Suzanne Hacking

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.

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.

An angel on my shoulder: a study of relationships between women with anorexia and healthcare professionals.

Accessible summary • This study explored the therapeutic relationship among adults who access day care services for anorexia and their healthcare professionals. • There were six important themes that emerged from interviews with healthcare professionals and patients: the authenticity of the relationship, safety, the externalization of the eating disorder, recovery measured in kilos, the power of hope and optimism and maternalism. • Women attending day care for anorexia felt safer and more optimistic and therefore more supported when the healthcare professional had a nurturing and maternalistic approach. Abstract Adults with anorexia are an under-researched group because the usual focus is on adolescents. The relationships that occur between healthcare professionals and adults with anorexia are often challenging, because they do not necessarily agree on the goals of treatment. The therapeutic relationship is widely recognized as crucial to care, even healing and restorative in its own right but problematic in this setting. This is a phenomenological study of how therapeutic relationships are negotiated and maintained in a day care service. Six women with anorexia nervosa and seven of their healthcare professionals were interviewed in the care setting to explore their lived experience of their relationships. Six important themes emerged from the interviews: the authenticity of the relationship, safety, the externalization of the eating disorder, recovery measured in kilos, the power of hope and optimism and the use and acceptance of maternalism in the care setting. Findings suggest that patients appreciated the safety and security of care, but some were using the service as respite rather than recovery. Patients saw goals and tasks related directly to weight gain as irrelevant to their main concerns, but engagement with people who provided a secure, nurturing and maternalistic context for safety and optimism was seen as supportive.Adults with anorexia are an under-researched group because the usual focus is on adolescents. The relationships that occur between healthcare professionals and adults with anorexia are often challenging, because they do not necessarily agree on the goals of treatment. The therapeutic relationship is widely recognized as crucial to care, even healing and restorative in its own right but problematic in this setting. This is a phenomenological study of how therapeutic relationships are negotiated and maintained in a day care service. Six women with anorexia nervosa and seven of their healthcare professionals were interviewed in the care setting to explore their lived experience of their relationships. Six important themes emerged from the interviews: the authenticity of the relationship, safety, the externalization of the eating disorder, recovery measured in kilos, the power of hope and optimism and the use and acceptance of maternalism in the care setting. Findings suggest that patients appreciated the safety and security of care, but some were using the service as respite rather than recovery. Patients saw goals and tasks related directly to weight gain as irrelevant to their main concerns, but engagement with people who provided a secure, nurturing and maternalistic context for safety and optimism was seen as supportive.

The Inclusion Web: A Tool for Person‐centered Planning and Service Evaluation

Supporting community participation and social inclusion is a key goal of modernised day services but there is a lack of instruments to measure these outcomes. This paper discusses issues around the measurement of social inclusion, presents a pilot study and introduces the Inclusion Web, a strategy to record changes in social networks and environment while supporting the concept of a shared perspective of social inclusion. Two aspects of social and community participation are quantified and tallied over eight life domains: people (personal relationships) and places (institutions that matter to the individual).

Why does it happen like this?. Consulting with users and providers prior to an evaluation of services for children with life-limiting conditions and their families

Children with life limiting conditions and their families have complex needs. Evaluations must consider their views and perspectives to ensure care is relevant, appropriate and acceptable. We consulted with children, young people, their parents and local professionals to gain a more informed picture of issues affecting them prior to preparing a bid to evaluate services in the area. Multiple methods included focus groups, face-to-face and telephone interviews and participatory activities. Recordings and products from activities were analysed for content to identify areas of relevance and concern. An overarching theme from parents was ‘Why does it happen like this?’ Services did not seem designed to meet their needs. Whilst children and young people expressed ideas related to quality of environment, services and social life, professionals focused on ways of meeting the families’ needs. The theme that linked families’ concerns with those of professionals was ‘assessing individual needs’. Two questions to be addressed by the evaluation are (1) to what extent are services designed to meet the needs of children and families and (2) to what extent are children, young people and their families consulted about what they need? Consultations with families and service providers encouraged us to continue their involvement as partners in the evaluation.