Lyn Kent

Evaluating the impact of participatory art projects for people with mental health needs

Participatory art projects for people with mental health needs typically claim outcomes such as improvements in confidence, self-esteem, social participation and mental health. However, such claims have rarely been subjected to robust outcome research. This paper reports outcomes from a survey of 44 female and 18 male new art project participants attending 22 art projects in England, carried out as part of a national evaluation. Outcomes were quantified through self-completed questionnaires on first entry to the project, during January to March of 2006, and 6 months later. The questionnaires included three measures: empowerment, mental health [Clinical Outcomes in Routine Evaluation (CORE)] and social inclusion. Paired t-tests were used to compare overall change, and mixed model repeated measures analysis of variance to compare subgroups, including age, gender, educational level, mental health and level of participation. Results showed significant improvements in empowerment (P = 0.01), mental health (P = 0.03) and social inclusion (P = 0.01). Participants with higher CORE scores, no new stress in their lives and positive impressions of the impact of arts on their life benefited most over all three measures. Positive impressions of the impact of arts were significantly associated with improvement on all three measures, but the largest effect was for empowerment (P = 0.002) rather than mental health or social inclusion. This study suggests that arts participation positively benefits people with mental health difficulties. Arts participation increased levels of empowerment and had potential to impact on mental health and social inclusion.

Mental Health and arts participation: the state of the art in England

Although participation in arts activity is believed to have important mental health and social benefits for people with mental health needs, the evidence base is currently weak. This article reports the first phase of a study intended to support the development of stronger evidence. Objectives for the first phase were to map current participatory arts activity, to identify appropriate indicators and to develop measures for use in the second phase of the research. A survey of participatory arts projects for people with mental health needs aged 16 to 65 in England, identified via the Internet and relevant organizations, was carried out to map the scale and scope of activity and to establish the nature of current approaches to evaluation. The results indicate that the scope of activity, in terms of projects’ settings, referral sources, art forms and participation is impressively wide. In terms of scale, however, projects reported low funding and staffing levels that may have implications for the feasibility of routine evaluation in this field. Current approaches to evaluation were limited, but entailed considerable effort and ingenuity, suggesting that projects are keen to demonstrate their benefits. The survey has enabled us to build on the best evaluation practice identified to develop a measure for assessing the mental health, social inclusion and empowerment outcomes of arts participation for people with mental health needs. For the second phase of the study we will work with arts and mental health projects, using the measure alongside qualitative work in a realistic evaluation design, in order to identify the characteristics of effective projects.

Development of a measure of social inclusion for arts and mental health project participants

Background: Promoting the social inclusion of mental health service users is a UK policy priority, but the development of outcome measures in this area is at an early stage. Aim: To develop a social inclusion measure for use in a study assessing the outcomes of arts participation for people with mental health needs. Method: Concept and question development based on literature review, national and European surveys and results of a survey of arts and mental health projects. Measure piloted with 23 arts participants/service user researchers and field tested with 88 arts project participants returning questionnaires including the social inclusion measure, a measure of empowerment and the CORE mental health measure. Results: Three scales were constructed measuring social acceptance, social isolation and social relations. Internal consistency was good for the individual scales and for the measure as a whole. Correlations with empowerment and CORE scores indicate reasonable predictive power for the population. Conclusions: Tests to date indicate the measure is acceptable and measures relevant concepts with good internal consistency. Test-retest reliability and construct validity are not established and replication is required to confirm internal consistency and establish a normative profile for the population.

Empowerment and arts participation for people with mental health needs

Empowerment has been described as the ‘holy grail’ of health promotion. This article describes an evaluation of arts participation for people with mental health needs that both measured empowerment outcomes and explored the processes by which positive outcomes were achieved, through six qualitative case studies. For the outcomes study, 62 arts and mental health project participants returned a questionnaire, including a measure of empowerment, soon after joining their project and again six months later. The follow‐up questionnaire asked participants to rate the impact of their arts involvement on the issues addressed in the measure. Six diverse arts and mental health projects took part in the case studies. Interviews with project participants explored what they saw as the benefits of arts involvement and how these came about. Results from the outcomes study showed significant improvements in empowerment and were suggestive of a strong causal link with arts participation. Analysis of the case study interviews revealed five processes through which benefits relating to empowerment were brought about. We argue that psychological empowerment is in itself important for people with mental health needs. In addition, our case studies indicate that some arts and mental health projects do empower participants at a social as well as individual level.

Promoting mental well-being and social inclusion through art: evaluation of an arts and mental health project

Background : Interest in the health potential of arts participation is growing in the UK, but the field lacks a robust evidence base. This article describes the evaluation of 29 introductory arts courses provided by one arts and mental health project. Methods : Formative evaluation methods comprised focus groups attended by 29 participants after four of the introductory courses. Outcomes were assessed through questionnaires measuring mental well-being and social inclusion at the beginning and end of the 29 courses. Results : Formative evaluation participants identified gains in well-being and social inclusion alongside a need to address expectations more clearly and provide more individualised learning Of course completers, 33% returned both outcomes questionnaires. Results indicated significant improvements in well-being and social inclusion. Ratings of participation were very positive and supported attribution of impacts to arts participation. Conclusions : While the results are promising, methodological issues limit the conclusions that can be drawn. Controlled designs would enable impacts to be attributed to arts participation with greater certainty and further research is also needed to assess longer-term impacts. Commissioners need to include evaluation in funding criteria and allocate resources for this in order to help increase response rates by ensuring data collection is adequately resourced.

Why art? Exploring the contribution to mental well-being of the creative aspects and processes of visual art-making in an arts and mental health course

Abstract Background: Evaluations of participatory arts and mental health projects have consistently found improvements in mental well-being but the part played by the creative aspects, as distinct from the benefits of social interaction, remains unclear. Methods: This study explored the specific part played by the creative aspects of introductory arts courses that aim to improve mental well-being. Nine course participants consented to recording of accreditation assessment meetings held with them towards the end of their course. Results: Thematic analysis identified themes relating to two categories: creative processes and the learning that ensued. The creative processes were playful experimentation and inspiration. Learning processes revolved around learning to learn and artistic development. Conclusions: Previous studies have found play, inspiration and learning to be associated with well-being. It therefore seems reasonable to conclude that the creative aspects of the courses did play an important part in improving participants’ well-being.

Promoting mental wellbeing and social inclusion through art: six month follow-up results from Open Arts Essex

Abstract Previous evaluations have demonstrated improvements in well-being and social inclusion for people with mental health difficulties after participating in Open Arts’ introductory participatory arts courses. This evaluation aimed to ascertain whether improvements are maintained long-term. Course participants completed measures of well-being and social inclusion at the beginning and end of their course and after three and six months. At initial follow-up participants rated their experience of their course, and at three and six months they reported activities taken up after attending. Scores significantly increased from baseline to first follow-up and remained significantly higher than at baseline at three and six months. End-of-course ratings were positive and most participants continued their art work. Other activities included education/training and voluntary/paid work. Further studies are needed to examine whether improvements can be attributed with confidence to arts participation, but these results add to a growing weight of evidence pointing to that conclusion.