There is currently a great deal of interest in the potential of art, and in particular participatory art, to improve the mental health of the population. This is driven by several factors. The current climate of fiscal and cultural austerity presses arts organisations facing significant cuts to identify new trends that may inform project delivery. UK Arts organisations, due to the history of cultural policy, are necessarily adept at adapting practices and programmes and seeking new collaborators in order to gain funding. Simultaneously, the health sector, also facing substantial cuts, and adapting to new financial and managerial models, are seeking experimental yet cost-effective solutions to improving public health. Furthermore, intense changes to the socio-economic landscape and punitive welfare policy, and the consequent increase in social inequalities in the UK are placing significant demand on mental health services. Insecurity, vulnerability, poverty and disadvantage impact adversely on peoples’ mental well being and their access to mental health services.
The Coalition Government’s ‘well-being’ agenda broadens definitions of mental health beyond diagnosis of a mental illness, and recognises that well-being is impacted upon by experiences of where we live, what we do, our levels of health, our relationships, our financial security, education and skills, and the quality of the environment. Policies which aim to improve access to and the effectiveness of mental health services such as ‘No Health Without Mental Health’ (DoH, 2011) foreground improving mental health as a priority for public health, and the population’s overall ‘well being. (These policies regarding happiness and well-being, arise out of the apparent contradiction whereby an increase in GDP does not correspond with an increase in reports of well-being. (Tomlinson and Kelly 2013)).
Therefore, within public health policy it has become possible to target mental health interventions towards a wide range of needs. Together these factors represent a significant impetus from both the arts and health sectors, for partnership work and the co-delivery of services, often with museum and gallery education departments as well as emerging ‘Arts on Prescription’ models of service provision. Arts and mental health collaborations support many of the declared NHS outcomes, including improving the effectiveness of care and quality of patient and ‘user’ experience. However, they are developing in a complex and evolving local, regional and national strategic landscapes, which mean that partners from each sector do not necessarily understand one another’s ways of working and sectorial cultures. Much of this work is driven by ‘Champions’ in each sector who are skilled enough and willing to ‘ride both horses’.
Over the last year I have been working with CUCR researchers Imogen Slater and Laura Cuch researching and evaluating such a partnership. We have been carrying out a formative evaluation of a collaboration between South London Gallery’s Education Team, Southwarks’ Parental Mental Health Team and two Children’s Centres in the Peckham. Creative Families is an early-intervention arts programme for parents experiencing mental health difficulties and their children aged under-five in Southwark funded by Guys and St Thomas’s Charitable Trust.
As a pilot Creative Families develops and tests new ways of working and this places exploration, collaboration and learning at the heart of the project. Unusually the programme is evaluated by CUCR for it’s process and impact and the Institute of Psychiatry for it’s clinical outcomes. The Creative Collisions and Critical Conversations that have taken place within and around the project drew attention to the micro-politics of collaborative interventions which make the cultural values of partner organisations apparent. These include tensions arising over understandings of ‘safety and risk’ where an emphasis on ‘safeguarding’ and ‘containment’ at times stands in contrast with a desire to allow affective intersubjective encounters, characteristic of much socially-engaged art practice. There were also tensions between an artistic commitment to egalitarian co-production and the collective elaboration of meaning through creativity and an emphasis on boundaries between a professional team and participants or ‘service users’. Tensions also exist around how the capacity and vulnerability of participants is understood, and between desire for a replicable structured project model versus the evolution of delivery in a more open and adaptive way. Finally, tensions existed between participants’ desire to share the artwork and experience of taking part and the need for maintaining confidentiality and anonymity of ‘users’. These tensions and their implications for arts and mental health collaborations have been explored through a series of discussions including events at South London Gallery, The Maudsley’s Learning programme as part of the Festival of Anxiety (http://www.anxietyartsfestival.org/) and an AHRC Cultural Value Expert Workshop entitled Creative Collisions and Critical Conversations, organised in Collaboration with Frances Williams (formerly of South London Gallery).
At the workshop the terms through which these interventions are evaluated were debated, as it is here that cultural values are also negotiated. The predominance of evaluative frameworks which foreground well-being and mental capital as concepts to frame these projects may make it easier to conceptualise and evidence the individual impact of collective participation in art activities. These are often framed in terms that make sense to medical professionals: clinical outcomes, measured through standardised health and well-being measures and clinical outcome assessment scales. However, these individualised scales and measures obfuscate the relationship between individual well-being and the social and creative processes that characterise participatory arts. Rather than framing this as merely a ‘collision’ between the epistemological and methodological binaries of science/facts/rationality versus art/stories/experience, the space of translation between ‘art’ and ‘research’ was scrutinised as a site where value is made through the ‘social life of methods’ (Law et al 2013). From this perspective evaluative methodologies are sites where the values of individual social actors and institutional cultural values congeal. These social (research) practices in themselves enact and sustain cultural value through multiple and selective practices which constitute the ‘objects’ of research they are concerned with. Hence, debates over evaluative methodologies are debates over systems of status, value and the significance of knowledge within research communities and outcomes of the governance of research, its organisation and division of labour as well as regarding the politics of intellectual property and publishing. These institutional processes are obfuscated in the tidy production of research papers, reports and ‘findings’.
While the value, evaluation and measurement of well-being are matters that continue to be unresolved. There remains a strong case for the development of research approaches that enable researchers to being able to make comparative judgements across these seemingly incommensurable registers. The workshop succeeded in providing a space where the competing sectoral requirements of a critical, appropriate and robust evaluative methodology could be discussed. While the demand for an evidence base which meets the demands of policy makers and funders is necessary, there is a clear danger that that the nuances of participatory and socially engaged practice can be ‘lost in translation’ through this drive for empirical evidence that rests ultimately on statistical evidence. Incorporating the evaluation of this participatory process by imposing the orthodoxies of ‘clinical outcomes’ is contradictory as it is incongruous with the ethos and aesthetics of this practice. Such an approach risks co-opting a distinct effective and the critical framework it has developed through. The development of an approach to research and evaluation, which could emerge out of an imaginative interdisciplinary dialogue, may provide a way forward from what appear to be incommensurable starting points.
A longer report on the AHRC Cultural Value Curating Community Expert Workshop is available on the AHRC Cultural Value site at
Dr Alison Rooke is CoDirector at CUCR, Goldsmiths College. firstname.lastname@example.org