Do the arts have a role to play in healthcare? I asked myself that question more than 10 years ago when there seemed little else to offer patients suffering from mild depression, anxiety and stressful life events, other than antidepressants and a listening ear.
The arts in healthcare movement is dedicated to connecting people with the power of the arts and so helping to improve their health and wellbeing. The therapeutic effects of art and creativity have been recognised for many centuries but it is only in the last 10-15 years that we have had rigorous and controlled studies providing detailed evidence about these effects.
There are many areas in which research studies have shown clear improvements in clinical outcomes when arts interventions have been incorporated into healthcare. In cancer care, for example, visual art and music have reduced anxiety and depression in patients undergoing chemotherapy.1 In a controlled study of patients undergoing day surgery, those exposed to music during or after an operation reported significantly lower pain intensity and required fewer analgesics in the immediate post-operative period than those not exposed to music.2 A study of the use of synthesised female vocal music and lullabies in new-born intensive care units reported a beneficial effect on weight and caloric intake, and a significantly reduced length of hospital stay.3 Benefits have also been shown for patients with mental health problems: one study showed a significant reduction in levels of depression in patients who were guided to read selected literature, fiction or poetry, compared to a control group who did not participate in reading.4
The arts can also be valuable by giving patients the opportunity to take part in creative activities. These may help people process a difficult or painful experience such as illness, bereavement or divorce, and from this create something of value, something of which they can feel proud. Creative endeavour can help us find a way to ‘be heard’, in a world in which many people feel insignificant, unnoticed and not special. It can help build self esteem which is so important for good mental health, through painting, creative writing, pottery, photography, music, and a whole host of other creative outlets.
In my own surgery we had a poet-in-residence for six months who worked with patients both individually and in groups. Those who participated had a variety of health problems including depression, anxiety, obesity and chronic pain. Evaluation at the end of the project showed that all the patients involved felt the sessions had helped them, had found poetry a useful way to work with their problems and wanted more sessions in the future.
Another scheme called Art-Lift delivered weekly creative sessions in GP surgeries, acute hospital wards and mental healthcare settings across Gloucestershire from 2007. Many of the patients who participated were affected by anxiety, depression and isolation and were frequent attenders at their GP surgery. Simon Opher, a GP who carried out evaluation of the project, found the average GP consultation rate per year for patients who took part in the Art-Lift sessions fell by 37%, from 11.3 before the project to 7.1 afterwards. Overall healthcare expenditure for 90 participating patients fell by 27% (around £42,000) in the year following the project.5
Engaging with medical issues
Art can also be used to raise awareness of specific illnesses and help people think about medical issues they might otherwise choose not to engage with. Cervical cancer, for example, is a frightening topic for many women and one they might prefer not to think about. It can be time consuming to discuss the issues around cervical screening and HPV to help women and girls make informed choices about having smear tests and HPV vaccination. Although we can offer information through leaflets and health-related websites, women may choose not to read this information, or may be unaware of it if they have little contact with their GP surgery or local sexual health services.
An exhibition at the Brewhouse Arts Centre in Taunton entitled Heavy Words – Stories From The Cervix showed works by the artist Kamina Walton that were beautiful, witty, thought provoking and uplifting and offered an imaginative commentary on women’s personal experiences of cervical cancer and on clinical issues relating to the disease. This kind of exhibition, held in a setting unrelated to hospitals and primary care services, offers a novel route into a difficult health topic for members of the public.
From 2002 onwards a touring exhibition called Tree of Life encouraged viewers to appreciate the beauty of the heart and its blood supply and to consider the question "Why damage this beauty by smoking?" Artworks including wood and stone sculptures, ceramic bowls, oil paintings and glass works were used to illustrate the workings of the human heart. The British Heart Foundation said "We are looking for new and creative ways of delivering heart health messages to the public. Supporting the Tree of Life exhibition offers us a wonderful opportunity to do just that".
So, the arts can offer the world of healthcare far more than just decorative images on waiting room walls.
Dr Rice is a GP partner in Bristol
Use these resources to find out more:
1. Staricoff R, Loppert S. Integrating the arts into healthcare: can we affect clinical outcomes? in Kirklin, D., Richardson, R. (eds). The Healing Environment: Without and Within. 2003. Royal College of Physicians. Chapter 5.
2. Nilsson U, Rawal N, Unestahl LE, Zettergerg C, Unosson M. Improved recovery after music and therapeutic suggestions during general anaesthesia: a double-blind randomised controlled trial. Acta Anaesthesiol Scand 2001; 45: 812-7.
3. Caine J. The effects of music on the selected stress behaviours, weight, caloric and formula intake, and length of hospital stay of premature and low birth weight neonates in a Newborn Intensive Care Unit. J Music Ther 1991; 28(4): 180-92.
4. Smith NM, Floyd M, Scogin F, Jamison CS. Three-year follow-up of bibliotherapy for depression. J Consult Clin Psychol 1997; 65: 324-7.
5. Cost-benefit evaluation of Artlift 2009-12.