Prescribing the arts for better health

Arts and health is a focus for many regional cultural organisations according to a recent study by Dave O’Brien called ‘What to expect from Tory cultural policy: where the axe will fall’. At the same time, social prescribing seems to be gaining ground among health professionals and there is growing interest in schemes in many parts of the country commissioned by clinical commissioning groups or public health services.

‘Social prescribing’, of which arts and culture on prescription are a part, is a practice which extends the boundaries of traditional general practice in the health sector, strengthening links between primary care and the voluntary sector. It enables health professionals to refer people to non-clinical services for mental health problems, such as anxiety and depression, chronic pain and some long-term conditions. Through referral, people are linked to services in the community that support wellbeing, encourage social inclusion and promote self-care where appropriate. This is often described as an asset-based approach to improving health and wellbeing.

Funding from commissioners covers a set number of weeks of activity… so sustaining activities for participants who want to continue for longer is a challenge

Social prescribing is often discussed with reference to the Marmot Review which poses a direct correlation between health inequalities and social and economic inequalities. In other words, health is influenced by material circumstances, social environment, psychosocial factors and behaviours. The review recommends preventing ill-health through better integration of primary care with resources available through other public and third-sector channels, and through the development of healthy and sustainable places and communities. Prevention of ill-health and health promotion are now central tenets of NHS policy and practice and many regard social prescribing as a model which addresses this.

However, the challenges for cultural organisations interested in developing and delivering ‘on prescription’ schemes need to be understood, along with the opportunities. Kerry Wilson from the Institute for Cultural Capital says that organisations need expertise and skills in both health and arts practice, and also require good knowledge of local structures and referral routes for health and wellbeing. Project management, co-ordination and liaison with referral agencies, service-users and providers of activity are all distinct and important roles. Referral agencies can be many and varied. GP link workers, NHS services for older adults, public health teams, psychiatrists, Jobcentre Plus, Citizens Advice, and charities such as MIND and Alzheimer’s Society, are just some of the potential referral routes. Understanding how they work and the ability to build relationships with them is important.

Start in Salford draws clear distinctions between the roles of artists and the roles of others who work for it. While its artists may be trained in areas such as mental health issues and teaching in the lifelong learning sector, they are seen as artists first and foremost and encouraged to maintain and develop their artistic skills. Creative Alternatives uses a specialist referrals officer to undertake initial phone conversations with people, applying clear criteria to assess who is appropriate for the scheme and will benefit from it. Where further assessment is needed, the referrals officer and the creativity and health co-ordinator run taster sessions to enable this, signposting individuals experiencing severe problems to alternative, more suitable provision.

Funding from commissioners covers a set number of weeks of activity (in many cases ten weeks), so sustaining activities for participants who want to continue for longer is a challenge that many providers have sought to address. Colour your Life runs a membership scheme after an initial ten-week, free-of-charge block of activities which is funded by Durham County’s Public Health Service. Those who become members continue to attend activities that are part-financed by their weekly donations and part-financed by the Public Health Service. While people referred to Start in Salford’s scheme are allocated a six-month intervention, it is committed to supporting further participation. Those requiring it are referred onwards to alternative pathways, and it also helps a number of people to develop arts skills through work experience, mentoring and accredited courses in the creative sector. As a result, some move on as artists in their own right.

Being part of a network of wider provision is a consideration for many schemes. Colour your Life is part of a consortium of third-sector organisations, under the management of the charity, Pioneering Care Partnership. This enables its arts activities to be seen as part and parcel of the fabric of wider social prescribing in the county of Durham. While much of the county’s offer focuses on deprived communities, Colour your Life’s arts programme is funded to provide a broader offer, open to those who wish to self-refer. This responds to requests by many participants, who when consulted on their preferences by the county’s Public Health Service, frequently mentioned artistic pursuits.

Supplying evidence wanted by commissioners can be a further challenge for many arts and cultural organisations. Some commissioners may determine the measurement systems to be used, while others may be open to provider organisations proposing ways of measuring impact. One measure often used by arts organisations in this field – and which also tends to have currency with commissioners – is the Warwick Edinburgh Mental Wellbeing Scale. However, experiences of arts providers has also shown that commissioners are interested in case studies which tell a more personal story of change resulting from arts participation.

Measurement of cost-effectiveness is expected by some commissioners. Start in Salford has undertaken cost-benefit analysis, using a light version of the social return on investment model. This has helped it identify the impact of its work on cost reductions, such as savings from reduction in GP referrals and savings to employers from reduction in number of working days lost.

In the libraries sector, a national Reading Well Books on Prescription scheme is delivered by the Reading Agency and the Society of Chief Librarians. This is enabling local library services to develop relationships with commissioners for public health, children and young people’s mental health, and adult social care, since it is an evidence-based scheme that is endorsed by health bodies including the Royal College of General Practitioners, the Royal College of Nursing and the Royal College of Psychiatrists.

The museums sector is also beginning to move into the field of social prescribing. A research programme, conducted by Canterbury Christchurch University and the University of Central London, into social prescribing in the UK and internationally has identified evidence of the impact on mental health and wellbeing, and on physical health. Two schemes are now being developed across central London and Kent, which will be evaluated, and a cost-benefit analysis undertaken, to inform future learning on how to expand and sustain museums-on-prescription schemes.

With the Institute of Cultural Capital we held a conference on The Art of Social Prescribing in September, profiling the work of a number of arts and culture on prescription schemes The issues raised included:

• The scope for arts and culture on prescription schemes to be scaled up to enable creative, asset-based approaches to improving health and wellbeing to become more widespread.
• The ways of ensuring a focus on arts and cultural practice in itself, to ensure that high-quality work and a concern for good artistic practice is at the heart of on prescription schemes.
• The scope for greater collaboration between schemes to build the evidence base and demonstrate cost-effectiveness.

With many in the health sector keen to look at innovative, community-based partnerships, we think there’s mileage in these discussions being taken further.

Jessica Harris is Cultural Commissioning Programme Manager at the National Council for Voluntary Organisations.
www.ncvo.org/CCProg

The Cultural Commissioning Programme is a three-year Arts Council England funded programme which supports the arts and cultural sector to engage with public service commissioning, and also works with commissioners to raise their awareness and understanding of how the arts and cultural sector can help deliver their outcomes. It is delivered by a partnership of National Council for Voluntary Organisations (lead partner), NPC and nef.

This article, sponsored and contributed by the Cultural Commissioning Programme, is in a series exploring opportunities for arts organisations, museums and library services to engage in public service commissioning.