Portal de Periódicos da CAPES

Entertaining Apollo or Dionysus? Either way we need to pay the bills . . .

2007; Wiley; Volume: 14; Issue: 4 Linguagem: Inglês

10.1111/j.1365-2850.2007.01118_2.x

1365-2850

Theodore Stickley,

Island Studies and Pacific Affairs

In recent years in the UK, there has grown up something that has come to be known as The Arts and Health Agenda. Perpetrated by employees of the Arts Council and the Department of Health, arts and health practitioners and researchers around the country have understandably expected much because this Arts and Health Agenda has promised much. The National Network for the Arts in Health appeared on the scene and there was, for while at least, a glimmer of hope that health care might at last be recognizing the usefulness of creative approaches in care provision. The UK's Department of Health have initiated local implementations of the Action Plan for Social Inclusion (SEU 2004a,b) that includes a call for arts and mental health work. This has coincided with a research project commissioned by the Department for Culture Media and Sport that is being jointly managed by a team comprising academics from Lancaster University and the Anglia Polytechnic University. This project is conducting a national mapping exercise specifically for the arts and mental health and evaluating the efficacy of such projects through the lens of social inclusion (Hacking et al. 2006). Thus, the arts and mental health agenda has, for the first time, become nationally recognized at governmental level. Having led on an arts-based mental health promotion project in one of the most deprived areas of inner city Nottingham over the last few years, I have become all too aware of the politics that surround this Arts and Health Agenda. If mental health nurses seek to become involved in any kind of Arts and Health Agenda, they should also become aware of the highly politicized nature of this work. I am writing this editorial from a position of common sense based on years of personal experience of mental health (my own and others) and engagement with the arts. Engaging with some form of creative expression is good for me. When I express myself, I feel emotional release, I feel good about myself, I often feel satisfied with what I produce and pleased for other people to see my work. I have worked with people who have reported the same; for example, instead of cutting herself, Mary could paint the bright red blood on the paper and talk about her need to self-harm. Rupert helped to set up a local community arts project on a shoe-string budget and this enabled him to feel a sense of belonging to other local people. These activities helped Rupert to come off the drugs he had been dependent upon for many years. He, along with his friends, has now rented studio space and regularly exhibit and sell their work. I am not alone in this common sense approach; in his 2002 editorial for the British Medical Journal, Richard Smith asserted that: The British government spends about £50 billion a year on health care and £300 million supporting the arts. My contention is that diverting 0.5% of the healthcare budget to the arts would improve the health of people in Britain. (Smith 2002, p. 1432) Common sense, however, does not go a long way when it comes to securing the kind of funding that is required to provide arts in health care. Smith goes on to point out that the arts do not solve problems, and the National Health Service is beset by problems. Neither might investment in the arts and health win seats in elections. When the University College hospital spent £70 000 on John Aiken's pebble sculpture, the media had a field day; of course, the tax payer does not wish to spend money on fluffy things like the arts in hospitals, and they naturally want the money spending on ‘proper’ healthcare facilities. A writer for the Guardian newspaper questioned why it was that no one stopped to ask: ‘. . . whether there was not some way that this cash . . . could not have been diverted into researching the causes of leukaemia’ (Mangan 2006). In 2006, the Policy Exchange published a collection of papers largely condemning the Arts Council and its arts in health agenda considering its agenda as politicized rhetoric (see: Belfiore 2006, Brighton 2006, Heartfield 2006, Selwood 2006). The collection of essays challenges all of the claims made for the personal and social benefits of the arts citing inadequate evidence and exaggerated claims: Arts policy today (within the wider remit of cultural policy) is infused with the idea that the arts are good for society, and that they can help achieve a number of social policy objectives. The people who fund the arts, provide the arts, and research the arts have all produced a consensus about the value of what they do, which hardly anyone challenges. But do the numbers add up? For all the claims made about the arts, how accurate are they? If you read the policy literature, it seems uncontroversial that the arts can stimulate economic growth, reduce social exclusion and improve our health – in short, transform our society. Yet . . . there is surprisingly little evidence for these claims. We may have a government that calls for ‘evidence-based policy’ but as its support for the arts demonstrates, they don't have much of a leg to stand on. (Mirza 2006, p. 15) While the publication of these papers stimulated a vociferous reaction from proponents of the arts in health agenda (e.g. White 2006), the fact remains that what constitutes evidence in terms of scientific inquiry is often beyond the reach of arts in health projects and researchers. There is plenty of evidence for the efficacy of the arts in terms of personal and social outcomes; however, until the right kind of evidence is produced, the evidence remains marginalized and will continue to be subject to criticism within the scientifically dominated healthcare arena. Understandably, the Arts and Health Agenda has stimulated much research activity that seeks to prove the efficacy of the arts in health care, in order to provide the much needed evidence in order to satisfy the evidence-based practice agenda. Without the evidence base (the argument goes) projects will not get funded. The problem here is that arts practitioners and researchers then get caught up in the agendas of the respective politicians. We find ourselves scrabbling around trying to pick up any bits of funding that might have fallen off the tables of the masters, provide compromised short-term projects and then somehow conduct robust research to provide the evidence. What about professionalism? What about the ethics of building up people's hopes only to have them shattered when the funding runs out? What about the integrity of the researcher? During the last 5 years, those with an interest in working to promote the arts and health have had cause to be excited. The Arts Council England apparently embraced the idea and virtually took ownership of the agenda; a strategy was promised for 2006. Simultaneously, however, the National Health Service found itself on its financial knees and the ‘strategy’ when published was little more than (another) review (ACE 2007a) and was full of air. In April 2007 in the UK, two other statutory reports were produced on the Arts and Health agenda (ACE 2007b, DH 2007). These too were long awaited but when examined were full of glossy pictures and pop-up pages but of little substance. The problem with the Arts and Health Agenda is that it has been subject to far too much recycling of information. Nothing new emerges; furthermore it is evident that the policy writers' ears are a long way from the grass-roots voice. On the bright side, there is evidence of good mental health promotion through the arts. Parr (2006), for example, interviewed 35 participants in a community arts programme promoting mental health. For many, engagement with the arts activities provided stability for their lives and contributed to social well-being in terms of forming and sustaining relationships with other participants. . . . feeling welcome and confident to sit in cafes and bars with other artists and workers, being invited to attend other gallery openings and having access tomainstream exhibition space for the work of project participants. (Parr 2006, p. 25) This is the kind of work we are doing in Nottingham too in the Art in Mind programme. The work is not rocket science but it is good mental health promotion, the kind of work mental health nurses may easily engage with. There is plenty of evidence for the efficacy of the arts in mental health but there will never be enough. Like it or not, for the time being, it seems that we have to settle for the scraps of funding we can lay our hands on. Furthermore, when these scraps come with promises of strategies and investments, take them with a big pinch of salt. I am aware that this editorial retains a gloomy tone. So on a positive note, I have been invited to be one of the guest editors for a future special edition of the JPMHN focusing on the arts and mental health. I look forward to seeing submissions over the next few months of reports of work from around the world. Additionally, we will dedicate a section of the special edition to the views, opinions and experiences of people who use mental health services either who have worked in an arts project or who have been on the receiving end.