my dissertation pdf
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THE PERSPECTIVES OF HEALTHCARE
PROFESSIONALS IN THE SOUTH EAST REGION
ON THEIR EXPERIENCE OF THE PARTICIPATORY ARTS IN
A MENTAL HEALTH SETTING
Úna Kavanagh
Masters in Arts and Heritage Management 2014
The perspectives of healthcare professionals in the South East region
on their experience of the participatory arts in a mental health setting
Úna Kavanagh
Research Supervisor: Ms. Susan Connolly, MA.
A dissertation submitted in partial fulfilment of the requirements for the degree of
Masters in Arts and Heritage Management
in Waterford Institute of Technology
29th
August 2014
I
PLAGIRISM DECLARATION
I certify that this dissertation is all my own work and contains no plagiarism. By submitting
this dissertation, I agree to the following terms:
Any text, diagrams or other material copied from other sources (including, but not limited to,
books, journals and the internet) have been clearly acknowledged and referenced as such in
the text by the use of ‘quotation marks’ (or indented italics for longer quotations) followed by
the author’s name and date [e.g. (Byrne, 2008)] either in the text or in a footnote/endnote.
These details are then confirmed by a fuller reference in the bibliography.
I have read the sections on referencing and plagiarism in the handbook or in the WIT
plagiarism policy and I understand that only submissions which are free of plagiarism will be
awarded marks. By submitting this dissertation I agree to the following terms. I further
understand that WIT has a plagiarism policy which can lead to the suspension or permanent
expulsion of students in serious cases. (WIT, 2008)
Signed: ______________________________________________________
Date: ________________________________________________________
II
DEDICATION
To Caroline, Mam, Jim and Rosie ♥
III
ACKNOWLEGDMENTS
Thank you to all in the Waterford Healing Arts Trust, especially to Claire, Mary, June and
Stefanie. I wouldn’t have a research question if it were not for Claire Meaney, my lovely
work placement mentor in WHAT, so thanks for the research ideas and setting the ball
rolling. I learned a lot about the art of editing from Mary Grehan, and her wealth of
knowledge on Arts and Health was invaluable. To June Bolger and Stefanie Fleischer who
always showed an interest and asked me how I was getting on with my dissertation. The
supportive chats were much appreciated and needed.
I would like to say a huge thank you to the interviewees who participated in this study and for
freely giving their time and sharing their experiences, even though they were all really busy.
Thank you to Fionnuala Brennan for the kind support and encouragement to our class
throughout the year in regard to our dissertations, and to all the team of staff behind the MA
in Arts & Heritage Management, especially Dr. Rachel Finnegan, the course leader.
To Susan Connolly, my research supervisor, for her approachability and flexibility in regard
to the way I work, last minute.com...ahem! You don’t know how much it meant to me that I
could work in my own way on this dissertation and that you supported that. Thank you.
To my good friend, Trisha, for her support and generosity, and for listening to me talking
about my research subject; a true friend indeed.
To Caroline, for all the help and support she always gives me, and for listening to my many
stress related rants and cheering me up and making me giggle with her insanely witty
humour. A girl couldn’t ask for a better best friend; I’d be truly lost without her. ‘Knowledge
cannot replace friendship. I’d rather be an idiot than lose you.’ ~ Patrick to Spongebob.
I am indebted to my beautiful Mother, Mary, my hero, and the most patient, good and kind
person, without whom I couldn’t have got through this year. I owe you so much and couldn’t
have done it without you.
To all my fellow classmates: Peter Brennan, Heather Haskins, Sandra Kelly, Denise Kienzle,
Kathleen Lane, Jennifer Marshall, Kery Mullaly, Michelle O’Brien, Jayne Sutcliffe and
Joanne Tuohy, with whom I had the pleasure of sharing a year of one another’s company and
who walked ‘the higher level of confusion’ road with me. If Carlsberg made classes! What a
truly wonderful group. The support and unity of our class and the endless laughs we all
shared got us through. Good times and great memories to treasure!
IV
ABSTRACT
The focus of this research is in the area of Arts and Health, and more specifically, an
exploration of the perspectives of healthcare professionals in the South East region on their
experience of the participatory arts in mental health settings, in which service users are
actively engaged in the participatory arts. The healthcare professionals are all mental health
nurses who work in different types of mental health settings, from acute inpatient hospital
services, to community health settings and day care centres.
Such a study is important in order to determine the impact of the participatory arts, if any, on
service users in the South East region, and the role of the participatory arts in mental health
settings in terms of care planning and recovery approach from the perspectives of mental
health nurses who are the primary caregivers most in contact with service users and are the
largest staff group involved in the provision of mental health care in Ireland.
The methodological research approach adopted in this dissertation was qualitative in nature
and involved undertaking a literature review, observation, and action based research in the
form of face to face, semi structured, in depth exploratory interviews. Four healthcare
professionals were interviewed to gather relevant data and the data collected was triangulated
and presented as a case study.
The findings from this study show that all research participants were unanimous in the belief
that the participatory arts benefited service users in mental health settings, and where
participation was not possible, the receptive arts provided some measure of comfort and
solace for clients.
The main conclusions drawn from this study are that the research participants are unified in
the belief that engagement with the participatory arts is important to service users in mental
health settings and should be prioritised in the development of care planning and budgetary
matters.
This dissertation recommends that there should be more collaboration between staff, service
users, artists and other relevant organisations in the delivery of an effective recovery
approach which would incorporate the arts into mental healthcare. There is room for more
thorough research in Arts and Health in terms of impact on service users, resources, funding
and cost effectiveness. There should be greater liaison between the HSE and the Arts Council
in this research.
V
TABLE OF CONTENTS
Plagiarism declaration………………………………………………………………………….I
Dedication……………………………………………………………………………………..II
Acknowledgements…………………………………………………………………………..III
Abstract………………………………………………………………………………………IV
Table of contents……………………………………………………………………………...V
List of abbreviations and acronyms………………………………………………………...VIII
List of figures………………………………………………………………………………...IX
Chapter 1 Introduction………………………………………………………………………1
1.0 Research question………………………………………………………………………….1
1.1 Rationale…………………………………………………………………………………...2
1.2 Relevance to the area of arts management and location of research………………………3
1.3 Delimiting factors for this study…………………………………………………………...3
1.4 Position of researcher……………………………………………………………………...4
1.5 Summary of chapters………………………………………………………………………4
Chapter 2 Literature Review………………………………………………………………...6
2.0 Introduction………………………………………………………………………………..6
2.1 Mental health policy in Ireland……………………………………………………………6
2.2 Arts and health policy in Ireland…………………………………………………………10
2.3 The participatory arts in a mental health setting………………………………………....12
2.4 The medical humanities in healthcare professional education……...…………………....19
2.5 Conclusion……………………………………………………………………………......22
VI
Chapter 3 Methodology………………………………………………………………….....23
3.0 Introduction………………………………………………………………………............23
3.1 Purpose……………………………………………………………………………...........23
3.2 Theory…………………………………………………………………………………....24
3.3 Rationale for choice of qualitative approach……………………………………..............24
3.4 Data description and analysis.……………………………………………………………25
3.5 Sampling strategy………………………………………………………………………...26
3.6 Reliability and validity.…………………………………………......................................27
3.7 Ethical considerations.…………………………………………………………………...27
3.8 Challenges faced………………………………………………………………………….28
3.9 Conclusion..........................................................................................................................29
Chapter 4 Findings……………………………………………………………………….....30
4.0 Introduction………………………………………………………………………………30
4.1 The value of the participatory arts in a mental health setting……………………………31
4.2 Changing attitudes to mental health in Ireland…………………………………………...33
4.3 Relevance of the participatory arts to care planning and education……………………...34
4.4 Experience and training of research participants………………………………………...35
4.5 Conclusion………………………………………………………………………………..36
Chapter 5 Discussion………………………………………………………………………..37
5.0 Introduction………………………………………………………………………………37
5.1 The place of the participatory arts as part of care planning and recovery approach……..38
5.2 Partnership with arts and health organisations.…………………………………………..39
5.3 Education of healthcare professionals……………………………………………………40
5.4 Impact of the participatory arts on service users…………………………………………41
VII
5.5 Conclusion.……………………………………………………………………………….42
Chapter 6 Conclusion & Recommendations………………………………………………44
6.0 Introduction………………………………………………………………………………44
6.1 Research objectives………………………………………………………………………45
6.2 Research limitations……………………………………………………………………...45
6.3 Theoretical conclusions…………………………………………………………………..45
6.4 Recommendations………………………………………………………………………..46
Glossary………………………………………………………………………………………48
References……………………………………………………………………………………50
Bibliography………………………………………………………………………………….57
Appendices…………………………………………………………………………………...73
Appendix A: Information sheet for research participants in interviews.……………….........A1
Appendix B: Participant informed consent form…………………………………………….B1
Appendix C: Interview questions for healthcare professionals……………………………...C1
Appendix D: Interview transcripts…………………………………………………………..D1
Interview A……………………………………………………………………………..........D1
Interview B…………………………………………………………………………………D19
Interview C…………………………………………………………………………………D32
Interview D………………………………………………………………………………....D35
Appendix E: Images from mental health documents in Australia…………………………...E1
Appendix F: Images of clown-doctors………………………………………………………F1
Appendix G: The arts and humanities in healthcare professional education………………..G1
Appendix H: Images of the participatory arts in mental health settings………………….....H1
Word count: 16,487
VIII
LIST OF ABBREVIATIONS AND ACRONYMS
AHCI Arts and Health Coordinators Ireland
AMNCH Adelaide and Meath incorporating the National Children’s Hospital
AVFC A Vision for Change
CAHHM Centre for Arts and Humanities in Health and Medicine, Durham
CAHP Cork Arts + Health Programme
HIQA Health Information Quality Authority
HPE Health Professional Education
HSE Health Service Executive
GTI Galway Technical Institute
NHS National Health Service
MHC Mental Health Commission
WIT Waterford Institute of Technology
WHAT Waterford Healing Arts Trust
IX
LIST OF FIGURES
Fig.1: Front cover of a Vision for Change.
Fig.2: The artwork by Pauline Miles titled The Journey depicts the view from the front seats
of a vehicle travelling on a road to a distant horizon - journey of hope and new beginnings.
Fig.3: The artwork by Pauline Miles titled The Advocate depicts a speaker standing at a
lectern addressing an audience with images relating to art on the screen immediately behind
the speaker - recovery is different for everyone.
Fig.4: The artwork by Pauline Miles titled The Journey – Rowing My Own Boat depicts a
figure paddling a small boat or surfboard towards three boats. The central boat, Recovery, is
flanked by two boats Hope and Support - maximising choice and self-determination.
Fig.5: The artwork by Pauline Miles titled The Kitchen Table depicts the interior of a kitchen
and meals area with a figure standing at a bench. Most of a person’s recovery occurs at home.
Fig.6: The artwork by Pauline Miles titled There are Many Points of View depicts a figure
standing in a room with artist materials on work surfaces and different views of external
images on the far wall.
Fig.7: ‘Guthlan’ Carolyn Fyfe discusses her journey of recovery and healing. The art is called
the Journey. The journey of recovery and healing starts from the outer circle identifying the
challenges that a person would experience. The colours: Brown - the challenges to make the
change in your thoughts/emotions (trying to move ahead). Black are the dark times
(depression). Mauve - identified the reasons and have moved forward. White - you have the
control. As you get closer to the centre it represents the wellness of health - socially,
emotionally and spiritually. It is a long journey and you need to have people who can let you
explain your story and they theirs.
Fig.8: ‘Guthlan’ Carolyn Fyfe depicts the journey of layers that have impacted the social and
emotional wellbeing of Indigenous people from invasion, colonisation and segregation to
assimilation. As the layers and their impacts are removed, a person’s journey of healing and
recovery starts. Fyfe explains: I never really had a name for this piece of art. I painted it to
help educate others on the impacts of invasion, colonisation, segregation to assimilation and
how this journey has affected the wellbeing of our Indigenous race socially, emotionally,
culturally and spiritually - mind, body and soul.
Fig.9: Dr. Crazyface and Dr. Scatterbrain with five year old Dylan Fagan in the National
Children's Hospital in Tallaght, Dublin.
Fig.10: Clown-doctor at work.
Fig.11: Four year old Harley Slack who had his limbs amputated and had to be resuscitated
three times in hospital after contracting meningitis has fun with the Clown Doctors. He also
made a Christmas card for his parents. He used reindeer and snowman sponges on the front
and his hospital ‘play’ lady had written ‘Happy Christmas’ inside and he signed ‘Harley’ by
X
putting the paintbrush in his mouth. While this is not in a specific mental health setting, the
child’s condition would have caused severe stress both to himself and to his family.
Fig.12: Illness as Human Experience.
Fig.13: Nurse-Patient Relationship.
Fig.14: Sacred Work of Palliative Nursing.
Fig.15: Suffering.
Fig.16 - 23: Arts + Minds music workshop.
Fig.24: The Leeside Seratones, an Arts + Minds choral project involving HSE Cork mental
health staff, service users and friends, performing with Choral Leader Liz Powell in the
Crawford Art Gallery.
Fig.25: Artist Jo Nichols (centre) working with the Arts + Minds Time to Dance group.
Photograph by Ger McCarthy.
Fig.26: An arts facilitator working with an arts on prescription group.
Fig.27: Participatory art session.
Fig.28: Wandering Methods, participatory art workshop for older people. Photograph by Lian
Bell.
Fig.29: Arts Ability: Towers by Ray and Tom, Recreational Therapy Unit, St. Senan’s
Hospital, Enniscorthy (RT). Photograph by Rory Nolan.
Fig.30: Arts Ability: Floyd Patterson and Jerry Quarry by Francis Joseph Power, County
Wexford Community Workshop (New Ross) Ltd. (CWCW). Photograph by Declan Kennedy.
Fig.31: Arts Ability: Twelve Disc After Heron by Tom, Killagoley Training & Activation
Centre, Enniscorthy (KTAC). Photography by Rory Nolan.
Fig.32: Votive #1 featured in the 2013 Let’s Connect exhibition at the Dunamaise Arts
Centre, Portaloise, which explored the significant connections between art and mental health;
the power that art can play in shaping ideas and how it provides a strong medium to
communicate for people who sometimes struggle to engage with society. It serves to
normalise the experience of mental health illness and prevent stigmatisation and exclusion of
people who are sometimes on the margins of society. Oils on canvas, Éilis Crean.
1
Chapter 1
INTRODUCTION
1.0 Research question
The general focus of this research is in the area of Arts and Health, while the specific aim is
to gather qualitative feedback from healthcare professionals in the South East region on their
experience of the participatory arts in the mental health settings where they work, in which
service users are actively engaged in the participatory arts. The healthcare professionals
interviewed are all mental health nurses who work in different types of mental health settings,
from acute inpatient hospital services, to community health settings and day care centres.
The term ‘perspectives’ is a broad one, therefore in order to avoid being vague and to
facilitate the participants, the questions asked were divided into five categories; the perceived
impact of the participatory arts on service users from the viewpoint of mental healthcare
professionals, the inclusion of the participatory arts in mental health care planning policy,
partnership programmes between mental health settings and arts and health organisations, the
healthcare professionals own interest in the arts, and whether the arts and humanities should
be included in the education of healthcare professionals.
All of the above categories can be linked with the arts in a mental health setting. Since an in
depth study of each one is beyond the scope of this dissertation, the principal focus will be on
the perceived impact of the arts on service users from the healthcare professionals’ viewpoint,
while the ancillary aspects will remain on the periphery of the discussion in the literature
review and the findings and discussion chapters.
There has been a gradual shift in attitude towards the arts in healthcare. The impact of the
inclusion of the arts into mental health settings is increasingly recognised, but the level of
research is relatively sparse in comparison to that of other factors associated with health and
wellbeing, such as the biomedical approach. (Moss, Donnellan & O’Neill, 2012, p.106)
Psychiatric nurses play a pivotal role in mental health services, are the largest staff group
involved in the provision of mental health care in Ireland (Department of Health and
2
Children, 2006), and are responsible for a wide range of services in community and hospital
environments. What I wanted to learn more specifically is what the primary caregivers of
service users, who are in constant contact with them, think of the participatory arts in their
mental health workplace, and what the role of the participatory arts means to them in terms of
care planning. ‘Staff members are a very useful source of information since they often know
service users on a professional as well as a personal level and will have interesting insights.’
(Tsiris, Pavlicevic & Farrant, 2014, p.105)
Therefore, given the relatively undeveloped research undertaken in this area, I decided to
interview four mental health nurses in the South East region to document their experience of
the participatory arts in a mental health setting. Their unique perspectives could give valuable
insights into the development and implementation of arts programmes within healthcare
contexts. The research aim was to garner qualitative feedback, in order to set the parameters
for future research.
1.1 Rationale
I have chosen this area of study to explore the perspectives of healthcare professionals on
their experience of the participatory arts so as to help create new knowledge in an area where
constant research is needed, but because of financial and time constraints, is not always
possible. The healthcare professionals chosen for this study are all mental health nurses. The
rationale for this choice is that they are the primary care givers who have most contact with
the service users on an ongoing, day to day basis. These staff had never been interviewed in
depth before on the role of arts participation in their workplace; therefore it is possible that
their unique insights might provide new areas of discussion in the fields of arts and health.
Since my current work placement is in Waterford Healing Arts Trust (WHAT), the
knowledge gained might be of use in relation to their participatory arts and mental health
programme in partnership with the Waterford and Wexford Mental Health Services. Focusing
on a small area, such as the South East, enables an evaluation of the place of the participatory
arts in mental healthcare, thus helping to build a new body of knowledge and information. It
also provides a foundation for the future planning of arts programmes in mental health
settings. In Creative Arts as a Public Health Resource: Moving from Practice-based
Research to Evidence-based Practice, Clift (2012) argues that the challenge now in the
3
healthcare context is to devise progressive research programmes which provide a strong body
of knowledge for evidence based practice.
1.2 Relevance to the area of arts management and location of research
The audience for this research comprises healthcare professionals, arts and health
coordinators, artists involved in the field of arts and healthcare, the Health Service Executive
(HSE), which is at the centre of healthcare in Ireland, and The Arts Council of Ireland. The
potential benefits of this study include a qualitative analysis based on the perspectives and
observations of healthcare professionals who are involved in the implementation of
participatory arts programmes for service users on a continuous basis. Their observations can
contribute to the ongoing debate on arts and health, enhance the future development of
participatory arts programmes in mental health settings, and provide new insights for arts and
health and healthcare professional managers.
1.3 Delimiting factors for this study
As a newcomer to arts and health and a novice researcher in this area, my approach to the
identification, critique and synthesising of the literature and findings may lack the expertise
of a more experienced researcher. Prior to undertaking the Masters Degree in Arts and
Heritage Management, and engaging in a college work placement in WHAT from November
2013 to August 2014, I had no previous in the area of arts and health.
I have a background in visual art and have always been interested in art therapy; thus it was a
natural progression to be drawn to the area of arts and health. While these two areas appear
similar in nature, their core value is different. ‘There is a clear distinction between arts and
health practice, where a key goal is the experience and production of art, and the arts
therapies, where the primary goal is clinical.’ (Arts + Health: Arts and Health Editorial
Policy, 2013, p.4)
Another limiting factor is that arts and health is a broad topic and much that is of interest has
to be omitted or peremptorily discussed in order to meet the narrower criteria of this research
study.
4
1.4 Position of researcher
This area of research has been chosen as a result of an interest in the field of arts and health,
and my work in WHAT has prompted me to investigate, from the healthcare professionals’
viewpoint, various claims that involvement in the participatory arts by service users is an
important aspect of mental healthcare provision. Participatory arts programmes claim many
benefits for people with mental health difficulties, and the aim of this research is to explore
the validity of such claims from the viewpoint of each mental health nurse working in their
own mental health setting.
The growing interest in the area of the arts in healthcare in Ireland is relatively new, largely
under researched, and merits further study. In The Creative Path and the Road to Recovery,
Dr. Nasir Warfa, senior lecturer in psychiatry in London University, argues that despite a
growing awareness of the benefits of arts in healthcare, mental health treatment is still
dominated by a biomedical approach, making it difficult to integrate arts based activities into
the system. (Lynch, 2014)
The literature studied also reveals that Ireland has not progressed as well as other countries in
the promotion of arts and health. While some progress has been made, there is further scope
for research in the development, implementation and appraisal of arts programmes in mental
health settings.
1.5 Summary of chapters
The literature review chapter is structured to allow for the exploration of several aspects
relevant to the perspectives of healthcare professionals on their experience of the
participatory arts in a mental health setting. For this reason, the literature review has been
divided into the following headings: Mental Health Policy in Ireland, Arts and Health Policy
in Ireland, The Participatory Arts in a Mental Health Setting and The Medical Humanities in
Healthcare Professional Education.
In the methodology chapter, the research design and data collection methods for this research
study are identified and explained. This is a qualitative exploration of data collected from
four mental health nurses by means of face to face, semi structured in depth interviews.
5
In the findings chapter, the data collected is presented, examined and synthesised in relation
to the literature reviewed. The discussion chapter identifies themes in relation to the
interviews and the literature reviewed. The final chapter makes recommendations to various
organisations, including the HSE, The Arts Council and The National Network of Arts and
Health Coordinators Ireland (AHCI).
6
Chapter 2
LITERATURE REVIEW
2.0 Introduction
The main focus of this dissertation is an exploration of the perspectives of healthcare
professionals in the South East region on their experience of the participatory arts in a mental
health setting. It is a qualitative study, where all relevant aspects of the topic are discussed, to
allow for a fluid, comprehensive picture to emerge of the diversity of human experience. The
literature is reviewed under the following headings: Mental Health Policy in Ireland, Arts and
Health Policy in Ireland, The Participatory Arts in a Mental Health Setting and The Medical
Humanities in Healthcare Professional Education.
A challenge faced in this study is that each of the three concepts, mental health, the arts, and
qualitative research can be difficult to define, and consequently the arguments about them are
sometimes controversial. The arts are difficult to define in an objective way. ‘Mental health
can also be culturally and subjectively determined; and qualitative research is diverse, and
often regarded as the poor relation of scientific research.’ (Stickley, 2012, p.viii)
Nevertheless, the type of study undertaken here is best suited to the qualitative method, since
it is reliant on the exploration and analysis of the personal perspectives of the participants.
Also, the arts in healthcare is a relatively new concept in Ireland, and is sometimes regarded
with suspicion, though simultaneously growing more popular as a way to complement mental
healthcare.
Taking into account the growing awareness of the arts in healthcare, the review explores
relevant literature in a systematic way, drawing on many different sources, books, journals
and databases, which discuss theory, practice and policy. A meta-ethnographical approach
was used to synthesise the main themes in the literature reviewed.
2.1 Mental health policy in Ireland
A Vision for Change: Report on the Expert Group on Mental Health Policy (AVFC) argues
that each citizen should have access to comprehensive mental health provision of the highest
7
standard. (Department of Health and Children, 2006) It proposes a holistic view of mental
health and recommends an integrated, multi-disciplinary approach to addressing the
biological, psychological and social factors that contribute to mental health problems,
stressing that a recovery oriented approach is vital. However, there was little exploration of
the meaning of a recovery oriented approach, except for an acknowledgement that ‘…the
principles and values of recovery mark a substantial shift in how services are developed,
delivered and evaluated.’ (Higgins & McDaid, 2014, p.66)
The recommendations of A Vision for Change (AVFC) report include greater consultation
with service users, carers and providers. In the course of consultations carried out by the
Expert Group on Mental Health, service users articulated their views on what needed to be
changed. The areas of change most sought were in the training of healthcare professionals,
the involvement of service users in service planning, and the delivery of community based
interventions that are effective in promoting recovery and re-integration. In 2008, the Mental
Health Commission (MHC) published A Recovery Approach within the Irish Mental Health
Service: A Framework for Development. (Higgins, 2008) This document highlights the need
for a paradigm shift in how people think of mental illness, and how people living with mental
distress are supported. (Higgins et al, 2014)
The following themes emerged from the AVFC report. There is a need for multi-disciplinary
teams offering a range of treatment and care to service users, a need to adopt a recovery
perspective at all levels of service delivery and a need for service users to be treated with
dignity and respect. Services should respond to the needs of service users, who may be held
back more by the practical problems of living rather than by their symptoms. There should be
access to psychological ‘talk therapies’ and social therapies. There is a need for community
based services and for formalised links between specialised mental health services, primary
care, and mainstream community agencies to provide support and care. It is essential for
service users to be active participants in their own recovery rather than passive recipients of
care.
The report concluded that integration into mainstream community life was the ultimate goal
of recovery. The vision of the Expert Group on Mental Health is to create a mental health
system that addresses the needs of the population through a focus on the requirements of the
8
individual. The importance of the human interaction at the heart of treatment and care was
stressed, and it was acknowledged that the artificial separation of biological from
psychological factors has been an enormous obstacle to a true understanding of mental health.
It is now recognised that mental disorders are a complex interaction of many causal factors
and that the over emphasis on the biological model can prevent provision of effective social
and psychological interventions. It is noted that this imbalance may be driven by reliance for
funding on pharmaceutical companies who want to promote their products.
Fig.1: Front cover of a Vision for Change.
From: Department of Health and Children, A Vision for
Change: Report on the Expert Group on Mental Health
Policy, 2006.
Throughout the 288 page document, no mention was
made of the use of the arts in healthcare, though The Irish
Association of Creative Arts Therapists is cited in
Appendix 1 in the list of submissions to the Expert Group
on Mental Health. In the list of 268 references, there was
none which was arts related. Ironically, there is an artistic
representation on the front cover: A butterfly symbol is
used to portray mental health and it is explained that the Greek word for butterfly is ‘psyche’,
which is also the word for ‘soul’. This is followed by a quotation from Thomas Bullfinch in
The Age of Fable, using the symbolism of a butterfly emerging from its chrysalis to denote
recovery from mental health. This is significant as it implies that the arts have a place in
healthcare. However, it does not go beyond implication.
The goals of mental health care should be to promote wellbeing and to help people cope with
their illness. In 2004, The National Institute for Mental Health in England published a
definition of recovery as ‘a personal process of overcoming the negative impact of diagnosed
mental illness despite its continued presence.’ (Barker, 2011, p.83) It stresses that recovery
focuses on wellness rather than illness and can occur without professional intervention.
Similarly, in A Recovery Approach within the Irish Mental health Service (Higgins, 2008),
recovery is seen as a transformational ideology which challenges stereotypes about mental
health and treatment.
9
The arts in healthcare, although developing, are not widely practised in Ireland. It may be that
some facilities utilise the arts, but until it is enshrined in a combined HSE and Arts Council
policy document, it will not be widespread. The literature review documents successful
projects that have been conducted in Australia, Britain, North America and elsewhere, and
thus highlights the paucity of such literature published in Ireland.
Both the Australian Health Ministers’ Advisory Council’s A National Framework for
Recovery-oriented Mental Health Services: Policy and Theory (Australian Health Ministers’
Advisory Council, 2013), and A National Framework for Recovery-oriented Mental Health
Services: Guide for Practitioners and Providers (Australian Health Ministers’ Advisory
Council, 2013) utilise imagery and descriptions of artworks created by service users in their
publications, unlike Ireland’s A Vision for Change: Report on the Expert Group on Mental
Health Policy (Department of Health and Children, 2006)
Mental Health Reform Ireland’s analysis of the mental health system in Ireland supports the
need for major transformation. (Mental Health Reform, 2014) They state on their website that
mental health services have not been prioritised by the Irish government, that the quality of
services lag behind international best practice and that there is an over reliance on the
medical model and in-patient treatment. This is at odds with the ideals laid out in AVFC
which they state has not yet been fully implemented.
Mental Health Reform Ireland (2014) explains that the recovery model central to AVFC will
challenge the traditional psychiatry base. Successful implementation will require a paradigm
shift in how mental health is understood and how services are provided. They state that the
HSE has primary responsibility for delivery of AVFC, but that the action needed to
encourage a cultural change to bridge the gap between AVFC policy and practice will be
challenging. They state that service users have a low visibility because of the nature and
stigma of mental illness, but that the service user movement is growing in strength and will
become a radical challenge to the status quo.
The recent publication Healthy Ireland: A Framework for Improving Health and Wellbeing
2013-2025, is a new Government plan that involves every part of Irish society in improving
our health and wellbeing, and sets a vision where ‘everyone can enjoy physical and mental
health and wellbeing to their full potential.’ (Department of Health 2013, p.6) This will
10
require a conceptual shift from illness to a ‘wellness’ trend, where the focus is on positive
mental health. (Higgins et al, 2014)
2.2 Arts & health policy in Ireland
The development of arts and health in Ireland can be mapped through policy and strategy
documents and literature arising from national conferences. The Arts Council’s Arts and
Health: Policy and Strategy (2010) is the most recent policy document specific to arts and
health published by a government agency in Ireland and outlines the values that underpin its
approach to arts and health practice, and strategic actions for the five-year period 2010 –
2014. Prior to this document, The Arts Council published Mapping the Arts in Healthcare in
the Republic of Ireland (2001), The Arts & Health Handbook, A Practical Guide (2003), and
Arts and Health: Summary Policy Paper (2005).
One of the proposals arising from The Arts Council’s Arts and Health: Policy and Strategy
(2010, p.10) is the development of a strategic partnership with the HSE at national level in
order to ‘facilitate practical collaboration across respective Arts and Health policies, facilitate
cross sector learning and develop shared understanding and language relating to Arts and
Health practice, build a strategic framework for the sustainable development and support of
Arts and Health practice, at national and regional level, into the future.’ The HSE has funded
various projects on a local level but does not have a national policy on arts and health.
On the other hand, Australia is at the forefront of arts and health practice, and in July 2014,
Health and Arts Ministers in Australia joined forces to publish the country’s National Arts
and Health Framework. (National Arts and Health Framework, 2014) This means that the
arts and health sector has now received state, territory and federal backing. ‘The Framework
has been developed to enhance the profile of arts and health in Australia and to promote
greater integration of arts and health practice and approaches into health promotion, services,
settings and facilities.’ (National Arts and Health Framework, 2014, p.1) The framework
contains links to a range of information relating to arts and health practice including
resources, research findings and evidence of the value of a collaborative approach to arts and
health. It has relevance for all agencies, departments and organisations with a role in
promoting health and wellbeing and in delivering health care and services, including arts
agencies and all those already engaging with arts and health practice.
11
The Australian Institute for Creative Health (The Institute for Creative Health, 2014) which
supported and coordinated the development of the framework highlights the formal
endorsement. The Institute’s Chairman, Michael Brogan, says: ‘A national framework signals
what we are trying to do in arts and health as a nation.’ (London Arts in Health Forum, 2014)
Australia’s Health and Cultural Ministers aim to improve the health and wellbeing of all
Australians and recognise the role of the arts in contributing to this objective. (National Arts
and Health Framework, 2014, p.1) If Ireland could initiate a similar policy, tailored to its own
needs, it would fulfil The Arts Councils partnership aim, and their aims to learn from the
experience of other similar international organisations in promoting and supporting the
practice of arts and health. (The Arts Council of Ireland, 2010, p.10)
Warner (2013, Arts + Health), Principal Community Social Worker with the HSE South,
suggests that a social model of health should be incorporated into the arts and health policy
and practice in Ireland. The social model of health considers the social factors that determine
health and wellbeing, for instance, social or community networks, economic and
environmental conditions. He asserts that there is currently an insufficient focus on these
aspects in the arts and health debate. The health services are only one element in terms of
promoting individual and community health and wellbeing. The social model encompasses a
broader range of sectors, such as education, housing and local government. This has
implications for the arts and health debate, in that the agenda needs to be broadened to
include aspects such as inequalities in healthcare, social inclusion, advocacy, early
intervention and relevant recovery models.
He argues that arts and health is a partnership between two very diverse sectors, and there is a
need for discussion not only between the sectors, but within them. On the health side, there is
a need to move from limiting terminology, such as healthcare settings, and to recognise the
validity of the arts not just in traditional healthcare settings, but across the wider community.
Extending the range of settings in which the participatory arts are practised will enhance the
importance of arts and health, through emphasis on individual and community health, and
will provide opportunities for greater access to the arts to groups otherwise excluded from
therm. He concludes that it will involve collaborative partnerships at local, regional and
national level to create a truly efficient social model of health.
12
2.3 The participatory arts in a mental health setting
Beyond Diagnosis: The Transformative Potential of the Arts in Mental health Recovery
(Sapouna & Pamer, 2012), is a seminal Irish document based on research findings from an
Arts + Minds (Arts + Minds Cork, 2014) action research project, involving service users,
healthcare staff and artists, to investigate the impact of the arts in mental health settings, with
particular emphasis on care planning. Arts + Minds is a HSE and arts and health run
initiative, set up in 2007, which began as a series of music workshops, but later expanded its
range of arts programmes.
The principal aims of Arts + Minds are the enhancement of mental health and wellbeing of
service users through engagement with the arts, to enable them to participate fully in the
cultural life of their community and to facilitate partnership between service users, health and
arts professionals. Their ideal is to develop user accessible programmes informed by national
arts policy to promote the value of arts in mental healthcare. The research was underpinned
by the philosophy of Arts + Minds, which is to consider the potential for integrating the arts
into mental health care planning. Service users played key roles in articulating how they wish
to transform their lives. The ethos of the project is informed by principles of inclusion and
recovery. Evidence based research was constructed in the form of service users’ narratives,
and the findings showed that participants’ creative skills, confidence and concentration were
enhanced.
The study found that institutionalisation and social isolation are still problems for service
users. They revealed that participation in the arts gave them more choices and more control in
their lives. Both staff and service users recognised arts participation as part of a recovery
approach, and staff acknowledged a gradual move from a biomedical approach to a fuller
awareness of the power of creativity to enhance the lives of service users. ‘Making the arts an
integral part of mental health requires an appreciation from the multi-disciplinary team.’
(Sapouna et al, 2011, p.23)
In The Weapons of Life: A Case for Arts Participation as a Creative Response to Mental
Health Problems (Dineen, 2012), Dineen argues for arts participation as a creative response
to mental health problems, and believes that persuasive arguments can be made to use the arts
13
in healthcare as a recovery approach. ‘The inclusion of an arts programme sits comfortably
within the context of the Irish Mental Health Policy.’ (Dineen, 2012, p.14)
The research concluded that the arts are filtering slowly into the system, although mental
health is still dominated by the biomedical model of care. These considerations have led to
my research topic: the perspectives of mental health professionals on the impact of the
participatory arts in a mental health setting. The focus was narrowed to the views of mental
health nurses in the South East to investigate their partnership with WHAT and how it could
benefit them. My interview questions were based on those for mental health staff in Beyond
Diagnosis (Sapouna et al, 2011, p.52) to ascertain whether there would be a variation of
responses in a different location. As they were from an Arts + Minds project, I adapted them
to suit my research of the participatory arts in mental health settings from the health
professionals’ perspectives. I noticed there were three strands of questioning: the impact of
the participatory arts on service users, care planning policy, and partnership with arts and
health organisations. I added two more strands of questioning which I thought were relevant,
the healthcare professionals’ own interest in the arts and their views on the inclusion of the
arts and medical humanities into professional healthcare training.
In Mental Health, Psychiatry and the Arts, a Teaching Handbook, Tischler (2010) presents a
case for the inclusion of the arts in care planning, practice and education. The author argues
that art highlights core human emotions and provides a safe way to engage with difficult and
painful emotions that might arise in mental healthcare. (Tischler, 2010, p.2) Tischler
describes the experience of establishing a humanities course into the medical curriculum: The
Arts in Psychiatry. Following extensive research, the Arts in Psychiatry programme was set
up in Nottingham University and was welcomed by healthcare professionals and students.
Tischler argues that biological techniques alone for understanding mental illness reveal little
about the reality of living with depression or other such ailments. The practitioner is also
reliant on verbal exchange to make sense of the individual’s distress. This emphasises the
importance of ‘perception, subjectivity and interpretation in mental healthcare.’ (Tischler,
2010, p.3) The arts and humanities integrate physical, emotional, psychological and spiritual
elements, and their inclusion can lead to a holistic and patient-centred approach to mental
14
healthcare. ‘The combination of arts with medicine evokes the German idea of
Wissenshchaft, a science that includes both science and humanities.’ (Tischler, 2010, p.3)
Tischler states that education courses should emphasise reflection and participation which
may be an antidote to the largely reductionist learning, currently predominant in mental
health education. Tischler believes that by shifting the current emphasis of psychiatry from
the biological study of the brain to a broader study of the mind, a more holistic model for
understanding and interpreting mental pathologies may be attained.
In Qualitative Research in Arts and Mental Health (Stickley, 2012), Stickley presents auto
ethnographical accounts of service users, artists and professional healthcare workers through
a series of articles, written by experts in the field of arts and health. The main thread of
discussion is the belief in the efficacy of the participatory arts in terms of personal and social
outcomes.
In chapter one, Parr, in an essay entitled The Arts and Mental Health: Creativity and
Inclusion describes research carried out between 2003 and 2007 on two city mental health
and arts related projects in Scotland, Art Angel, based in Dundee and The Trongate Studios in
Glasgow’s city centre. A broad spectrum of arts activities was organised for people with
mental health difficulties.
Interviews conducted with participants from both these facilities revealed that they
experienced stability and wellbeing as a result of their involvement in the projects. Parr
interpreted their experiences in terms of moving into different artistic geographies, from
individual isolation to social inclusion. Artists encountered ‘interior creative space’ as a calm,
safe ‘location’ which could be accessed as part of a strategy for recovery. (Stickley, 2012.
p.7)
In an article entitled Catching Life: The Contribution of Arts Initiatives to Recovery
Approaches and Mental Health (Stickley, 2012, pp.199-212), a National Study conducted in
Britain is described in which members of vulnerable groups were interviewed about
participation in arts based projects. The main focus was on recovery.
15
New notions of recovery were inspired by service users’ accounts. It emerged that recovery
was not just the clinical absence of symptoms, but a sense of empowerment and purpose in
the service user which amounted to their moving towards the type of life they wanted to lead.
Arts participation and creativity often featured in individual recovery journeys, and research
suggests that involvement in the participatory arts did have a range of therapeutic benefits for
those with mental health needs. They also reported an increased awareness of their latent
abilities, such as sensory perception. It helped them to engage with other aspects of their lives
and improved their motivation and coping strategies. Thus, it was found that recovery is
linked to creativity. In some cases, it also led to freedom and independence, in that they
discovered a new sense of identity and did not necessarily wish to belong to mainstream
society which had rejected them.
Qualitative Research in Arts and Mental Health (Stickley, 2012) is a useful work in that it
presents examples of arts based projects that have used various qualitative methods to explore
the links between arts and mental health. The research endeavoured to reflect the voice of the
participant, concentrating on their personal experiences, perceptions and the unique
expression of their inner world. A recurring theme is the need to shift the focus from the
medicalisation of mental illness to a more holistic model. As long as mental healthcare
remains dominated by reductionist science, researching the place of the arts will be largely
neglected. There is also the danger of ‘commodifying’ the use of the arts to make it fit in with
the health agenda and conform to the statutory services provision. (Stickey, 2012, p.214)
Wholeperson Healthcare, the Arts & Health (Serlin, 2007) explores various forms of arts in
healthcare through a series of articles by healthcare professionals. In the chapter entitled
Applications of Art to Health (Serlin, 2007, pp.1-21), Graham-Pole examines the links
between the arts and the auto immune, hormonal and other systems of the body. He cites the
neuroscientist, Candace Pert, whose groundbreaking research showed that new brain wave
patterns are produced and the body’s physiology changes from stress to relaxation when
exposed to creative and inspirational activities. (Serlin, 2007, p.16) Thus, they argue that the
arts have become a potent, holistic force for human healing, and their perceived value in
research and healthcare is increasing.
16
In History of the Arts and Health across Cultures (Serlin, 2007, pp.23-41), Sonke-Henderson
states that until the sixteenth century, health and illness were considered by every known
culture to be spiritual matters, before the reductionist ideals of Western medicine
predominated, separating mind, body and spirit. This reduced illness to a physical matter and
established medicine as a purely physical science. (Serlin, 2007, p.25)
The mid to late 20th
century saw the gradual introduction of the arts in healthcare. Sonke-
Henderson cites their colleague, Graham-Pole as calling this a ‘second renaissance’ in
Western healthcare. Reductionist ideals were once again expanded to take into account the
service user’s emotional, psychological and spiritual attributes as part of the whole person.
This created a balance in the ‘sterile, discomforting, and scientific environment of Western
hospitals.’ (Serlin, 2007, p.38)
Using The Creative Arts in Therapy and Healthcare (Warren, 2008) provides a series of
articles by various artistic and healthcare experts in the field of arts and health on the benefits
of a broad spectrum of the arts. The editor, Warren, is the Artistic Director of the Fools for
Health clown-doctor programme. In chapter eleven, entitled Arts for Children in Hospitals:
Helping to Put the ‘Art’ Back in Medicine (Warren, 2008, pp.181-195), the author, Rollins,
states that ‘a small but growing body of research supports that physiological processes may
take place through contact with the arts.’ (Warren, 2008, p.12) Rollins continues that studies
indicate a relationship between arts experiences and the release of endorphins, and states that
technology makes this visible when patients at the hospital are attached to monitors to gauge
oxygen saturation levels. When music is being played, the level rises on the monitor, even if
the patient is unconscious.
Fig.9: Dr. Crazyface
and Dr. Scatterbrain
with five year old Dylan
Fagan in the National
Children's Hospital in
Tallaght [Online
image].
From: Irishhealth.com,
2006.
17
In Healing Laughter: The Role and Benefits of Clown-doctors Working in Hospitals and
Healthcare (Warren, 2008, pp.213-228), Warren discusses the role of clown-doctors in
hospitals and healthcare, stating that it is a relatively new phenomenon. The initiative, begun
in 2001, was a catalyst for change as the programme gathered strength in Europe and Canada
and delivered services to diverse healthcare facilities to children and adults. (Warren, 2008,
p.213) Clown-doctors are specially trained artists who work in hospitals and are a blend of
artist and healthcare worker. ‘They work in pairs, wear a red nose, use a minimal amount of
make up, wear a white lab coat and are usually referred to as doctor (e.g. Dr. Haven’t-A-
Clue).’ (Warren, 2008, p.214) They work with patients, their families and the healthcare team
to promote wellbeing through the use of humour, improvisation and music. They interact
with their audience in a public space where healthcare is delivered. They are not merely
entertainers, but accepted members of a multi-disciplinary team of healthcare workers.
Warren states that they help to humanise the healthcare experience, reduce anxiety in children
awaiting surgery, and make hospitals more accessible and user friendly.
The Arts in Healthcare: Learning from Experience (Haldane & Loppert, 1999) examines
widely different arts in healthcare projects from the design of hospitals to the use of visual
arts. In an article entitled Evaluating the Arts in Healthcare and Mental Health Promotion
(Haldane et al, 1999, pp.96-114) Dr. Philips explores the use of poetry in patient recovery.
According to Philips, there is growing evidence that looking inwards, or ‘inscaping’ and the
process of linking thoughts and emotions and writing them down is beneficial to mental
health, especially if the words are written in a poetic way, with cadence and rhythm. (Haldene
et al, 1999, p.101) Personal experience is a powerful motivating factor and the ensuing visual
and emotive imagery is evocative in charting personal progress. According to Philips, poetry
has been likened to medicine because it explores aspects of communication and demonstrates
the complexity of the human condition. (Haldene et al, 1999, p.103) Philips also states that
poetry can reduce stress and anxiety and improve wellbeing by helping the service user to
unburden negative thoughts and feelings, thus reducing the need for medication.
The National Health Service (NHS) publication, Improving the Patient Experience, The Art
of Good Health Using the Visual Arts in Healthcare (2002) focuses on enhancing the patient
experience by effecting improvements in the physical environment. It showcases examples of
the application of visual arts in healthcare settings and examines the benefits to service users
18
and staff. In section five, Creative Activity - Therapeutic Activity and New Skills for Patients
and Staff (NHS Estates, 2002, p.53-62), the power of creative activity is discussed, especially
for long stay mental health patients. Participation in creative activities can help people to
alleviate boredom and offers a way of connecting to everyday life. ‘On an acute mental ward,
patients say that life can seem anything but normal, surrounded by other people in varying
degrees of mental illness.’ (NHS Estates, 2002, p.53) They see taking part in creative
activities as ‘normalising’ and comforting. Taking part in an art project sometimes helps with
functionality also, as mental illness can affect vision and cognition, so ‘[c]oncentrating on
colours, shapes, forms and textures can help to improve vision and cognitive skills.’ (NHS
Estates, 2002, p.53) The arts also provide important links between acute and community
mental health services, helping people reduce the isolation and loneliness that contributes to
relapses, by keeping in touch and forming friendships through art projects.
Stickley supports the view that even though recovery has become the main focus of mental
health policy in the UK, there are few models of practice showing how mental health nurses
can promote recovery through the use of participatory arts. (Stickley, 2010) His article in
Nursing Times, Does Prescribing Participation in Arts Help to Promote Recovery for Mental
Health Clients? explores the experiences of people who engaged in an arts for prescription
programme. The study conducted employed narrative enquiry techniques and the participants
were interviewed three times during the course of one year. Results showed that participants
benefited greatly from the programmes in terms of having a safe place to come to,
experiencing peer support and gaining access to voluntary work and education. (Stickley,
2010)
Art based activities mark a shift from verbal communication to active engagement with the
process of creating, which enables a meaningful interaction between service user, artist and
health workers. Arts based interventions also have the potential to enhance overall feelings of
wellbeing, and to provide meaning and purpose through a range of goal oriented activities.
Creative arts activities provide an avenue for self expression and motivation, thus reinforcing
personal empowerment and increasing self esteem. (Yaqub & Burwash, 2013) Results from
the studies showed that the art making process had a transformative effect which effected
internal changes contributing to recovery. (Yaqub et al, 2013)
19
Similar outcomes were demonstrated in studies conducted in Salford, England by Makin and
Gask (2011). The research explored the value of an arts on prescription programme to aid the
process of recovery in people with chronic mental health difficulties, who had previously
experienced psychological talk based therapies. Recovery was perceived by participants as
returning to normality through enjoying life again, setting goals and resuming former
activities. (Makin et al, 2011) Active engagement with the arts was seen to aid the process of
recovery by enabling the participants fulfill these criteria. The arts based programmes aided
recovery in ways not always achieved by talk therapies alone. (Makin et al, 2011)
Participatory arts projects for people with mental health needs consistently claim benefits
such as increased confidence, social participation and psychological wellbeing. However, the
evidence to support these claims is weak. (Hacking, Secker, Kent, Shenton & Spandler, 2008)
Leckey (2011) contends that there seems to be a lack of clarity in relation to the definition of
mental health. It is a nebulous concept open to different interpretations. This, in turn, affects
how the effectiveness of the participatory arts in mental health settings is measured. (Leckey,
2011) In terms of policy, outcome evaluation is important for several reasons. (Hacking et al,
2008)
2.4 The medical humanities in healthcare professional education
Young-Mason (2003, p.66) asks in their paper, Art, Literature, and Nursing Phenomena,
‘How do nurses continue to evolve their understanding of the human condition? How do they
continue to develop their aesthetic perception?’ They answer these questions by suggesting
that literature and the arts ‘…are attempts to comprehend and communicate the human
experience.’ (Young-Mason, 2003, p.66) This idea is echoed in Biley & Galvin’s (2007,
p.802) article, Lifeworld, the Arts and Mental Health Nursing in which they argue that the
arts ‘…has the potential to reach and express the depths of human experience when used as
an approach for enquiry.’
The term Medical Humanities, first coined in 1976 by Australian Surgeon, A R Moore
(Moore, 1976), covers an evolving interdisciplinary field of medicine that draws on the
creative and intellectual strengths of diverse disciplines such as the humanities, social science
and the arts in pursuit of medical educational goals. The arts and humanities can enrich
understanding of health, medicine and disease by providing insights into the human
20
condition, and are concerned with the history and culture of human health, disease and
medicine, and how research into these areas can influence policy and practice. They
investigate the experiences, narratives and representations of health and illness often ignored
by the biomedical sciences alone, and help to develop and nurture skills of observation,
analysis, empathy, and self-reflection, skills that are essential for humane medical care.
(Hurwitz, 2003; Reilly, Ring & Duke, 2005; Biley & Galvin, 2007, Brett-MacLean, 2007;
Macneill, 2011)
British research papers by Robinson (2007), Holistic Health Promotion: Putting the Art into
Nurse Education and Using Art in Pre-registration Nurse Education conclude that
introducing a Holistic Health Promotion course and art related education for student nurses
was welcomed by most students and had positive effects on them, such as increased
awareness of health care environments and more empathy for patients. They found the
inclusion of arts therapeutic and enjoyable experience. Similar findings were discovered in an
Irish research paper, Evaluation of an Art in Health Care Elective Module – A Nurse
Education Initiative (McCabe, Neill, Granville & Grace, 2013) in which nursing students’
experiences of undertaking an arts and health module was evaluated.
In Honouring the Patients’ Voice in Health Professional Education (Shah in McLean &
Kelly, 2010, pp.349-368), Shah states that there is increasing recognition that patients have a
vital role to play in Health Professional Education (HPE) and claims that healthcare is
experiencing a paradigm shift from a paternalistic to a patient centred approach, where the
individuality of the patient and their need to be involved in decision making regarding their
care are taken into account.
Shah makes a case for the use of arts and humanities in HPE in this context, and advocated
Participatory Action Research which was undertaken in The University of British Columbia,
incorporating various groups to develop, evaluate and refine patient-led interdisciplinary HPE
workshops. This combined the direct sharing of patient narratives with the use of a literary
narrative of illness, and the involvement of patients who were also health professionals. The
workshops focused mainly on mental illness.
Charon, a physician and literary scholar, pioneered the Narrative Medicine Movement and
called it ‘the clinical cousin’ of literature in medicine. ‘Narrative Medicine provides an
21
approach to the hands on use of literature in medicine.’ (Shah in McLean, 2010, p.357)
Shah’s own experience of mental illness reinforced this theory, changing the way she
practised medicine. Shah claims it led her to exercise more empathy and greater validation of
patients’ experiences.
Literature providing evidence of the role the arts can play in the healing process is increasing,
and how it is used to enhance the physical environment for service users, provide
psychological support and communicate health information (Huxley, 1997; Staricoff, 2004;
Daykin & Byrne, 2006; Stuckley & Nobel, 2010), but despite this, undergraduate healthcare
professional education rarely covers this aspect of education.
However, the arts and humanities are slowly filtering into healthcare professional education
in Ireland. In June 2014, Dr. T Stickley, Associate Professor in Mental Health at the
University of Nottingham gave a lecture in the School of Nursing and Midwifery in Trinity
College Dublin, in conjunction with the Irish Institute of Mental Health Nursing. The lecture
was entitled, Being Human: Creativity in Mental Health Care, which dealt with the
implications for mental health practice in Western healthcare becoming increasingly focused
on evidence-based medicine, and a culture more driven by targets and goals. Stickley calls for
a re-focusing of care towards a more creative approach; one where practice is led by values,
not by targets.
In Galway Technical Institute (GTI), The Music of What Happens: A Students Guide to Arts
and Health (Macleman, 2014) was created to redress a gap in GTI’s Nursing Studies
Programme, and to support students in exploring their own creativity whilst introducing the
guiding values of arts and health practice. This guide was made by and for students, and is
intended as an educational resource for future year groups studying Art and Applied Health
and Social Sciences at GTI.
WHAT are also establishing links with student nurses in Waterford Institute of Technology
(WIT) in a bid to incorporate the arts into their professional training and practice. Integrating
the medical humanities into healthcare professionals’ curriculum ‘…advances the objectives
of a profession that operates at the intersection of science and art.’ (Frei, Alvarez &
Alexander, 2010, p.676)
22
2.5 Conclusion
The literature reveals that the implementation of the arts in a mental health setting has
beneficial effects on the wellbeing of service users. Significant research, conducted in other
countries, notably Australia, Britain and North America, highlights these benefits. However,
on examining mental health policy documents in Ireland, it was found that there is a
significant gap between theory and practice. The documents make recommendations for
sweeping changes, for instance in patient centred recovery approach, but there is a
discrepancy between the ideals and aspirations and their implementation.
There is no mention of the arts in the Mental Health Commission’s; A Vision for Change:
Report on the Expert Group on Mental Health Policy, nor is there a national arts and health
policy framework. There is insufficient provision for the arts in healthcare professional
training to date. Not enough research has been undertaken in Ireland on the potential benefits
or the cost effectiveness of the arts in mental health settings, and despite growing enthusiasm
for the arts in some settings, it is not widespread, and Irish health services are still dominated
by the biomedical model of recovery. Even in settings where the arts are welcomed in
healthcare, there is confusion about definitions and outcomes. The term ‘arts in healthcare’ is
nebulous and elusive. Participation in the arts is sometimes confused with the radically
different discipline of art therapy. The literature has revealed a need for more thorough
training and clarification in this regard.
Taking these factors into account, the research question that emerges is: What are the
perspectives of healthcare professionals on their experience of the participatory arts in a
mental setting? I decided to interview four mental health nurses to discover their opinions on
the impact of the participatory arts on service users in their specific areas of mental
healthcare.
23
Chapter 3
METHODOLOGY
3.0 Introduction
Methodology, research design and data analysis for this research study are discussed in this
chapter. The primary research undertaken was an exploration of the perspectives of
healthcare professionals in the South East region on their experience of the participatory arts
in a mental health setting in their workplace. The general methodological research technique
was qualitative, involving a literature review, observation, and action based research in the
form of face to face, semi structured, in depth interviews. Four healthcare professionals were
interviewed to gather relevant data. The data collected is triangulated into a case study to
discern possible commonality of themes. An attempt to obtain a comprehensive picture of
human experience underpins this choice of methodology.
3.1 Purpose
The purpose of this study is to explore the healthcare professionals’ experience of the
participatory arts in a mental health setting, and to examine the perceived impact of the
participatory arts on service users, their role in care planning policy, partnership with arts and
health organisations, and their thoughts on the medical humanities. Through this exploration,
the aim was to gain further insights from primary caregivers and generate new ideas for
future research, since the use of the arts in healthcare, although developing, is a relatively
new concept in Ireland.
Dineen (2013, Arts + Health) in The Weapons of Life: A case for arts participation as a
creative response to mental health problems, asserts ‘I would argue that arts programming
can be justified within the context of current government policy on mental health and that
persuasive arguments can be made that the arts in mental healthcare are an effective tool in
the recovery process.’ Mental health nurses are primary caregivers in mental health settings,
thus garnering qualitative feedback from them will provide useful insights and information in
regard to Dinnen’s statement, and can contribute new knowledge to this area of research for
the South East region.
24
3.2 Theory
Since a Relativist approach rejects the idea of absolute standards for judging truth and relies
more on the personal perspectives of individuals (Robson, 2002), it was deemed to be the
most suitable epistemological approach. The aim of the research was not solely to accumulate
empirical facts, but also to generate working hypotheses upon which to build future research.
Thus, the phenomenological study of direct human experience is a major epistemological
approach in this study, where truth and value are determined by subjective perspectives of
healthcare professionals rather than purely objective reality. This, in essence, constitutes a
constructivist or interpretivist approach. In this approach, language is recognised as an
important vehicle to convey these meanings. Therefore, the in depth interviews provided an
atmosphere conducive to this purpose. ‘Meanings are constructed by human beings as they
engage in the world they are interpreting.’ (Crotty, 1998, as cited in Creswell, 2003, p.9)
3.3 Rationale for choice of qualitative approach
In depth interviews are an optimal means of collecting data on individuals’ personal
perspectives and experiences, especially where sensitive issues, such as mental health
difficulties are being explored. Seale (1998, p.203) observes that the researcher can ‘…use an
interview to find out about things that cannot be seen or heard, such as…the reasoning behind
their actions and their feelings.’ By interviewing mental health nurses who work in mental
health settings, I had the opportunity to probe any line of questioning that was particularly
interesting, which might be beyond the scope of my original set questions and could reveal
rich material to allow broader investigation in that area. Ritchie, et al (2004, p.58) highlights
that an interview also provides ‘for in depth understanding of the personal context within
which the phenomenon is located.’
Language plays an important role in terms of its use to represent multi-faceted aspects of
experience. Qualitative methods can also help to identify abstract factors such as
inclusiveness, isolation or social status. Such intangible factors come within the remit of this
study, since there are many ‘grey areas’ and contradictory beliefs associated with mental
health. Thus, a qualitative approach was deemed to be the most suitable method for an
exploration of the use of the participatory arts in a mental health setting.
25
Direct observation is another qualitative method used in my research. Observation is the
selection and recording of behaviours of people in their natural setting. It is useful for
obtaining information that is otherwise inaccessible, and for conducting research when other
methods are inadequate.
I attended one art and two music workshops where I interviewed healthcare staff in a mental
health setting. This was to gain firsthand experience of art and music participatory
workshops, to which I was unaccustomed. There was a stipulation that I participate in these
workshops rather than merely observe. I did this with the permission of the service users and
the artists and musicians presenting the workshops. For ethical reasons I chose not to record
these observations in a journal, because of the personal nature of these workshops. However,
it was still a valid and worthwhile experience, as my participation provided me with
invaluable insights into the dynamic between artists, healthcare staff and service users, and
made me aware of what exactly participatory workshops in a mental health setting entailed.
3.4 Data description and analysis
I telephoned the four participants and explained the research to them. Three people wanted a
set of questions emailed to them prior to the interview. This did not detract from the
spontaneity of the interviews, as the set format was not always adhered to in the course of
conversation. The interviews were conducted over a three week period at dates and times
convenient to the research participants, and ranged in length from 45 minutes to one hour.
Three of the participants were interviewed in their own workplace, and one in WHAT. All
participants wished to be interviewed during working hours in their workplace, except one,
who said there would be too many interruptions if the interview took place in their office.
Open ended questions were mainly used to enable participants to express their views. They
were asked specifically about the perceived impact of the participatory arts on service users
from their own perspective, and also about the implementation of the arts into care planning
policy and educational training for healthcare professionals. They were also asked about
partnership with arts and health organisations and their own interest in the arts.
The questions were selected to observe the general modus operandi of the implementation of
arts and health projects in mental health settings. In the course of the data analysis process,
26
emerging themes were identified and triangulated into a case study. According to Robson
(2002, p.89), the typical features of a case study include the ‘selection of a single case (or a
small number of related cases) of a situation, individual or group of interest or concern.’
Miles and Huberman (1994, p.267) argue that ‘[t]he aim is to pick triangulation sources that
have different biases, different strengths so that they can complement each other.’
Yin (2003) categorises case study into three types, exploratory, explanatory and descriptive.
Exploratory case study investigates the ‘why’ as well as the ‘how’ of the research area. An
exploratory case study is used in this dissertation, as the healthcare professionals in the case
study are interviewed to explore their perceptions of the participatory arts in a mental health
setting. Oppenheim (1992, p.67) verifies that ‘the exploratory interview is to develop ideas
and research hypotheses rather than to gather facts and statistics.’
3.5 Sampling techniques
A purposive sampling technique was employed, in that all participants were mental health
nurses, selected on the basis that they possessed a certain degree of knowledge that would be
a key factor in understanding the role of the participatory arts in a mental health setting.
According to Ritchie (2004, p.78), ‘[t]he sample units are chosen because they have
particular features or characteristics which will enable detailed exploration and understanding
of the central themes and puzzles which the researcher wishes to study.’
A snowballing technique was used in that the participants were recommended by a work
colleague in WHAT, who knew they were exposed to participatory arts workshops in their
workplace. This work colleague, an experienced arts and health manager, examined the list of
interview questions I had prepared, to assure suitability and relevance to the research
question.
A flexible rather than a fixed design approach was used. This allowed for some measure of
reflexivity on the part of both the researcher and the participants, and allowed the research
design to unfold during the process of data collection. (Robson, 2002)
27
3.6 Reliability and validity
The researcher should be unbiased, objective, without any prejudice or preconceived views
on the subject, as this may result in distorted or corrupted data. Oppenheim (1992, p.145)
states that ‘validity…tells us whether the question…measures what it is supposed to
measure’, therefore to ensure accuracy and consistency in the interviews, the same set of
questions were asked of all participants.
The research participants in the study were not known to me, thus minimising the risk of bias.
While there is a view that reliability is more difficult to establish in flexible design research
than in a fixed one, care was taken to ascertain the reliability of the interviews, and to ensure
that there were no leading questions nor any sharing of views on the part of the interviewer.
Prompts and probes were used only when the questions required further development. The
interviews were conducted in a fair, objective way.
The interview questions were piloted with an experienced arts and health manager to test the
clarity and relevance of the questions. Valid strategies and research techniques were
employed to gather and analyse data. Three out of the four interviews were audio taped and
the transcripts are available in the appendix of this dissertation. Participant C, who didn’t
permit their interview to be audio taped, typed out answers to interview questions and
submitted them after the interview, and these are also in the appendix.
3.7 Ethical considerations
Participants were provided with an explanatory ‘plain language statement’ via email prior to
the interview, detailing the introduction to the research study, its objectives, details of what
involvement in interview phase of the research study will require, and confidentiality of data.
They were also provided with an ‘informed consent form’, detailing the research study title,
clarification of the purpose of the research, objectives of this research, and clarification of
particular requirements as highlighted in the plain language statement.
The interviewees were informed that they could withdraw from participation in the research
at any stage; before, during or after the interview had occurred, and their confidentiality
would be assured by the researcher. The anonymity of the participants was safeguarded in
28
order to enable them to express their views and recount their experiences freely, without
undue stress. Oppenheim (1992, p.105) emphasises ‘that steps must be taken to ensure that no
information will be published about identifiable persons or organisations without their
permission.’
Interviews were recorded with the permission and solely at the discretion of the participants
on a digital recording device. All interview recordings were treated with utmost
confidentiality and names disguised. This electronic raw data and transcripts of these
recordings by the researcher will be saved as password protected files on a computer fitted
with anti-virus software. Physical raw data, such as hand written notes, et cetera, will be held
for five years in secure researcher’s archives, and a copy of all original data to be retained by
the researcher with an electronic password for a period of five years.
Each participant signed the informed consent form indicating their willingness to take part in
the interview. All interviews were conducted in a professional manner at a time convenient to
the participant. The data was collected in a discreet manner and caused no discomfort or
invasion of privacy of the individuals concerned.
3.8 Challenges faced
Initially, it was difficult to establish a date and time for each interview, as the research
participants found it difficult to find time in their busy work schedules; consequently, the
process of establishing dates and times was time consuming. One participant had to cancel on
the morning of an interview due to a colleague’s absence, so the interview had to be
rescheduled. Another didn’t agree to being interviewed because of time constraints and
severe staff shortage, but expressed their willingness to be interviewed in the future when
staffing issues had been resolved. These time constraints and staffing issues reflect a wider
problem in the healthcare system in general.
Distances had to be travelled to reach interview venues, and transcribing the audio tapes was
time consuming. Since one participant did not wish to be audiotaped, collating the interview
and taking notes made the task doubly challenging. For this reason, I choose to interview a
fourth person who agreed to their interview being audiotaped, so as to have adequate
29
information to triangulate the case study for the research findings. Oppenheim (1992, p.67)
stresses that ‘it is essential for exploratory interviews to be recorded…in this way they can be
analysed afterwards, for there is much that will have escaped the busy interviewer.’
3.9 Conclusion
This chapter has outlined the methodology, research design and data collection methods for
the research study. The study focused on the perspectives of healthcare professionals in the
South East region on their experience of the participatory arts in a mental health setting. The
areas explored in the interviews were the perceived impact of the participatory arts on service
users, the role of the participatory arts in care planning, partnership with arts and health
organisations, health care professionals’ own interest in the arts, and their thoughts on the
medical humanities.
It was a qualitative research study employing four face to face, semi structured, in depth
interviews in order to collect data from healthcare professionals. The data collected was
triangulated and presented as a case study. Ethical considerations and issues relating to
reliability, validity, data storage and analysis were taken into account as required. The
findings from this research can potentially benefit the arts and health community, comprising
healthcare professionals, service users, arts and health managers, artists involved in running
participatory workshops and the HSE. The National Network of Arts and Health
Coordinators Ireland would welcome further research on the benefits and potential positive
outcomes of this fusion of arts and healthcare.
30
Chapter 4
FINDINGS
4.0 Introduction
Introducing art and culture into the life and fabric of health services is now regarded as best
practice in health care internationally and there is an increasing acceptance of the idea that
participation in the arts can have beneficial effects on the mental health and wellbeing of
service users. (Daykin & Byrne, 2006) Though slowly becoming recognised in Ireland as an
integral part of mental healthcare, the impact of the arts has been largely under researched in
relation to other countries. The literature review identifies gaps in the knowledge of arts and
health in Ireland and a discrepancy between theory and practice in some respects. This is
borne out in the findings from the interviews conducted in this study.
Specific areas of research relating to arts and health from the perspectives of four mental
health nurses are presented in the findings. These are the value of the participatory arts in a
mental health setting, the training and experience of the participants, changing attitudes to
mental health in Ireland and the relevance of the participatory arts to care planning and to the
education of healthcare professionals, as these were the major themes emerging from the
study. Difficulties with regard to the implementation of arts programmes will be mentioned,
but will be developed more fully in the discussion chapter. These difficulties mainly arose
from recessionary cutbacks, inadequate staffing levels and subsequent heavy workloads.
All of the participants interviewed were experienced nurse managers working in various
mental health settings, from acute inpatient hospital services, to community health settings
and day care centres. Face to face, semi structured, in depth interviews were conducted.
Three of the interviews were audio taped and the conversations transcribed verbatim.
However, words which could lead to the participants’ identity have been omitted to safeguard
their anonymity. The transcripts are included in the appendix. This was a qualitative,
phenomenological study.
31
4.1 The value of the participatory arts in a mental health setting
All four participants affirmed that the arts programmes implemented in their respective work
places had a beneficial effect on service users, enhancing their quality of life and increasing
self esteem. Participant A, who works in an acute hospital setting, described a collaborative
art piece undertaken with the help of a facilitator from WHAT in which staff and service
users participated. It comprised a mosaic of squares, made up of four panels, each with
twenty-eight artworks and contains the work of approximately ninety people. The panels
represent the themes of sky, sea, forest and land, and the artwork is about being part of nature
and life and the fact that we are all connected. The artwork featured in the Wellness
Exhibition in Garter Lane. Participant A observed that it contributed to a sense of
achievement and co-operation in staff and service users alike. ‘Staff, service users all
contributed to the pieces and it’s just, it’s beautiful. I think it’s under viewed where it is
currently, so we’ve decided to…we’ve had a think about it and we’re going to move it to a
more focal point’.
Participant B spoke of music programmes undertaken in conjunction with WHAT’s
participatory arts and mental health projects in the day care centre where they work.
Participant B reported that involvement in these music workshops lightened the mood of the
service users, inculcated a sense of empowerment and provided a non threatening, non
invasive and relaxing environment. In the case of all mental health settings in the study,
engagement with the arts programmes is voluntary and the service users have a say in
running the workshops, which are tailored to suit individual needs. According to participant
B, music can also have a deeper resonance for service users, enabling them to tap into
hitherto incommunicable feelings or memories. ‘Say if somebody comes out and says oh, “I
feel a little bit tearful”, and they might start telling you other stories as to why they were
tearful…that you’re kind of linking into something new with them that you didn’t know
before.’
Both participant C and participant D work with people who have enduring mental health
needs, and both agree that involvement in the arts can have long term benefits for service
users. Participant C claims that the arts can help to provide different ways for people to
express themselves and to explore their latent creativity. Participant C thinks it can improve
32
confidence and social skills which are integral components of mental health. Participant C
observed that engagement with arts programmes can decrease negative outlook and induce a
calming effect on service users.
Participant D cites several examples of the impact of music on service users, both in a
participatory and receptive capacity. A woman with Alzheimers ‘who was never into music’
now looks forward to the day on which the music workshop is held. According to participant
D, music can aid service users to release difficult emotions, particularly those who have
trouble communicating verbally. Another service user who had Huntingdon’s disease did not
normally want to engage with other people and stayed in bed all day. The musicians asked
permission to go to her bedside, and while she was agitated at first, the music relaxed her and
helped her gain acceptance and trust. Participant D described this experience as a learning
curve for them as a healthcare professional.
One of the musicians said, “Can I bring the music to her bedside?”, and she
would get agitated when she’d see them coming, but once they started playing
soft music, she just totally relaxed, and she’d go…she accepted them and trusted
them, so it was wrong of me to assume she wasn’t suitable, because bringing the
music to the bedside as well as to the group, are you with me?
Another service user never participated actively in the music workshops, but regularly
walked by the window during the sessions. Participant D said, ‘He was listening from his
own distance.’
Participant D also refers to the value of puppetry and drama workshops conducted in the
mental health setting where they work, stating that it helped service users experiencing
communication difficulties to engage meaningfully in relationships. Participant D sees
puppetry and drama as a means of stimulating imaginations which have been blunted by
illness or medication.
All participants concurred that engagement with the arts, whether receptive or participatory,
helped to dissolve barriers to communication and played an important role in the recovery
process. Participant B stated, ‘It could open windows or doors for you.’
33
4.2 Changing attitudes to mental health in Ireland
Participant A believes that, in line with the Mental Health Commission’s recommendations, it
is crucial to allow for a recovery approach in which the service user plays a significant role.
‘It is very much part of the mental health forum now to include service users. It’s essential, I
personally think.’ Also, terminology has changed; the emphasis now is on maintaining health
rather than on treating illness. ‘I think we need to change our mindset about what we think of
mental health. Rather than the abnormalities, we talk about the fact that we want to maintain
and protect mental health.’ Participant A goes on to state that the arts play a role in offering
choices to service users in different workshops, in which participation is voluntary. There is
no pressure to participate and the enjoyment of service users is paramount.
All of the participants in the research believed that the paternalistic approach in mental health
care is giving way to a more patient centred one. The Advocacy Movement is gathering
strength and service users have the opportunity to make their voices heard regarding their
care. The traditional medical model is being replaced by one which seeks to instil a sense of
empowerment and a measure of control to service users. Participant A states, ‘They’re
experts in their own recovery, we’re just part of the journey.’
Participant B, too, sees the recovery plan as building on the service users’ strengths and
regards participation in the arts without coercion as part of a holistic recovery journey.
Participant C has embraced change to the extent that they have brought alternative and
complementary therapies into their work. As clinical nurse manager, their aim (Participant C)
is to endeavour to help clients to maximise their health and social wellbeing, by using the
resources available as effectively as possible. Participant C considers the use of the arts as
part of her role.
According to Participant D, who trained in the UK and worked there for eight years, Britain
is ahead in terms of innovative arts and health programmes for the enhancement of mental
health, stating that Ireland is now at the stage of development existent in Britain in the late
1980s. Like the other participants, they believe in a holistic model of individual care plans,
voluntary participation in arts and health programmes and collaboration with other
organisations in the wider community. Rapport and proactive feedback are of the essence.
Participant D confirms, ‘Communication is the key.’
34
Based on these observations, it is reasonable to believe that the views of these individuals
reflect similar views of a changing mental health system in the broader setting.
4.3 Relevance of the participatory arts to care planning and education
All of the participants considered the integration of the arts into mental health care planning
to be important, but all cited lack of resources, financial cutbacks and recruitment embargos
as major barriers to the successful implementation of arts programmes. This topic will be
dealt with more comprehensively in the discussion chapter. The participants also believed
that an arts and health module should be incorporated into the training of healthcare
professionals. None were offered such options in their own professional training.
According to participant D, attitudes are changing in relation to the place of the arts in care
planning and education. They believe there is a definite place for an arts and health module in
healthcare professional training. ‘I think it has to start in the college with the students, that’s
where the education starts, when you are training people, you know.’ They themselves have
done a course in arts and health and have used the expertise gained from it in their workplace.
Participant D claims that nurses are more open to new ideas and change in relation to arts and
health than other healthcare professionals. They refer to Mary Dineen, a community mental
health nurse involved with Arts + Minds Cork and Beyond Diagnosis, the Transformative
Potential of the Arts in Mental Health Recovery (2012) as an advocate for change in the area
of arts and health practice.
Participant C thinks that the inclusion of the arts into care planning could be beneficial to the
clients’ mental health and could aid recovery. ‘The workshops can be entertaining, encourage
latent skills or talents and decrease anxiety and stress and improve self esteem.’ Participant B
believes that the partnership with WHAT and the programmes it facilitates are of vital
importance in the promotion of the arts in mental healthcare, as did the other participants.
Participant A says in this regard: ‘I couldn’t praise the relationship between arts and health
highly enough. We have stronger bonds over the years, particularly the Waterford Healing
Arts Trust, because that’s our first link, I suppose.’
35
4.4 Experience and training of research participants
Participant A is clinical nurse manager in an acute inpatient hospital setting, with twenty-four
years’ experience. They have also worked in other related areas, such as rehabilitation and
methadone programmes. They are very much involved in partnership with WHAT and other
arts and health facilitators. They have a personal interest in the arts and are keen to promote
the aesthetic aspects of the hospital experience. They stress the significance of arts and music
programmes in a mental health setting.
Participant B is nurse manager in a day centre for people with mild to moderate mental health
issues, with thirty years’ experience. They have worked in various mental health settings, but
their present workplace was their first experience of the arts in healthcare. They are
enthusiastic about the arts programmes, particularly the music workshops, but have not
previously had a personal interest in the arts. However, they state that their interest has
broadened from their experience in their workplace.
Participant C is a job sharing clinical nurse manager in an activation therapy unit which
operates as a day service catering for community based service users with enduring mental
health issues. The service users attend from their own homes and from a rehabilitation unit on
hospital grounds. The unit acts as a day care type service. The staff aims to provide support
for service users to live as normal and meaningful a life as possible and to develop their
individual potential in a supported environment. They deal with the day to day mental health,
social and medical needs of those attending, as well as providing daily programmes of
therapeutic, individual and group activities along with learning opportunities and activation
programmes.
Participant C has thirty five years of experience in mental health work. They have been
working in the activation therapy unit for thirteen years and have been involved in developing
and organising programmes and activities for the unit. They have done courses in
complementary therapies which they have incorporated into the workplace. Participant C has
a personal interest in the arts.
Participant D is a clinical nurse manager in a day care centre, with thirty one years’
experience. They trained in the UK and worked there for eight years. Since then they have
36
worked in various mental health settings. They have a personal interest in the arts,
particularly in drama. Participant D would like to see more drama workshops in their
workplace. ‘I’d like to see more drama come our way, because it makes work more enjoyable
for us, sort of non clinical and it’s fun.’
4.5 Conclusion
All participants recounted positive experiences of the arts in a mental health setting,
regardless of their own personal interest in the arts. They were unanimous in the belief that
the participatory arts benefited service users, and where participation was not possible, the
receptive arts provided some measure of comfort and solace for clients. All were agreed that
development and implementation of arts programmes were sometimes hampered by financial
restraints or lack of staffing. For example, participant A speaks of a project previously
sponsored by pharmaceutical companies that had to be withdrawn due to lack of funding.
The findings from this study support findings in the literature review in relation to the
benefits of the participatory arts for service users in a mental health setting. The findings also
suggest that further research is needed on the role of the arts in healthcare in general and on
mental healthcare in particular and that there should be greater variety and diversity in the
range of arts programmes available. The research indicates that a more patient centred
approach to recovery and to the development of arts and health programmes is feasible. The
research participants are unified in the belief that engagement with the participatory arts is
important to service users and should be prioritised in the development of care planning and
budgetary matters.
37
Chapter 5
DISCUSSION
5.0 Introduction
The most significant theme emerging from this research is the beneficial effect of the
participatory arts in a mental health setting on service users in terms of recovery, increased
self esteem and quality of life. In depth consultation with mental health nurses reinforced
various literature findings on the perceived potential psychological benefits of the
participatory arts in a mental health setting. The arts have been widely used to promote
mental health and tackle social exclusion and stigma, but the evidence remains elusive and
the benefits need to be demonstrated more fully. (Hamilton, Hinks & Petticrew, 2003, p.401)
Interviews undertaken in this study reveal that attitudes to mental health in Ireland are
evolving from an authoritarian, paternalistic model to a patient-centred approach where client
involvement in recovery and care planning is crucial. However, it is clear that progress is
slow compared with other countries and that comprehensive reviews need to be undertaken to
assess the social and psychological impact of the arts in a mental health setting. Since lack of
funding was cited in the combined interviews as a reason for curtailing arts programmes, it is
imperative for future evaluations to make a good case for the cost effectiveness of these
programmes in terms of long term health benefits.
The interviews were triangulated to form a single case study. In the case study, partnerships
with WHAT and other arts and health facilitators are seen as valuable resources in the
promotion of client empowerment. The recessionary cutbacks and depletion of funding are
deplored and cited as major obstacles to the implementation of arts and health programmes.
Participant A refers to the ‘Lundbeck Initiative’, a programme sponsored by pharmaceutical
companies, where service users’ art would be exhibited in various places. Due to lack of
funding, this programme had to be withdrawn.
Most of the nurses interviewed have indicated a strong personal interest in the arts and all
appear enthusiastic about developing arts programmes in their places of work. As primary
carers with most client contact and as clinical nurse managers, they occupy a strong
38
leadership position to promote the arts in mental healthcare. The evidence suggests that they
should be given a stronger forum to voice their opinions in relation to this aspect of mental
health enhancement.
None of the participants interviewed was offered an arts and health module during their
training, but all affirm that such modules are to be welcomed in future training of healthcare
professionals. Some of the participants have supplemented their existing expertise with
further arts and health courses and complementary therapies. This fact lends credence to the
view that the participatory arts play a significant role in the enhancement of patient care and
policy planning.
5.1 The role of the participatory arts as part of care planning and recovery approach
It has emerged from this case study that the participatory arts have a significant role to play in
mental health enhancement, and all respondents believed arts programmes should be
integrated into care planning policies. All of the nurses interviewed have ongoing experience
of the implementation of arts in healthcare and are willing to take new projects on board.
They would welcome greater variety and diversity in the types of programmes available for
service users. They see a clear need for arts programmes, but all are hampered by lack of
consistent funding and over reliance on outside benevolent donors. Participant A argues for
‘the development and the expansion of programmes and more varied options for everybody
and choices surrounding their own mental health.’ Concerns were expressed by the
participants that some healthcare professionals, including doctors, still subscribe to traditional
biomedical approaches of recovery, which can hinder much needed change and innovation in
areas such as mental health. More widespread support for a social model of care is necessary
to validate the work of those pioneering the participatory arts in their mental health settings.
Participant A also pointed to an inconsistency in that the arts programmes in the acute setting
where they work runs during the week from Monday to Friday only, with no provision for
organised activities at the weekends. Participant A discovered from service user feedback that
this is a serious drawback and that there is a need for continuity if optimal success is to be
achieved. The emergence of the consumer movement internationally and the concept of
service user leadership has helped to reinforce the need to take a different approach to service
provision and to work with service users to create the services which work best for them.
39
Many service users expect more from services and recommend developments that enable
them to retain ownership of their recovery. (Mental Health Foundation, 2007) ‘The service
user is the expert.’ (Participant A)
In general, the research participants did not make a clear distinction between art therapy,
which is clinical in nature, and participation, which can be therapeutic, but whose primary
aim is to create artistic fulfillment and enjoyment. They sometimes referred to the
participatory arts as ‘therapy’. Clearly, there is a discrepancy here and room for further
clarification for the benefit of healthcare professionals. ‘The specific subjects of ‘arts’ and
‘health’ do not exist as concrete entities, but are shifting, amorphous and contested; subject to
competing claims within their own disciplines.’ (Broderick, 2011, p.95)
The participants all agreed that the arts in mental health settings is relatively new in Ireland,
with Participant D stating that it is only in the last eight years that they have seen any
significant innovation in this area, in contrast to when they worked in England in the 80s
where arts and health practice was the norm at that time. Since the mental health nurses are
the primary carers at ‘the coal face’, having most contact with the service users, monitoring
their medication, assessing them for change and acting as ‘safety net’, (Participant D), it is
reasonable to believe that they are the best judges to gage the satisfaction of service users in
their experience of arts in a mental health setting. Building on the data acquired in this regard,
it is fair to recommend that more funding and education should be invested in this area,
particularly when the nurses are open to new knowledge and training.
5.2 Partnership with arts and health organisations
All of the participants valued the partnership with arts and health facilitators, particularly
WHAT, their main link with arts programmes. ‘Partnerships are effective in increasing the
resources available to a project to support recruitment, provide health and welfare links, and
expand networks.’ (Victorian Health Promotion Foundation, 2003, p.11) In general, they
relied almost completely on these facilitators, stating that they had neither the confidence nor
the skills to deliver arts programmes on their own. This could be a further area of education
for healthcare professionals, at least as an optional module. On the other hand, some measure
of involvement in the arts is accepted on the part of the staff. In some of the mental health
settings, the staff are involved in the arts with the service users, as participant A has affirmed,
40
while participant B said that the staff remain ‘on the periphery’, and considered too much
involvement on their part as ‘interference’. All participants arrange outings for service users
from time to time, to art galleries, the cinema and other cultural venues. All agree that using
the arts in healthcare is still seen as a luxury, but that it should be part of the service. ‘It’s
becoming part of the service.’ (Participant D)
Participant B said that the day care centre in which they work may become a day hospital in
future, but that the process of transition is slow because of financial restrictions. This would
open up more avenues of opportunity for more links with community based projects and help
decrease stigma and social exclusion. It would pave the way for a social model of mental
health by emphasising interrelated factors that influence health and point to changes that can
be made to make a population healthier. The advance of arts practices in healthcare settings
present a challenge to clinical orthodoxy. (Broderick, 2011)
Partnership is a vital support for mental health settings at a time when arts practices are at a
relatively innovative or transitional stage in Irish medical settings. As Broderick suggests,
(Broderick, 2011), both ‘arts’ and ‘health’ are nebulous concepts and there may be ambiguity
about what arts practices might mean for artists, service users and healthcare professionals.
There might be different expectations such as the hope for a sense of wellbeing, aesthetic
outcomes or clinical outcomes. Expert facilitators such as WHAT can provide satisfactory
infrastructures for arts and health practices as well as resources and training for healthcare
professionals. According to its five year strategy 2010-2014, the Arts council is committed to
the promotion of arts and health at national level, and the provision of supports, resources and
partnerships. (Dunne, 2011)
5.3 Education of healthcare professionals
None of the participants interviewed had received or been offered an arts module in their
professional training. All said they would like to see it introduced in some measure in future
training of mental health nurses, at least as an option. This points to a need for an
examination and possible modification of training courses to include arts and health modules,
in light of the growing awareness of the potential benefits. ‘We always encourage students to
participate in the workshops and programmes, so having it included as a module in college
would be of great benefit.’ (Participant C) Arts programmes can complement clinical care
41
and thus enhance the hospital environment. The participants were adamant that having access
to the arts can help make service users feel supported and cared for and help normalise the
mental health setting.
In relation to current policy, the Mental Health Commission, the HSE and Health Information
Quality Authority (HIQA) are in favour of implementing new programmes. More research
must be undertaken to persuade them of the cost effectiveness of arts programmes in terms of
health benefits to service users. In 2010, the Arts Council created a bursary award for arts and
health practitioners working in the area of arts participation. However, recent developments
seem to be arts sector led rather than initiated by the health sector.
‘Interventions that involve creativity and spirituality are offering nurses a new perspective on
caring for patients today.’ (Lane, 2005, p.122) Studies have shown that creativity can heal by
changing a person’s physiology from one of stress to deep relaxation. The creative process
can cause areas of the brain to release endorphins and neurotransmitters which help to relieve
pain and aid the immune system to function more efficiently. When people engage in creative
activity, the endorphins act like opiates, restoring hope and optimism and helping them deal
with debilitating problems. (Lane, 2005)
Lane describes arts in healthcare as a new paradigm for holistic nursing practice and says it is
one of the most transformative methodologies in healthcare today. She says that nurses, by
virtue of their close contact with service users, are key to integrating creativity into
healthcare. She affirms the power and primacy of the person and the power of the human
spirit and imagination as vital inner resources which can be drawn out by effective creative
activities, and describes several successful programmes that have been undertaken in The
United States. (Lane, 2006)
5.4 Impact of the participatory arts on service users
Studies indicate that the participatory arts can and do aid overall mental health ‘…by
providing opportunities to share experiences in an empathic environment through
symbolically expressing emotions in a concrete way.’ (Smilen, 2009, p.381) In the mental
health settings I visited and where I interviewed healthcare professionals, service users were
engaged in the creative process and appeared to be positively reinforced by being provided
42
with a safe space for them to express themselves. It was clear that the arts are a simple and
effective means for people to learn multiple forms of expression. In all the mental health
settings, service users were allowed to express themselves without judgement or criticism,
and were given the option to choose from various creative activities that increase their sense
of internal control and willingness to participate.
A sense of community and social interaction, mutual support and peer modeling is created in
this type of environment, particularly when supportive staff are present. Completing a piece
of art or finishing a performance in the presence of supportive staff and peers can boost a
service user’s confidence and self esteem. This is something I witnessed at the participatory
art and music workshops I attended in the mental health settings where I interviewed the
healthcare professionals. By creating and sharing a safe and supportive environment, service
users were able to break their sense of isolation.
Bhagwan (2009, p.226) wrote ‘Individuals do not exist as isolated, discrete or separate
entities, but as interconnected beings whose growth, wellbeing and transformation are shaped
by dynamic and fluid relationships between friends, family, the global community, and a
Higher Spirit within the Universe.’ Adult facilitators carefully monitored the process of arts
participation and offered affirmation and validation.
In 2006, a working group on arts and health carried out research in three major Scottish
hospitals, the Royal Infirmary in Edinburgh, Stobhill Hospital and the Victoria Infirmary,
both in Glasgow. The findings showed that the arts have a clear contribution to make and
offer opportunities for improved health and wellbeing for staff and service users alike.
(Lankston, Cusack, Freemantle & Isles, 2010) Hamish McDonald, an artist and patient at
Beatson Hospital, Glasgow, wrote: ‘I am a firm believer in the power that art has to inspire
and help alleviate suffering and that it can play a key role in lessening the burden that illness
brings.’ (Lankston et al, 2010)
5.5 Conclusion
The research has shown that participation in the arts has the potential to contribute to mental
health in a significant way. Art created by people with mental health issues can provide
valuable insights into their life experiences so that they can be better understood, respected
43
and included equally in society. Participatory arts can engage the senses in a way that
transcends the ordinary, banal aspects of life. As people connect to their poems, songs,
dances or paintings, they become more aware of their thoughts and emotions. This assists in
self discovery, self understanding and the search for meaning. Talk therapies do not work for
everyone in a mental health setting, as they may find it difficult to articulate deep feelings,
inner sensations and memories. Thus alternative forms of non verbal communication need to
be used to engage people fully in the healing process.
A number of Australian based research studies found that visual arts, music programmes and
performance are now regarded as best practice in healthcare. Some of the benefits were
recorded as reduced stress and anxiety, speedier recovery rates and beneficial effects on the
immune system. (Putland, 2012) Collectively, these studies present a persuasive case for the
inclusion of arts programmes into mental health settings. The arts in healthcare are capable of
addressing the complexity of health promotion by fostering interrelations between physical,
emotional, cognitive and mental health aspects of wellbeing. (Putland, 2012)
Studies carried out in Britain by Staricoff (Staricoff, 2004 & 2006), Ulrich and Zimring
(Ulrich & Zimring, 2004) have found that patient stay is one day shorter when they
experience visual and auditory arts. Studies have also shown that singing helps to improve
quality of life for dementia sufferers and that visual arts and music can reduce depression in
people suffering from incurable illnesses. Other studies have demonstrated economic savings
and higher service user satisfaction. (Department of Health with Arts Council England, 2007)
‘Small scale projects can act as catalysts for major change.’ (Department of Health with Arts
Council England, 2007, p.22)
44
Chapter 6
CONCLUSIONS & RECOMMENDATIONS
6.0 Introduction
This chapter concludes the study by setting out the research objectives and reiterating the
theoretical conclusions drawn from the case study and the literature reviewed. It also
highlights the research limitations and makes practical recommendations to relevant
stakeholders in the area of arts and health in Ireland, such as the HSE, The Arts Council and
the National Network of Arts and Health Coordinators of Ireland.
6.1 Research objectives
In this research, the perspectives of mental health nurses on their experience of the
participatory arts in mental health settings were explored. There is an increasing interest in
the use of the arts in mental healthcare, but because it is a relatively new concept in Irish
mental health settings, it can present challenges to existing norms based on the traditional
biomedical approach. Since psychiatric nurses play a pivotal role as primary care givers in
mental healthcare, their perspectives could be useful in gaining insights into the value of the
arts in mental health settings. The aim of the research was to garner qualitative feedback in
the form of semi structured, in depth interviews so as to set the parameters for future
research.
The aim of the study was to learn what these primary care givers, who have the most contact
with service users, think of the arts in terms of care planning and effective recovery
approaches. I also wanted to know what they thought of the impact of the arts on the health
and wellbeing of the service users in their care. Considering the relatively undeveloped
research carried out in this area, I undertook to interview four mental health nurses in the
South East region to discover their experience of the participatory arts in their own
workplaces. Their perspectives in such specific contexts could give significant insight into
the development and implementation of arts programmes in mental healthcare settings.
45
6.2 Research limitations
I interviewed four mental health nurses who had a common interest in the arts in healthcare
and an appreciation of their value in the enhancement of the health and wellbeing of service
users. However, these participants do not represent the experience of healthcare professionals
in general, who may not have an awareness of the arts in healthcare, or where they are not
incorporated into care planning policy. The nurses interviewed were in the privileged position
of being in partnership with WHAT and therefore qualified to assist in delivering arts
programmes relevant to the needs of service users in their general practice, and they also had
an appreciation of the arts in mental healthcare.
6.3 Theoretical conclusions
The research participants were unanimous in their opinion of the arts as an integral
component of mental health promotion and all considered it as an essential part of the
recovery approach process and their views echoed the aspirations and ideals laid out in the
document Beyond Diagnosis. (Sapouna et al, 2012) The findings revealed that engagement in
the participatory arts help service users to adjust their perceptions about themselves, discover
latent skills and rebuild an identity damaged by illness. Participation in arts activities created
a new and creative way of thinking about problem solving and adapting to difficult situations.
Participation also encouraged flexibility, a characteristic of creative thinking, which
improved the person’s ability to cope with the inevitable stresses of life as well as
overcoming limitations connected with their illness.
The participatory arts workshops provided an opportunity for achievement and self
fulfillment on many levels, raising self esteem and increasing motivation in service users.
The importance of having a sense of hope is seen as a key factor in the recovery process.
Hope generally involves the anticipation of a sense of personal competence, psychological
wellbeing and a sense of purpose. All the nurses interviewed agreed that the arts programmes
implemented in their workplaces had a positive effect on service users in this respect, and
viewed them as an important contribution to the recovery approach.
46
The literature review reinforced these findings and revealed that participation in the arts
increased personal empowerment in service users and justified its inclusion in mental
healthcare provision. The findings from the literature review also identified a lack of clarity
in the understanding of the concepts of both mental health and the arts in healthcare. The
need for further, more structured research into the impact and effectiveness of creative
activities was also identified.
The literature review also cited common outcomes of arts projects in helping service users
gain wider social networks and wider community involvement. The multiple benefits accrued
by service users and healthcare professionals in the research studies described in the literature
support the need for the provision of creative resources within the mental health services. The
range of arts programmes is varied and multi-faceted, and includes literature, music,
performance and visual art, providing broad scope for tailoring programmes to suit individual
and community needs. The shift away from focus on medical symptoms to an emphasis on
ability helps to reduce stigma and support social inclusion.
Overall, the emergent themes from the literature review reflect the therapeutic benefits of arts
based activities in mental health settings and their positive influence on the recovery process.
This concept of the healing and transformative power of the arts adds an extra dimension to
service delivery in mental health. It creates a positive culture of hope and belief that recovery
is possible despite the militating factors of illness. The literature describing arts programmes
in mental health settings in other countries provides a framework for policy and practice in
Ireland, where the arts and healthcare is relatively new. Both the literature review and the
research undertaken point to the potential benefits of the participatory arts and the need for
further research in the area.
6.4 Recommendations
Since the research findings suggest positive experiences on the part of healthcare
professionals and a beneficial impact on service users, arts programmes in mental health
settings and the arts and health professionals who implement them should be given strong,
ongoing support. It is in the interests of the HSE and the MHC to promote health and
wellbeing of service users and staff by maintaining existing support structures and extending
social and community networks.
47
On examining the ideals and aspirations of the MHC, it was clear that there is a gap between
theory and practice. Since arts and health policy and practice in Ireland often lack
consistency, clarity and cohesiveness, there is room for more thorough and structured
research and training in this area in terms of impact on service users, resources and funding.
Cost effectiveness of arts in mental healthcare as opposed to the biomedical aspect of care
should also be investigated. There should be greater liaison between the HSE, the Arts
Council and other relevant organisations in this regard. If the Arts Council were to implement
a National Arts and Health Policy Framework, it would guarantee that arts and health
organisations would not be working in isolation, and would in fact be playing a greater role in
gaining recognition for arts and health. Researching successful arts programmes in other
mental health settings would also be useful.
There should be further collaboration between staff, service users, artists and other relevant
bodies in the delivery of an effective recovery approach that incorporates the arts in mental
healthcare. There should also be more feedback and research evaluation meetings between
the Health Services and relevant organisations within the wider community. A more thorough
investigation is feasible for the potential integration of the arts in care planning, effective
recovery approach, best practice and future arts and health development. These
recommendations are in line with those of Beyond Diagnosis (Sapouna et al, 2012) In the
preface of this document, Kathleen Lynch, T.D., states that the arts add value to mental health
provision and plays a vital role in a progressive, recovery directed mental health service.
While Arts and Health is not guaranteed to work in all circumstances, it can be a valuable and
enjoyable compliment to traditional medicine.
48
GLOSSARY
Arts and Health: ‘Arts and Health is the generic term that embraces a range of arts
practices occurring primarily in healthcare settings, which brings together the skills and
priorities of both Arts and Health professionals.’ (Arts Council’s Arts and Health Policy and
Strategy, 2010, p.4) ‘Founded on a principle of equal partnership between Arts and Health
sectors, Arts and Health is a specific field of work that is characterised by clear artistic vision,
goals and outcomes that seeks to enhance individual and community health and wellbeing.’
(WHAT/CAHP) Arts and Health can cross over with any number of other arts practices such
as: community-based arts, arts and medical humanities, and arts and science.
Arts and Health Practitioners: The term ‘Arts and Health Practitioner’, or ‘Practitioner’,
refers to anyone who has a professional role in the preparation, delivery and evaluation of
Arts and Health work.
Arts + Minds: Arts + Minds is a Health Service Executive (HSE) arts and mental health
programme based in Cork. It is a mental health staff led initiative supported through the HSE
Cork Arts and Health Programme. It involves six mental health settings and aims to enhance
the health and wellbeing of mental health service users through high quality engagement with
the arts.
Arts Therapy: Arts Therapy is a form of psychotherapy that uses the arts as its primary
mode of communication. ‘There is a clear distinction between arts and health practice, where
a key goal is the experience and production of art, and the arts therapies, where the primary
goal is clinical.’ (Arts + Health: Arts and Health Editorial Policy, 2013, p.4)
Holistic View of Health: ‘A holistic view of health recognises the integral connection
between the mind, body, and spirit of an individual.’ (Serlin, 2007, p.282)
Medical Training and Medical Humanities: ‘For hundreds of years, the arts have played a
part in developing the practice of medicine and the understanding of wellbeing. Lots of
doctors will now have an arts aspect to their training and many health-workers find that
active participation in arts activity helps them with their work. The arts are also often used to
help explore ethical issues in medicine.’ (National Alliance for Arts Health and Wellbeing,
2014)
Mental Health: Mental health is an integral and essential component of health. The World
Health Organisation's (WHO) constitution states: “Health is a state of complete physical,
mental and social well-being and not merely the absence of disease or infirmity.” (WHO,
2014) An important implication of this definition is that mental health is more than just the
absence of mental disorders or disabilities. Mental health is a state of well-being in which an
individual realises his or her own abilities, can cope with the normal stresses of life, can work
productively and is able to make a contribution to his or her community. Mental health and
49
well-being are fundamental to our collective and individual ability as humans to think, emote,
interact with each other, earn a living and enjoy life. On this basis, the promotion, protection
and restoration of mental health can be regarded as a vital concern of individuals,
communities and societies throughout the world.
Mental Illness: Mental illness refers to a wide range of mental health conditions - disorders
that affect your mood, thinking and behaviour. Examples of mental illness include
depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviours.
Participant: The term participant is used to refer to any person participating in a
participatory/collaborative Arts and Health project. In the case of Arts and Health practice,
participants are often Health Service Users.
Participatory Art: Arts Participation includes a broad range of practice where individuals or
groups collaborate with skilled artists to make or interpret art. The practice involves a
mutually beneficial two way engagement that nurtures and values the different ideas,
experiences and skills of all involved. ‘Professional artists collaborate with people to create
original artistic works that relate to and/or express to others the participants’ experience,
outlook and/or community context in some way. Participants can be involved in the planning,
development and in some cases evaluation of the project along with the project staff.
Participatory art will have a high level of meaningful participation which includes the process
through which the project develops and outcomes in terms of the benefits experienced by
participants.’ (Mental Health Foundation, 2011, p.8)
Participatory Arts: Expressive and Participatory Arts include activities such as drawing,
painting, sculpting, dancing, drama, creative writing, writing poetry, making music,
photography, and any other activity or subjects of study primarily concerned with human
creative skill and imagination. ‘Arts and Health is not limited to any particular artform. It can
include any artform, or indeed, any genre within a particular artform.’ (Arts Council’s Arts
and Health Policy and Strategy, 2010, p.4)
Service User: The term service user is used to mean anyone using the Health Service in
Ireland. It is used instead of the term ‘patient’ or ‘client’. It is popular with service providers,
particularly within the public sector. It is used as a generic description of the people who use
mental health services.
The Arts: ‘Any creative or interpretative expression (whether traditional or contemporary) in
whatever form, and includes, in particular, visual arts, theatre, literature, music, dance, opera,
film, circus and architecture, and includes any medium when used for those purposes.’ (Arts
Act 2003)
50
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APPENDICES
A1
Appendix A: Information Sheet for Research Participants in Interviews
For Research Participants in Interviews
Purpose of the study: As part of the requirements of the Master’s Degree in Arts and
Heritage Management in Waterford Institute of Technology, I have to carry out research and
complete a dissertation. The dissertation is concerned with ‘The perspective of healthcare
professionals in the South-East Region on their experience of the participatory arts in a
mental health setting.’
What will the study involve? The study will involve a discussion during an interview which
will take approximately one hour. Some questions will be raised about your experience of the
participatory arts in your workplace. The researcher will request that interviews be recorded
(audio only) in order to facilitate data gathering and subsequent data analysis. Participants
retain the right to decline the researcher’s request to record an interview
Why have you been asked to take part? You have been asked to take part because of your
experience as a healthcare professional that has experienced the participatory arts in a mental
health setting.
Do you have to take part? No. Participants’ involvement in this research is totally
voluntary. The consent form ensures that you have the option to withdraw before the study
commences or discontinuing after data is collected. If you have any afterthoughts within two
weeks and you wish to withdraw your information, the data from your interview will be
removed from the study and destroyed. In addition, you may choose not to answer any
questions with which you are not comfortable. You may keep this information sheet and a
copy of the consent form.
Will your participation in the study be kept confidential? Yes. Every effort will be made
to respect participants’ anonymity. The data collected will be analysed by the principal
researcher alone. Participants’ actual names will be protected and fake names will be used if
direct references and quotations are required. No reference will be made in oral or written
reports that could link you to the study. Interview notes and/or transcripts will be held by the
principal researcher and stored in a secure location. At all times your confidentiality will be
respected.
What will happen to the information which you give? The data will be kept confidential
from third parties, workers’, superiors, etc. for the duration of the study. On completion of the
dissertation, the data will be retained for a further five years in a secure environment and then
destroyed.
A2
What will happen to the results? The results will be presented in the dissertation, which
will be seen by my supervisor, a second marker, and an external examiner. The dissertation
may be read by future students on the course. The study may be published in an academic
journal.
What are the possible disadvantages of taking part? I don’t envisage any negative
consequences for you in taking part. There are no known risks associated with this research
project other than possible discomfort with the following:
You will be asked to be completely honest about your perspective of your personal
experiences of the participatory arts in a mental health setting.
Possible benefits from participation in this project are:
You will have an opportunity to reflect on your experiences.
You will contribute to knowledge about the participatory arts in a mental health
setting, which could help to improve arts related projects or workshops for future
participants.
What if there is a problem? At the end of the interview, I will discuss with you how you
found the experience. You may wish to contact me about your research contribution.
Who has reviewed this study? Susan Connolly, Supervisor, MA Arts & Heritage
Management, Waterford Institute of Technology, School of Humanities, College Street
Campus, Waterford.
Any further queries? If you need any further information, you can contact me: Úna
Kavanagh. Mobile number: Email address:
If you agree to take part in this study, please sign the attached informed consent form.
B1
Appendix B: Participant Informed Consent Form
Participant Informed Consent Form
Title of study: The perspective of healthcare professionals in the South-East Region on their
experience of the participatory arts in a mental health setting.
Purpose of the study: As part of the requirements of the Master’s degree in Arts and
Heritage Management in Waterford Institute of Technology, I have to carry out research and
complete a dissertation. The dissertation is concerned with the perspective of healthcare
professionals in the South-East Region on their experience of the participatory arts in a
mental health setting. Susan Connolly, Supervisor, MA Arts & Heritage Management has
reviewed this study.
Name of researcher: Úna Kavanagh.
I………………………………………agree to participate in Úna Kavanagh’s research study.
The purpose and nature of the study has been explained to me in writing.
I am participating voluntarily.
I give permission for my interview with Úna Kavanagh to be audio-recorded.
I understand that I can withdraw from the study, without repercussions, at any time, whether
before it starts or while I am participating.
I understand that I can withdraw permission to use the data within two weeks of the
interview, in which case the material will be deleted.
I understand that anonymity will be ensured in the write-up by disguising my identity.
I understand that disguised extracts from my interview may be quoted in the dissertation and
any subsequent publications.
I will also retain a signed copy of this consent form for my own personal records.
……........................................... ........................... ....................................................................
Name of participant Date Signature
C1
Appendix C: Interview Questions for Healthcare Professionals in a Mental Health Setting
Interview Questions for Healthcare
Professionals in a Mental Health Setting
1. What is your role in the workplace?
2. How long have you been working in the area of mental health? (What is your
previous experience in the area of mental health?)
3. What is your (previous) experience in the use of the arts in mental health (if any?)
4. What do you think the arts can contribute to service users of your workplace? (For
example what was the impact of previous art & music projects or workshops on
participants?)
5. What are your expectations of the art & music projects or workshops in your
workplace?
6. In your opinion what are the strengths of the art & music projects or workshops in
your workplace?
7. In your opinion what may be the areas that need to be further developed in the art &
music projects or workshops in your workplace?
8. At the end of a block of art & music projects or workshops what would constitute a
successful outcome?
9. At the end of a block of art & music projects or workshops what would constitute
failure?
10. What do you think the arts can contribute to mental health care in general?
11. Current mental health policy recommends more options/alternatives in service
delivery. Can you talk a bit about the impact of these recommendations on care
planning in your work place?
12. How do you think these recommendations are manifesting in the practice context?
13. What do you think the arts can contribute to care planning in your workplace in
particular, and in mental health settings in general?
C2
14. How do you think the arts have impacted on mental health service delivery in your
workplace?
15. How do you think the arts have impacted on the clients of your service?
16. Have the arts in your work place impacted on you personally in any way?
17. Have the arts in your work place made your job easier or harder, or a bit of both?
18. At this point do you think that you have adequate resources to do your job as you
think it should be done and have appropriate support in your position?
19. The WHAT participatory arts and mental health programme is a product of a
partnership approach between various stakeholders.
What are the benefits of the partnership?
What are the possible limitations?
20. On a personal level, do you have an interest in the arts yourself outside of the
workplace?
21. Would what you think of the arts personally influence your decision in what you think
of the arts in your workplace?
22. Previously I asked you what your role was in the workplace. Would you like to see
the arts as part of your role in the workplace?
23. Do you think it would be a good idea to integrate an arts and health module into the
student nurse/doctor curriculum in college? Were you offered, or did you have
anything like this in your training?
24. Would this have been a module you would have chosen yourself? Why?
25. Are there any other points concerning the arts in a mental health setting that you
would like to make that maybe I didn’t ask or think of that would be relevant to know
in terms of this dissertation?
Thank you!
D1
Appendix D: Interview A Transcript
So first of all what’s your role in the workplace?
My role is clinical nurse manager in the […] and my role in that area would be to provide therapeutic activities
for the, I suppose how many are in at whatever time. We have capacity for forty-four. Thirty-three in sub-acute:
oh sorry, actually it’s thirty-four in sub-acute and ten in the acute area, and now we do actually offer service to
both acute and sub-acute. I do have a staff nurse working with me now, so that helps I must say and obviously
the input from other agencies helps, but that’s basically my role.
How long have you been working in the area of mental health?
Do I have to answer that one? [Laughs] I have been working; oh God, I commenced my training in 1990, so
we’re 2014, so do the maths. Twenty-four, twenty-four years? Would that be right?
So you’ve always been in the area of mental health as well?
I did some work in the ID services also. I crossed over, did respite work, but basically most of my work has
been in acute mental health, but also in other areas, mostly acute I’ll have to say, but I’ve had time out in
rehabilitation in the methadone programmes, worked with substance misuse and the like, so I’ve had a bit of a
cross over.
So plenty of experience then?
Varied now in the last twenty years.
Plenty of experience in the mental health area by the sound of it
Yeah, I think so. [Laughs]
So what is your previous, or what is your experience in the use of arts in the mental health setting? Is that
something you’re familiar with?
Yeah, well I suppose initially my role would have been on the ward in the […] prior to getting involved in the
arts aspect of any projects that we had. I took over as the nurse manager in the therapeutic activities so that was
when I really started to get very much involved with Waterford Healing Arts in particular and other facilitators
that would come into us. Generally most of the work that I would have done would have been in collaboration
and in partnership with Waterford Healing Arts through either music workshops, art workshops.
So when you say therapeutic, that covers, that could cover a lot of different things could it?
Yeah, well my role being therapeutic activities would be whatever is therapeutic for an individual. That mightn’t
necessarily be…you know, some will enjoy music, some will enjoy art.
So you go by the individual?
Yeah, well it’s…
So that’s your role as well really?
Well, yeah, a plan of care really and obviously the major roll on from the mental health commission and from
ourselves as mental health workers is to allow for a recovery approach which is very much the service user’s
decision and they are crucial in the roll out of their planning of their own care.
D2
That’s changed now as well. They’re encouraged to get involved in their own (talked over).
It always occurred, but I think more so now. It’s accepted and expected. I think that would be the most
important thing to say is that it is accepted and expected. In the past, they would have been involved, but it
necessarily wasn’t documented and it’s very much part of the mental health forum now to include service users.
It’s essential, I personally think.
So what do you think the arts can contribute to service users at your workplace? I mean for example,
what was the impact of previous art and music workshops?
Yeah, the impact has been, it’s been fantastic actually. For example, I do have a few…there were a few different
projects that we ran, one particular one that we did which I’m very fond of because it was one of my
favourites…was the collaborative art piece that we did with the facilitator from Waterford Healing Arts and we
did squares…
I know the one you’re talking about.
It’s fabulous. Colour-wise and just variety and we’ve actually made a decision now to move that out onto the
unit. To be honest, I suppose the most, the big reason I would be so proud of it is because it was in the Wellness
exhibition in Garter Lane and it’s…
It’s a sense of achievement, something like that?
Absolutely, for everybody, because staff, service users all contributed to the pieces and it’s just…it’s beautiful. I
think it’s under-viewed where it is currently, so we’ve decided to…we’ve had a think about it and we’re going
to move it to a more focal point.
Yeah, and brighten up the corridors outside.
I think so, yeah. We thought it might be a nice welcoming thing to walk in to the […] and see it, maybe on the
walls as you come down, because it’s a beautiful piece.
So how long has arts been a part of the department over there?
Now, I suppose…
Since WHAT started maybe?
Yeah, I would imagine. I wouldn’t be 100% sure date-wise, but I do know from the offset there would have
been a link. My predecessor would have linked with, obviously with the arts here, and there would have been a
lot of…funnily enough not only the WHAT, also in the past…things have changed where drug companies are
concerned, but there would have been the Lundbeck, obviously, Initiative. Maybe you’ve heard of it? It would
have been exhibitions of art by our service users and we would go to different places and exhibit their works and
prizes and the like. Fabulous sense of achievement for anyone that was involved in it. I have been involved in it,
but unfortunately due to funding and recession and whatever other, it was withdrawn.
It always comes back down to funding and the recession doesn’t it?
Up until I’d say two years ago cos the lads here would have been involved, you know, would have been aware
of it. It was fabulous, fabulous!
Lundbeck you say?
D3
The Lundbeck Initiative. It’s through drugs companies. That’s where the money was released, through the
pharmaceutical companies and they had a lot of work around mental health at the time, so yeah, it was a pity to
lose it, but it’s another example of work we were involved in.
When you say the beautiful brightly coloured squares, are you there witnessing that? Are you getting
involved yourself?
Yeah, the way it came about initially was the project was discussed, the collaborative artwork that we had
decided to do, and it was decided that over a few months we would have in the session on Wednesday, that we
would have card like pieces and everybody would be given in the group, and the facilitator would encourage
staff members also to sit at the table and do a piece and add to it, so yes, there was involvement from ourselves
also and anyone that passed in was encouraged to sit and join in, and obviously some people were
uncomfortable with it initially, but then sat and joined in, and it was great. The end result sure says it all really.
It doesn’t sound like something you’d be uncomfortable with yourself.
No, no, not at all. I’m massively…I would have great aesthetic…I suppose I love to see beautiful things and see
things created.
What would be the expectations of the arts and music projects or workshops in your workplace?
Our own expectations?
Yes, your own expectations.
Our own expectations. Well, our own expectations would be, well I suppose the very basic thing would be that
people would enjoy it and that they would feel that it was something that they wanted to do, or that they would
actually gain something that they would use maybe later on when they would be discharged, that they might find
an interest, or even a leisure time pursuit that they might gain from it, but also that they would feel that they
weren’t pressurised into doing something, and that they might actually learn something new, a new skill.
I suppose it’s just participation in something and it could be enjoyable as well
Yeah, absolutely, because in a lot of cases when you’re…obviously it’s mental health that we’re talking about
and it’s about improving mental health and we’re all about protecting mental health. We try not to use ill health
anymore; we talk about health rather than…
The terminology has changed…
Well yeah. It’s good too because I think we need to change our mindset about what we think of mental health.
Rather than the abnormalities, we talk about the fact that we want to maintain and protect mental health. And I
suppose what we’ve been able to do through having the arts in the programme is offer people choice in different
workshops, be it art, be it music and get some enjoyment out of it too without pressure.
Yeah, and again what would have been there before? Would there have been anything?
In the programmes I suppose over the years, we’ve always had art as an aspect. There’s always been an
art…there’s always been a creative aspect to the programmes. I think because it can, it has always been
something that people can gently sit down with maybe, allow themselves time to reflect and perhaps then create
something without maybe speaking if they don’t want to. Which I think helps sometimes when you’re not
feeling on top of your game. We’ve found that through, and particularly even through the expression of what is
on the page, be it somebody that’s maybe feeling particularly low, or somebody that’s maybe particularly high
actually. What they…I mean, we know obviously from the discussions in history about when artists were
maybe, perhaps elated when they did their pieces, or were low, and I mean, it’s very…you can actually see it.
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Obviously you can in your role, but I mean, it’s amazing what’s in your mind can go on a page, you know? And
I find that fascinating.
Yeah, as an artist I find that fascinating. I suppose I’m used to my own work, but it’s interesting to hear
your opinion of it and you’re in here every day so…
Yeah, I do, and I see it in...When a service user would sit and do a piece that sometimes I can actually…I can’t
say I can read everything, but I can certainly tell maybe the momentum or the feeling that was maybe just put on
the page.
[Speaking together] You’re getting the judgement…
Yeah, so it’s good, it’s good.
Okay, so in your opinion, what are the strengths of the art and music workshops in your workplace?
Well the biggest strength I would think is that it crosses all divides, particularly say for age. Age is a big thing,
and gender. Obviously our service is an adult service and we’re talking about eighteen and upwards, so you’ve
got eighteen, and when I say upwards, we’re talking eighteen to a hundred, you know? [Laughs] Basically, we
are…
[Speaking together] God you have a broad range of people…
We have like a mix of any age group and also genders and I think it manages to cross that, like it manages to
cross that barrier. Obviously there’s certain things that women maybe feel that they’re better at, or men feel that
they’re better at, but when it comes to a group like that, it’s amazing what people will sit around at a session,
and it really just…particularly the art, but also the music because obviously with the music we’ve seen, and
through the projects that we have and the current one, the Iontas, it is amazing what we see from individuals and
what they can produce.
And would the arts and music be different? Well obviously they are different, but do they produce
different effects, or are they similar?
I think it is varied, definitely. At times it’s amazing what you see, particularly say for music. Also the fact that
different genders will join in certain things, have different interests in music…
Yeah, it depends on the age group I take it?
It does depend on the age group and I think they tend to bring it a certain way themselves if they have an interest
in a certain genre, and we’re very lucky with the facilitators we have that they’ll go, as they say, they’ll go with
the flow. If you see someone leaning towards traditional music, we’ll go that way. We’ve had young people that
may have their interests in…whatever, from Coldplay to, you know, it’s very varied and it’s lovely to see that
they can tap into a very eclectic style, you know, which is great.
You probably need that style over there where people can go with the flow?
Yeah, because depending on the day and because we go to the acute area also, depending on the day…the mood,
the music may have to change to facilitate what’s going on. It may be very tranquil. In most cases it is, but even
the setting, the environment, and where we have the music session, we move with…we may have it in the small
room, or we may have it out on the main floor, or as we’ve had, when the weather was good, we’ve been able to
have it out in the garden. We’d have little mini festivals which were fantastic.
So, in your opinion, what may be the areas that need to be further developed in those art and music
workshops?
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I think we always want more of what we have and I suppose it’s human nature to look for more all the time. I
have to say, we have received a lot more time from Waterford Healing Arts through the Iontas project in
particular. That has added hours to our programmes which is great and we’d love more of it. I mean, yeah, we’re
getting a varied programme for this year which is absolutely fantastic and the feedback so far is brilliant, so I
suppose I think that could be further developed in the sense that…and I know that this is in the plans
also…would be I suppose to incorporate the staff themselves on the unit rather than just me. And I obviously
have a staff member that works with me who is very familiar with the arts but I often find that staff members on
the unit mightn’t know as much about the programmes as we do ourselves.
So it probably would be beneficial if they knew, would it?
I think so, I think so because they would be primary nurses for the service users on the ward, and so it would be
up to them to have a feel for the plan of care for that individual, so obviously they need to know that we’re
running programmes. Well they do know that we’re running programmes, but maybe a little bit more
information. And maybe just for them to feel comfortable with the whole arts…
Yeah, because if everyone is on the same page, I suppose it makes your job easier?
That’s it, that’s it, definitely.
So at the end of a block of art and music workshops or projects, what for you would constitute a
successful outcome?
We’ve just finished a block at the moment through the Iontas. We had our feedback session there on Friday and
basically for me, would be just to get the feedback that we got, and I mean I couldn’t be happier with the
feedback from both staff and from service users. I mean, the big thing was, and I have said it quite a lot lately to
the groups, is that we had never had the opportunity to have our acute area which is where people go when
they’re a little bit more unwell. It’s when they initially come in, some people are acutely unwell and the acute
area is used for that purpose. It’s sort of like our special care area and up until this year, there was very little
work done around therapeutic programmes for them and that has been broken now, that back of…we’ve broken
that.
So you think that’s a good thing?
I think it’s fantastic. Initially change was hard for staff I think to…because health and safety would be huge in
that area, but we’ve managed to create, I suppose comfort and give them reassurance around the health and
safety issues, and have the plans in place that if something did happen in the acute area that we had
everything…we had the preparation and we had the discussions prior to the groups of what we would do and
they’ve worked well. You know we’ve changed it at times, our approach, and when we’d have the feedback
we’d change something slightly because we decided that we were going to get in there no matter what.
Whose decision was it to go in there no matter what?
Well, I had spoken to our consultant, the ECD, which would be the Executive Clinical Director, and it was
always going to come, I felt, because the Mental Health Commission were putting us as non-compliant for that
area of late. I was obviously in a position where eventually I got a staff nurse working with me because I would
have worked alone for the past few years. I would have only just had sessional workers coming in. I would
never have had a staff nurse full time with me. So this opened the gates to…
It’s a lot of work on your own…
Well yeah, and at times it could be quite frustrating, because like that, I wanted to do work in the acute area, but
being one person with two hands and two legs and just being able to be in one place at one time, it was quite
difficult. So that extra resource has allowed us open those doors. And also the adding of occupational therapists
has made a difference to the programmes, because they can run individual programmes too and we’ve worked in
D6
conjunction with each other to provide programmes in the acute area, so that, and obviously with the arts which
is fantastic.
So a little bit of resistance starting off, but it’s beginning to take off?
It is, yeah.
It probably needs more work, but it’s getting there?
Yeah, I think we’re tweaking it as we’re going along, so we’re taking on board whatever feedback we’re getting
and we’re dealing with it. I think that’s the big thing, because initially there as you said yourself, there was
resistance. It did occur. But it wasn’t that we couldn’t get past that. I think that was the big thing. There’s loads
of ways of getting over a wall, you know.
Well change can be difficult.
Yeah, just get over the wall, in different ways. We don’t need to knock the wall down, you know what I mean?
We can chip away at it…and I think that’s huge.
So at the end of a block of art and music workshops, what wouldn’t be maybe so successful? What would
you maybe say that was a bit of a failure? Failure might be a bit of a strong word but…
Well I mean I’ve had nothing but positive reports so…
[Speaking together] Well that’s ok too.
So I can’t go with negative. The only negative thing that I would see is that people look for, and it’s not even a
negative, it’s that people want more, so that’s not negative.
So the need and demand is there, but there’s not enough?
Yeah
And does that boil down to money?
Ah yeah, it does yeah. And I think…what I would…actually, the one thing I could say here…
So the lack of money is probably a negative then?
Funding I suppose, and resources…and expansion. And I would have a huge problem with the fact that at
weekends, just nothing. Nothing happens at weekends, but yet loads happen at weekends. And when you think
of it…in the community, you know yourself, weekends is where people go to arts events.
That’s when your mind needs to be occupied really.
Yeah, and I mean in the ward, in our setting, at weekends…I mean obviously our service is Monday to Friday,
so I can see it going seven days, where I’m asked to do a seven. I don’t have a major issue around that. I think
for the services we need to have it.
Does the service just finish at the weekend? It’s the same with most mental health services; well that’s an
ongoing problem really.
Well it is. It is. It’s probably the fact that traditionally the services were offered always as Monday to Friday
programmes. Maybe you’d be looking at it like people do programmes and then they need time off. But I think
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the other side of it is that there needs to be something available and this comes through feedback…something
available for the service users at weekends. Now I’ve done my best to provide, and this goes back to arts as
well, to provide materials, to leave them with staff for weekends so that they can actually do some artwork, do
some jigsaws, do whatever they wish. Those services, resources are provided, but there’s nothing organised or
in place formally for weekends.
And has that come from the service users themselves, that they’ve said that there’s nothing to do at the
weekends?
Yeah, from our feedback groups and from our own sessions that we would run in the day programmes. We are
currently doing a service user forum group where we’re going to work on them taking the lead for weekends as
in, like, get an opportunity for programmes to push it forward a bit so, yeah, I think that could be good.
So you’re constantly trying to upskill and get new things going, so getting feedback is important?
Sure, feedback is everything. Good or bad. It’s essential, I think, to make anything work and to improve
anything, you have to allow for somebody to say what we can improve on, because we don’t have all the
answers as the professionals. I mean, to be honest, the service users are the experts.
Yeah, they know what they want and what they need.
They’re the expert in their own recovery. We’re just part of the journey really, I think.
So, again, you’ve probably answered this…
I’m probably repeating myself [laughs].
No, I’m probably repeating myself.
No, you’re fine.
What do you think the arts can contribute to mental health care in general? I know what it contributes in
your workplace, but in general, what do you think it can contribute?
Well I think again the utilization of it outside of the department would be…for different exhibitions…people
may find that they have a skill in an area. They may learn something whether they might use it later on, but also,
I suppose the arts has a way of sometimes…even a picture of something relating to mental health is something
you might remember rather than a speech. Visual stuff, visual arts…and I can see it working in mental health.
Posters, I mean, we use it in the mental health Ireland. Music also, I mean, I think it’s…music is one amazing,
regardless, you know we talk about art, but music has a massive way of impacting on how a person feels and
how they do things, even going to simple things like, your own personal opinions on it. If you’re feeling really
bad of a day, that sometimes, that feel good factor song can actually jiz you up, and stick your ear phones in, if
that’s what you do and go for your walk, and I mean, I know from my personal experience, that if you put on a
fast song you walk faster because you tend to do what the song brings you, so I think it has huge benefits in
mental health.
In general is the attendance good at the workshops?
Unbelievable. There are times when I suppose, even the groups, you sort of think, oh God there is too many at a
table, you know for the facilitators sometimes, so we’ve often said, maybe if there was two sessions rather than
one big one that people would get more out of it, but that’s again down to people wanting it and that’s a good
thing because the demand is so high, so that’s fantastic.
D8
You did mention it a little bit, but current mental health policy recommends more options and
alternatives in service delivery, so can you talk a little bit about the impact of these recommendations in
care planning in your work place?
Yeah, am I think that I’ve already probably touched on it that the care plan, the plan of care for an individual,
obviously again back to service users and the recovery approach and the ethos, that you are your own journey,
you know what I mean? You’re recovery as a unique person, it’s a personal thing, it’s about you and how you
see your recovery, so that is the essence of it. I mean the plan of care has to work from that, you know that the
service user may have an interest in the arts, may have an interest in the music and that they were given the
opportunity to develop that.
So you work with them with that?
Yeah.
There’s yoga isn’t there, there’s...
We’ve yoga, well they are all expressions of yourself really, yoga. We do education groups and recovery
sessions. As you said yoga. We do relaxation groups and we also do relaxation meditation sessions. I think it all
comes from expression, you know, and what a person needs. We do other programmes obviously, cooking
programmes, solutions for wellness around the healthy living, healthy lifestyle choices. Yes, so it’s all about
promotion of mental health, you know it’s a healthy attitude and making healthy life choices.
So the approach to mental health is changing? Is policy saying that these things should be done?
I think it’s moving away from the traditional model, definitely. I’ve seen, and I’m sure that’s a lot to do with the
mental health commission in collaboration with the service users, because they have a voice now, they’re on
panels, they’re on consumer panels, so it’s huge that they get the opportunity to make the choices and that it is
definitely moving from that whole, I suppose the parental type, the old traditional medical module.
Where you were signed in and signed out?
That paternal approach, like you know, you make decisions. Obviously there still are individuals that would be
brought to hospital against their own will and yet that’s changed too. They have the opportunity to have their
tribunals, discuss their own care, dispute and refute if they are not you know, if they feel that they shouldn’t of
been detained. They have those opportunities and have their legal representatives. So yeah, it is changing, and I
think it has a lot to do with the fact that consumers voice is been listened to more, I think.
So when you say those consumers, the service users, the families, they have a chance to put their voice
forward now, they can be on the board, whereas before, that probably wasn’t something they could do?
I think you know, if you want to say yes, there may have been a name on a document somewhere as they say,
but I think definitely going from working in the unit and speaking to those who have had the opportunity to
attend various forums and workshops and panels and particulary, am, a word that I haven’t used
probably…advocacy, which is where it all comes from. The advocacy service too, where they actually advocate
on behalf of those that, am, you know they give choice and support and information and a lot of the advocacy
have pushed their own service users to get involved on the likes of consumer panels to have themselves heard.
And it’s been used for self esteem as well to finally say look, well I suggested that and their doing something
about it.
It gives them a sense of empowerment?
Absolutely, which is huge. People have to feel responsible for their own development, and if they feel if
something is moved that way because they’ve made a choice…
D9
They are in control, I suppose.
Absolutely, it’s control, it’s taking control and that’s what it’s all about, that’s what it boils down too.
So how do you think these recommendations are manifesting in the practice context. You probably get a
list of things you have to do, but in actual practice, how is it working out?
Do you mean in the sense of…
Well, just the impact of these recommendations. So those recommendations, how are they actually
manifesting in the workplace?
Well very much what I’ve said, is the development of programmes and the expansion of programmes and more
varied options for everybody and choices surrounding their own mental health, you know. I suppose we’ve
increased our, even our development with, you know we’ve always had GROW, Mental Health Ireland, Shine,
all those bodies coming in, but we’ve expanded you know, Employability Services, Housing First, all those
different organisations and linked in because really it is about the wider sense of the community. Even though
we are an inpatient facility, we needed to extend our links on that and that’s huge, because the recommendations
have helped us do that through choice and through the service users again having huge involvement in what they
want, or what they need in their care plan. That maybe as basic as I need to work part-time, so how do we go
about doing that. How do we go about linking in with someone that will have an understanding of your mental
health needs, but also maybe get you something that might be something you might have an interest in, that
would be of some value, has purpose really.
Okay, so it’s all systems go?
It is. I think it’s finally realised that positive risks can happen, and when I say positive risks, I mean, yes
somebody may have been unwell for six months, but why can’t they have an opportunity to do something, you
know. We tend to, would of in the past, we would of…oh that person wouldn’t be able to do that because they
have a history of aggression, just because when somebody has been acutely unwell, something has happened…if
they’ve taken control and put measures in place…
Given a chance?
To be well and given an opportunity, I mean why not, they have to have that opportunity.
Okay, so what do you think the arts can contribute to care planning in your workplace?
Well, I think it has, you know, I couldn’t phrase the relationship between arts and mental health highly enough.
We have stronger bonds over the years, particularly with the Waterford Healing Arts Trust, because that’s our
first link I suppose.
It’s a good thing to have then, as a lot of hospitals don’t have this at all.
To have it on site, absolutely, I mean, I’m just so used to this building being here since I’ve worked with my
programmes in the day programmes, that we’ve been very lucky, as you correctly said, to have it on site, that
it’s a facility here. And what I didn’t even mention is the fact that the open art workshops, that the lads would
come over too from our own unit. It’s not necessarily just something that has to happen on the unit, they can
come over here to the open workshops that occur and that has worked really, really well, you know, because I
think it’s important for people to be outside of the unit doing something, and we discussed this earlier, bringing
it to the community. Yeah, being on site has been huge. So it has impacted positively on all aspects of our
programmes and being involved on the steering committee for the Iontas projects to develop it, and I think it’s
only going to get better. This has been the first, the Iontas project obviously is the new programme and also we
have a service user on the steering committee and that has helped as well you know, because his voice has been
heard.
D10
So the arts are a huge part of your care plan?
Yeah.
Ok, so again, you’ve answered this as well, but how do you think the arts have impacted on mental health
service delivery in your workplace, for yourself, for other people that work there?
Yeah, I think I have found that the resistance that I spoke about in the acute area has lessened. So that’s huge.
So obviously people have seen that it works, and that it helps, and that it’s effective and that’s great. People
have been able to change their minds, so maybe too perhaps, and I know that this is something that is up and
coming where that’s concerned, a talk even with our own staff, about how the arts is delivered in mental health
and how it can be embraced, enhanced, improved and how our own staff can become more involved.
It’s a bit of a shock, the new?
Yeah, for some people, others again are going to bring their own personal, am, attributes to the table, because
they can be massively interested in the arts themselves you know. They may have music backgrounds, they may
have you know, an interest in the arts and over the years projects have been run through the hospital here with
staff where they produce their own artwork. And some obviously are very talented and they have been able to
contribute their own pieces, you know, which is great.
How do you think the arts have impacted on the clients of your service? I mean, I’m sure you probably
have people who are not in for very long, or they’re in and out. Have any of them said that the arts have
really impacted them in any way?
Yeah I think both music, both arts, and again the reactions are varied. I think the emotions that happen at times
can surprise people particularly, I suppose music, because I think it could be that somebody hears a piece of
music while they are attending the group and it impacts them in a way that maybe it unclogs, or taps into
something, deep down. Without being too philosophical, but also again, having the opportunity to reflect when
we do the feedback sessions that’s what you find. Some of them who didn’t think that I would actually be good
at anything like this, or I didn’t think I could do this and you know, sometimes the pride even at the end of a
session, someone coming to me with a piece and say, […] I did this you know, amazing pieces, you know.
Recently somebody gave me a piece in a frame that they did and wanted me to put it up in the day programmes,
now we have a wall of all the work, but this was a framed piece that she had and she wanted me to put it
somewhere, which I am doing, which I think is lovely you know. Because it’s like her mark on the place now, I
mean obviously there are walls of art work that we have and some would hit you and you’d say, wow that’s
some piece.
Especially when you are connected with the people?
Yeah.
You must probably feel it more?
Yeah, yeah it’s great, it’s unbelievable at times and then from the service users when they tell you that they
never really realised that they could do anything like that. I mean currently with the visual arts, the one that we
have is not just your paint or your canvas, you know yourself, and the arts goes across everything.
Yeah.
And they’ve been doing clay art and it’s been amazing, some of the things that they’ve produced and again the
fear of doing the piece and the confidence then, and it’s even funny, the competitiveness amongst a group
sometimes.
Really?
D11
Yeah, I mean someone may have had a piece and they are working away at it and you can see somebody else
looking at it, and thinking right, so I’m going to do mine bigger and better you know, because that’s human
nature I suppose, but it’s fabulous.
So it kinds of draws them out?
It can yeah, it can.
And do family members see the benefits?
Family members do. They comment on pieces. They often ask to come in and have a look and you know, within
reason, once the content is with the other service. They come in and have a little sit down and sometimes they
actually do a piece. Also obviously, we have to be very careful when we add someone to the group because we
have to make sure it’s ok with all those, because it’s such a gentle way of having a workshop you know, it’s not
about people describing their traumas, it’s actually people sitting there producing something on paper so you
know it works very well and family members find it…what you’ll often find is if family members are visiting
they’ll call back if they are in a group of art because they are literally…because they are enjoying it, they don’t
want to take that enjoyment from them and you might not come until after that session, because I’m really
looking forward to it which is great as well you know, that they want to be there.
Yeah.
And it’s not about us coercing people or pushing people into it.
Yeah it’s always if they want to, isn’t it?
It’s about participation. Now obviously I find that sometimes, I would say to people that you know, in some
circumstances, somebody would say no to something, because they’ve never done it before and to be honest I
would encourage them to come down and have a look.
At least have a look.
Have a look and sometimes you’d find they’d walk around the table while it’s going on and they’ll eventually sit
down. We bring the new doctors, anyone that starts, and depending on their adaptability and how they feel,
they’ll sit down and get involved as well.
Ok, so staff and everyone?
Oh god yeah, well we’d encourage them too, again some of them will find a hundred excuses, no we’re busy but
others will sit and partake.
So team effort, that seems to be what you’re striving for?
I think so yeah, I mean you can’t expect the service users to do pieces if none of us are willing to do it, you
know and I can’t sell a product, if I haven’t sold it myself.
That’s very true yeah.
I mean there’s no point in me saying, oh this is great, and they say well have you done anything yourself and me
saying well no actually I haven’t, you know, it just doesn’t make sense.
Yeah. So has the arts in your work place, has it impacted on you personally in any way?
D12
I love, I’d have to say I’m very...aesthetic would be the word I would use. I love to see beautiful things. I would
have an interest anywhere I would go, if I go travel, I have to go somewhere different every time I go away
because, I like to see something and I would be a little bit…sometimes my children would say, a little bit nerdy
[laughs]. I have to go to maybe churches, certain things would appeal to me. I have to see…
Would you go see music, bands?
Yeah, museums if I’m away, I can’t not go, I have to go see and I find out before I leave for a country, what
they have. Certain things over the years have impacted on me over the years, in the sense of even museum, I
would have seen maybe, gone to, and I suppose Pablo Picasso in Barcelona, that museum…
I went to that, it’s fabulous isn’t it? Yeah.
I was very taken by it. I was in the massive museums in Rotterdam. I could name loads of places, I mean the
Pantheon in Rome, just blew me away. I still think of everything about the place and you know, different pieces,
be it architecture, pieces of beauty and music, I’m a massive music fan myself anyway. If I could go to live
music every week I would go, you know. I would be a massive fan of it and it would be very eclectic, tradition
to rock. I’ve been to all types of concerts and if I had the money, I’d be gone every week.
So obviously it impacts greatly in your work then, if you see something that triggers something in you, it’s
going to…
Yeah, I think I came to the job with a love of arts and music anyway so it wasn’t hard to tap into it for me.
So, it’s helped you?
Yeah, it has, it has definitely.
So have the arts in your workplace made your job easier or harder, or a bit of both?
I’d say it made my job easier.
It’s probably more work in terms of administration. It might take up more time?
I think paper work in the sense of documentation has always been the thing we all hate to a point, but if we want
to talk about feedback or we want to talk about something having an impact on somebody, we need to write it
and we need to document it.
You need to measure it, yeah.
Absolutely. I hate the terms sometimes, measures and outcomes, but we need them, and I mean we can’t turn
around and say we need more of this. The questions that’s asked of you then is, well show me, why do you need
more of this, where does it say you need that, you need more of this, how can you prove it to me? So we need to
measure.
I suppose it’s very different from medical trials where it can be fully...it’s harder to document proof of…
It is, because a lot of the time it’s more ??? (45.44 minutes) isn’t it about, and I suppose even the fact that you’re
doing research around that says it all. I mean anyone that picks a research, a thesis or a dissertation of you
know…picking it around an area that maybe needs further research is always a good idea because it is an area
that has expanded in the last few years and it’s, perhaps maybe that’s the way it’s going because we are not
stuck in little boxes anymore in mental health. We have to expand, to accept that recovery encompasses all of
that and you as a person comes to hospital with maybe a love of arts and a love of music and why shouldn’t that
be explored, because it’s not just about getting the medication that improves your hallucinations or delusions.
It’s about an expression of your personality and that’s what service users feel they are allowed to do in this. It’s
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huge, because they can actually express themselves without been told, oh no, that’s not something you can do
because you’re not well at the moment, so you can’t be doing that you know, they can express it at a level that
they feel comfortable, and it’s really allowing a person to be an individual.
Yeah, because they do say it’s an area that’s hard to measure, but if you’re in there every day and you’re
witnessing it, I suppose, that’s what I wanted to ask, am, health care professionals, because they are in
there every day doing work unseen by most of the people so…
Absolutely, that’s right, and I think our role as even in the day programmes perhaps was viewed a little bit like,
oh, what do ye do down there, [laughs], you know, without being crass, oh ye do a few jigsaws, you take out a
few pens and a few pencils and I suppose I would feel quiet annoyed at times, that someone would stick my role
as just that, when I can see that it’s a lot more than that you know. I think people are open to it now. I’m sure
that’s again back to ignorance of not knowing what arts and mental health is.
Its stigma, it’s not just about art.
Yeah it’s knowledge of arts in general and it’s again back to realising that it has a huge role to play in mental
health.
So again maybe if it was in policies, or in care plans, or maybe if it was given more of an important role,
people might take it more seriously. Do you think people take it seriously then, or they don’t really?
I think it can be hit and miss. Certain people can see the benefits, but that maybe be coming from the fact that
they as a person can see the impact, you know, again going back, we are all individuals and we bring our own
personalities to a job even though we’re in a profession you know. But I do think that there’s definitely scope to
maybe, and I hate using this…structure, because I like the fact that things can be fluid like and whatever, but I
maybe, I think some kind of a module, some kind of, something in the curriculum you know, maybe even in the
training of, you know, of students that they realise that this is a very valuable part of mental health and you
know, even that they get the opportunity as student nurses to you know, to work on projects with maybe certain
service users. You know there’s lots of ideas out there and I know even with our own work in the Iontas the
steering committee would be that, I know […] and […] and […] and myself discussed the option of students
having a bigger part in you know, in our programmes.
Yeah, you’re working with student nurses?
All the time, yeah.
So do you think it would be a good idea to integrate an arts and health module into student nurse
curriculum in college, or was it something you were offered when you were training?
No, I was never offered anything like that.
Was there any element of it in it at all?
I mean [laughs], I could go back, but my memories starting to fade about my student days, but I mean I enjoyed
my training, very much on site training you see, when I would have trained it was totally you know, out there on
the wards, get stuck in, starting with the basic nursing care. And I think that everybody that goes into nursing
appreciates the value of learning the basics. The basics as in the care of a person, the physical aspects of you
know, your own basic pulse, as we say your TPR, Temperature Pulse Pate in respirations however, I think
there’s definitely a need to incorporate an aspect of arts.
Maybe for all health care staff - nurses, doctors?
Yeah, not just nursing.
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Would it have been a module you would have chosen yourself?
I think I possibly would of, because I suppose I had the interest personally in it, art, so I’d have no doubt I
would have picked it.
Yeah, do you think it would have been beneficial for yourself personally, or as well as for service users?
I think both. It may have given me knowledge; it would have given me a confidence to utilize arts from a
younger year in my student years to bring it through. I suppose I was lucky that I already had an interest, so I
kind of was, I was lucky enough to get a role that allowed me to sing the praises and feel the need from service
users. I know I would have picked it as a module and I know it would have been beneficial.
And what do you do with the student nurses? What kind of work do you do with them?
Basically I would have students from each year from first, second, fourth year and they get basically, a snap shot
of my area. They’ll do a placement, be it a short placement, anything from two weeks, two to four weeks in the
day programmes, where there’re assigned literally to my programmes, so they have the options and I encourage
that they attend the art workshop.
Yeah.
The music programmes, the yoga again, going back to how can I tell them about something if they haven’t had
the opportunity to actually sit in and partake, and I think also then at least if they’ve partaken in the groups they
can then use it later on in their own training.
In their own training.
And some, I think may use it in some of the programmes, some of their assignments, because they can see the
benefits.
Would you like to see the arts as part of your role? It already is by the sounds of it, part of your role, but
I suppose would you like to have more of like what’s done here…would you like to be doing that side of it
in your role, or in your workplace?
I think you know I love what I do. I enjoy the fact that I have the opportunity to be partnered with these services.
I’d like to see the staff become more aware of it. Perhaps that’s something that could be thought about,
expanding you know, that kind of a link to give the staff more of a knowledge about you know, I don’t know
where…I suppose it’s really important that I remember the role that I have.
Yeah, your role first is your role; you have your own role first so…
Well, I’m the nurse manager of the area.
Yeah.
So I have to manage that ultimately, but in that I can incorporate an expansion of the role of arts in. I think I’ve
been doing that anyway.
You’ve been doing that quiet naturally anyway.
Yeah, so I think through the steering committees, and I mean I have already expanded by becoming involved
with the committees, so I think I’m able to advise whatever comes from groups on that committee and this is
going to roll out and keep pushing it. I think we’re lucky enough with our hospital manager that she herself
actually has an interest in the art, you know, so that then back to money, she holds the strings of the purse so if
D15
she has an interest and is aware of the committee and the feedback, then maybe she can loosen the purse strings
and give a bit more money to it.
Is it seen as a little bit of a luxury, or is it that I might not get any more money?
I think in the past it’s been seen as a luxury that it’s not the first thing you look for.
If the budget is tight, it’s tough to get money for that reason?
Yes, and if we’re going to cut, we cut from the arts budget. Again back to even the questions you’ve asked me
about my personal interests and stuff, I think if somebody has a personal interest in the arts, can be very lucky to
kind of to encourage that in that hospital management. And to get the partnership going and it can work well.
She can see the benefits you know, and if she sees the benefits and sees that it is helping and I mean at the end
of the day that’s the approved centres that she’s the manager of that approved centre of mental health are
advocating this, this is the way we go, mental commission want therapeutic activities.
They want more of this anyway?
They want more of it.
Yeah.
So she will be compliant. She will tick the box and sometimes it boils down to that.
Ok, so I suppose at this point do you think that you have adequate resources to do your job as you think it
should be done and do you have appropriate support in your position. I mean in relation to the arts or in
general?
We never have enough resources and I’m sure that’s the same the world over. We say that and sometimes I
think it’s not just all about money you know. It’s about finding links, encouraging them and sometimes it does,
it’s not just simply money.
It’s about new ways of doing things?
New ways of doing things, yeah, and adding programmes without necessarily financial add on, you know, and
again it boils down to a new way of thinking, how you utilize what you already have, how you break it up, how
not to use people but, utilize the already existing programme to a better you know…everything is about using
something adequately and efficiently, that’s what we are constantly been told is how do we manage things
better.
So, I suppose the resources can be lacking financially, but in terms of support, would you feel like you
have enough support?
I think we’re lucky with the support we have, although I do think that at times other departments, other areas get
precedence when there is…again it boils down to the fact, do you think that the arts are necessarily in…I think
they are, but sometimes they can be forgotten about.
Dismissed a bit?
I think they can be dismissed a bit, but then I think the encouragement of staff and you know, information is key
to everything, and knowledge is power, I think too.
Education?
D16
Yeah, but also I think even with work I’ve done, when you engage people and let people have a voice on
something, it’s really important, because then they feel they’ve been part of the process and if staff are involved
in committees and like, I’m not all about meetings, that can happen, but if they’re involved in/with the decision
making process and they’ve had an option or opportunity to give their opinion and it’s listened to and valued, it
does make a difference definitely. That’s where the support comes from, but it’s not like the decision is been
made before people have an opportunity to voice.
So everyone has an opportunity to voice their opinion, so that’s support in itself?
It is yeah.
Ok, the WHAT arts and mental health programme is a partnership between various stakeholders. What
are the benefits of this partnership for you?
Again the relevance of having all the stakeholders in the room even to see from a service user to community
ventures and that they can all…again it’s this link up, it’s the support, networking really, which allows people to
see all aspects of where we’re going with the arts and the improvement of the service we’re providing to mental
health service users and its impact on them. The more networking we do the more that’s out there.
Yeah, because it’s a lot of different people coming together from such different backgrounds and...
Yeah, and I think the most important thing is that everyone that comes to that room has a genuine interest in
developing it, furthering it, and making it work for the service users that they serve I suppose really, and from
that aspect the Iontas project is just an amazing opportunity for all stakeholders to input, to give their opinions,
to come up with ideas, new novel ways of presenting a programme, you know, even something which I haven’t
mentioned which is something we’ve spoken of, arts and music, we’ve been talking about projects, combining
them, both having an art project going on and music in the background combining both you know, these are all
ideas.
There’s writing, there’s poetry?
Creative writing, its coming shortly, we haven’t had that in a very long time that’s another. We also have the
dance, expression with dance; we have that coming, that’s all in the Iontas programme, so we’re getting every
aspect of the arts. It will again be down to an individual to join in one or maybe more. The Iontas has done that
and will continue to do that by all accounts I feel.
What are the possible limitations of the partnership?
I find limitations can occur, again it’s back to maybe the HSE itself as a body, as a structure, as an organisation,
that you know, oh protocol, protocol, we find…
The HSE gets a bad rap.
It does, it does, but the other side of it is bringing all these people into the same room you know, a lot of heads
around the table you know. If somebody says no to something we can go at it a different road again, it’s back to
like…and I know it’s a metaphor, there’s loads of ways of skinning a cat and we might not be able to get it
through this way, but we’ll come at it another way and having that many people around the table who’ve
worked in different organisations, they’ve experienced different things, like I don’t know everything, neither
does any of the people.
Everyone brings their own speciality?
That’s it; we’re all bringing different things to the table. So, the HSE is it purely budget cuts or is for what
reason…Well I think of the clinical implications sometimes people will say no to stuff too. Now we’re very
lucky that the lady that is on the Iontas group is […], who again herself is very musical, she plays certain
D17
instruments, she has a massive interest in music and arts. So she is bringing her personal interest to the table too
and we’re lucky and that’s what happens sometimes, you’ll find that people will be drawn towards something
because they have a specific interest in it, so that’s positive in itself, so her clinical role is to the rehabilitation
centre services, she’s the consultant psychiatrists. Just her area of interest outside of work and in work
obviously, as well she will be developing with her service user’s plans of care which incorporates attending
workshops here and we’re lucky that her area touches on that too. So yeah, I’m sounding very positive about it
all, we were just very lucky with the players we have at the table.
That’s a good thing, yeah. On a personal level do you have an interest in the arts, but you obviously do,
but would you think the arts personally influenced what you think of the arts in your workplace? I mean
you’re into the arts so...
Look, I think obviously it’s going to, for me it’s always going to be positive, but I have to be also very objective
and I can’t be biased, just because I have an interest in something doesn’t mean everybody likes it.
That’s what I mean yeah.
And I can see that it has helped in various aspects of the programmes I provide. I don’t want to push something
down someone’s throat if they don’t want to do it, but I can see that it does work and I think it’s only natural
that your own personal values are brought to the table, but you have to remember that you have to be…you have
to hold back and is non-judgemental in a sense that they’re my values, they’re not everyone else’s values, but I
can see how it works and obviously my own personal options you know, I can’t change those, but I have to
allow for others.
Yeah, because it’s not necessarily everyone that will be into the arts, well, I think I’ve asked you that. Do
you think it would be a good idea to integrate an arts and health module into the curriculum?
Oh yeah, well I was suggesting that as an opinion yeah, and I mean I suppose another thing is to see in the
student curriculum like when they’re going back to block, perhaps there could be some work done around
feedback from them, if they felt it would be of beneficial value. Bring that aspect to the programmes you know.
Because it’s very intense, the healthcare care profession, doctors, nurses…do you think it would help
them personally as well in terms of stress, you know, would it be beneficial to have it?
Yeah, I think again, you know, we say ‘Physician heal thyself’ you know, it’s that real saying of you have to be
able to deal with certain things yourself before you impart them on others, so you have to experience the arts,
the meditations, the relaxation, all that stuff before you can bring it to others. So an element of grounding and an
element of focusing maybe are essential in the training rather than just the busy, busy. Look, at the end of the
day the assignments have to be done, we all know that. You have to get…your deal lines are there, they have to
be in, but the important aspect, like we said, of reducing stress of learning to do yourself what you can do, to
make your life easier and maybe that is through the arts at times and maybe adding that to the curriculum would
be helpful.
Is it in there at all, anywhere in Ireland?
I couldn’t say because I honestly being of the older groups...
So it’s not here in Waterford?
Not that I’m aware of. I know that they come to me for their modules and that they get the opportunity to do that
and I know one or two of the students expressed on interest in attending some of the music workshops when
they were off placement, because they were obviously deciding to do an assignment around that, but I think that
was their own choice, I don’t think that was because it was mandatory.
D18
So people are coming of their own choice?
Yeah, I’m not a clinical placement co-ordinator so I don’t know, so maybe there are. I know from the last
meeting we had we spoke about it as an option.
So it’s beginning to filter in anyway?
Yeah, yeah, it’s beginning to become an option.
Okay, I think that’s about it, but is there any other point concerning the arts in the mental setting that
you’d like to make or maybe that I didn’t think to ask, or that might be relevant or…?
No, no, I don’t think so. I’ve probably maybe answered some questions as you were getting to them, but I
suppose that happens but, no, no, I’m ok. I’m happy enough if you are, if you think I’ve answered things
adequately?
Yeah, thank you very much!
ENDS
D19
Appendix D: Interview B Transcript
What is your role in the workplace?
Well, I’m acting to […] at the present time. And what that is, is I’m the nurse in charge and I look after all the
nursing aspects and anything to do with clients and their recovery.
Okay.
And I’d be in charge of the nursing staff as well.
How long have you been working in the area of mental health?
Thirty odd years working here now; not in […] alone, but throughout the whole services. Yeah, you know
various places and things where I’ve worked, and different units down through the years.
So plenty of experience in that area?
Well, I’d hope so, in different areas.
What is your experience of the use of the arts in a mental health setting, before or now?
Just only recently, from here now, from […].
Oh right.
This is the only place that we’ve ever used it because it’s only kind of come on stream in the last couple of
years, but in […] now, in the last few years, the music therapy is what we do with it.
Oh okay.
We found that clients really enjoyed it. At first they were a bit hesitant, needless to say, because they didn’t
know it, it was unchartered water to them, but because they didn’t know it like, but eventually when they found
out what it was, they thoroughly enjoyed it and like looking at them going in, they’d feel, they felt, you’d see by
them that they kind of really enjoyed themselves, you know, yeah, and it was an non threatening, non invasive
and very relaxing environment for them. Yeah, so they were able to kind of am, enjoy themselves as well as
participating in it without feeling under pressure.
So it was the first time you’ve experienced the arts in a mental health setting?
Yes, just here in […].
Just here in […], okay. So it was new to you as well?
New to me as well, yes, yeah.
And when you say ‘art therapy workshops’, was it participation, or did you actually have a music
therapist?
We had the music therapist from WHAT. We had […] and then […], now who is doing that at the moment, so
they linked in, okay, so we left them we’ll say once they established themselves and once they knew what they
were doing…they were able to address to the clients…we left them have a free hand to run the groups
themselves and we were always in the background so if anything was going wrong, if they needed any back up
assistance or anything like that, but they never did like, you know what I mean like? They just felt they had a
D20
free hand to do what they wanted to do and the clients thoroughly enjoyed it, because it was new, it was a
change for them without having staff interfere, you know, involved with it, because it was new. Sometimes they
like things to be outside the staffing situation if you understand me, outside of staff, looking after them. It’s
lovely just to go into…
Something separate…
Exactly, separate from coming to […], something different, you know, which is good too, because they are not
always under the constant care of […].
So a bit of control for them?
Absolutely, so they are stepping out into a different environment and the music was kind of, oh wow, this is all
new like, you kind of am, I suppose, for anyone who would be shy about going forward you know, about
engaging with groups and strangers, it was good for them to test themselves, yeah, you know and to be able to
do that, you know?
Okay. Am, I suppose, well you’ve kind of answered a few questions there…
Answered a few questions there, yeah [laugh].
What do you think the arts can contribute to the service users of your workplace? So, for example, what
was the impact of previous art/music workshops? Have you seen any difference?
We have, with the music therapy workshops now. We’d see that the clients would go in like, they’d be engaging
and they would come like out an awful lot lighter in mood and that and at the start they were a bit in awe of it,
you know, what’s this about, but as it progressed and went on and on they, ah really enjoyed it. Ah, second, the
second set second term this year, as I said we had […], she had her different way of doing things and she did
books for them and left them to come back to her with a lot of what would you like done you know what I mean,
put a lot of am, and empowered them to what they would like to get out of it, and they have really thoroughly
enjoyed themselves with her now.
Yeah.
You could see it in them. I never, I used to have to call them and tell them you know, am, music is on. The
minute you open the door, just say music and they are all out, you know, so they really got a lot out of it.
They took to it?
They did, and they put a lot into it themselves because she just allowed them, you know, she picked their brains
and allowed them run freely with it, you know what I mean, she put together the kind of music that they wanted,
the songs, because our age profile would be kind of somewhere between fiftyish upwards, you know what I
mean, and they have a lot of their own songs and things that might have meant something to them when they
were children, that sort of thing, you know and they have a lot of their own songs and things that might have
meant something to them when they were children, that sort of thing, you know, but their mood level was
definitely, they’d tell you that themselves, was much better and they used to look forward to it.
Okay. So again, I suppose they felt a little bit of control maybe?
Yeah, yeah, yeah…when they went in there they were able to say how they felt or how, or what that song,
especially, if a song might of brought a tear to the eye to somebody and […] was able to ask them, how did that
feel for you like? And they were able to say, oh I remember that when I was a child, [cough], excuse me, or their
parents might have passed away and you know, and what would have brought back memories to them.
Yeah. And was participation high with everyone joining in or…?
D21
Oh they would, they would yeah, we always had, in with […] like now, we’ll say about 8 to 15 you know
depending on the weather, of course, a couple of times, it was on in the winter, but mostly now we would have a
good crowd, the average I’d say being about 12, you know.
Yeah, am, so it was good attendance then?
Yeah.
So what are your expectations of art/music projects or workshops? I know you haven’t experienced it
before, and it was new to you, but having gone to them now and seen them, what would your expectations
for them be?
Well I hope it would continue the way it’s going at the moment, because if you could see the clients and how
well they enjoyed it and how well they come out of it, you know and they are in good form and they feel a little
bit lighter than when they went in, I would hope that that would continue and also if there was anything that we
could change, that would be for the better, but like as it is it’s working very, very well. And I don’t see much to
change like you know, maybe down the line you know, maybe somebody might get, might feel, a little bit more
confident and maybe and play an instrument themselves and engage.
So one of the service users could bring in an instrument or something?
Yeah, you know that sort of thing and engage…
Yeah well, that’s what I was going to say…in your opinion what areas could be further developed in the
workshops?
Yeah, so if any of them had say maybe years ago, if they used to play an accordion or a guitar or something and
down through the years for some reason or another they lost interest, you know, maybe they might be able to
pick it up again and maybe run, do their style of music for a programme for a session, you know down the line
like to keep all options open for them.
Yeah. So at the end of a block of art/music workshops, what would be a successful outcome in your eyes?
Well, to be successful, to see that they both got on well themselves and with the music therapist, because if that
happens you are going to have a great session, because everyone is going to be comfortable, the clients will be
comfortable with the music therapist, the therapist is going to be comfortable with the clients and if the outcome
of that is that they can all walk away, I really enjoyed that six week block and I felt especially for the therapist
they felt that they got something out of it that they were able to give the clients cause they see them first hand
whether people are getting something out of it or not cause they are with them, so I’d hope for that to continue
on like, you know, and for the therapist maybe to measure on that and say well I see them now, I see their
abilities and maybe be able to push them a little bit more and get more out of them.
So kind of keep building on what’s there?
Keep building on what’s there like, you know what I mean, going forward and because of the positive reaction
that they got, and they missed it too, they missed it because, it’s been cut back, a couple of blocks have been
taken out for financial reasons, which is fair enough, but they do miss that, do you know what I mean, and
they’d tell you that like which is a good sign, you know what I mean.
Yeah, it’s a good sign that they are talking about it.
I mean so like if going forward if they could replace instead of having two sessions of six weeks, maybe if there
was two sessions of eight, because it does work very well for them, very well.
Yeah, so have they longer?
D22
Yeah.
At the end of a block of art/music workshops, what constitutes failure?
Well, I suppose, no, well what I would say for us would be that you wouldn’t have the participants, like you’d
have very low numbers and you’d have some people in there that wouldn’t be interested, it must be very hard
for them.
They wouldn’t be engaging with the music?
Yeah, yeah, but thank God we haven’t had that problem so far.
Okay, but that would be the main negative of it?
You know what I mean, yeah, or I suppose if they weren’t been listened to, somebody was doing their own style
of music which mightn’t be from their era, do you know what I mean and that kind of thing, yeah.
And that’s probably something that needs to be taken into account.
Yeah, and think that a lot of them do that when they sit down and they see the clientele that they have, you
know, and they have the chat in the first week or two, you get the feel for the music that they like.
Yeah.
And you work on that then yeah, you know, yeah.
So have you participated in them yourselves, as staff?
No, no, we would of sat in say at the very start now with […], we would have, but then we found that with them,
with some of the clients, it still, oh the nurse is still in there with them like. Yeah, and it’s something different
for them that we’re not involved, yeah, in it with them, but we’re always out on the periphery, do you know
what I mean and we might sit in for ten or fifteen minutes and then leave them to themselves. Yeah, because
some people might be very shy and they might say, oh I’d love to sing this, so we are always in the background.
When someone is there maybe and the music therapist knows that we are there if they ever want us, yeah know
what I mean.
Yeah oh okay.
Ah and we get feedback from them yeah know.
I was just going to say that…feedback…so there is constant feedback?
Oh there is constant feedback, every time, so we would be well aware of what would be going on, you know,
yeah, so, well, as I’ve said, it’s kind of been answered.
What do you think the arts can contribute to mental health care in general, you know, maybe not just
here, but in general?
I think going forward in mental health, it’s kind of a broader look from people, it’s like art therapy and that you
know, am people can paint away like and they might be able to explain their feelings in painting, where they
may not be able to do it on a one to one basis with someone…
With words?
D23
Yeah, or with people…people might be very shy, or they are not able to articulate themselves enough, but as
where you can do that with music as well as painting so, you know. Unfortunately the financial aspect of it will
play a big role in it, but I think down the line, it will become more and more, ah, play a big role in it.
Do you think money should be allocated to it, or does that money need to go somewhere more urgent?
Well you see it’s hard to call, because I know people will say, ah oh, why waste that money there when you
could have money in major issues in beds for example, in operating units and things like that, do you know, but
at the same time, if the art therapy can do for somebody, maybe, you know keep them out of hospital for a little
bit longer, you know, if they can give…I’d say with it being new like as well, there’s not an awful lot of
research or background done, as against most programmes might have ten or fifteen years like, you know what I
mean, research done, like you know, but I wouldn’t say that they would be knocking it on the head at all. I’d say
going forward it will take a big part, oh definitely, it’s just a matter of breaking down the barriers, of breaking
through, you know.
Yeah, okay.
And Like that is, it’s the kind of thing that like am you know, ah, as regarding mental illness and not a lot of
people would have major mental illnesses, you know what I mean, and like, it could be just kind of anxiety
disorder or something like that, am, I mean music could work very well in bringing them through a bad patch or
something like that, you know.
So you could definitely see the benefits of it?
Oh yes.
Okay. Well current mental health policy recommends more options and alternatives in the service
delivery, so can you talk a little bit about the impact of these recommendations on care planning in your
work place, you know more activities and more programmes…
Well hopefully now, going forward, we would hope […] would be a day hospital, you know, instead of being a
day centre.
And what’s the difference?
A day centre is really like where somebody, ok, am, maybe any age profile, but well it is they would come link
in with us and spend the day and so do kind of light activities. Whereas a day hospital would be more, would be
more…what’s the word I am looking for…would be more kind of, am, run on a stricter regime where say, like
instead of being hospitalised as an in-patient you’d be treated on an out-patient bases and you’d go be seen by
the doctors and the nurses or any councillor or any therapy that you’d want, but it’s done on an out-patients
basis, whereas a day centre now would be kind of where you’d have a kind of, have a lot of activities for people
who just want socialisation, to link in with other people, you know like and that.
So it’s more like intense treatment then, is it?
Yeah, and going forward like, that’s the new way for going forward, treating people outside mental
health…with mental health issues outside hospitals, you know, it’s about treating them on a daily basis and you
can also link them on a daily basis and you can also link them in to these kinds of things like the music therapy
and the art therapies and that, you know, as against with day centres, the people might feel there is a mixed age
group and people might think well they are all too old, I’m not going in there, you know what I mean.
Yeah.
Where as you can set up these programmes and individually, they can go and you can put your age profile
together, because you know exactly what you are dealing with.
D24
Okay, so is there a certain age profile, or do you want to make it all age profiles?
Well with the day hospital you can make it a certain age profile because you’d have the day centre separate and
that would be dealing with the older, kind of, you know what I mean, or the less acute, whereas the day hospital
would be dealing with the acute, you know.
Okay, yes, so that’s the avenue, that’s what’s been recommended?
Yeah, yeah, to go down that road, yeah.
Okay.
And a lot of them done on the community based, as well, you know, people visiting people in their homes and
seeing how they are getting on and that, so again that’s down the road.
Okay, so it’s trying to keep people out of the hospital?
Absolutely, that’s the aim of the hospital setting, the hospital environment, and try and treat people, try and keep
everything as normal as possible, that they can continue to do their daily routine, maybe continue to even work,
or you know, whatever, little jobs they’ve been doing, trying to normalise everything for them.
Yeah, okay, and well I suppose, how do you think these recommendations are manifesting in the practice
context now? Is it beginning to happen, or is it slow?
It’s very slow, it’s very slow, it’s out there, it’s on paper, but because of the financial restrictions on, you know,
the health boards and everything and finances, everything is taking priority, you know what I mean and that and
am, it’s slow, but hopefully, eventually, we’ll get around to it.
Yeah, so again, I suppose finance is the big thing at the moment isn’t it?
Well at this point in time it is, if the Celtic tiger was around now again, I’d say these things would be taken on
board, but because of the restrictions on nursing staff and the embargo on people, you know what I mean, it’s
very hard to get things up and running because you don’t have the staff, you know.
Yeah, so that’s a major setback really, isn’t it? Because I think they are trying to make mental health, to
bring it to the fore and make it....
Oh, bring it up there and make it less, less am, stigmatized, you know what I mean, and that, and bring it out
there, you know, and you’d see this too by the ads on the television like, you know and all that like, you know.
It seems to be becoming more prevalent.
Yeah and you’ve got a lot of voluntary groups out there too like you know what I mean, who help along the
way.
And do you link in with all them or…?
We do yes, they come and they speak to us like from GROW and we have the Advocacy and various groups like
that, you know what I mean, and if they don’t come, but their time is restricted and their staffing levels are
restricted too, as well, and everybody is kind of cut short, but if we ever wanted them to come and have a group
talk session with people, they are more than willing to do it.
What do you think the arts can contribute to care planning in your work place in particular…in this
mental health setting? Are the arts in your care plan, or will they be in your care plan?
D25
Am, it is, it is in it indeed, and well we’d hope that it would be continued to stay in it, but as I said again, it’s
back to resources and everything and if we can get over that hurdle and like bring it in more and more and kind
of implement more and more things, you know what I mean, that sort of…and people would be kind of, very
objective you know, looking and saying, oh it’s not just doctor, hospital, tablets, you know.
So you’d like to go beyond that?
Yeah, yeah, and rightly so, sure cause people are working and they’re entitled to be able to go out to work and
stay working even if they do have mental health issues, you know, and that’s what you want, you want to be
able to keep people, normalise their lives, as normal as possible, you know.
So what kind of other programmes do you have?
Well we do, we would do stress management, you know, in that then would involve yoga and relaxation and we
would do our own kind of solution to issues, am, people would have issues regarding weight and we do
medication compliance and am we do am, recovery programmes you know where people are coming out of
hospital. If somebody is after spending six weeks maybe, or ten weeks in hospital, you know, it can be very
daunting to be…you’re minded while you are in hospital, but then when you are out, you’re on your own, when
you’re back home, in your own environment. Maybe somebody is living on their own in their own place and
they kind of think, oh my God, I’ve had all these people around me for six to 8 weeks you know, so like it’s
about like you know, saying, look this is what it’s going to be like when you go out, you know, you have to take
your own responsibility, but we’re here to help you take the small steps and then by linking in with the likes of
[…] and that, they are not at home on their own thinking…
So maybe they can come in here and do art or music…?
They can do art or music, or even run outside in the Waterford Regional at times; people can go sit in out there
and visit it, not to be reminded the whole time, you know what I mean like. It’s just nice to kind of link into
something on the general side of the hospital as well.
Yeah, that’s very interesting. So how do you think the arts have impacted on mental health service
delivery in your workplace? Has it impacted in any way?
Well am, it’s extra work, but that goes without saying for everything. But again like our idea of it is if it’s
helpful for the clients, we’ll run it. Anything that we’d find that would be of benefit for them and they seem to
am, as I said become…I hope I’m not repeating myself, but they seem to enjoy it very much and the benefits of
it are very good, you know. And you’d see them in good form, you know what I mean, and that sort of thing,
am, enjoying themselves.
How do you think it’s impacted on the clients? It’s probably hard to measure…
The thing about it is, if they don’t want to go into it, we wouldn’t like, we wouldn’t force anybody into it.
Because at the end of the day, if someone is going to do something like, they’re going to bring in negativity in
with them and like, that’s not going to be good. You know what I mean, and that so, but mostly as I’d say they’d
all, everybody would go in and engage in it.
So has the arts in your workplace impacted on you personally in anyway?
Am, well like before like, you’d say oh what’s the arts, what’s that got to do with mental health issues. But now
you’re kind of going, oh hang on a minute, like we discussed earlier, you could see a place in it going forward,
you know, but like everything else I think, it has to be in the right place, do you know what I mean, have its own
settings and everything. Like everything else like, say the Advocacy and all these groups, like in mental health,
that if you can build it up to be kind of like, ah something that the people will get used to and it will grow on
people and they say oh God sure that’s very good and that’s it. And then sure it just becomes part of the norm,
you know, and it would become…
D26
So a bit of education on the subject, maybe?
Absolutely, and to encourage people like to just listen to see what it is first of all, you know, because it is new
and anything that is new coming into a time when everybody is very busy in fairness, they really don’t have
time to sit down and listen, that sort of thing like. So like being you and are and it’s always going to be ah, it’s
lovely when I’ve free time. I’ve other things to prioritise, you know, so I suppose the more and more it grows
the more and more it’s been put out there. You know, being introduced and as you said yourself, knowledge
about what it is and where you’re going with it and you know, that sort of thing.
And as you said yourself, it will just fit in easier once...
Absolutely, it will slot in.
So, a little bit of extra work at the start maybe but then…
Yeah, yeah, and it will always find its own setting you know, and that sort of thing.
Yeah. So when you say setting, it just needs to be with the right people and at the right time?
Yeah and say like now for instance, like in going forward as a day hospital now, that would be a lovely setting
for it because you’d be able to group all of your profile, you could profile all your people and group all your
ages together. Do you know what I mean like, and get a lovely young, a lovely young age group between twenty
and twenty-five maybe, or thirty, you know what I mean, who’d understand it.
Yeah.
And maybe who’d be able to benefit from it. Our age profile now, they loved it, but they see it as a musical
thing and reminisce.
It’s nostalgic really, isn’t it?
Yeah, whereas some of the younger people might turn around something for them, see things in a different
aspect, you know, when we’re all feeling down and when a kind of a bit of a jizzed up song or something like
you kind of get in good feel factor, ah to hell with all that and shove it all off, you know. Whereas with young
people, the one huge thing with young people would be open you know, they are open to change in their minds.
And do younger people come here as well, or is it mainly for older people?
We do have a lot of young people here, but they would be on a review. But, like because we are all like all
mixed in together, they won’t engage with them like, which is like fair enough, you know what I mean.
So, with the day hospital, this is where it would change?
Yeah, it would change, you would solely have only a specific age group going there, you know. Then, if you
know, you could empower them to start going on their own groups and doing a little bit, things for themselves,
you know, that sort of way. Then again, going back to having the right setting, do you know what I mean?
So again, you think it could help all age groups?
Oh definitely, just because, you know, it’s not just age specific, might sit there reminiscing, doesn’t mean to say
it wouldn’t help them, but definitely. You should see their faces, and I mean that’s worth it even if they just
happen to go one day a week like you know. So, I mean it’s open to everything.
D27
Yeah, okay. So has the arts in your workplace made your job harder or easier, or maybe a little bit of
both?
Ah no, I wouldn’t have said it makes it easier or harder. I just feel that it’s just, it’s given us another alternative,
do you know what I mean, it’s given us another alternative to say, well look this is, you can, you can challenge
your issues or emotions or whatever through music, so like then I suppose, it’s onto the people, will they pick up
on that then. But it does I suppose, it gives another alternative as against kind of saying aww woe is me, what
am I going to do with myself like, and it’s a nice way, because the art and music are very open minded too as
well aren’t they?
Yeah, exactly. So more alternatives mean you can reach more people?
Absolutely, cause like people don’t want to be caught up in that like, strict medical module, or you know like,
medication, doctor role kind of thing. The way I see it is if you had a heart condition that you don’t want to be
going down to the hospital to see the consultant all the time, you go to the rehabilitation and you meet people
where you kind of do your rehabilitation exercises and all that and you bring up friends. People discuss then, oh
God I felt awful over this, you know, and I feel like that too, you know, get a little bit of support out of
everybody, you know, that sort of thing, help each other.
So yeah, branching out of maybe the old traditional way of...not that there is anything wrong with that…
No, because we need that.
Yes.
Oh you definitely need that now, but it’s nice to have something to move onto, you know what I mean.
Okay, yeah, so at his point do you think that you’ve got adequate resources to do your job as you think it
should be done and appropriate support in your position? I know you mentioned the lack of funding and
money and that’s probably something and staff and everything?
Am, but I think at the moment we do like you know, we’re able to manage it and we’re able to kind of, to get
things we want. It’s a bit of a struggle, but you know, who’s not struggling at this stage?
So, it’s managed?
It’s managed, yeah.
And with the new plans?
Yeah and with the new plans and things, yes, yes, because the new plans are going forward, do you know what I
mean and they have to kind of keep going forward.
And that’s the way to do it, isn’t it?
Exactly.
The WHAT participatory arts and mental health programme is a product of the partnership between
yourselves and themselves, different, various stakeholders. What do you think are the benefits of that
partnership?
The clients?
Well, you know for you and the clients.
D28
Well again like you know they can go along and they can express how they feel, they can come back and say, oh
I went to the music and am, ah oh God I feel a little bit tearful, say if somebody comes out and says oh I feel a
little bit tearful and they might start telling you other stories as to why they were tearful, that sort, that brought
back a lot of memories for me or what you know. That you’re kind of linking into something new with them that
you didn’t know before like, you know.
So even if they’re being, even if they’re sad, that seems, that’s a good thing really then is it?
Well it is yeah, yeah. A lot of people these days will kind of keep everything in. Some people just don’t feel it,
but if you can feel it, somebody like you know, kind of say on they opened up a little bit there now. Oh, another
avenue now, I might be able to channel through that now and see is there something that might be bothering
them, that might be…could address down the road, like you know.
Yeah.
Like it could open other doors or windows for you, you know that sort of way, that you could pick up on, you
know, so I mean it’s good like that you know, from that point of view.
So the partnership, it’s probably, it’s a positive thing then, between WHAT and here?
Oh yeah, yeah, because I mean, oh God it is, because as I said again, the clients really do benefit from it, you
know, and you’d see their moods lifting and that sort of thing and like they might even, even if they only came
and told you a story about what the song meant or something, you know, it’s all new. It gets them talking
themselves, about maybe things because you’d hear someone saying, oh I never thought, I remember that now
and I forgot all about that and that reminds them.
So it triggers something?
Yeah, yeah, you know and sometimes it can trigger something. It can trigger sadness off too, but it’s good for
them like for them to address it too like. They’re addressing it in a safe environment too like, you know as well,
you know.
Yeah okay, so well, I suppose are there any possible limitations or negative sides to the partnership with
WHAT?
Not really unless, now I know it sounds boring, but unless financial restrictions came in and that they had to pull
it say, you know what I mean like, and say we can’t really afford that, but as regards that getting along, there has
never been anything.
So it’s good, a positive thing?
It’s good yeah and as I said, going forward, hopefully as I said, you could build on that, you know.
Yeah, so, I suppose on a personal level, do you have an interest in the arts yourself outside of the
workplace?
No, I just do it now, I just do it now really for here and that, but as I said, my own experience from it here, it
would have broadened.
What you think of the arts yourself; would that influence your decision of what you think of it here in the
workplace?
Yeah, well it would really, because even now from knowing how it works here and what I’ve done and seen
myself that would have influenced that. Before I might just of passed it off if I was in the ward at the Waterford
Regional Hospital, but now I’d say, oh what are they up to this time, so you know what I mean like, you know,
D29
you would be open to things, or if there was an exhibition on or something like that in the hospital you know,
you’d still, like you might not go out or link in, but you would be there, you would be able to see what’s going
on.
Yeah.
You’d have kind of an open window into it, you know.
So, it’s kind of made you think a little bit more about it?
Yes, yes, yeah, yeah. Or if you see anything in the paper, or the email, you’d say what’s WHAT up to now, do
you know what I mean. Disruption: knock at the door.
Yeah, yeah, sorry.
Yeah, no bother, work away.
Now, sorry about that.
No problem, we’re getting there anyway, we’re flying through it. Now, if you weren’t interested in arts
yourself, are you happy to see them in here?
Oh absolutely. Oh good lord yeah, and even, I’d like to see maybe them even in more places like, if they were in
schools, or things like that even, you know like. The children nowadays, they are so tuned into everything like.
They take everything in and I mean if you can get it even…you could start your own like, children through
music, you know, through the arts like, you could, you’d be surprised that certainly like, even in the hospital, it’s
self on the general, it’s proved very positive.
Yeah okay.
It really has, it lifts people’s spirits up, if they are in hospital on the general side as well, you know.
So you might start painting yourself now, will you? [Laughs]
The front door! [Laughs]
So previously I asked you what your role was in the workplace. Would you like to see the arts as part of
your role in the workplace, or are you happier with it as the collaboration with WHAT?
I would go with the collaboration with WHAT, I really would, because I think when it’s run by an external
thing, then it won’t kind of get swallowed up, or it won’t kind of get put to the side or whatever. The thing about
it is, being part of a role, going forward, my concern would be time and money and then would it get pushed to
the side, you know, oh we don’t have time, we don’t have money, but whereas if you collaborate, it’s still run by
somebody outside and you can always link in with people you know. It’s good. It’s good.
Yeah, again so as I’ve said, it might be a little bit of extra work starting off, but once you get going at it, it
works?
Oh yeah, and it’s just very hard to try and visualise say that in a nursing setting, if you understand me. I’m
trying to visualise, now definitely, if we were in a day hospital setting, we could see it playing a big part there,
because you would be very involved in it yourself. But the fact that we’re two here, you’re wearing all hats to
all people and it’s very hard to kind of visualise yourself, do you know what I mean.
D30
I suppose with that question, there seems to be such a link between nurses and art, so many nurses are so
into the arts; not all obviously, but a lot, that there seems to be such a link there, that maybe they’d like to
do that role themselves…
Well, a role as a music therapist?
Well I suppose just that they would co-ordinate the workshops themselves, take more control of that side
of it.
Yeah, well that would be, I have to say, that would be lovely, if you were in the right setting at the right time
and you weren’t very busy. If you weren’t, but here now like, we’d be just so busy you wouldn’t even have time
for it.
So, it’s great to have WHAT?
I’d prefer to have WHAT involved, let them do the running of it, but going back, as I said again, if you were in
the right environment, like, say if we were in a day hospital, you could run that yourself. I could see a place for
it, do you know that sort of thing, definitely without having to am, am now whether the nurse would be
musically orientated or not.
Yeah, well I think it has to be dependent on the person.
It has to be, the person would have to be, like I, I couldn’t play anything, I haven’t a musical note in my head
and there is no point in me trying, to get me to play music like, because I wouldn’t know what’s what, but I
think certainly, if any nurse had ever…
No like, I think it wouldn’t be fair to force something on someone who wouldn’t want....
But I think if you had a musical background and you had an interest in music, oh by all means, I would
encourage anybody. The nursing staff here, if you know what I mean, if they were ever musical or had a creative
background like, that, yeah, yeah, definitely they could run it themselves.
Okay.
Well now let’s say, at the moment, as we are, it’s just so busy, you know, and that sort of thing.
It’s all go.
It is.
Do you think it would be a good idea to integrate an arts and health module into the student nurse or
doctor curriculum in college? Were you ever offered anything like that during your own training?
Oh no, no, that wouldn’t have been, but I mean, I think anything going forward, that’s going to help anybody,
clients at the end of the day, I mean a module wouldn’t be any harm to anybody, do you know what I mean.
Yeah again, just for the staff themselves, for their own…
Absolutely, yeah, and to know, kind of the young people of today like, they’re very shy about ah, getting
involved with people. If there was a module introduced during their training, like they could say, oh yeah, well
we did that now in training, you know, but if you said to them like here, or in any place like, I have music
therapy, they’d be saying, what’s music therapy, oh my God, what am I going to do, what have I got to do in
this? It’s all a learning process for them and I think anything that they can learn or pick up certainly won’t go
astray on them.
D31
Well I think training for nurses and doctors can be very stressful in itself, so maybe it could benefit them
as well?
Absolutely, any kind of holistic thing would benefit them at the end of the day. Anything that you could
introduce, because it’s all about going forward, it’s all about helping the clients and helping yourself as well
along the way too. If you can have a positive outlook, well you know, you’re going to have a positive kind of,
ah, they are going to feel positive from it as well, you know.
Would it have been a module you would have chosen yourself?
Ah no, back then when I trained, it would of never, it would never of come in, but I think going forward, it
would certainly be of no harm to bring it into it and to introduce it.
If they could have a choice, if they could pick it...
Yeah, yeah, you know, I mean, if it was a module, as against what else, if you wanted to pick it up against
something, you know, it would be no harm to give them a choice and say…let’s face it, the music is going into
the general side as well like in psychiatry, so overall it would be nice, it would be interesting.
Are there any other points concerning the arts in a mental health setting that you would like to make, or
maybe that I didn’t ask you, or that you think might be relevant?
No, I think we’ve covered them all there now. I’d say from my own point of view working here now, and am
from the people who have worked here, the music therapists, they’ve all felt that they’ve given something to the
client and the clients have given them something back and everybody has really enjoyed it.
So, very positive?
Oh God yeah and I just hope that it would continue and be able to be continued with, even to increase it a little
bit, you know, and I hope that was helpful?
Oh absolutely, thank you so much.
ENDS
D32
Appendix D: Interview Transcripts – Interview C – Written by the Participant
1. What is your role in the workplace?
Clinical Nurse Manager (job share). I am in charge of managing the unit with my job share partner. The aim of
the unit is to endeavour to help the clients to maximise their health and social wellbeing. We try to do this by
using resources that are available to us as effectively as possible. Most of our clients would have enduring
mental health problems.
2. What is your previous experience in the area of mental health?
I have worked in mental health for 35 years on and off. I have done courses in complementary therapies and
activities. I have been working in the unit for 13 years. I have been involved in developing and organising
programmes and activities for the unit.
3. What is your previous experience in the use of arts in mental health (if any?)
We have always had some art and music as part of our programmes. We have had art therapy students and have
been involved with WHAT for some years. If any of our students have any artistic or musical talent, we
encourage them to work with the clients in this area.
4. What do you think the arts can contribute to mental health care in general?
I think arts can help to explore different ways for people to express themselves and their personal creativity,
make the day more fulfilling and have a relaxing and calming effect.
5. What do you think the arts can contribute to service users of your workplace? (For example what was the
impact of previous art & music projects or workshops on participants?)
I think it can improve confidence and self esteem, improve social skills, decrease negative outlook and have a
relaxing and calming effect.
6. What do you think the arts can contribute to care planning in particular?
I think to include arts in a care plan can be beneficial to the client’s mental health and aid recovery. The
workshops can be entertaining, encourage latent skills or talents and decrease anxiety
7. What are your expectations of the art & music projects or workshops in your workplace?
Similar to Q.5. I would hope it would make the day more interesting, improve self esteem, promote self
expression, reduce stress and improve mood.
8. In your opinion what are the strengths of the art & music projects or workshops in your workplace?
I think they give clients structured times to relax, unwind and be creative and expressive.
9. In your opinion what may be the areas that need to be further developed in the art & music projects or
workshops in your workplace?
I think off site visits to art galleries, museums, theatres, etc. are a good idea. We have done a few ‘cultural’ days
with our clients and they really enjoy them.
D33
10. At this point do you think that you have adequate in-service and other training?
Training is offered in the music workshops. It is possible to do some other courses, but they are a bit curtailed
due to financial constraints.
11. At this point do you think that you have appropriate support in your position?
Yes. We got 2 extra staff in the last 2 years. We also have more outsourced workshops and activities.
12. At this point do you think that you have adequate resources to do your job as you think it should be
done?
We have limited transport to attend outside activities and events, e.g. a minibus. We have requested one and it
has been promised to us for some time in the future.
13. Current mental health policy recommends more options/alternatives in service delivery. Can you talk a
bit more about the impact of these recommendations on care planning?
The Mental Health Commission are happy with the last inspection of the unit. Any recommendations are taken
seriously by management. We have received more resources in terms of staff and hours from WHAT.
14. How do you think these recommendations are manifesting in the practice context?
The recommendations are worked on carefully by the consultant and staff and the hospital manager and they try
where possible to give us resources.
15. How do you think the arts have impacted on the clients of your service?
Many clients who were resistive to participating in the workshops and programmes now look forward to them
and enjoy them. We have also noticed improved confidence and self esteem in many clients.
16. How do you think the arts have impacted on mental health service delivery in your workplace?
It means we have more programmes to offer, more variety and stimulation and a different focus for clients.
17. Have the arts in your work place impacted on you personally in any way?
The clients are often in better form after a session. This makes life easier for everyone. The staff in the unit learn
more about the arts and running that type of programme from attending the sessions.
18. Have the arts in your work place made your job easier or harder, or a bit of both?
A bit of both. We have to do more planning, attend meetings, collect feedback and do evaluations. We also have
to take care of the art supplies and musical instruments. On the other hand, it is great to have the programmes
available to us for the clients.
19. The WHAT participatory arts and mental health programme programme is a product of a partnership
approach between various stakeholders. What are the benefits of the partnership?
We have an input into the type of workshops that we get and we can choose the ones that we think would be
more beneficial for the clients.
D34
20. The WHAT participatory arts and mental health programme programme is a product of a partnership
approach between various stakeholders. What are the possible limitations?
There’s quite good scope. There were no limits so far. All ideas are listened to and worked on.
21. At the end of a block of art & music projects or workshops what would constitute a successful outcome?
Positive feedback from clients and interest in doing further similar workshops.
22. At the end of a block of art & music projects or workshops what would constitute failure?
If the feedback was bad, or if clients said they did not want to attend again, or if they were disruptive, agitated or
in bad form during the workshop.
23. On a personal level, do you have an interest in the arts yourself?
Yes. I’m not good at any, but I like to look and listen. I always encouraged my kids in the arts. They all play
some instruments and like art and the theatre.
24. Would what you think of the arts personally influence your decision in what you think of the arts in your
workplace?
I suppose it’s bound to have some effect, but I listen to the opinions of the clients, other staff and the artists /
musicians themselves before making a decision.
25. Previously I asked you what your role was in the workplace. Would you like to see the arts as part of your
role in the workplace?
I do see the arts as part of my role. As I said earlier, programmes and activities are part of my role and the arts
are part of the programmes. I also organise cultural days out to art galleries, museums, festivals, concerts, etc.
26. Do you think it would be a good idea to integrate an arts and health module into the student nurse
curriculum in college, especially in mental health nursing?
Definitely. We always encourage students to participate in workshop and programmes, so having it included as
a module in college would be of great benefit.
27. Would this have been a module you would have chosen yourself?
Yes.
28. Are there any other points concerning art & music workshops in your workplace that you would like to
make?
Due to the workshops, many hidden talents have been discovered in the clients, e.g. artistic talents, or the ability
to play instruments or sing.
Thank you!
D35
Appendix D: Interview D Transcript
Well first of all what is your role in the work place?
Okay, I’m the clinical nurse manager of […].
How long have you been working in the area of mental health, or what is your previous experience in the
area of mental health?
Ah am, thirty one years of mental health, from student to now.
Yeah, thirty one years.
My previous experience, is that what you asked me?
Yeah.
Sorry, am, I trained in the U.K., so I went to England at eighteen and I trained to be ah, what was known as a
psychiatric nurse then, and I spent eight years there working, came back here then and I worked in St. Otterans,
St. Pats, in Dublin, and got a permanent post in St. Otterans, worked in care of the elderly, long stay, and
enduring mental illness and now I’m in the day care setting in west Waterford.
Okay so, a long…lot of experience.
Yeah, that’s it in a nutshell [laughs].
What is your experience, or previous experience in the use of the arts in a mental health setting?
Well, I have to say it’s only in the last, possibly eight years that I’ve seen an increase in arts in mental health.
When I was in England, going back, 1988 possibly ’87, there was a lot of art therapy with qualified art
therapists. Ah, but I hadn’t seen it when I came back to Ireland because St. Otteran’s, they didn’t have that
facility and I still don’t see it in our service unless we paid for it privately.
Oh right, is this in terms of arts and health, or art therapy, because there is a distinction. I suppose art
therapy is therapeutic and arts and health is for participation.
Yeah, well it was art therapy, yeah, I’ve seen that, but as I say in the last eight years I’ve seen that, but as I say
in the last eight years I’ve seen an increase in, because of the Waterford Healing Arts Trust.
Okay, yeah.
That they have shown huge interest and support in mental health and luckily one of our consultants, Dr. […],
who is am, rehab, she is the rehab consultant, has huge interest in it, so she welcomed them and we all got on
board and there was funding provided by St. Otteran’s at that time, going back about six years ago and some of
us staff went for training.
Okay.
To get a better understanding of the importance of am, art in mental health, you know, participate in art, so we
took it on board and we have it ever since and it’s been marvellous.
What did the art training involve?
D36
It involved am, group work for people working in different areas, we got together where we had to become
participants in group work of how to bring art to the…
Okay, so was it arts and music or…?
Art and music, oh it was always music, mainly music, arts and music, bringing music to the people.
Yeah.
Am, it was good fun, but what really gave me the awareness of the music you see, we don’t do a lot of arts as
such, art and music/music, they’re all one and the same thing.
Well arts can be art, music, writing, dance, etc.
Yeah, yeah, it was a DVD they showed us from France.
Oh.
Where they went to do their own training, the art therapists, music therapists, am, that brought it home to me,
the importance of music in all areas of health, be it neonates, be it intellectual disability, be it the dying, be it
mental health.
So it was something that wasn’t…so, it’s relatively new then?
Personally, it’s relevantly new in our areas, but has massive benefit, I can see…my own mother has Alzheimer’s
and she goes to a day centre and she was never ever into music. Never ever turned on the radio, never listened,
and now that day, is on a Wednesday, it’s her most important day at the day centre, that’s the day she doesn’t
want to go home early because she gets some relief or something from the music.
That’s the day the music is on?
Yeah, am, I have seen, I’ve worked with the elderly and I’ve seen people with, we’d say, enduring mental
illness/Alzheimer’s, who’d have no communication, crying with songs, and music that jigs something in their
memory and I think it’s wonderful to see that emotion jogged. People say put it away, it’s upsetting her. I think
it’s wonderful…leave her, because it’s giving her, it’s jogging something within her, or whatever him. I had a
lady with, ah Huntington’s chorea, I don’t know have you heard of that disease, it’s…
I’ve heard of it alright
It’s desperate, desperate disease.
It’s very degenerative isn’t it?
Oh desperate, and am, we didn’t take her to the music, we didn’t bring her to the music session and we were
wrong because ah, she didn’t like people looking at her, so she had her own private space in bed, and she was in
bed twenty four hours. But one of the musicians said, can I bring the music to her bed side, and she would get
agitated when she’d see them coming, but once they started playing soft music she just totally relaxed, and she’d
go…she accepted them and trusted them, so it was wrong of me to assume she wasn’t suitable, because bringing
the music to the bed side as well as to the group, are you with me?
So it was a learning curve then?
Oh absolutely, learning for me, yeah, yeah, yeah, but am, and here now they just love it.
D37
Yeah.
They love it, and we started, ah, the puppetry, which is also part of arts and music, am, this year because I
always felt that people in mental health needed to express themselves, they are very blunted, a lot of people can
be blunted, either by their illness or the treatment they’re on, their emotions can be very blunted, they don’t
express themselves, they’re not even able to engage in relationships, a lot of people, not all, but some people.
Yeah.
And I just felt a bit of drama would help them restore who they were, maybe or to act out who they might like to
be without having to be that person, so we got the puppetry onboard with support of Waterford Healing Arts
Trust.
Okay.
And it was a great success. This year was the first, we had people from all works of life here engaging in that
and that was wonderful to see it.
From all different age groups?
All different age groups, all different illnesses, yeah.
So, all different strains and strands?
Oh absolutely. We had chronic schizophrenia, we had a lovely lady here, who has am, early Alzheimer’s and
Parkinson’s, and she had to retire early from her workplace because she’s a solicitor…so you can take from that
what you want.
Yeah.
And she loved doing that and the reason she told me she loved it was because she could act again as she used to
in court.
Oh yeah.
You know like, it brings a lot home, so that’s it really.
What do you think the arts can contribute to service users of your workplace? What was the impact of
previous art/music workshops, but I mean, you’ve said a lot there.
You can take it all out of that.
Yeah, yeah, you’ve definitely said a lot there. Am, so, what are your expectations of the art/music projects
or workshops in your workplace, you know, would you have any particular expectations?
I don’t have expectations to be honest with you.
Yeah, yeah.
Because they come with their own I think, the people, the therapists that come...
The art and music and that?
D38
Yeah. And they’re well established, all of them. Am, the puppetry was new to us, so it took time to establish,
expectations and sometimes you know, expectations are not our goal, our runner here, you’re better off having
none and going with the flow, and seeing where it will take you and being flexible, and it can take you to big
places, you know, is that ok ? [Laughs]
Absolutely, yes, thank you.
But seriously, I know I’m on a role there, but expectations, you find you go in and this is not going to work here
so you have to be flexible to change your course.
With some people it‘s something new as well.
Yeah, but you know, you might have come in with, I’m going to deliver this and this is a goal, then you might
come in and say Jesus, this group, they don’t want this, nor are they able for it, so I have to go with what they
want.
You do, you have to bend and flow.
Yeah, ah, I know yeah.
Am, well so, in your opinion, what are the strengths of art or music or any other art form or projects or
workshops or what’s the strengths of those?
Well when you say art, do you mean?
Well when I say art, I mean it can be actual physical art, it could be music, it could be dance, it could be
drama, it could be poetry, etc.
Yeah.
It could be...
Anything to do with arts?
Yeah, so basically it could be anything I think, yeah.
Ok, can I have that question again?
Well in your opinion, what are the strengths of the art/music projects or workshops in your workplace?
Am, well, I’ve said that again haven’t I?
Yeah, you’ve kind of said that, so basically...
They’re therapeutic.
Yeah.
Definitely therapeutic, each individual gets their own thing from it, and if it’s only a second, people, everyone
gets something from it.
Yeah.
We had a gentleman here and he never participated in it...
D39
I was just going to ask you, do people, does everyone participate?
No, no, there is no one forced, but they do have a very large group here. We had a gentleman who would never
participate in music, but he always walked up and down at the window when it was on.
So, he was curious?
So, he was listening from his own distance.
Yeah.
We might have another who’d sit and you’d think, oh God, they’re not getting anything from this, but their foot
is going.
So they are getting something from it, and can you say like, I suppose you know them because you’re in
constant contact, so you can probably tell if they, so something small like that, that might be nondescript
to someone else, you can say that that is actually...
A huge thing.
Yeah.
Oh absolutely, yeah, you see, I saw it particularly in the care of the elderly again when there was nothing going
on in a person’s life all day, just sitting in a chair bar communication and contact at, ah routine times, which is
awful to say. There is no therapeutic touch or communication in a environment of routine, you know and
institution.
Yeah.
And when that music went on, you know, you’d see, you’d see the foot, even if it was only the toes, that had a
tap going onto the beat and it’s in time, so they are listening whether they know it or not themselves, you know
they are listening, you know.
At a subconscious level, it’s coming in?
Absolutely, and you know, a lot of people have lost their ability, particulary in our service, have lost ability to
communicate, will always remember the words of a song once they are jolted, you know and they get free
flowing again, it must be wonderful for them.
It’s nostalgia, I suppose, isn’t it, coming back?
Yeah, it’s like people with a stammer, they can’t, they have a stammer when they talk, but they don’t have it
when they sing.
Oh yeah.
That’s their freedom.
Like ‘The King’s Speech’. At the end of a block of art and music projects, again, I use that word loosely,
any related workshops, what for you, would constitute a successful outcome?
That everyone’s happy and they, we always have a wind up, we have am, a little party on our last day of our
music workshops, am, and they have a little project, because they know them so well now that they design a
little booklet with songs, and it comes from them, they name the programme themselves, they pick their own
D40
songs, they sing solo songs, they sing as a group and it’s like a little concert, always at the end, and we have a
party and it’s achievement and it’s happiness, everyone’s happy at music, you know.
Yeah, and it’s probably something they look forward to, yeah ok [interruption, knock at door].
You ok?
Yeah, it’s grand there now again, am, so, what would constitute a failure then, at the end of workshops I
mean, or if there is any?
Yeah, we don’t have any but am, but what would constitute a failure would be lack of participants, yeah, lack of
participation, reluctance, am, am, not engaging relationships with am, the artists, we don’t have that issue but,
that would constitute a failure.
Yeah, so maybe different musicians or artists coming in, it could possibly happen?
It doesn’t happen, but it could happen, so that would...
Rapport like, you know.
Yeah, it’s very important.
Yeah, it’s very important, and trust and ah...
But it doesn’t happen here, we don’t have an issue with it.
What do you think the arts can contribute to mental health care in general, I mean ah, you’ve spoken
about what it does here, but you know, in general, if in other practices you know, or if it was to be
introduced into the mental health policy, what do you think the arts can contribute?
Personally I think they have a huge place in mental health, am and only for their own funding and as well as
some funding from ourselves, we wouldn’t have it, I mean they get grants for us and whatever to, to come to us
but am, I always feel it’s good to have outsiders come in as well, not the same faces here. There was an issue
there a while ago because we were trained in the music therapy, trained to be, ah, what’s the word I’m looking
for, trained to be ah...
Oh, yeah, you were delivering it yourself?
Yeah, we were trained to deliver, it couldn’t work, I couldn’t play an instrument, I can’t sing, you have to have
some degree of skill in the art you bring to a place, whatever it is, am yes, you could put on a tape recorder or
say let’s sing a song, but it’s not the same, they need the instruments, they need the musicians, they need the
change of face and any therapies we run here outside of what we do ourselves as nurse.
Yeah.
They engage better because they see us as their am, their keeper, their minder, we’re the one at them about
medication. We’re the one...
You are the mammy, kind of...
The mammy figures, we’re the ones that assess them for changes in their mental health state and sometimes it
doesn’t suit them that we do that because we call in doctors, etc., so they see us in a good role, a safety net but
for the enjoyable therapies, it’s good to have new faces, new people who come just for that function, do you
understand me?
D41
Yeah, because I suppose you’re saying if you blend the two, their view of you could become blurred, they
don’t really know, you know, you mightn’t be seen as professional.
Well, I wouldn’t have an issue about their views of me becoming blurred, I hope I have a relaxed or we, the staff
here have a relaxed atmosphere for them, but we’re not specialists in any arts, if we are we’d bring it here, do
you know, if we are am, none of us play instruments, none of us can draw, none of us can be creative that way.
Yeah, yeah.
You know but we do other things with them, we take them to the cinema and we take them on meals out, and we
do different things like that, that’s the only way we’re creative as well as supporting them.
Yeah, but it’s good to have qualified...
It’s good to have, yeah the outside…what’s the question you asked? Now I’ve lost my train of thought?
What do you think the arts can contribute to mental health care in general, no but that has answered
other questions that are coming up so you know it’s relevant.
Yeah, well it has a huge purpose in mental health...arts. Well I suppose what’s happening here I suppose could
happen…as a whole, you’re asking me?
Yeah, because the places WHAT work with are very lucky, but this doesn’t go on in so many other places.
That’s right, it’s because we have the WHAT there at our door stop, that’s why, at the heart of it, and I’ve huge
regard and respect for them for that reason.
Yeah.
But it has a huge function definitely, massive role, I would say.
U: Does it be seen kind of maybe as a luxury?
Well it is seen as a luxury, but am
Should it be seen as a luxury?
No, it should be part of it, should be part of the service, but it’s becoming more knitted in, it should be part of
the service, it’s not, yeah definitely.
Am, cause current mental health policy is recommending more options and alternatives in service
delivery, so can you talk a little bit about the impact of these recommendations on care planning in your
workplace?
The impact of what recommendations?
Care planning in mental health policies recommending more options, that it’s not just always the
medicated route or biomedical approach.
Not the medical route.
Yeah, just more alternatives, I mean it that happening here?
D42
Definitely, we don’t work the medical module to be honest with yeah here, it’s part of it, but is a small
percentage, yeah, or we have a holistic approach, we have a very social approach to care.
Yeah.
A lot of problems that we deal with on a day to day basis are social issues, you know, it’s not that the medical
thing is there, it’s always there but it’s secondary to us and I think that’s good, am and definitely arts and am
am…
They’re part of the care plan are they?
They would be am, saying that now, am, I wouldn’t say I have it in my care plan about individuals here, we all
have individual care plans as a whole piece, but it would be part of it definitely, like we might say, to assist
somebody to recovery or independent living and as part of that, like we have one gentleman who attends what
he likes here, he doesn’t like a lot here but he loves the arts, he loves the music therapy, yeah and that was part
of his care plan.
So yeah, you go by the individuals?
It’s an individual thing and it’s individual care plans, we don’t have one for the whole place, it’s individual care
plans.
Yeah.
It’s not part of our policy, but we as in am, legislative policy, but therapies are I would say on top of the list, art
therapy would be one on the top of the mental health commission and rightly so and, yeah they love to see it and
demand it.
Yeah, so it’s obviously manifesting in the practice then?
It’s happening and yeah…as well we do pottery here, we do arts and crafts and we have am, like these are made
here.
Oh right.
All recycling and things like that, so as well as the music that comes from Waterford Healing Arts Trust, we
have our own thing going on here as well like.
Yeah, so if you didn’t have Waterford Healing Arts Trust, you would have your own things going on as
well?
Yeah, they are just part of our yearly plan, the Waterford Healing Arts, we have them twice a year, which is
great, we’re very grateful, you know.
What do you think the arts can contribute to care planning in your workplace as well, am, what I mean,
you did answer that, it depends on the individuals and whether they like the arts, so you do see it as part...
Definitely.
Ok, am, and service users they work on their own individual plan with staff?
In the care planning is it?
Yeah, yeah.
D43
Yes, what we do is am, we have am, it’s, we have a team meeting here first of all and then we have the
individual planning, sorry, go back a bit, individual planning before the team meeting, where as I, we work in
groups here, we have a primary nurse and we all have approximately twelve to fourteen people each that we are
solely responsible for their plan of care and then we have an associate, so if I’m not around that somebody else
can pick up the pieces, associate nurse, so the first thing we do is we do a preparation leaflet which is great, and
we am, that. Can you stop that for a minute? [Interview interrupted]
[Piece of interview missing]
That will explain what we do, that’s their involvement there. [Brochure]
Yeah, ok. How do you think the arts have impacted on mental health service delivery in your workplace, I
mean obviously yourself you’re very involved in it, but what about other people in the workplace?
In the delivery, what we do is, we don’t personally get involved too much as we’ve a lot of things to be doing,
you know we run a lot of different things here, like even when the art is going on and it’s like their time, what
we do is at the end, we do come in and at the end of every am, what will I say, number of sessions we come
twice a year here and like we get involved.
Probably get block of eight?
Block of eight, yeah. If we are free, yes we do, they’ll tell you that we always pop in and we sing along, we chat
and we keep an eye and we can…
You have participated?
Oh definitely yeah.
So you know what’s going on?
Yeah, yeah, yeah, yeah, oh we know exactly what’s going on and we, like we walk through the area at times,
just to see how they all are and check everybody’s ok and happy with it or whatever. Ah, we don’t participate
probably as much as we should, because we’re busy, otherwise, well, they’re coming in to provide the service as
well you know, they don’t need us.
The service users are happy enough?
They’re well established their own thing there and they know all the musicians and you don’t have to call them
and say come on, come on for music, they are all in there waiting for it, you know so.
They just willingly come out?
Oh yeah just, there is no gathering people, they come from next door too, which is quiet supportive, mental
health service next door, they come over from there and we don’t have to encourage that, sometimes they might
be a bit late and we’d ring them and say are ya on your way, you know, but they love it, they just love it.
Yeah, okay, yeah, so how do you think the arts have impacted on the clients of your service, you know,
has it had any, you talked a bit about you know…
I think it has increased their confidence as individuals and as a group and happiness, I think is a big thing, the
jolliness that they come out with afterwards.
Yeah okay, yeah, so it’s noticeable?
D44
Very noticeable and you’d see, it’s not formal, it’s informal and that’s the beauty of it as well, there is no
pressure, you know, but the happiness and the jolliness and the voluntary participation is massive, and the
increase in their confidence within the group.
It probably doesn’t even have to be a major thing, even if it’s small minor things, I’m sure that it helps?
Yeah, yeah.
Have the arts in your workplace impacted on you personally in any way?
I love change and I love, am art. I wouldn’t be a musician, I wouldn’t be a singer. I did a lot of drama myself
over time and I’d like to see more drama come our way. Am, it has because it makes work more enjoyable for
us, sort of non clinical and it’s fun, it’s a bit of fun at work as well and similar to themselves, it’s am, the
jolliness of the two hour, one hour, whatever it is. Am, well that’s it really.
Have the arts in the workplace made your job easier or harder, or a bit of both?
In a way it’s made it a bit easier I suppose because am, it’s a therapy that we’re getting that we don’t have to go
looking for, that’s the only reason I’d say that now. It gives us time to do other things or whatever. And you
know, people are satisfied with that hour they get, or two hours they may get from the Healing Arts or from arts,
so you’re satisfied and people are satisfied, if your service users are satisfied, you’re happy, do you know what
I’m saying?
Yeah, yeah, would it be harder in terms of evaluation or extra paper work or admin?
No, that’s at the end of every session. We do an evaluation at the end of every session, we meet, and a meeting
possibly once a year with the Waterford Healing Arts as well.
Yeah.
Personally I’m very pro arts so, some people might be, they might find it more of a challenge, ya dealing with it
in their area, or dealing with it might be a nuisance, it will be a chore, you know. [Laughs]
Yeah okay.
And you will meet those obstacles. [Laughs]
Yeah, because I’m sure not everyone loves the arts, ya, obviously it would.
Oh God, yeah know [laughs], there is work involved rounding people up, fixing the environment on the morning
of them coming.
Yeah, getting things right and...
But that wouldn’t bother me like you know.
Yeah, it’s probably only a minor thing, but I suppose the gains from it?
Yeah, absolutely.
At this point do you think you have adequate resources to do your job as you think it should be done and
appropriate support in your position? I suppose that’s kind of referring to the economic climate and cut
backs.
D45
Yeah, I think considering the times we’re in and cut backs and that I think we did very well you know. Ah, it
doesn’t matter what it is we will engage in it because if you have an open mind you’ll take on anything. It’s like
making a silk purse out of a sow’s ear, you know. We do things here that you wouldn’t think possible, with no
space and no environment, like we ah, we run a one to one talk time.
Oh right yeah.
On our own initiative.
And what does that involve?
It’s one and a half hours, we give each person that comes in, some from here, very few actually, it’s people from
the community who hold down jobs, mothers, fathers, ah young people that are having difficulty with their
mental health, am, come through referral from the clinic, the out-patients clinic and they are maybe on a waiting
list for psychology, which can take up to twelve months.
Yeah.
You know, or any other am, addictions, or whatever, we intervene in the mean time just to give them a support,
and we offer them one to one talk time to off load in a confidential environment and we offer them relaxation
techniques, anxiety management.
Sounds very innovative, is it something you came up with yourselves or…?
It’s something that was kind of going on here for years, offering relaxation, but we broadened it out, one to one
talk time, plus relaxation or anxiety management, cause not everybody wants relaxation techniques or anxiety
management, but they might want to talk, which creates their anxiety if they can’t talk.
Yeah, and there’s a culture in Ireland really of not talking, so that ah…
Absolutely, so we’ve a separate diary for that, and it’s a big undertaking and we get referrals. We get at least
one, if not two a week up from the clinic and we split them up, we take, if I take a client, I’ll see them through to
the end. If I’m not here, I’ll have a nurse that will back me…and I will always tell them that, if I’m not here, so
and so will take you, but they don’t like change. I can understand that, they get used to a person. Some people
we can’t move them on. More people come once, they never come again, am, and others are here for months on
end, you know, but it’s great, people from all walks of life and we’re very, very flexible, you have to be and
that’s it.
You spoke a little bit about this before, but the WHAT participatory arts and mental health programme
is a product partnership between yourselves and them, you know, various different stakeholders I
suppose, so what are the benefits of this partnership, or having an arts manager, I mean, you said it
before I suppose that it’s nice to have people coming in, so what are the benefits of this?
Of who now, of WHAT?
Yeah, just of the partnership between yourself and WHAT?
Well I think it works both ways, we give them feedback, positive feedback and negative feedback, whatever it is
and they in fairness to them, they take it onboard, they learn from it. Am, we have huge gain from them because
we get therapies, you know that we wouldn’t of had without them.
Yeah.
There is no way we could afford to do what they provide for us on our own.
D46
On your own budget?
On our own budget, yeah, and am, I think it’s a learning curve for both them and us always and I would always
tell them at the meeting, that I’m invited too, because I think it’s important that we have rapport and feedback,
two way, two way feedback. And it’s because of that, that we had puppetry this year. If I didn’t attend meetings
and show interest, they would never have known.
Yeah, that’s very true, yeah.
That puppetry was important to me here, and because it’s important to me here, it worked well and when I say
me, I, it was important for me to try it here. And they took it onboard in fairness to them, and it worked very
well.
Yeah ok, yeah.
Communication is important.
Communication, yeah, that’s key then that’s...
That’s key, and the service needs that. And in fairness to them they always want to know what our needs are.
Yeah, they probably want to get the right match and the right fit. Is there any possible limitations to the
partnership, or is there any negative connotations? I don’t mean particularly with WHAT, but just you
know, you know things that are maybe negative about it.
Obstacles or anything?
Yeah.
I can’t say there is to be honest, am, we’re not overloaded with it and that’s probably a good thing, because
you’d tire of it. We only have it twice a year.
Yeah.
We have, am, we meet up with other counties, that’s a new thing that we kind of do because we are interested,
again, and am, so we have west Cork and Cork that we meet, now once a year now, it’s just kind of happened
and it’s great, they’re coming to us and we went up to them last year and they’re coming down to us this year.
Oh right, okay.
And am [interruption, knock on door, some of interview missing].
Well, we do showers and have personal hygiene here and everything, and give them tablets and Christ knows
what else, you know.
Yeah, so if there’s anything negative, I’m sure they take it on board and work with you, work in
collaboration?
Well there hasn’t been anything I have to say now, but if there was, of course they would. I could ring them
straight away and say, look, this is not working or something. They would, they are very proactive, you know.
On a personal level, do you have an interest in the arts yourself outside of the workplace?
D47
Yeah, not as much as I would like to be because of my work. I’m working full time and I’ve children, etc. Am,
but I do love it and I think it’s very important in all walks of life and I see it in my own community, with drama
and pantomime and children and the confidence and the fun, you know, am, not everybody’s for sport, not
everybody, it’s not for everybody. And the arts are another thing, opportunity out there for people. I think the
arts are massively important throughout all walks of life really.
Does what you think of the arts personally influence your decision of what you think of the arts in the
workplace?
I think it does. It does influence it.
If you like it, or you don’t like it?
Yeah, some people are not into anything and they would just be blinkered at anything coming into their service
and it’s not many today I have to say, but they’re there and I’d be very broad minded, I’d be very up for the
crack if you’d like, up for fun, and am, be it in the pub or be it work, it doesn’t matter, you know, and I think it’s
important that am, you have that attitude of flexibility and open mindedness.
Yeah, just because you don’t like something, maybe, you know, give it a chance because it could work?
Absolutely, cause not everybody is into puppetry, not everybody is into drama, you know, I can’t see another
nurse here who’s into drama, but they loved the facility that was provided for people.
Yeah. That’s what I mean, you don’t want to force things on people either, but I suppose...
But it’s never forced from the Waterford Healing Arts, always very gently done, because I think that therapists
are gentle people anyway, you know.
Yeah, yeah, yeah. It’s the nature of it, isn’t it, the participation. I previously asked you what your role
was in the workplace. Would you like to see…work away, you’re grand, I can turn it off. [Disruption]
I previously asked you what your role was in the workplace, but would you like to see the arts as part of
your role? I suppose what I’m referring to there is you know, take over the arts managers side, say from
WHAT, or do that job yourself in the work place?
No. No interest whatsoever! I think it belongs where it belongs and in fairness they tried to change how we run,
they tried to make us, as I said the facilitator and I…I just can’t go there, it doesn’t work for me because I need
them to come and do it and I need, I’m not a facilitator for music for starters, or for any arts to be honest with
ya, maybe drama, if I had time, but I’d want to be retired for that, I couldn’t do the job I’m doing now and doing
that as well.
So that would completely infringe on your role as…
As the nurse manager? Definitely.
Yeah, so it’s good to have them separate as you said?
Well I just like to have it that way and I think am, outside therapists coming in works better with the clients here
as well, with the people that attend here.
Yeah.
Because they see that role as their role and mine is what I do and ah, if I was retired I would have no problem
going into a place and offering ah, being an activist, in some part of drama or whatever but am...
D48
Yeah, cause a lot of nurses seem to be creative and they do that role, but again when they’re...
When they are retired, they do. A lot of them bring in their dog for ‘pat the dog, pat the patients’, whatever they
call it, in time and all that you know, it’s great.
So separate is good?
Separate is good like, for me. It may not be the right thing, but that’s how I see it.
Again, it all comes back to money and budgets, but the arts are in your role anyway, in a small way…
It is, we have to ensure its delivered. I can’t personally deliver it. I could sit down and do colouring with them,
as colouring books with people. We do cookery programmes here as well, and am, we get actively involved, but
there’s people qualified in every walk of arts, why are they trained, why are they there to deliver, if I can do it
all. I think its specialists, each area is a specialists area.
Yeah. Do you think it would be a good idea to maybe integrate an arts and health module into the student
nurse/doctor curriculum in college?
Definitely, I’ve said it, and I’ve brought this up at the Waterford Healing Arts annual meetings, I’ve said…I’ve
bought it up with the tutors in Waterford Institute of Technology, about bringing them, the healing arts to them
for a talk and you know, to integrate it earlier into their training. It was never integrated into my training.
Yeah, I was just going to say that, to ask were you ever offered anything like that?
No, no, not back in ’85, it wouldn’t be.
Yeah.
And that was the medical model, but saying that I was in the U.K. and I, we were ahead of Ireland then, we were
actually nearly where we are in Ireland now today [laughs] to be honest with ya and...
Well America, U.K., yeah, way ahead in that area.
Ah now in fairness to them here in am Waterford, when I came back from England, when I came back 1988-
1990…oh no sure it was ’85, whatever year I came back, there was music bought into the wards, you know, a
musician came in which was a similar thing, you know they came in, they played their instruments, as they do in
a lot of nursing homes now, they have musicians and little bands coming in to places.
Yeah, and wouldn’t of had that label I suppose, but what would they have been called, just...?
It was just a bit of music, you know, music on a Sunday. They do it in St. Patrick’s Hospital, they do it, you
know, everywhere, they have musicians coming in. Where my mother attends the day centre, my daughter play
music over in a disability high support residence, but because there is pressure from HIQA as well, that’s a lot
of the reasons as well.
Yeah.
And they’re right, they’re putting pressure on them for providing therapies.
That’s again the new policies coming in, is it?
Yes it is, with HIQA and the Mental Health Commission. HIQA for the general side and Mental Health
Commission for the mental health side.
D49
And why would they be bringing it in, I suppose because...?
They are demanding that, it should be part of everybody’s human rights, you know.
Yeah, cause it must be, it’s beneficial?
Absolutely.
Would it have been a module you would have chosen yourself if there was an arts and health module
when you were training? Would you have taken it?
I don’t know.
Yeah, yeah, you don’t know, because I suppose it’s yeah...?
It’s not for everybody you see.
You can’t force it if you don’t like it?
No, you can’t force, you can’t, and you get people who are very medically minded, clinically minded, and
people who are very creative and music minded and they would bring huge stuff to their work area, but so will
everybody, everybody will, you know.
But in saying that, would an option of it be a good idea in future training for nurses?
It should be part of the training. It should be part of it, I definitely think it should be part of it, the therapeutic
value of nursing, it has to be, I think, but no, I know that am…
And is it happening anywhere in Ireland?
No, I don’t think so. It was when it was encountered in Waterford, when I highlighted it to the tutors in the WIT.
They did go to the Healing Arts in fairness to them and I think the Healing Arts went to them as well.
I think […] links with them a bit.
She does, but I think it was working out very expensive to get them in for a lecture, you know, you see that’s a
lot of it as well, funding you know.
Yeah, so is it being put aside because of lack of funding?
It is being put to the side because of funding.
Because of funding, and you think it’s only funding, or is there other reasons?
Obstacles? No I would say money is an issue from speaking to tutors now, from speaking to […].
Yeah. It’s not that maybe…?
Segregated, it is segregated as well, it needs to be amalgamated more.
Is it taken seriously? Would it be taken seriously if there was funding there?
I think it would take time.
D50
Yeah, like anything.
Yeah, it’s like anything, it would take time, but it should be part of the training.
Yeah, so that’s pretty much it, but is there any other points concerning the arts and health in a mental
health setting maybe that I didn’t ask, or you feel would be relevant or anything?
I think we’ve changed a lot over the last number of years, particulary in the last five years, in our attitude, and a
lot of it, I don’t know, if I should say it or not, is new consultants have come onboard with different training,
different thinking and across the board we have embraced a lot more therapies, that crafts, ah, dance, drama,
singing, whatever, all of those things and the same in the intellectual disability maybe a bit ahead of us I think.
But that’s in the Vision for Change though, mental health policy, so I mean, well it’s not the arts, but it’s
therapeutic so it’s becoming…
Well that’s what I say it is, and it has to be, the Mental Health Commission will demand it, and they want to see
the proof of it.
They probably, I mean there is people, obviously, who don’t want to get involved with it…
Let others, if you don’t, that’s fine, but let others. There is always one in the area that’s interested, always one.
So maybe education available for people too…would that be a good idea?
Yeah well we have discussed this again at the Waterford Healing Arts Trust meeting and I think it has to start in
the college with the students, that’s where the education starts, when you are training people, you know. In
fairness, myself and others did the course with the Waterford Healing Arts and we bring it back to the different
areas, we role model it, we embrace it, yeah, and offload it onto others and it does work, are you with me?
Yeah.
So the majority of mature nurses, we’ll say are therapists, but I think it has to begin in training, medics don’t get
it at all. They don’t see anything beyond the books and they should get a bit of it too.
So the doctors, is it?
It’s not in them, I don’t think it’s in there.
Cause again, it’s something in America definitely. Doctors are brought out to art galleries, you know for
their own...
Stress management
Exactly.
They should definitely have it, should definitely have ah, a music workshop, or an arts workshop as part of their
college...
Because you’re making the person...
Medical model, end of, you know.
Yeah, no, it’s an interesting area. Mary Dineen, a mental health nurse from Cork I think is a big advocate for
bringing this in.
D51
Focusing on this, yeah, she’s right like I mean...
Okay, well I think that’s it.
Was that ok?
Yes, thank you very much!
ENDS
E1
Appendix E: Images used in Australian Health Ministers’ Advisory Council’s A National
Framework for Recovery-oriented Mental Health Services: Guide for Practitioners and
Providers, 2013, and A National Framework for Recovery-oriented Mental Health Services:
Policy and Theory, 2013.
Fig.2: The artwork by Pauline Miles
titled The Journey depicts the view
from the front seats of a vehicle
travelling on a road to a distant
horizon - journey of hope and new
beginnings.
From: Australian Health Ministers’
Advisory Council, A National
Framework for Recovery-oriented
Mental Health Services: Guide for
Practitioners and Providers, 2013, p.6.
Fig.3: The artwork by Pauline Miles
titled The Advocate depicts a speaker
standing at a lectern addressing an
audience with images relating to art on
the screen immediately behind the
speaker - recovery is different for
everyone.
From: Australian Health Ministers’
Advisory Council, A National
Framework for Recovery-oriented
Mental Health Services: Guide for
Practitioners and Providers, 2013,
p.16.
E2
Fig.4: The artwork by Pauline Miles
titled The Journey – Rowing My Own
Boat depicts a figure paddling a small
boat or surfboard towards three boats.
The central boat, Recovery, is flanked
by two boats Hope and Support -
maximising choice and self-
determination
From: Australian Health Ministers’
Advisory Council, A National
Framework for Recovery-oriented
Mental Health Services: Guide for
Practitioners and Providers, 2013,
p.23.
Fig.5: The artwork by Pauline Miles titled The Kitchen Table depicts the interior of a kitchen
and meals area with a figure standing at a bench. Most of a person’s recovery occurs at home.
From: Australian Health Ministers’ Advisory Council, A National Framework for Recovery-
oriented Mental Health Services: Guide for Practitioners and Providers, 2013, p.27.
E3
Fig.6: The artwork by Pauline Miles titled There are Many Points of View depicts a figure
standing in a room with artist materials on work surfaces and different views of external
images on the far wall.
From: Australian Health Ministers’ Advisory Council, A National Framework for Recovery-
oriented Mental Health Services: Guide for Practitioners and Providers, 2013, p.32.
E4
Fig.7: ‘Guthlan’ Carolyn Fyfe discusses
her journey of recovery and healing. The
art is called the Journey. The journey of
recovery and healing starts from the
outer circle identifying the challenges
that a person would experience. The
colours: Brown - the challenges to make
the change in your thoughts/emotions
(trying to move ahead). Black are the
dark times (depression). Mauve -
identified the reasons and have moved
forward. White - you have the control.
As you get closer to the centre it
represents the wellness of health -
socially, emotionally and spiritually. It is a long journey and you need to have people who
can let you explain your story and they theirs.
From: Australian Health Ministers’ Advisory Council, A National Framework for Recovery-
oriented Mental Health Services: Policy and Theory, 2013, p.20.
Fig.8: ‘Guthlan’ Carolyn
Fyfe depicts the journey of
layers that have impacted
the social and emotional
wellbeing of Indigenous
people from invasion,
colonisation and segregation
to assimilation. As the
layers and their impacts are
removed, a person’s journey
of healing and recovery
starts. Fyfe explains: I never
really had a name for this
piece of art. I painted it to
help educate others on the
impacts of invasion, colonisation, segregation to assimilation and how this journey has
affected the wellbeing of our Indigenous race socially, emotionally, culturally and spiritually
- mind, body and soul.
From: Australian Health Ministers’ Advisory Council, A National Framework for Recovery-
oriented Mental Health Services: Policy and Theory, 2013, p.20.
F1
Appendix F: Images of Clown-doctors
Fig.10: Clown-doctor
at work.
[Online image]
From: Clown
Doctors New
Zealand, 2014.
Fig.11: Four year old Harley Slack who had his limbs amputated and had to be resuscitated
three times in hospital after contracting meningitis has fun with the Clown Doctors. He also
made a Christmas card for his parents. He used reindeer and snowman sponges on the front
and his hospital ‘play’ lady had written ‘Happy Christmas’ inside and he signed ‘Harley’ by
putting the paintbrush in his mouth. While this is not in a specific mental health setting, the
child’s condition would have caused severe stress both to himself and to his family. [Online
image]
G1
Appendix G: Images Used in Arts and Humanities Healthcare Professional Education
Fig.12: Illness as Human Experience Fig.13: Nurse-Patient Relationship
Fig.14: Sacred Work of Palliative Nursing Fig.15: Suffering
The artwork in figures 12 – 15 are examples of illustrations used in the End of Life Nursing
Education Consortium (ELNEC) curriculum to capture key issues in palliative nursing. The
inclusion of art, poetry, film, narrative, drama, and other means enables the faculty to teach
the ‘art’ of palliative nursing, which can be summarised in the above following themes. ‘The
depth and breadth of palliative nursing care is advanced through integration of arts and
humanities in our education.’ (Ferrell, Harrington Jacobs & Kelly, 2010, p.945)
From: Ferrell, B. Harrington Jacobs, H. & Kelly, K. (2010) Arts and Humanities in Palliative
Nursing Education, Journal of Pain and Symptom Management, p.941-945.
H1
Appendix H: Images of the Participatory Arts in Mental Health Settings
Fig.16: Arts + Minds music workshop.
From: Sapouna, L. & Pamer, R. (2012) Beyond Diagnosis: The Transformative
Potential of the Arts in Mental Health Recovery, p.19.
H2
Fig.17: Arts + Minds music workshop.
From: Sapouna, L. & Pamer, R. (2012) Beyond Diagnosis: The Transformative
Potential of the Arts in Mental Health Recovery, p.19.
H3
Fig.18 & 19: Arts + Minds music workshop.
From: Sapouna, L. & Pamer, R. (2012) Beyond Diagnosis: The Transformative
Potential of the Arts in Mental Health Recovery, p.27&26.
H4
Fig.20 & 21: Arts + Minds music workshop.
From: Sapouna, L. & Pamer, R. (2012) Beyond Diagnosis: The Transformative
Potential of the Arts in Mental Health Recovery, p.25&23.
H5
Fig.22 & 23: Arts + Minds music workshop.
From: Sapouna, L. & Pamer, R. (2012) Beyond Diagnosis: The Transformative Potential of
the Arts in Mental Health Recovery, p.11.
H6
Fig.24: The Leeside Seratones, an Arts + Minds choral project involving HSE Cork mental
health staff, service users and friends, performing with Choral Leader Liz Powell in the
Crawford Art Gallery. [Online image]
From: Lynch, D. (2014) The Creative Path and the Road to Recovery [Online], The Medical
Independent: For All That Matters in Medicine, July.
Fig.25: Artist Jo Nichols (centre) working with the Arts + Minds Time to Dance group.
Photograph by Ger McCarthy. [Online image]
From: Arts + Health, 2014.
H7
Fig.26: An arts facilitator working with an arts on prescription group.
From: Stickley, T. (2010) Does Prescribing Participation in Arts Help to Promote Recovery
for Mental Health Clients?, Nursing Times, 106 (18), May, p.19.
H8
Fig.27: Participatory art session. [Online image]
From: National Centre for Arts and Health (Arts Department), 2014.
Fig.28: Wandering Methods, participatory art workshop for older people. Photograph by
Lian Bell. [Online image]
From: The Arts Council of Ireland, 2014.
H9
Fig.29: Arts Ability: Towers by Ray and Tom, Recreational Therapy Unit, St. Senan’s
Hospital, Enniscorthy (RT). Photograph by Rory Nolan. [Online image]
From: Arts + Health, 2014.
Fig.29-31: Arts Ability is an inclusive, participatory arts programme that celebrates the
artistic and creative imagination of people who experience mental health problems and/or
intellectual, physical or sensory disabilities. Initiated in 2003, the programme has included
music, drama, literature, dance and visual art in a variety of venues throughout County
Wexford.
H10
Fig.30: Arts Ability: Floyd Patterson and Jerry Quarry by Francis Joseph Power, County
Wexford Community Workshop (New Ross) Ltd. (CWCW). Photograph by Declan Kennedy.
[Online image]
From: Arts + Health, 2014.
H11
Fig.31: Arts Ability: Twelve Discs after Heron by Tom, Killagoley Training & Activation
Centre, Enniscorthy (KTAC). Photograph by Rory Nolan. [Online image]
From: Arts + Health, 2014.
H12
Fig.32: Votive #1 featured in the 2013 Let’s Connect exhibition at the Dunamaise Arts
Centre, Portaloise, which explored the significant connections between art and mental health;
the power that art can play in shaping ideas and how it provides a strong medium to
communicate for people who sometimes struggle to engage with society. It serves to
normalise the experience of mental health illness and prevent stigmatisation and exclusion of
people who are sometimes on the margins of society. Oils on canvas, Éilis Crean. [Online
image]
From: Arts + Health, 2014.
