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Arts in Health and WellbeingAn Action Plan for Wales

March 2009

Audience:

NHS TrustsLocal AuthoritiesNational Public Health ServiceCo-ordinators of Healthy School schemesArtists and Arts OrganisationsCommunity artistsArts TherapistsStatutory and voluntary agencies working with community groups

Overview:

This Action Plan describes collaborative action between the Welsh Assembly Government and Arts Council of Walesto benefit and enhance the health and wellbeing of the population of Wales through arts and creativity. The Plan isintended as the basis for future development of arts and health initiatives in Wales.

Enquiries:

Arts Council of Wales Planning and Development TeamBute PlaceCardiff CF10 5ALTel: 029 2044 1380

Welsh Assembly GovernmentDepartment of Public Health & Health Professions Health Improvement DivisionYoung and Older People BranchGovernment Buildings Cathays Park, Cardiff CF10 3NQ

Welsh Assembly GovernmentCulture & Welsh Language & Sports DivisionArts Policy BranchGovernment BuildingsCathays ParkCardiff CF10 3NQ Email [email protected]

Further copies: can be downloaded from http://www.artswales.org.uk

Key to organisations and abbreviations:ACC Age Concern CymruACW Arts Council of WalesSafle An Independent Public Arts ConsultancyWACA Welsh Association of Community ArtistsWAG Welsh Assembly GovernmentWCfH Wales Centre for HealthWHE Welsh Health Estates

Front cover photo: Ysbyty Bronglais, Mick Dunwell (photo: Keith Morris)

Arts in Health and Wellbeing

Foreword

We are pleased to introduce this Arts inHealth and Wellbeing Action Plan for Wales.It has long been recognised that there is a connection between the arts and health, and that people gain benefits from being in a conducive environment enhanced bygood design and art, as well as from active engagement in creative pursuits. These benefits relate mainly to emotional healthand wellbeing: for example through thepower of music, literature and the visual artsto provide deep relaxation and emotional release, or the opportunities provided by thearts for self expression and enjoyable socialcontact.

The Plan is intended to increaseunderstanding of the role of the arts in healthand wellbeing, and support the developmentof arts and health initiatives throughinformation and guidance. It describes actionin five main areas:

The Arts and Public Health and WellbeingThe Arts in Healthcare Settings Community Arts and Health and WellbeingArts Therapies Professions Art in Humanities and Healthcare

These span the continuum of arts and healthinitiatives, from those for people who are fitand well, through those for people who arevulnerable to illness from stress, socialisolation or difficult family circumstances, to those for patients in hospital and otherhealthcare settings.

In Wales we have many examples ofsuccessful arts and health projects. The Welsh Assembly Government is alreadysupporting Healthy Sounds; a scheme tobring live music into hospitals and Gwanwyn;a festival to promote and celebrate creativityin older age. Our Welsh Network of HealthySchool Schemes involves over fifteen hundredschools in Wales, and many local schemeshave used the arts to promote health. InSwansea, the University School of HealthScience offers a course on medical sciencesand humanities, which was the first of its kind in the UK. Many hospitals haveengaged artists to improve the healthcareenvironment, and several NHS Trusts haveestablished arts and health strategies.

Wales is fortunate to have a thrivingcommunity of visual artists and artstherapists, musicians, dancers, film makers, writers, poets and dramatists. Their willingness to use their creative vision and skills for the benefit of others is the foundation for arts and health work and we are grateful to them. We hope that theexamples included in this plan will serve toinspire others to explore the opportunities topromote and protect health and wellbeingthrough the arts.

Edwina Hart AM Alun Ffred Jones AM


Contents

Background 5

Evidence for the impact of the arts on health and wellbeing 6

What does the Plan aim to do? 9

The Arts and Public Health and Wellbeing 10

Arts in Healthcare Settings 14

Community Arts and Health and Wellbeing. 18

Arts Therapies Professions 20

Art in Humanities and Healthcare 22

Arts Council of Wales is committed to makinginformation available in large print, Braille and on audiotape. We will endeavour toprovide information in languages other thanWelsh or English on request.

Arts Council of Wales operates an equal opportunities policy.


photo: Royal Glamorgan Hospital - ‘Wish you were here’, painting session with Heather Parnell and Nigel Talbot


4

Remains To Be Seen - GwanwynChoreography by Caroline Lamb (photo: Anne Keeling)

5Background

The Arts have a vibrant and valuable role to play in health and wellbeing at all levels,and we are fortunate in Wales to have a richresource of creativity, experience andcommitment in this field.

Wales has a wealth of organisations andagencies which are delivering excellent workin a variety of health settings across thecountry. The Arts Council of Wales ‘Review of Arts and Health Activities in Wales’1

highlights some of the many successfulprojects and programmes that have beendelivered.

In December 2006 Arts Council of Walesheld a ground breaking conference whichfocused on arts and health in a Wales widecontext. The conference, supported by thethen Welsh Assembly Government Ministersfor Health and Social Services, and Culture,the Welsh Language and Sport, was the firstmajor step towards partnership workingbetween the Welsh Assembly Government,the Arts Council of Wales and other keystrategic bodies on this issue.

Following on from the conference, ArtsCouncil of Wales established a formal Artsand Health Steering Group to oversee thedevelopment of a strategy for arts in healthand wellbeing in Wales. The Steering Groupproduced a draft strategic framework whichwas the subject of a public consultationexercise in autumn 2007, the outcome ofwhich was presented to the Arts StrategyBoard in early 2008.

The draft framework has been used by theArts Strategy Board and the Welsh AssemblyGovernment Department of Public Healthand Health Professions to inform thedevelopment of this shared action plan. This involved engagement with arts therapistsfrom across Wales. The plan, which is jointlyowned by Arts Council of Wales andDepartments of Heritage, and Public Healthand Health Professions, is intended as thebasis for the future development of arts andhealth in Wales.


1 Tillcock A. (2005) Review of Arts and Health Activities in Wales. Arts Council of Wales

There is an increasing amount of evidenceboth from the UK and internationally thatdemonstrates the beneficial impact of the arts and creativity on health and wellbeing.Although the evidence varies in strength,there is a considerable evidence base, withhundreds of research studies and evaluatedprojects that clearly show the benefits ofusing the arts to promote health. For example:

Dr Rosalia Staricoff’s review of the medicalliterature in 2004 cites nearly 400 papersshowing the beneficial impact of the artson a wide range of health outcomes.2

A study by Professors Ulrich and CraigZimring3 found some 700 peer-reviewedrobust research studies demonstrating thebeneficial impact of the built environmenton health outcomes. Many have alsodemonstrated economic savings as well as higher patient and service usersatisfaction levels.

Some arts and health initiatives derive theirbenefits partly from increased physicalactivity, for example in dance or choralsinging. However, the main benefits in all artsand health initiatives are to emotional healthand wellbeing, relating to the development of self expression and self-esteem, reductionof symptoms of anxiety and depression, andprovision of opportunities for supportivesocial contact. These benefits can be

described as the therapeutic effects ofengagement with the arts, but it is importantto be clear that they are not art therapy,which is a specialist skill where art isintentionally used as therapy/treatment for people with various problems.

The therapeutic effects of the arts areapplicable to all groups of the population,from active involvement in the arts for peoplein their local community; to the accelerationof recovery of patients on hospital wardswhere the environment has been enhancedwith art or music.

The transformative effects of the arts are not,and should not be limited to those who areclassified as ‘patients’ or ‘vulnerable groups’.For example staff in health settings or otherworkplaces can benefit from the relaxing andstress relieving effects of working in aconducive environment. This in turn haslonger term impacts on job satisfaction,retention and recruitment.

In relation to health behaviour, evaluation of the ‘Invest to Save’ programme suggeststhat benefits may lie in the fact thatengagement with arts activity enhances theindividual, building their capacity for change by stimulating personal growth, self-determination, and contributing towardsself- awareness and transformation ofidentity.4 This would in turn affect all aspectsof behaviour, including lifestyle choices.

6 Evidence for the impact of the arts on health and wellbeing

2 www.artscouncil.org.uk/documents/publications/php7FMawE.doc3 Ulrich R. & Zimring C. (2004) The role of the physical environment in the hospital of the 21st century

The Center for Health Design4 Towards Transformation: Exploring the impact of culture, creativity and the arts on health and wellbeing

Arts for Health, Manchester Metropolitan University 2007


Canteen Gallery, Ysbyty Bronglais (photo: Keith Morris)Canteen Gallery, Ysbyty Bronglais (photo: Keith Morris)


8

‘Shooting Star’ Women’s Cancer Unit, Maelor, WrexhamTree of Life, Craig and Mary Matthews

9What does the Plan aim to do?

A vision shared

Partnerships between arts providers, the health sector, occupational and artstherapists, arts and health educators andlocal authorities are key to moving thisagenda forward.

The aims of the Plan are to:

1. Raise the profile and increaseunderstanding of the role of the arts in health and wellbeing.

2. Support the development andimplementation of arts and healthinitiatives through information andguidance.

3. Encourage strategic and co-ordinatedpartnership approaches to engagementwith the arts to enhance health andwellbeing.

4. Provide a foundation for futuredevelopment of the arts and health in Wales.

The Plan describes action in five main areas of:

The Arts and Public Health and Wellbeing

The Arts in Healthcare Settings

Community Arts and Health andWellbeing

Arts Therapies Professions

Art in Humanities and Healthcare

each of which is described in more detail at the beginning of the section. However, it should be noted that in practice, manyinitiatives fit into several different categories.


Public health may be defined as ‘the scienceand art of preventing disease, prolonging lifeand promoting health through the organisedefforts and informed choices of society,organisations, public and private,communities and individuals’.

Involvement with the arts has a central role toplay in tackling inactivity, raising aspiration,confidence, a sense of community andcohesion, and individual and communitywellbeing. With 1 in 4 of the population likelyto experience mental distress at some pointin their lives, the impact of the arts on moodand thoughts can be a powerful force in thedevelopment of improved emotional healthand wellbeing.

Moreover, the arts can be used effectively toraise debate and deliver health promotionmessages on matters of major importancesuch as teenage pregnancy, drug andsubstance abuse, obesity, heart disease andcancer.

For example, in West Wales, Arts Care GofalCelf offers a diverse range of arts initiativesincluding on-going programmes withprobation services for offenders with drugmisuse problems, and with social services for clients with drug and alcohol problems. In partnership with CarmarthenshireCommunity Safety Partnership, Arts Care hasalso worked with 10-16 year old children atrisk from substance misuse problems in theLlanelli area.

10 The Arts and Public Health and Wellbeing



Arts Care Gofal Celf

11

12


Raise awareness of the beneficial effects ofarts on health and wellbeing, and advocatefor arts and health schemes through:

1. Arts Council of Wales membership of the All Wales Mental Health PromotionNetwork, run by the Wales Centre forHealth.

2. Publication of relevant arts and health articles and research studies on theMental Health Promotion Networkwebsite.

3. An arts and health seminar/conferencecovering all aspects of arts and healthactivity to be hosted by the Mental HealthPromotion Network.

4. Inclusion of this Action Plan within theforthcoming ‘Our Healthy Future’ Strategy(setting the strategic direction for publichealth in Wales).

Publish a compendium on the arts andhealth. This will comprise

An overview of the research evidence to support arts and health initiatives.

Examples of schemes that illustrate activity in the 5 areas of the arts and public health, arts in healthcare settings;community arts and health; arts therapiesprofessions; and the arts in humanitiesand healthcare.

Action Lead Timing

WAG/WCfH/ACW

ACW/WAG

Point 1 by March2009.

Points 2, 3 & 4 by March 2010.

Compendium to bepublished in 2010.

The Arts and Public Health and Wellbeing

Action Lead Timing

Healthy Schools Co-ordinators and PSE Co-ordinators to encourage schools to utilise theatre including singing in educationmethodology, and singing, to support the Personal and Social Education curriculum.

Recognise business and organisations’ investment in the arts and health as a contributing factor towards achievement of the Corporate Health Standard

WAG/local authorities/localHealthy SchoolSchemes/NPHS

WAG/NPHS

Ongoing

Ongoing

13


Arts in Healthcare Settings

Arts in health initiatives take place in all typesof healthcare settings: primary, secondaryand tertiary care; acute and mental healthcare.

The arts can have an impact on anyone whoenters the facility, whether patient, visitor, orstaff and can be found in clinics, treatmentrooms, recovery rooms, consultant offices, as well as the wards and public areas of the building. Arts interactions may beparticipatory, engaging actively with patients,visitors and staff. They often include but arenot limited to:

public performances of dance, music ordrama;

artists in residence working in public areas such as waiting rooms;

site-specific commissioned artwork; and

all artwork displayed, hung or exhibited inany public area from lobbies and foyers torestaurants and book stores.

The use of arts within healthcare settings hasa beneficial role, not only for all those whohave reason to visit healthcare premises butalso for people working within them. Healthenvironments that incorporate the arts areproven to have a positive influence onrecovery rates for patients and to generallycontribute to better sense of wellbeing. Thearts are therefore an important considerationin the design of the built environment.

Many hospitals and healthcare settings inWales have employed artists in residence,and several NHS Trusts have established Artsin Health Strategies. In North West Wales theprogramme includes an artist in residenceworking with older people in a hospitalsetting, a music and art therapy service withinthe Trust’s Mental Health and LearningDisabilities Directorate, and thecommissioning of 5 pieces of public art for a new Community Hospital. The North WalesNHS Trust in Conwy and Denbighshireemploys two artists in residence whose role isto seek to engage patients in creative projectsas part of a holistic approach to recoveryand wellbeing.

14


“In clinical settings, encouraging patients to engage with the arts can help them to manage painand the side effects of some treatments, to alleviate stress and anxiety and to come to terms with what can be major and distressing episodes in their lives. Incorporating the arts into thedesign of healthcare facilities has positive benefits for staff, patients and carers.”

Dr. Rosalia Staricoff, (2004)

In Wrexham Maelor Hospital, the Cancerand Women’s Unit (the Shooting Star Unit) isenhanced by four commissioned art works:the Tree of Life Sculpture, the Ruabon BrickWall, a feature window in the café area andthree textile works based on the three phasesof the Gwenfro River. The themes for thesecommissions were based on local interest.

The Welsh Assembly Government supports a‘Healthy Sounds’ scheme, through whichamateur music groups provide live musicperformances in hospitals and care settings.Relaxing music has been shown to have abeneficial effect on anxiety, heart rate, bloodpressure, immune response and painperception5 – all of which are especiallyrelevant to patients.

15


“Little as we know about the way in which we are affected by form, by colour and light, we doknow this; they have an actual physical effect.”

Florence Nightingale (1860)

‘Healthy Sounds’, Congress Youth Theatre (photo: Wayne Beecham)

5 www.artscouncil.org.uk/documents/publications/php7FMawE.doc

Publish an ‘Art of Good Health’ handbookfor NHS organisations on setting up an artsprogramme in a healthcare setting.

The principles outlined will apply equally tothe visual arts and working with musicians, writers, storytellers, dancers and other artforms.

The guidance document will:

Demonstrate how the arts might be usedto improve healthcare environments andbuild links with communities.

Provide advice on setting up and runningan ongoing arts programme in both newbuildings and areas for refurbishment inexisting buildings.

Outline the role and responsibilities of an Arts Co-ordinator.

Offer guidelines for working with artists, including appropriate induction and supervision/governance processes.

Provide advice on purchasing andborrowing works of art, setting upchanging exhibitions and commissioningartists.

Provide guidance on assessing the impact of arts projects, from a health impact assessment before the project begins, to a final evaluation after completion.

Action Lead Timing

ACW/WHE/WAG Document to bepublished by ArtsCouncil of Wales byMarch 2009.

16


Arts in Healthcare Settings

Make available an electronic database ofUK and International examples of promisingpractice in arts in healthcare settings.

Provide an electronic directory of arts co-ordinators and artists available to engage with public organizations.

Expand the role of NHS Design Championsto include art in the healthcare environment.

Further develop and deliver a HealthySounds scheme of live music performances in hospitals and care settings, provided byWelsh amateur music groups.

Maintain links with the Kings Fund ‘Enhancing the Healing Environment’ programme with a view to introducing theprogramme in Wales when funding permits.

Action Lead Timing

ACW/WHE/Safle

ACW/Safle

WHE

WAG/Ty Cerdd/Welsh Amateur Music Federation

WAG/WHE

An electronic database to bemade available byMarch 2010.

An electronic database to bemade available byMarch 2010.

This will be implemented following NHS restructuring andthe nomination ofdesign championsfor the 7 newhealthcare organisations, provisionally in thelatter half of 2009.

Ongoing

Ongoing

17


Community arts and health projects seek to provide meaningful activity, influencemotivation and encourage behaviourchange. Local authority partnerships, thevoluntary sector, neighbourhood renewal andcommunity regeneration schemes all shareagendas that involve tackling economicinactivity, encouraging citizenship andcommunity involvement. The artist engagesin a creative participatory process withcommunity groups in order to create workthat has a sense of meaning and value forthose who participate. This involvementdevelops a sense of personal achievementand self-esteem and can generateconfidence within individuals and thecommunities involved.

Celf o Gwmpas is a community artsorganisation working with people withlearning disabilities in Powys. Their aimsinclude the provision of inclusiveopportunities for creative expression; toprovide a showcase for artistic work; and todevelop self expression and self advocacythrough art. An added benefit of theprogramme is improved physical health forparticipants, as many people with learningdisabilities have long periods of immobility.During workshops that required participantsto walk around town, it was noticed howunused to walking any distance many peoplewere. As a result, workshops were planned toencourage movement and mobility, andincluded activities such as forest craft days,photography workshops, circle dancing anddrumming, all of which involve a degree ofphysical activity.

The Welsh Assembly Government works inpartnership with Age Concern Cymru andArts Council of Wales to support Gwanwyn, a national festival to celebrate creativity inolder age. Gwanwyn aims to challengenegative stereotypes of ageing, and reducesocial isolation for older people throughenjoyable creative activity. Launched in 2007,the festival has been well received with over6,000 older people taking part in 182 eventsor sessions in the 2008 festival month ofMay. The longer term aim of Gwanwyn is toincrease opportunities for older people to beinvolved in creative pursuits in their localcommunity all year round.

18 Community Arts and Health and Wellbeing


Establish an electronic network for community artists who work in health. Thiswill provide a forum for networking andfacilitate the development of working partnerships.

Publicise the availability of arts and healthtraining courses for community artists.

Support the further development and delivery of Gwanwyn; a festival to celebratecreativity in older age.

Action Lead Timing

ACW/Safle/WACA

ACW/WACA

WAG/ACW/ACC

Network to beestablished by theend of March 2010.

Information oncourses to be madeavailable on theWACA website byMarch 2010.

Gwanwyn is currently fundeduntil March 2011.

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The Arts Therapies Professions comprise four separate professions: art therapy/psychotherapy, dance movement therapy,drama therapy and music therapy. All areHPC (Health Professions Council) registered,except for dance which is in the process ofbeing registered.

In recognition of the powerful and profoundnature of non-verbal communication, the arts therapies have established professionaltraining and principles of practice. Theseensure safe and effective methods of workingin partnership with clients to creativelyexplore, express and challenge distress. The aim is to offer opportunities forexpression, exploration and interaction thatcan enable positive change and greaterwellbeing.

Arts Therapies Professionals work with peopleof all ages in a variety of settings, includinghealth and social services, education, prisonservices and the voluntary sector. Counsellingand psychotherapy skills are a central part oftraining and practice.

The Ragamuffin project, based in Swansea,provides creative arts therapy for childrenand adults suffering from emotional distressand psychological damage. Ragamuffinworks directly with such individuals andgroups as well as providing training andsupervision for arts therapists and staffworking with vulnerable individuals damagedby abuse, family breakdown, war andtrauma. Ragamuffin’s aim is to begin to undothe damage caused, to enable individuals tointegrate fully into the community, and livefull and productive lives.

Recent work includes Incredible Journeys;weekly group and individual sessions withasylum seekers from many different ethnicbackgrounds. Music, drama, movement,story telling and the visual arts are used inthe project to enable expression of thoughts,feelings and events, providing a safe way tocontain feelings which might otherwise beoverwhelming. The creative arts are universaland translate across cultures regardless ofskills or language.

20 Arts Therapies Professions


Bodelwyddan Cancer Centre, Carved Wood Screen, Christine Kowal-Post

Improve workforce planning for artstherapies through inclusion in the annualNHS workforce planning data collection.

Explore opportunities for establishing artstherapy training in Wales.

Involve arts therapists in arts and health initiatives where artists are working with patients, to:·

Provide clinical awareness training

Provide supervision/governance

Action Lead Timing

WAG

WAG

ACW/WHE/WAG

From March 2009.

By March 2010.

Guidance will be included in the Artof Good HealthHandbook, to bepublished by March2009.

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Humanities and Healthcare is a multi-disciplinary field of study which challengesthe tendency to reduce the experiences ofpatients and staff to what is easilymeasurable, by drawing on disciplines suchas literature and history, philosophy andtheology. For example, in nursing education,the introduction of a piece of art which hadan elderly woman as its subject, resulted inan improved perception of ageing. This ledto a more sensitive and humane approach to care. Similarly the study of literature inmedical and nursing undergraduate coursescan promote clarity of observation,expression and fluency in ordinary language– all of which are essential ingredients fordeveloping communication skills andunderstanding in the doctor or nurse andpatient relationship.

In Wales, the School of Health Science atSwansea University offers a degree course onmedical sciences and humanities, which wasthe first of its kind in the UK. The course aimsto develop an understanding of medicineand health care as a body of knowledge thatis not limited to technical/scientific matters,but which also incorporates a wide range ofsocial and cultural perspectives, and thatrecognises unique human individuals indiverse healthcare and medical contexts.

Art in Humanities and Healthcare22


Staff Workshops, Glan Clwyd Hospital, Conwy and Denbighshire NHS Trust Artists in residence, Sian Hughes and Jenny Fell

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NHS Trusts to consider funding humanitiesand healthcare study days and courses fromtheir central CPD (continuing professional development) budget allocation.

Ensure that arts and health initiatives recognise and take account of the local culture, history and language of their setting.

Increase understanding of humanities andhealthcare through publications and websites.

NHS Trusts with arts and health programmesto publicise their schemes to patients throughNHS Trust information and websites.

Action Lead Timing

Relevant NHSTrusts/new ‘HealthCommunities’

ACW/WHE/WAG

ACW/Safle/WCfH

Relevant NHSTrusts/new ‘HealthCommunities’

From 2009/10.

Guidance on consultation and involvement of thelocal community tobe included in theArt of Good Healthhandbook, to bepublished by March2009.

By March 2010.

From 2009/10.

Art in Humanities and Healthcare

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