What do we mean by the use of performing arts in community NHS treatment?
In a previous article for the Hippocratic Post, I explained how working with the creative arts, and music in particular could improve wellbeing. In this article I will give examples of NHS community based performance projects which enhance well-being and quality of life, as well as an examples of NHS community-based arts therapies research and treatment.
There are three aspects to the title of this article:
The Hippocratic oath that doctor’s take involves a promise “primum non nocere,” which means ‘ first do no harm’. Simply to do no harm is not good enough in clinical practice and in the modern NHS.
Treatment interventions have to be carefully developed, and delivered so that they are ‘clinically effective’. The National Institute of Care Excellence (NICE) provides guidelines and recommendations for best clinical practice.
A community may be a group of people living in a particular area who frequently share the same values and have a sense of inter-dependence, or a community may be a group of nations with a shared interest. In the old mental health institutions there were entirely self-sufficient closed communities that aimed to keep mentally ill people and the wider community safe, occupational therapy and shared musical events were introduced, but over the years abuses were uncovered. The advances in effective medication for mental illness led to the introduction of NHS community care by which men and women who had been incarcerated for years needed help to adapt to living in the wider society.
The performing arts are a crucial part of society in bringing people together and providing creative and expressive ways to comment on political and social issues. Whether it is the video art of Creators such as Minister Atkins or Kelly Richardson, the creation of musical cryptograms in which composers such as J.S. Bach, Shostakovich and Elgar all used the letters that are attributed to the names of musical notes to convey messages, or the plays of Jo Orton such as ‘Loot’- recently revived but initially censored for immorality fifty years ago, they all have power to help us think and to act consciously in making a difference.
Last January, Nick Triggle reporting for the BBC on line, said that the NHS is in the middle of the most sustained squeeze on its funding in its history. With both cost effectiveness and clinical effectiveness in mind, there are massive challenges to NHS Employees and teams.
Nevertheless, there is plenty that the NHS is doing well and health economics play a very important part. Rigorous clinical research must follow specific stages and guidelines such as those which are laid out by the medical research council (MRC)
From Hospital to Community:
The Recovery Model
Recovery does not just mean clinical recovery from symptoms, it also means being able to live a meaningful life. This involves having positive feelings about how you can contribute to other peoples lives as well as how to grow as a person in the things that you can do.
If an individual suffers a psychotic breakdown they may be detained in hospital under a mental health section. Removal from society to hospital occurs if an individual is at severe high risk of harm or if they pose a risk to the public through violent behaviour. This is a stressful and distressing procedure as the patient temporarily looses his freedom and sense of choice. Sectioning can only occur if the three qualified people and / or a relative agree that it is the patient’s best interest to keep them safe from harm.
Reintegration back into society involves risk assessment, care and support. Multi-disciplinary teams (MDTs) are involved in the treatment and discharge process .The purpose is to help the individual to develop greater resilience by which to lead a meaningful life. This frequently involves participation in creative art, dance, drama or music projects in which a crucial sense of belonging can be fostered. To access these projects does not require previous musical or artistic skills.
According to renowned neuro-psychologist Allan Schore, creativity is a mental process that involves activation of the right hemisphere of the brain where intuitive self-reflection develops. This process can help individuals to ‘mentalise’ which means being able to self-reflect in a more intuitive way, rather than acting too impulsively, thereby developing imagination and inner mindfulness skills.
Performing Arts as NHS treatment
A Charter for Arts, Health and Wellbeing has been drawn up, so that there is a national alliance that promotes the role of the creative arts in health and care. They state that:
‘Creative activity has long been known to have tangible effects on health and quality of life. The arts, creativity and the imagination are agents of wellness: they help keep the individual resilient, aid recovery and foster a flourishing society’. Research is developing in this area on the interface between NHS treatment and community-based projects.
Taking the mic, the solo part in a choir, participating in a community based drama or music project?
Music and drama therapy in the NHS are not just about performance. The word ‘performance’ can bring up a range of positive or negative feelings. Some may fear exposure, others may seek the limelight and want to dominate. However there is the potential to gain some much-needed recognition.
Many NHS practitioners can apply music to stimulate a better ambient mood. However, music therapists are trained musicians who understand how to use different musical mediums by which to engage their patients in actively making music. In this way through facilitating an improvisation together, levels of emotional arousal can be very carefully mediated thereby enabling positive feelings of calm, peace, joy or whatever mood may be needed in the present moment.
Music, Art and Drama therapy are State registered professions. The role of the Health and Care Professions Council HCPC is as an independent regulator for the NHS to ensure the protection of the public. It does this by maintaining a register of all those who hold protected titles such as ‘Music Therapist ‘ thereby ensuring standards of treatment and care. Anyone who uses one of these titles must be on the HCPC Register.
The use of the performing arts at the interface between NHS treatment and charitably funded organisations can help men, women and children with mental illness, learning impairment, autism or dementia. This must be provided in a timely way with sensitive and expert consideration for service- users’ needs and difficulties, so that they are not overwhelmed.
A good example is that of the ‘Music in Mind’ creative music therapy initiative run by Manchester Camerata, one of the UK’s leading chamber orchestras. This receives charitable funding so that projects can run in both care homes and community settings. Music in Mind are fully aware that as yet there is no cure for dementia and so they want to support people with dementia to age well. This project brings together the clinical expertise of a Music Therapist and the first rate skills of a professional musician from the orchestra. They work together to bring people together in a group to express themselves through music
Music therapy for community based patients living with schizophrenia.
Music Therapy has been researched in both community and hospital settings and it is particular effective in psychologically based models in NHS treatment for men and women who live with schizophrenia. It can help these individuals to develop new ways of connecting to others and to express their feelings, as well as to feel understood, by which they become more able to relate effectively to others.
ABOUT THE AUTHOR
Dr Stella Compton-Dickinson is a London-based Health and Care Profession council registered music therapist, accredited supervisor, professional oboist and lecturer, UK Council for Psychotherapy registered Cognitive Analytic Therapist and Supervisor. She is author of The Clinician’s Guide to Forensic Music Therapy (Jessica Kingsley Publishers), and has her own private practice and twenty years’ experience in the National Health Service as a Clinician, Head of Arts Therapies and Clinical Research Lead her research was awarded the 2016 Ruskin Medal for the most impactful doctoral research.