonal and social acceptability experiences, and greater self-esteem due to the experience of being an artist.

CONCLUSION

This study contributes with knowledge about participation in creative activities as intervention even for a short period enables well-being, and performance and satisfaction with daily living for people experiencing severe mental illness.

Men's mental health and the arts: perceived benefits and dynamics of engagement

Arts engagement is gaining recognition as a non-clinical approach to promote mental health and well-being. However, the perceived utility of the arts to promote mental health among men with low socioeconomic status (SES) and how to best engage them is underexplored. This study explores the lived experiences of men with low SES who engage with the arts in Northern Ireland (n = 41). Data collected via focus groups (n = 5) and interviews (n = 11) were analysed using reflexive thematic analysis to inductively derive four themes. Theme 1 highlights how the arts facilitated friendship, a collective identity, peer support and a reason to socialize. Themes 2 and 3 explore how the arts enhanced self-esteem and emotional regulation by developing a routine, purpose, sense of mastery, a sense of catharsis through immersion in a soothing endeavour and an alternative outlet for self-expression. Theme 4 covers strategies that facilitate male engagement in the arts such as using a familiar space, delivering to an existing male group, framing the programme around male interests not health or creativity, building on existing strengths and capacities, enabling ownership, using tangible action-orientated activities, and being non-authoritative and flexible with delivery. This is one of the first studies to highlight the gendered dimensions in which men with low SES engage with and experience mental health benefits through arts engagement. This study points towards relevant theories to further understand the pathways between the arts and improved mental health among men which can inform development of tailored arts programmes for men.

Performing Arts in Suicide Prevention Strategies: A Scoping Review

Suicide is a leading cause of death all over the world. Suicide prevention is possible and should be pursued through a variety of strategies. The importance of the arts for positive health outcomes has been increasingly evidenced. This scoping review aimed to identify the possible role of the performing arts-defined as a type of art performed through actions such as music, dance, or drama executed alive by an artist or other participant in the presence of an audience,-in suicide prevention programs. PubMed, Embase, PsycINFO, CINAHL, ProQuest Psychology Database, Scopus, and Web of Science were searched using terms in English for publications of original studies that included performing arts in suicide prevention programs. Thirty-five studies conducted between 1981 and 2021 were identified, of which only five were randomized clinical trials and four quasi-randomized studies. Interventions used different performing arts to improve awareness, self-efficacy, and soft skills relevant to suicide prevention. Studies were addressed mainly to gatekeepers but also directly to at-risk populations. While the study designs do not allow inferences to be drawn about the effectiveness of performing arts in preventing suicide, the review found that performing arts have been successfully implemented in suicide prevention programs. Research to evaluate the possible therapeutic benefit is warranted.

Community and cultural engagement for people with lived experience of mental health conditions: what are the barriers and enablers?

Background

Community and cultural engagement can support recovery, help symptom management and increase social connections for people with lived experience of mental health conditions. However, research suggests that people with mental health conditions experience significant barriers to participation. The aim of this study was to explore barriers and enablers of participation in community and cultural activities among people with mental health conditions.

Methods

A qualitative interview study with 23 people with mild-to-moderate mental health conditions was undertaken. Data were analysed thematically, and themes were mapped to domains of the Capability, Opportunity and Motivation Model of Behaviour (COM-B).

Results

Eleven themes were identified from the analysis. Three themes involved participant Capability: physical skills, psychological traits and physical health limitations and three themes related to Opportunity: affordability and accessibility, structure and nature of the group, and support from others to attend. Five themes mapped to Motivation: creative identity, recovery and coping, enjoyment and fun, connecting with others, and information and planning. Participants were motivated to engage with community and cultural activities through “a creative identity”, belief that engagement would help recovery from mental illness, and a desire to connect with others and make friends. Motivation to participate was sustained by the enjoyable nature of activities. However, participants’ ability to engage was hampered by the expense, inaccessibility and sometimes unstructured nature of activities, and social anxiety associated with attending. Some participants had physical limitations such as fatigue or physical health problems to overcome. Interventions that could address these barriers include peer support, training for social prescribers to account for identity and previous experiences of participation, training for community organisations in providing a welcoming and structured environment, and provision of long-term sustainable funding to community organisations to subsidise attendance, transport or equipment costs.

Conclusion

People with mental health conditions may be at risk of experiencing barriers to community and cultural engagement due to existing social inequalities and social anxiety, however believing that involvement will support mental health was an enabler to participation. Future studies are needed to test the effectiveness of potential interventions to address the barriers and harness the facilitators identified here, to enable a more socially inclusive community and voluntary sector, and a potentially more responsive and effective social prescribing service in the UK for people experiencing mental health problems.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-022-00775-y.

Transformation from Marginalization to Society's Agent: A Narrative Inquiry on Experiences of Art Activity among People with Mental Illness

Using in-depth interviews, this study identified the experiences of five people with mental illness who participated in art activities. Findings indicated that the life journey that led to the participants' art activities and the impact of these activities in their lives were different and unique. The voices of the individuals with mental illness who participated in this study provided deeper understanding of how art activities have changed their lives. In addition, it was confirmed that art activities in which people with mental illness participate, bring positive inner changes and have the potential to improve their interpersonal relationships and social interactions.

The acceptability, effectiveness and gender responsiveness of participatory arts interventions in promoting mental health and Wellbeing: a systematic review

Background:This mixed methods review synthesizes the evidence of acceptability, effectiveness and gender-responsiveness of participatory arts interventions (PAIs) in promoting mental health and wellbeing among adults. Methods: The search was restricted to empirical studies of PAIs that reported on outcomes relating to common mental health problems and wellbeing among adults aged ≥18 years old. The mixed methods appraisal tool was used for quality appraisal. A narrative synthesis was conducted. Results:Thirty-two studies were included (1,058 participants). Typical PAI features are discussed. The evidence for effectiveness is limited by methodological issues. PAIs are perceived to benefit mental health via improved connectedness; emotional regulation; meaning-making & re-defining identity; and personal growth & empowerment. Conclusion: The review highlights the dearth of studies focused on men. Research standards to establish the evidence of effectiveness and the need to expand the evidence of acceptability beyond the "perceived effectiveness" domain are discussed.

Differential participation in community cultural activities amongst those with poor mental health: Analyses of the UK Taking Part Survey

Rationale. There is a growing literature on the benefits of arts and cultural engagement for mental health. However, whether poor mental health is a barrier to engaging in cultural activities remains unclear. Objective. To identify whether there are differential participation rates in community cultural activities amongst those with differing levels of mental health (specifically, feelings of anxiety and happiness) and identify potential explanatory factors. Method. We analysed data from 7241 participants in the Taking Part survey; a random face-to-face household survey conducted in England (2016–2017). Cultural engagement was measured using a four-factor variable of cultural participation derived from assessing annual attendance at 21 receptive cultural activities. Mental health was measured using two of the Office for National Statistics measures of subjective wellbeing: happiness and anxious feelings. Analyses were adjusted for demographic, socio-economic, geographic and behavioural factors. Results. There was no difference in participation amongst individuals experiencing high levels of anxious feelings, but individuals experiencing low levels of happiness were less likely to engage in ‘popular’ cultural activities (e.g., live music events/cinema), ‘high art’ cultural activities (e.g., opera/ballet), and crafts and literary cultural events (e.g., exhibitions/book fairs). Education and socio-economic status largely explained differences, but for ‘high art’ and ‘popular’ activities, differences persisted independent of all explanatory factors tested. There was no difference in participation in global cultural activities (e.g., festivals). Conclusions. Using behaviour change theory, our findings suggest that lower levels of physical and social opportunity and psychological capability may reduce levels of cultural participation amongst individuals with low levels of happiness, but other physical and perceived barriers still remain to be explored.

•

Low levels of happiness are associated with lower levels of cultural engagement.

•

Education level and socio-economic position explain some of these differences.

•

Mental health is not associated with participation in global cultural activities.

•

High levels of anxious feelings are not associated with lower cultural engagement.

Project eARTh: participatory arts and mental health recovery, a qualitative study

AIMS

To identify the potential mental health benefits of a rural-based participatory arts programme in the United Kingdom.

METHODS

Fourteen narrative interviews were conducted among participants of the Project eARTh programme. The data were subjected to a thematic analysis process.

RESULTS

Three overarching themes were identified: identity and self-expression; connectedness through occupation; wellbeing and personal growth. The importance of meaningful relationships was highlighted as preventing social isolation, particularly in rural locations. Engagement in artistic group activities enable participants to connect with their communities.

CONCLUSIONS

Artistic activities help people to develop friendships and to engage with local communities in rural locations. Connectedness to people and places were valued by participants as part of their personal growth. The groups empower people to experience increased confidence and identities beyond illness narratives. Artistic group activities can benefit the mental health of participants in rural locations.