Louisa NewmanBA(Hons), MA, MSc

Arts on Referral Project Manager NHS Bristol

Artshine Manager

louisa.newman@bristol.nhs.uk 0117 9841684

• BA (Hons) Creative Arts• MA Creative Writing• MSc Nutrition, Physical Activity &

Public Health• Experience teaching & working as

artist• Worked clinically – NHS (mental

health & dietetics) 2005• Bristol Public Health (NHS PCT)

2007• Post as AoR Manager 2010

Aims of today• Overview of Artshine

• Developing Best Practice:

training & supervision for artists working in arts & health

• First Year Evaluation

• Developments & New Directions

Arts & Health in the NHS ‘In improving patient health, it is clear that we need to look at prescribing more than just medicine in order to increase an individual’s sense of wellbeing.Taking part in arts activities has been shown to build self esteem, promoting both community engagement and positive mental health. The Artshine project in Bristol is a good example of how the

arts can contribute to innovative patient care within General Practice.’ Dr. Jon Rogers, BCC cabinet member Care & Health, GP Avonmouth Medical Centre

Project overview• Arts on Referral (arts on prescription)• Primary Care intervention: improve wellbeing, social

inclusion & promote positive mental health• Prevention / early intervention / maintenance• Adults mild to moderate mental health issues• Delivered by Public Health & funded by BCC (03.12)• Inner City & East GP practices: - 14 GP practices - approx 125,000 registered population• Staff: Manager, 4 artists, 1 day admin support

• Groups Oct 2010• 4 groups: 8 – 12 members each• Based in health centres / community venue• Lead artist for each group • Range of creative activities – mostly visual arts

based• Visiting artists & sessions for staff• Health trainers

Groups

• GP (70%), health trainer or other health professional / community workers

• Online system

• GPs informed of every referral

• Referral up to 30 weeks** – 10 week terms

• ** reverted to 20 wks + 10 wks ‘move on’

• Evidence supports longer intervention

Referrals

Criteria:• Mild to moderate anxiety & depression• Stress• Social isolation• Low self esteem / confidence• Chronic illness (ME, diabetes, heart disease)• Difficult life changes / challenges (divorce,

bereavement, new baby, relocation)• Other health behaviour change (drug & alcohol

rehabilitation, eating distress)

Who gets referred?

Referral Charts

Ethnicity of patients referred to ArtShine, September 2010 - February 2011

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

Black orBlack British:Black African

Black orBlack British:

BlackCaribbean

White: Other Asian orAsian British:

Indian

Asian orAsian British:

Pakistani

White: Irish Not stated

Per

cen

tag

e (%

)

Referral ChartsFrequency of reasons of referral to ArtShine, September 2010 -

February 2011

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Referral ChartsReferrals to Artshine Sep 2010 to Jul 2011

By Referral Type

GP59%

Other Health Professionals

37%

Self referral4%

Referrals

• 30% BME groups

• 89% ‘improve overall wellbeing’

• 60% GP referrals - (60 – 80%)

• Even spread across age groups

• 70+% female

Beyond the basic model

• Linked Health Trainers for each group

• Advice & 1:1 support for healthy life choices & social issues

• Reinforces a whole health focus & effective signposting ...I’ve had people

interested in diet and exerciseShe helps break the

ice for everybody and has a lot of

knowledge about other groups

She helps break the ice for everybody and

has a lot of knowledge about

other groups

‘Move On’• Artshine referral time limited• Expectation to move on – ‘meaningful’• Support to identify other opportunities: education, employment, volunteering…..• ‘Move On’ groups offer stepped approach - ‘hand held’• Engage with other groups towards end of referral• 1st yr: ArThur & Light Box• Shine On – set up by participants• The Mshed Sessions

Move On: Quotes

We could make our own group, even if it's just to meet up for coffee, or to do something creative

We could make our own group, even if it's just to meet up for coffee, or to do something creative

…people don't want to go [leave] but the move on

groups should help

…the group has discussed positive elements of Artshine to incorporate in their own group

We get on well and

would like to continue

meeting up

We get on well and

would like to continue

meeting up

Developing Best Practice:training & supervision for artists

• Ensuring quality service & care for patients

• Effective treatment & value for money

• Consistency in guidelines for good practice

• Arts & Health practitioners – some are unregulated / lack of definite training paths?

Best Practice cont.

• Supporting & valuing staff• Recognise & acknowledge the artists’ skill

set• Validating the work within a health & social

care context• Boundaries, policies & safe practice• Historically, adequate support has been hit

& miss

Artist experience:

• Working in isolation• Overlooked – value of work• Concerns about participants – who to

speak to?• Assumptions made about support –

difficulties with emotion & appropriate debrief

• Expected to work for free!

Lots of positives too!

…they often tell me how relaxed

they feel

I absolutely love it! It’s

therapeutic for me too!

I love the groups, it’s very diverse

and vibrant

Supervision: safe & accountable practice

a term to describe a formal process of professional support and learning which enables practitioners to develop knowledge and competence, assume responsibility for their own practice and enhance consumer protection and safety of care in complex situations (DOH 1993)

regular, protected time for facilitated, in-depth reflection on clinical practice aimed to enable the supervisee to achieve, sustain and creatively develop a high quality of practice through the means of focused support and development. (Bond and Holland 1998)

Artist Supervision

• 2 bi monthly supervision groups• 5 members, 2 hr session• Delivered in partnership with BCC• Free for associated artists• Subsidised places for all other artists working in

health / social care settings• Run by experienced external supervisor - NHS

clinical supervision• Artshine 1:1 time with manager

Artist Training

• 3 – 4 training events per year• Delivered with BCC & Wellspring HLC• Free to associated artists - subsidised for other

artists• Run by external trainers - variety of topics• Key topics: mental health training & safe practice• Validating existing knowledge, peer support,

information sharing• Recent event 19 artists + waiting list

..it’s great to have the 1:1s with her, I’ve not had that

in other areas

..it’s great to have the opportunity to discuss

concerns in confidence

I’ve had an issue come up tht I’ve not had experience of before so will attend the

next one [supervision session]

‘’I really enjoyed today, good to meet others and very

useful to share experiences’’

Artshine: Evaluation

• Range of evaluation & measurements• Quantitative & Qualitative• WEMWBS (validated measuring wellbeing in

populations)• Baseline, 10 wk & exit measures• 3 - 6 month follow up• Demographic data• GP attendances• Referral data

Evaluation cont: qualitative

• Individual outcomes

• Artwork

• Artist’s reflection / workbooks

• Photographs of sessions

• Participant ‘soundbites’

• Case studies

1st Year Evaluation Report

• July 2011 – end of 1st yr service delivery• Public Health Analysts – Emily Van de Venter• Analysis of quantitative data – graphs, charts &

surveys• Experiences of people involved - interviews with

HTs, GPs, participants & artists• Participant case studies• Portfolio of artwork – creative evaluation report!

Evaluation: Findings% of referrals

18-29 21%30-39 31%40-49 24%50-59 17%

60+ 7%Male 17%

Female 77%Not stated 6%

White British or Irish 70%White Other 5%

Asian or Asian British 7%Black or Black British 12%

Mixed or other 3%Not stated 3%

Yes 97%No 3%

Unemployed 72%Employed 15%

In education 7%Retired 6%

Physical disability 9%Sensory disability 2%

Mental disability 22%Learning disability 7%

Yes 12%No 88%

Employment Status

DisabilityCaring

responsibilities

Referral demographics

Age

Gender

Ethnicity

English speaker

• 77% females• 30% referrals BME groups• 70% unemployed• 35% stated having a disability – 22% mental disability• 115 referrals Sept 10 – June 11

Findings cont.Reasons for referral to Artshine, September 2010 to June 2011

0%10%20%30%40%50%60%70%80%90%

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ove

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Findings cont.

Statistically significant increase in overall wellbeing for

Artshine cohort over the duration of their intervention.

Paired

WEMWBS

results

Before

(<6sessions)

After

(10+ sessions)

n 9 9

Mean Score 38.8 49

T-Test Value 0.021

Findings cont.

• GP attendance rates• Sample of referred patients• Eastville mums group• No of attendances 1 yr prior to Artshine

and no. since referral to Artshine.• 87% reduction during intervention• ArtLift Gloucester – average 30%

reduction

Findings cont.

• Qualitative – interviews & case studies

• Artists, GPs & participants

I’m glad we’ve managed to get it off the ground. I didn’t know much about art and health before but now I understand more

and can see the benefits for patients

They welcomed me to the group with warmth and

enthusiasm, talking about themselves, their work

and the aspirations they have developed as a

result of being part of the Artshine programme….

They welcomed me to the group with warmth and

enthusiasm, talking about themselves, their work

and the aspirations they have developed as a

result of being part of the Artshine programme….

Findings cont.

I see the wall hanging and it fills me with

pride and a sense of achievement.

I see the wall hanging and it fills me with

pride and a sense of achievement.

Helps with my anxiety and gives me something to look forward to -

Cheers me up like ice cream!

Helps with my anxiety and gives me something to look forward to -

Cheers me up like ice cream!

Artshine has definitely made a difference to my mental health, I feel more motivated to get out

the door…

Artshine has definitely made a difference to my mental health, I feel more motivated to get out

the door…

Case Study• Participant 1 has attended 16 Artshine sessions and is coming to the end of

term 1.• This participant has a history of chaotic lifestyles with mental health and

substance misuse issues. The participant was previously involved in an abusive relationship with a problematic drinker and currently has children in care outside of Bristol, including a teenager with Aspergers syndrome. The participant is now feels they are in a supportive relationship but finds having children away from home a challenge. This participant is currently on anti-depressants, has been receiving support from MIND and is waiting for a support worker to be assigned to her. They have found mental health services in Bristol to have long waiting lists but “Artshine was easy to get into”.

• Participant 1 finds Artshine “…a complete escape” from some of the chaotic aspects of their life “it’s sociable and relaxing”. This individual was not practicing creative activities before coming to Artshine “it wasn’t something I was into before, I didn’t know what art was all about” but, after trying a number of activities, has found an interest in painting and is currently experimenting with water colours. Outside of the group the participant takes photos on days out for inspiration and commented “I often paint while my partner’s watching TV”. They have also been able to borrow books and resources from the art room at the practice.

• The participant commented on the positive impact of Artshine;• “I used to think drugs were the only way to get a buzz• but now I get a buzz from doing art!”• This participant has received diet and exercise advice from the

Health Trainer and commented;• “I have trust issues but I feel I can trust her”.• The participant felt attending Artshine had been a positive

experience.• “Artshine has definitely made a difference to my mental health,

I feel more motivated to get out the door. It’s been a chance to meet nice people. I’ve come to realise we’ve all got our own problems and need to be ready to move on to the next step of friendship outside of the group but I think it will come….we’ve all linked up on Facebook”.

• A number of members of this Artshine group have discussed forming their own art group;

• “we all get on well and would like to continue meeting up….I’m trying to get a Wii Fit group going too!”

Areas for improvement & actions taken• Increasing referrals & uptake – GP awareness…

new system• Displaying more artwork at practices…H&S

toolkit• More GP feedback…d/charge & completion• Improved referral system…contacts & emails• Patient information…leaflets – website…..• Father / men’s group…specific project• Uptake of referrals from BME communities…

outreach project

Developments & New Directions

• Funding…..long term?• Mshed Sessions – citywide AoR groups• Outreach workshops• Streamlining of service – enhanced

referral screening, attendance rate requirements

• Local media interest• And……

Exhibition: 27th – 31st MarchThe Parlour, Park Street, Bristol

VIP Launch EventTuesday 27th March12 – 2pmThe Parlour, Park Street

In the Words of….

“ The sessions have made me feel very productive not only for the rest of the day but also the artists have helped me to feel happy and very positive about the future, encouraging me and inspiring ideas that could possibly help me to turn my dreams into reality.”

Artshine participant, June 2011

Useful info• NHS Bristol Artshine – Arts for health and wellbeing. Arts on referral

scheme for inner-city Bristol. Evaluation report. NHS Bristol:Bristol 2011• Crone et al (2011). Art Lift, Gloucestershire: Evaluation Report. University of

Gloucestershire, U.K. 2011• Prof. S. Stewart-Brown & Dr K Janmohamed. Warwick-Edinburgh Mental

Well-Being Scale (WEMWBS). User Guide Version 1. University of Warwick & NHS Scotland. 2008.

• Jenny Secker et al. Mental Health, Social Inclusion & Arts: developing the evidence base. Final Report. The Anglia Ruskin / UClan Research Team. 2007.

• Dr. Rosalia L. Staricoff. Arts in Health: a review of the3 medical literature. Research Report. Arts Council England. 2004.

• L. Bayles. Arts & Minds: Arts on Prescription. A Scoping Report for Leeds PCT. 2008.

• Arts & Health South West www.ahsw.org.uk