engage 39: Visual Arts and Wellbeing
Cite this article
engage 39: Visual Arts and Wellbeing
Editor: Barbara Dougan
Published by engage, London
‘Well-being refers to positive and sustainable characteristics, which enable individuals and organisations to thrive and flourish.’
Wellbeing should be an obvious aim for human and societal development but has been neglected in many countries for centuries, in an unequal battle for economic development and the pursuit of material wealth. In Nature: international weekly journal of science, the Director of the Well-being Institute, University of Cambridge, reviews Derek Bok’s book on the politics of happiness published in 2010 http://www.nature.com/nature/journal/v464/n7293/full/4641275a.html and states,
‘It has long been assumed that economic prosperity brings happiness. However, the evidence is to the contrary. Economic growth in developed countries has gone hand-in-hand with a rise in mental and behavioural disorders, family breakdown, social exclusion and diminished social trust. In China, for example, a 2009 study by German sociologists showed that the lifting of hundreds of millions of people out of poverty in the 1990s has been accompanied by an alarming decrease in life satisfaction at every level of income, in both rural and urban areas.
In ‘The Politics of Happiness’, law professor Derek Bok, a former Harvard president, argues that it is time to rethink the goal of politics: to promote wellbeing rather than wealth. His appeal that this is both necessary and timely rests on two key points: first, that there is an increasingly solid body of evidence about the causes of happiness and its individual, social and environmental benefits; and second, that most people are unaware of and need education about what will give them lasting satisfaction.
Happiness is a legitimate goal for government policy, Bok argues, because it is more than a private, transient feeling. Lasting happiness – well-being or ‘flourishing’ – depends on the ongoing process of how we live our lives. Well-being encompasses close relationships, utilising our strengths, helping others,having a sense of purpose and believing that what we do makes a difference. Hence the pursuit of lasting happiness can lead to the development of more productive, cohesive, caring and sustainable societies.’
Governments and international agencies are increasingly engaged with notions of wellbeing and happiness. Many national policy-makers have begun to recognise that measuring a nation’s success by traditional economic values alone no longer suffices and that we need also urgently to understand how people experience the quality of their lives.
It is sobering that, as Walls and Munn remind us in their article, as long ago as 1946 the World Health Organisation declared that ‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ and that progress appears to be so slow (WHO, 1946).
It wasn’t until 2012 that the fomer Secretary-General of the United Nations, Ban Ki-moon persuaded the United Nations to accept that this approach to the health of nations is a valuable tool, and for the past five years this organisation has produced a happiness index http://worldhappiness.report/ ed/2016/, which often gives a different reading of a country’s performance from the ubiquitous gross domestic product measure, as this table demonstrates:
As far as the happiest countries in the world are concerned, Switzerland came out top in the latest survey because of its high employment, excellent public services, high levels of public participation in major decisions and its beautiful, pristine environment.
It is followed by Iceland, Denmark, Norway, Canada, Finland, Netherlands, Sweden, New Zealand, Australia. It is interesting that these are nearly all small countries with small populations in regard to their land mass. People have room to breathe.
Progress is slow partly because shifting from an economic understanding of progress to a more holistic approach is much easier said than done. Gross domestic product is relatively capable of measurement in the sense that we are dealing with things – goods and services produced by a country in a period of time, usually a year, and then divided by the population to reach output per person and levels of productivity.
By contrast, how do we measure wellbeing, not to say happiness?
In 2015, in the UK, the New Economics Foundation set out five goals for government in order to increase the happiness of individuals. They are secure, well-paid employment; high levels of life satisfaction; a congenial environment - free from carbon emissions, for example; fairness in the sense of greater equality since the opposite has a corrosive effect on individuals and the economy; and good public services, especially regarding health. http://neweconomics.org/five-headline-indicatorsof-national-success/?_sft_latest=research
We discuss here what part the arts – specifically the visual arts - play in promoting wellbeing, and we can see from the articles in this issue that they can help to achieve nearly all the goals set out by the New Economics Foundation. They can improve life-satisfaction by increasing self-esteem and self-worth, by practising new skills, by achieving new outputs. They can help towards a fairer society where success is not measured simply by financial outcomes but by something less tangible and more insightful. They can play a major role in improving the health of individuals and thereby reducing the demands on health provision. By increasing selfworth, facilitating new skills and enhancing resourcefulness they can also help towards better employment and even help towards a more sustainable environment.
The opposition between economic prosperity and happiness or wellbeing seen in the ‘developed’ world, and the distinction between individual and collective wellbeing, ‘a western world-view based on the individual, versus an indigenous worldview based on community, collectivity and connectivity’ 1 would be anathema to many supposedly less sophisticated societies.
In their article, Walls and Munn explain that ‘we benefit considerably from the influence of Maori and Pacific worldviews which understand health as wellbeing; holistic, relational and collective. This perspective resonates with expanding global understanding; from a medical model, which is essentially about fixing illness in individuals to a recognition that we are all part of a shared ecosystem and our wellbeing is mutually dependent. In short, healthy social environments nurture healthy people. This realisation has always been at the heart of Maori and Pacific worldviews’.
Progress may be slow but we can take some encouragement currently from the numerous examples of political interest in advancing wellbeing. These include the UK government, which has an All-Party Parliamentary Group on Arts, Health and Wellbeing currently taking evidence and due to report in 2017. The Wellbeing of Future Generations Act for Wales was passed in 2015, and two reports on arts and health were published in Australia this year, from Western Australia and New South Wales.
Political progress is reliant on research and evidence; wellbeing can be perceived as a bit ‘fluffy’ – maybe new age - and it is important to be able to define it, quantify the factors that influence it and the economic benefits of improved wellbeing. These include reducing the direct and indirect costs of loneliness, depression, mental illness and the psychological impact of these on physical health. The Well-being Institute, University of Cambridge, is inter-disciplinary and able to draw on all the interconnected subjects that affect wellbeing and the application of wellbeing to individuals, society and public policy. Interestingly, these disciplines include the arts.
The Institute contributes to policy and research, including the UK Government Office for Science’s Foresight Project on Mental Capital and Wellbeing https://www.gov.uk/government/collections/mental-capital-and-wellbeing, which commissioned work to identify the wellbeing equivalent of Five fruit and vegetables a day. The suggestions for individual action, Five ways to mental wellbeing, based on an extensive review of the evidence, are:
Connect... With the people around you. With family, friends, colleagues and neighbours. At home, work, school or in your local community. Think of these as the cornerstones of your life and invest time in developing them. Building these connections will support and enrich you every day.
Be active... Go for a walk or run. Step outside. Cycle. Play a game. Garden. Dance. Exercising makes you feel good. Most importantly, discover a physical activity you enjoy and that suits your level of mobility and fitness.
Take notice... Be curious. Catch sight of the beautiful. Remark on the unusual. Notice the changing seasons. Savour the moment, whether you are walking to work, eating lunch or talking to friends. Be aware of the world around you and what you are feeling. Reflecting on your experiences will help you appreciate what matters to you.
Keep learning... Try something new. Rediscover an old interest. Sign up for that course. Take on a different responsibility at work. Fix a bike. Learn to play an instrument or how to cook your favourite food. Set a challenge you enjoy achieving. Learning new things will make you more confident as well as being fun.
Give... Do something nice for a friend, or a stranger. Thank someone. Smile. Volunteer your time. Join a community group. Look out, as well as in. Seeing yourself, and your happiness, as linked to the wider community can be incredibly rewarding and creates connections with the people around you.
The programmes and projects that feature in this issue focus on members of society whose wellbeing is undermined by their circumstances, ageing, physical illness or mental illness. In response to these issues many galleries, visual arts organisations, artists and museums are developing skills and expertise to employ the visual arts in improving wellbeing. The Five Ways to Mental Wellbeing are apt to this work and recur in the articles that follow.
Louise Thompson describes how Manchester Art Gallery invites a wide range of audiences into The Mindful Museum to learn and practice mindfulness. Learners include adult mental health service users, primary school children, older people, newly qualified teachers, people who are long-term unemployed, and members of the public who seek quiet and mental space from busy lives. Thompson reminds us that wellbeing isn’t a state that can be achieved, rather a skill and set of attributes that have to be cultivated and nurtured. In teaching mindfulness, the gallery aims to give people a skill to help them to maintain their own wellbeing.
The gallery’s work with schools has shown that mindfulness can help children to build emotional resilience and self-worth, which is crucial in the light of what has been described in the UK and the USA at least, as a ‘mental health epidemic’ amongst children and young people. http://www.syp.org.uk/our_generation_s_epidemic
Lucy Medhurst introduces her article,
‘Mental health issues now affect one in ten young people in the UK, with the most common conditions being anxiety, depression and conduct disorder. This equates to an average of three children in every classroom experiencing mental health problems, at a time of diminishing resources available to tackle them. A survey conducted by the Association of School Leaders (ASCL) and the National Children’s Bureau (NCB) in March 2016 highlighted the urgent need for improvement in the provision of mental health care for children and young people across England.’
A survey conducted by the Association of School Leaders (ASCL) and the National Children’s Bureau (NCB) in March 2016 highlighted the urgent need for improvement in the provision of mental health care for children and young people across England.’
She goes on to discuss how pedagogies can impact on children’s wellbeing, referring to their education in Finland and Reggio Emilia in Italy before looking at the UK context, including gallery education pedagogy. Medhurst concludes with four case studies of programmes where visual arts organisations are working in partnerships with other agencies towards improved wellbeing for children and young people.
Lyn French reports on how INIVA works with A Space, an arts and therapies project, to publish Emotional Learning Cards. These themed boxed sets of cards feature works of art and provide a resource that facilitators use to prompt conversations with children and young people about feelings, and issues such as identity and personal histories. As with all arts and wellbeing work, it is fundamental that it is effective in addressing need and is recognised as doing so by participants and partners from other sectors. In this instance, Prue Barnes-Kemp, Executive Head Teacher responsible for Opossum Federation of Primary Schools & Educational Consultancy, values the cards, and not only uses them in her schools but has commissioned sets:
‘First of all, they feature culturally diverse artists, which is vitally important; the whole school community needs to see themselves represented in the artwork we use to bring learning alive. The cards also explore themes which are absolutely central to creating cohesive communities and to living with difference. We’ve commissioned ArtLab workshop programmes from Iniva such as the “A to Z of Emotions” and the “A to Z of Values” which have helped teachers as well as pupils to look at key aspects of relationships and emotional life from different perspectives.’
The focus for the South London Gallery’s Creative Families http://www.southlondongallery.org/page/creativefamiliesprogramme is parents who are experiencing mental health issues and their children aged under five. Developed in partnership with the Southwark Parental Mental Health Teams and local Children’s Centres, ‘Creative Families was a series of artist-led projects which explored the relationship of parenting to well-being. Through working directly with local families, it aimed to promote well-being as well as critically explore some of the ideas that shape notions of contemporary parenting through the medium of socially-engaged art practice’. Heather Kay notes how the projects create ‘a place to have a safe conversation about the challenges of life and parenthood’ as well as offering stimulating activities for parents and children together.
Physical and mental illness have a detrimental effect on confidence, emotional resilience and self-worth, which can be very hard to overcome. Since 2011, Art for Health (Milton Keynes) has been running an Arts on Prescription service, which offers arts activities on a referral basis. Referrals come from mental health charities, GPs, pain management clinics and Macmillan Cancer Support. Sharon Paulger describes the programme and the film by Jason Impey enables participants in arts workshops to express directly the difference they have made to their lives, and their pride in their achievements – physical, social and artistic. This is one of several articles that highlights how important art can be in validating people’s abilities and giving them confidence to extend themselves, in this case through exhibiting their work, maybe selling it, and becoming involved in social situations and volunteering.
Chris Kelly is Projects Coordinator for Tayside Healthcare Arts Trust and reports on the ST/ART (Stroke & Art) Project which was established by him in 2004. The aim is to provide opportunities for people who have suffered a stroke to engage in creative activities to aid rehabilitation, contributing to physical recovery and to recovery from the shock and mental impact of stroke, and a new reality.
Josie Vallely writes from the perspective of an artist who works in community and clinical health settings. She discusses how acute illness receives a great deal of attention and publicity whilst debilitating chronic illness can be overlooked; ‘This pattern of exclusion implies an effort to disregard people who “embody both the physical failure of medical practice” and serves to marginalise those that cannot return to their original ‘non sick’ state’. Vallely looks at the notion of illness narratives and through her own work, and the mediums of artist books and comics, explores how the visual arts enable artists who have a chronic illness and others to communicate a ‘richer and more “authentic” illness narrative’ and an expanded understanding of what it means to be chronically ill.
A number of articles explore the potential of the visual arts in working with elderly people. People are living longer, and the proportion of populations which are over the age of sixty-five is rising. Many live with ill health, dementia or Alzheimer’s, experience loneliness, lack of stimulation and isolation, and often do not have the support from family or friends to take part in activities. In describing the Art Makes Man project in the Netherlands, Hélene de Koekkoek reveals not only the depression that these circumstances lead to, but also boredom and lack of confidence. The interviews with participants highlight their pleasure at being able to make things, and by contrast, the low expectations of care staff.
Jayne Howard points out that people over sixty-five are significantly less likely than young people to engage in arts and culture, and yet everyone is entitled to enjoy arts and participate in creative activity – for its own sake, even if there can also be health and wellbeing benefits. She urges arts organisations to develop work with older people and the necessary skills to cater for those with dementia, for example. As an example she cites how Arts for Health Cornwall partnered with the contemporary Exchange Gallery in Penzance on two projects, which counter the oft-held view that older people are not interested in contemporary art and that reminiscence work, and looking at familiar, traditional imagery, is more appropriate.
Two further articles demonstrate –in different ways – the valuable role of artists working with older people. Rachel Cherry is a visual artist and photographer who has considerable experience of working in health and wellbeing, including with dance projects. Her photo essay illustrates a project which was part of the REgeneration programme, which The Dance Network Association runs to enable older people to participate in dance classes in sheltered housing in Chelmsford, Essex. Again, this project emphasises the importance of not underestimating people’s abilities or appetite to do something new, and the value of social intercourse and peer recognition.
‘It is important that the residents get to celebrate and share their achievements over the term, which is where visual art plays a crucial role. Having a physical manifestation of the time spent together brings with it a sense of achievement, as well as something more tangible. The final image in the essay sums up the experience, creating memories, capturing the participants and sharing the experience with their nearest and dearest.’
Helen O’Donoghue writes about a touring exhibition in Ireland, which was developed closely with artist Marie Brett and her work exploring the impacts and experience of Alzheimer’s. The article, images and film gives us a powerful example of how the visual arts can communicate difficult and challenging ideas, in open ended ways that can speak to many different people. O’Donoghue particularly interrogates and advocates the role of the gallery or museum educator. They mediate the work and the artist, and this can be crucial to the experience of the viewer or exhibition visitor, especially where sensitive and emotional issues are being raised.
The roles that the artist and mediator (which can be a curator or educator) play, and the factors that they need to consider when working on arts and wellbeing projects are discussed by Niki Colclough and Elizabeth Wewiora. These include decisions about when work from such projects should bepresented in care or community settings, and when it is appropriate to exhibit it in a gallery, and how it may be differently read and received depending on context. Colclough raises the concept of emotional labour, as working in health settings and working with people who are unwell is very demanding of artists, and takes an emotional toll. This can apply to participants as well, and is often overlooked.
Anna Croucher and Becky Waite each describe visual arts projects for artists who need support to make art and exhibit. The former talks about the work of the Salome Gallery in Brixton, London, which is for artists who use mental health services to show their work, sited in a room at Social Inclusion, Hope and Recovery Project, and also used as a therapy space. The curator works closely with artists throughout the planning, which assuages what can be a stressful experience. The professional development opportunity along with the credibility of showing publicly increases confidence and self-esteem.
Blue Room, an inclusive arts programme for adults with learning disabilities at the Bluecoat in Liverpool, also supports participants as artists. Three groups meet weekly at the art centre and engage with the visual arts through the exhibition programme, working with artists, visiting other venues and exhibitions, and making their own work. The film that the artists have made with Blue Room facilitator Becky Waite and volunteers, demonstrates the impact and how the participants use the Five Ways to Wellbeing to evaluate what they gain from the programme.
The articles demonstrate the importance of partnerships in art and wellbeing, where expertise and experience from the arts, health and social care sectors are crucial to devise and deliver effective work.
Partnerships are also invaluable in demonstrating first hand the potential of visual arts to improve wellbeing in different contexts. Consequently some receive funding and support in kind from education, health and social care agencies and organisations, including the Salome Gallery which receives some funding from South London and Maudsley NHS Foundation, Art as Creative Engagement for Stroke is funded in part by NHS Tayside, and Arts on Prescription has an office provided by Milton Keynes Hospital and funding from the hospital, local council and Milton Keynes Community Foundation.
However, the arts sector needs to provide solid evidence of the wellbeing advantages and outcomes illustrated in these articles if such work is to be expanded and properly resourced. For example in 2016 the UK All Party Parliamentary Group for Arts, Health and Wellbeing quite reasonably sought examples of the arts and culture influencing health and wellbeing outcomes. It asked for examples of practice from the past decade where there is reasonably reliable evidence of outcomes or evidence that a pilot or new approach has promise. http://www.kcl.ac.uk/Cultural/-/Projects/Arts,-Health-and-Wellbeing-Inquiry.aspx
The articles published here highlight some of the issues and challenges associated with evaluating arts and wellbeing work, which inevitably need to meet the particular needs of policy makers, delivery structures and funding. In the UK new systems for ‘commissioning services’ have gone hand in hand with reductions in national and local government funding and a desire to shed overhead and employment costs. Arts Council England (ACE) has pointed out that the voluntary sector plays a key role in delivering public services, the arts sector receiving £13.3bn in 2012/13 from government bodies, 83% earned through contracts or fees, and the majority coming through relationships with local government https://www.ncvo.org.uk/practical-support/public-services. As a result ACE provides extensive advice on commissioning and procurement and is running the Cultural Commissioning Programme, July 2016-December 2017 to ‘work with policy makers and stakeholder to embed support for cultural commissioning’ https://www.ncvo.org.uk/practical-support/public-services/culturalcommissioning-programme
Amber Walls explains the New Zealand context but the problems she outlines will be familiar to many:
‘This thinking has been slow to manifest in public health practice. It is exacerbated here (as it is overseas) by a focus on evidence-based commissioning, and a pre-occupation with RCT (Randomised Control Trials) and standardised evaluation frameworks as the only reliable form of evidence that something works. A recent report commissioned by the Prime Minister to inform youth mental health policy concluded that only evidence-based interventions tested by RCT and validated in peer reviewed literature should be commissioned. The report also recommends the commissioning of models of practice which are predictable, scalable and replicable (Office of the Prime Minister’s Science Advisory Committee, 2011). Arts-based practices rarely meet these specifications, and the challenge of adequately demonstrating the full benefits of more openended arts approaches using RCT evaluative models are commonly referred to in arts and health literature.’
The Arts on Prescription film is a good example, in which three prescription users are totally convincing about the difference the arts workshops have made to them, but each is individual and it is difficult to see how consistent evidence could be obtained and scaled up. Aesop, a ‘arts enterprise with a social purpose’, is currently focused on the role of the arts in health and social care, and in partnership with the NHS Alliance and College of Medicine presented the first national Arts in Health Conference and Showcase for health decision makers in February 2016 http://www.ae-sop.org. It was commissioned by Public Health England to develop an evaluation framework for health commissioners, third sector organisations, trainers, funders, practitioners, arts organisations and others with an interest in arts for health and wellbeing programmes. The framework can be downloaded here http://www.ae-sop.org/wpcontent/uploads/2015/12/PHE-Aesop-Arts-inhealth-evaluation-framework.pdf.
Public Health England published Arts for health and wellbeing: an evaluation framework in February 2016.
https://www.gov.uk/government/publications/arts-for-health-and-wellbeing-an-evaluation-framework and contributors to this issue are using a range of frameworks and methodologies to evaluate their work, often with the support and specialist skills of partners.
For example, Chris Kelly has worked with the University of Dundee to devise an appropriate framework and evaluate an unusual programme such as Art as Creative Engagement for Stroke. ‘The challenge, therefore, was how to examine the work in a research context that would be both feasible and rigorous? It was determined that a validated research model was needed to convincingly address this “novel” intervention and provide a robust research structure. The model that was identified was the Medical Research Council (MRC) Framework for Evaluating Complex Interventions’.
Heather Kay’s article explores a tangential benefit of evaluation; how it contributed to a deeper exploration of the work, a greater understanding between differing partners, trust in the work, and recognition of its importance. Kay identifies that process led projects are a strength of the visual artssector and that it’s difficult – but crucial - to evidence ‘hard’ outcomes, and make appropriate resources available for evaluation.
‘Whilst the evaluation was initially only allocated a small fund within the pilot programme, half the programme budget was eventually earmarked. As part of Guy’s and St. Thomas’ commitment to sustainability, it was recognised that to develop a replicable model there would need to be a strong evidence base and an ongoing commitment to evaluation from the partners.’
Goldsmiths’ Centre for Urban and Community Research (CUCR) was asked to evaluate the programme, which established an evaluation framework that aimed to capture ‘softer’ outcomes and in particular the learning from the process of the project.
Kay found that a cost-effectiveness analysis would have been useful, particularly in the context of commissioning (which is the system for providing services in the UK), and cost-effectiveness is rarely built in to arts project evaluation. ‘Cost-effectiveness is an intrinsic part of service-delivery and crucial in the current economic climate. However, the value placed by PMHT on this arts intervention has led to direct funding for the programme from their core budget, as part of a range of approaches in the community. Their knowledge of the local commissioning environment makes them valuable gatekeepers, enabling this strand of funding for the South London Gallery’.
The engage Journal has been published online now for ten issues and this edition sees a substantial increase in the amount and range of media. The inclusion of so many images, film and audio files is only possible online and gives a direct voice to participants, enabling us to appreciate and judge for ourselves the impact that visual arts projects have had on their wellbeing.
5 a day refers to any of various national campaigns in countries such as the United States, the United Kingdom and Germany, to encourage the consumption of at least five portions of fruit and vegetables each day, following a recommendation by the World Health Organisation that individuals consume ‘a minimum of 400g of fruit and vegetables per day (excluding potatoes and other starchy tubers)’ http://www.who.int/dietphysicalactivity/fruit/en/