Are the arts filling a gap in mental health provision? If so, how do we proceed ethically?

Author: Midge Ryall

My name is Midge Ryall. I am at my first ever Devoted and Disgruntled conference. I have decided to call a session, though my hand is shaking when I take the microphone. I find my breakout room and gingerly sit down in an empty circle of chairs labelled 'Fish', waiting for people to arrive.

The session I have decided to call is about a concern I have. I am a producer in a small theatre company based in the Northeast of England. We run a varied programme of arts projects utilising co-creation practice methods, including three youth theatres. I have noticed an emerging pattern whereby arts practitioners are expected to adopt a role that they are not necessarily qualified to do - namely, to improve participants' mental health. Or, at the very least, to provide support to participants experiencing mental health difficulties.

I am seeing this 'expectation' manifested in a number of different ways - funding criteria have an increased focus on wellbeing, sometimes referred to as 'mental health'; arts organisations are increasingly evaluated against health metrics, and/or referred to as 'services'; social prescribing practitioners within the NHS will signpost to youth theatres and other charity-led or community-based arts activities, sometimes without communicating or establishing a relationship with those organisations. I have a theory that this increased pressure on arts practitioners to fill a gap in mental health support provision is perhaps down to the NHS being overstretched. I also wonder whether we are all collectively crying out for more partnership working to ensure artists are equipped to manage the situations that may arise in creative spaces.

The first person arrives at the circle of chairs. We decide to sit on the floor together, as it's more comfortable. We talk about my worries about safeguarding children and young people within youth theatre settings who have been signposted to the group by NHS professionals, and the expectations that those children, young people and their parents/carers have about what impact that youth theatre will have on their mental health.

Some more people join. We talk about the film and television industry, and the BFI's requirement to provide 'wellbeing coordinators'. We talk about well-intentioned amateurs, and the lack of training that is required to assume certain titles and responsibilities. We talk about where the money is coming from, and who is prepared to spend the money on experts to make spaces safer.

Some others join who talk about access budgets, and who decides whether an issue is related to 'access', 'mental health', or both - are they equipped to make these decisions? We discuss the blurring of the lines between mental health conditions and neurodivergence. Human resources and management are mentioned as skills perhaps lacking in the sector.

An artist in the circle talks about a group they run in partnership with NHS practitioners, which has an infrastructure developed by all parties, to make the space safe for participants and staff. She suggests that this group simply couldn't happen safely without these relationships with the NHS.

As more people join the group, we talk about how we can continue to care about care, when budgets are so stretched; referrals vs. safeguarding and who is responsible for this; how we regulate this new territory we've entered into - is it the Arts Council? If not, who is it?

We talk about quality assurance. Do we need to develop a new evaluation framework to monitor the impact of arts activities, and bring them more in line with public health outcomes? Is that fundamentally the role of arts organisations?

We discussed the importance of having strong boundaries and knowing the limits of your role - just because we have lived experience, it does not make us experts in supporting others with that issue. We talked about how a lifeguard's role is very clear when we go swimming - it should be no different when a child goes into a youth theatre session. Perhaps we need to invite NHS practitioners into these spaces to ensure there is a qualified person to go to for support. Could we learn from other sectors to avoid reinventing the wheel (e.g. youth work charities)?

We talk about the level of risk that arts organisations are taking on, and how we ensure that this risk is reduced or eliminated for both participants and staff.

We talk about aftercare - how do we know who to signpost people on to for whom the group isn't a good fit? And is signposting ever really enough?

We discuss the importance of choice - arts organisations should get to choose whether they are a 'service' or not.
We conclude that actively preventing mental health issues is crucial, rather than reacting when an issue occurs. Two organisations are cited as interesting and relevant - Applause for Thought, a theatre company that has created a bank of resources to support arts organisations working in this 'creative health' space; and Creative Credible in Bristol, who created an evaluation framework that tries to better emulate that of medical services.

The discussion seems to come to a natural close. I inform the group about a scoping research project that Unfolding Theatre has been funded by a group of Northeast universities to conduct through the NortHFutures Hub. We are working with a multidisciplinary team of voluntary sector workers, an NHS social prescribing professional, and two academics. The title of the scoping research project is, 'Improving Mental Health for Young People in Gateshead: Effective Methods for Sharing Information and Best Practices'. We hope that this research will go some way towards working together better to ensure that children and young people can engage safely with arts activities.

I thank everyone for joining in the discussion, and encourage them to contact me afterwards so we can stay in touch. My email address is: midge@unfoldingtheatre.co.uk