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Allied Health Professions into Action: Art Therapy in cultural spaces

19 January 2017

Innovative art therapy practice included in the newly published ‘Allied Health Professions into Action‘...

England’s 145,000 allied health professionals will be encouraged to innovate and lead within the NHS and wider care system under a new shared commitment recently published by NHS England.


Allied Health Professions into Action‘ has bought together the views of the third largest workforce in the health and care system, including chiropodists, dieticians, orthoptists, paramedics, physiotherapists, art therapists and speech and language therapists. It sets out how the 12 Allied Health Professional groups across England can be at the forefront of innovative changes to patient care and shape future health policy by having a full involvement in transformation plans being developed across the country.

The new guidance aims to provide a blueprint for Clinical Commissioning Groups, provider organisations, health leaders and local authorities to fully utilise and involve Allied Health Professionals (AHPs) in transformation programmes and the delivery of NHS England’s Five Year Forward View. It offers 53 examples of AHPs working to drive and support change by working innovatively, and a framework to help utilise AHPs in the development and delivery of transformation planning.

Allied Health Professions into Action‘ aims to inform and inspire leaders and decision makers across the system by offering:
• A clear view regarding the transformative potential of AHPs
• Fifty-three examples of innovative AHP practice
• A framework to help develop local delivery plans.

Below is the example of innovative art therapy practice which is included in the document. To read the whole document please click here

 

Art Therapy in cultural spaces

Image: BALTIC Centre for Contemporary Art, Tyne and Wear

 

Understanding the problem

Art Therapy has been an important part of Learning Disabilities (LD) inpatient mental health services.

To address issues raised within the national programme of transforming care Simon Critchley has been working on a pilot project in the community with the aim of providing alternative person centred early interventions to those individuals assessed as showing an increasing risk of hospital admission.

It is recognised that there is historically a limited range of therapeutic interventions available to people with learning disabilities at the point of crisis in the community, especially those with limited verbal communication skills. Nationally and regionally Art Therapy is not always provided to community based learning disabled mental health service users. A small pilot project has been carried out in Gateshead to look at the engagement, acceptability, and naturalistic outcomes for people accessing Art Therapy in the community. Within this pilot project Art Therapy has been shown to be beneficial in helping service users avoid distressing and disruptive admissions to hospital inpatient wards, allowing them to maintain positive mental health and continue to establish a sense of purpose and rewarding lives in their communities. The Art Therapy approach being used also includes involvement with support networks, including family members and/or support workers.

It is also acknowledged that people with learning disabilities can become easily isolated once clinical mental health services cease to provide input, and adults with learning disabilities find it hard to become actively involved in inclusive social activities in the community. This isolation can lead to relapse and repeated deterioration in mental health and can contribute to the “revolving doors” syndrome of repeat hospital admissions.

Aims and Objective – solution

The aim of the project is to help prevent/reduce the frequency of admissions at the point of crisis to inpatient beds which are now becoming less readily available, and to help prevent deterioration in mental health for people with learning disabilities by reducing the sense of social isolation post discharge from clinical mental health services. To support this aim the project has been trying to bridge the gap between clinical Art Therapy interventions and Arts in Health provision in the community encouraging a more effective transition from clinical input to social community activities.

This work has recently been consolidated and celebrated with a group project with BALTIC Centre for Contemporary Art, Gateshead in which people with learning disabilities and a history of mental health difficulties who have previously received art therapy input in the community worked together with a resident artist and Art Therapists to explore the concept of mental health and dignity alongside the benefits of engagement in cultural creative spaces – culminating in an exhibition and film premiere in the BALTIC on World Mental Health Day 2015.

Method and approach

The approach involved working with previously identified at risk adult learning disabled mental health service users offering one to one short term (twelve or more planned sessions), directive and solution focussed Art Therapy interventions at the point of crisis.

Weekly Art Therapy sessions were offered and after a brief assessment period personal goals for therapy were identified with service users identifying up to three things they were struggling with at the point of crisis, which were then explored in therapy. Other information about the individuals was explored using person centred planning techniques (such as social network maps) and these were used to identify the social support that each individual received and whether they found this social structure helpful or unhelpful.

Anger, stress and anxiety levels were also rated on a weekly basis as this encouraged communication about other difficulties being experienced at the time of intervention.

Close communication with support services and families was also maintained during therapy so that the work done in sessions could be further supported on a daily basis by staff/families involved in the individuals’ care on a regular basis. In this way issues contributing to the marked deterioration in mental health could be more effectively resolved.

Working alongside Arts In Health projects in the community to foster links between community services up to and beyond the point of discharge with the aim of establishing community support structures around individuals at the end of therapy was explored and pursued.  In addition the Art Therapy service recently linked up with  BALTIC Centre for Contemporary Art to run a group project with adult learning disabled people in recovery from mental health difficulties as follow up work up to 6-12 months post therapy to further support and consolidate successful integration into cultural community activities and to help develop their confidence in engaging in public cultural spaces and to develop a sense of purpose and sense of belonging in the communities in which these often marginalised individuals live.

At this project a group of people with learning disabilities were given the opportunity to work alongside BALTIC Artist Lesley-Anne Rose and Art Therapist Simon Critchley on a 6-week project inspired by Fiona Tan's DEPOT exhibition.

This project was partially funded by charitable grants from community initiatives Launchpad and The Chrysalis Fund, with NHS staff costs being met by NHS budgets and venue and materials costs met by BALTIC.

To watch a short film about the project please click here

Results and evaluation

Quantitative outcome measures completed pre, during and post individual therapy, gathered from a cohort of 15 of the 40 individuals offered therapy have shown that mental health can be supported prior to hospital admission with changes in scores evidencing significant improvements in mental health measured on the HONOS-LD (Health Of the Nation Outcome Scales for Learning Disabilities) scale and significantly reduced levels of anxiety reported by service users on the GAS-LD (Glasgow Anxiety Scale). Other measures which have shown some improvement include Quality of Life questionnaires and Glasgow Depression Scale (GDS–LD) alongside personal goals identified at the point of referral.

This work goes some way to supporting a reduction in hospital admissions with less than 10% of 40 people being offered Art Therapy at the point of crisis needing eventual admission to an inpatient ward. This in the long term will also contribute to cost savings for NHS services in adult LD mental health.

BALTIC’s ANIMATE project was successful in engaging 9 individuals (6 female, 3 male) over the 6-week period, of which 3 were inpatients (previously seen for Art Therapy in the community) and 6 were outpatients currently living in the community.

The benefits of the gallery space as an inspirational creative therapeutic environment (in an era when the traditional art therapy space is less of a reality) and as a vehicle for exhibition (building confidence and self-esteem of those involved) and educational purposes (for the general public) around mental health issues was addressed.

Over the course of 6 weeks the group had the chance to work within a fantastic creative space and experienced using a variety of media that they have never worked with before over 6 lively afternoons, including:
• A tour of BALTIC Centre for Contemporary Art including Fiona Tan's exhibition, DEPOT.
• Clay model making and sculpture.
• Art making with a variety of media.
• Stop frame animation and digital media recording and editing.
• Silk screen printing and poster making.
• Musical performance and recording

The ANIMATE project at BALTIC allowed the attendees to be part of a social group in which they were able to develop skills and techniques and had an opportunity to continue to use art to help work towards better mental health. The work culminated in a short animated film produced by the group and screened at BALTIC on World Mental Health Day 2015 which also served as an AIR (Audio Image Recording) illustrating the aims and benefits of the work.

Follow up group projects and activities can be perceived to support and consolidate mental health recovery by reducing social isolation, with individuals engaging well in the activities offered and providing qualitative feedback that they had
• enjoyed the activities on offer,
• gained confidence from them,
• learned new skills,
• enjoyed the social atmosphere in the groups
• and also commenting that they would like to be able to access similar activities again in the future.

Key learning points

Positive points:
It is clear from this work that interventions more suited to individuals’ needs and capabilities can be beneficial in maintaining positive mental health in the community, and if these are offered at an early enough point in mental health crises then hospital admissions can be reduced for this client group.

It is also clear that close collaboration with community support services and community activities can enhance the wellbeing of the individuals as they interact with their environment and social group – contributing to a reduction in social isolation and anxiety about managing difficulties in their lives.

Follow up work post discharge can also contribute to sustained mental health in a client group that historically can experience repeated deterioration in mental health as a result of a lack of community opportunities and social difficulties and isolation.

The celebratory event at BALTIC provided validation of the group’s capabilities (rather than their difficulties and the negative aspects of their lives) and also highlighted their need for recognition and acceptance in society.
It also clearly had a positive impact on individuals’ self-esteem and confidence.

The animation and film produced and screened at BALTIC included voice recordings from individuals in the group discussing mental health and the theme of “Dignity” (World Mental Health Day 2015's theme), making the film a collaborative Audio Image Recording (AIR) but also an educational / awareness raising piece if viewed by the general public.

The individuals involved in the project also experienced something they never thought possible: having their animation screened at BALTIC and their artwork and music exhibited. The premiere event was a huge success and the attendees, staff and invited family members were thrilled by the film screening and chance to show off their work with 25 people attending in total on the evening.

Further learning

At times difficulties enabling individuals to access ongoing support were noted.
These could be explained by problems with people with learning disabilities sometimes not receiving adequate or flexible enough community/familial support to allow them to access the services on offer in the community. Also issues with limitations in finances were noted to be a predominant factor preventing this client group from being able to maintain involvement in community groups and social activities.

Some of these difficulties were addressed more successfully at the point of the ANIMATE project at BALTIC, as thanks to the charitable funding provided by community initiatives, transport was provided and some travel costs were met for individuals and their support staff to attend the groups. This enabled more individuals to engage in this activity than had been achieved in previously offered social activities/groups.

However this was a short term group running over 6 afternoons and it would be difficult to maintain this level of cost over a longer period of time without additional finances being factored more permanently into peoples’ personal budgets to meet such needs.

The long term implications of such a shift in thinking around finances could far outweigh the costs of hospital inpatient admissions, ongoing/repeated mental health service costs and additional expenses incurred on social services due to disruptions in placements and community support team employment if the costs of social community activities could be better supported financially for this vulnerable client group.

Plans for spread

The work produced with BALTIC was exhibited and presented at BALTIC on World Mental Health Day 2015 at a celebratory event and is archived in BALTIC’s catalogue of films.

The work done in the ANIMATE project at BALTIC has also been presented at a
British Association of Art Therapists Museums and Galleries Special Interest Group meeting and at the

“Finding Spaces, Making Places” Art Therapy Conference at Goldsmiths University, London, receiving positive feedback and recognition in highlighting the therapeutic benefits of utilising cultural spaces in Art Therapy provision.

Key contacts

Join in the conversation on Twitter at #AHPsintoAction
Suzanne Rastrick, Chief Allied Health Professions Officer @SuzanneRastrick
Shelagh Morris, Deputy Chief Allied Health Professions Officer @ShelaghDCAHPO

@WeAHPs connects and supports the Allied Health Professionals community through #WeAHPs tweet chats and social media resources.

Simon Critchley, Art Therapist,
Learning Disabilities (LD) North of Tyne Arts Therapies team,
Northumberland Tyne and Wear NHS Trust
Email: simon.critchley@ntw.nhs.uk

Simon Hackett                       
Learning Disabilities (LD) North of Tyne Arts Therapies team leader.
Northumberland Tyne and Wear NHS Trust

Sarah Bradbury,
BALTIC Centre for Contemporary Art, Tyne and Wear
Email: sarahbradbury@balticmill.com

Images: Stills from the animation created by the participants and BALTIC artist Lesley-anne Rose