The arts and health may have been officially coupled with the launch of a new evaluation framework, but will they ever be comfortable bedfellows? Frances Williams has her doubts.

Photo of begging poster

The Vacuum Cleaner

Arts and health have a long involvement with one another but a new framework has been unveiled which formalises this relationship. Policy, funding and evaluation approaches for this inter-disciplinary sector have been consolidated at recent events.

The Southbank Centre hosted Changing Minds, a weekend festival about mental health and the arts. It began with a conference aimed at health opinion-formers and invited guests, devised by arts enterprise Aesop. Its Chief Executive ,Tim Joss, promoted the efficacy of the arts in making a difference to how well people feel, both physically and mentally. A number of inter-disciplinary projects were showcased to demonstrate the wisdom of integrating arts into health budgets to mutual best effect in what was characterised as a ‘dating’ opportunity.

This new legitimisation of the relationship between arts and health was indeed borne out of mutual need as well as much trouble and strife

If this were a dating game, then the arts were certainly presented as a cheap date. Chair of ACE Sir Peter Bazelgette and Secretary of State for Health Jeremy Hunt stood side by side, pointing out how part of the allure of the arts was that they were often “cheaper than drugs”.

This gathering also saw the launch of the framework for health and wellbeing evaluation commissioned by Public Health England. It uses a particular methodology, empirically based, by which to measure and demonstrate robust positive outcomes (robust being a muscular adjective much used in this context though the arts are more often pejoratively denoted as optional ‘fluff’).

An arranged marriage

This new legitimisation of the relationship between arts and health was indeed borne out of mutual need as well as much trouble and strife. The way the NHS buys its services has fundamentally changed since the introduction of clinical commissioning groups (CCGs). Arts organisations, meanwhile, have experienced deep cuts causing them to seek new avenues of revenue. All the while, social inequality has increased the demand on existing mental health services for patients and staff alike. “At breaking point,” was how one psychiatrist characterised it. “If the NHS were my patient, I would diagnose it as clinically depressed.”

Perhaps this is why, even among those celebrating the showcase, the new coupling was presented more as a dutiful long-term marriage than joyful union. “Health decision-makers have a statutory obligation to make best use of money and to be innovators,” was how Dr Michael Dixon, Chair of the NHS Alliance, urged his colleagues to commit.

You could say this was more of an arranged marriage, and a non-consensual one at that. Junior doctors understand only too well that contractual partnerships can be ‘imposed’, even though the definition of the word contract is a legal agreement. Just like doctors, artists look set to struggle silently in the new trysts in which they find themselves implicated by the new terms of engagement between arts and health.

At talks hosted over the Changing Minds weekend, many participants agreed on who was dancing to whose tune. They saw these developments as a consequence of making the kinds of arguments that they know those in power will understand. “The argument for arts funding has to be that it will make people more productive and be good for the economy,” was how author Andrew Hankinson framed it at a panel discussion on the future of mental health which also included artists and service-users.

Lost in translation

These panelists (rather less powerful than those who launched the showcase) pointed out that the packaging and selling of arts projects, in these competitive market formats and using these types of evaluative metrics, did not come without risk.

One artist, who runs an arts project for people with mental health issues, complained of feeling that art practice was “often partly or wholly buried” under a “tangle of good will, public funding and medical diagnosis”, leaving him wondering whether “ends were being placed before means”. His sense of loss builds on long-standing concern around how the arts are valued and what might be lost in translation when their effects are converted into stark economic impacts.

In an AHRC report on cultural value published in 2012, Stan Papoulias, Research Fellow in patient involvement in health research at King’s College London, asked how “the logic of numbers and of evidence-based science [can] be aligned with the kinds of embodied knowledge that animate art practice or the experiences that such practice can generate”. She warned: “We should be vigilant that we do not lose such specific and fragile experiences in the process of making them meaningful to policymakers.”

This refrain was taken up again in an evaluation report of Creative Families, one of the projects showcased at the Aesop event. It was an early-intervention project aimed at parents at risk of developing mental illness, which saw artists co-create activities with mothers across children’s centres, working closely with local mental health and family services.

The report brought together approaches from psychology and sociology in its evaluation in an attempt to invite different disciplines to speak (and listen) to one another. Sociologist Alison Rooke identified creative process and mutual power-relationships as key to success. Her detailed analysis argued that it is the mutually affective qualities of social art practice that is best placed to bring about both positive social change and personal transformation.

Empowerment and control

Social art practice is effective precisely because it allows for more open and equitable ‘distributions of agency’. Lisa Blackman used this phrase at a Goldsmiths University event dedicated to exploring mental health, power and austerity. She was one of many contributors who linked social inequality to mental (ill) health. For good historical reason, people with mental illness are particularly sensitive to the uses and abuses of power. It is an unbalanced power-relationship itself that can impinge on our sense of mutual wellbeing. The social roles allocated by the new metrics are set to cast artists as service-deliverers to service-users in a problematic power-dynamic.

Wider evidence points to social frameworks and peer-support networks as playing a decisive, though often unacknowledged, role in wellbeing. As Michael Marmot argues powerfully in his book The Health Gap, it is empowerment, or rather “a sense of control over your life”, that plays a vital role in all our wellbeing. He relates health equity to social justice, arguing that it is only through being offered meaningful choices that you can gain the freedom to choose a life you have reason to value.

“I want to be supported, not cared for,” James Leadbitter insisted. He is an artist who works under the title of the Vacuum Cleaner who has experienced acute mental distress. “Often it is the small, human gestures that can count the most,” he said, citing the chance to sit with someone as something that allowed him, while suicidal, to avoid being prescribed valium in favour of sharing his art practice.

His comments invite us all to reflect on how we share our power and vulnerability with others – as individuals as much as organisations – opening up many ways of ‘being with’ that don’t seek to control, or ask us to dance for any tin-pot dictator.

Frances Williams is an independent writer, curator and researcher.

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