April saw the culmination of a major programme of research funded by the Research Councils UK/Arts and Humanities Research Council Connected Communities scheme - Creative practice as Mutual Recovery: Connecting Communities for Mental Health and Wellbeing (CPMR). The programme ran from May 2013 to April 2018 and was led by Professor Paul Crawford at the University of Nottingham.
The CPMR programme examined mutuality, mental health recovery and wellbeing in relation to a range of arts and humanities practices. The concept of ‘mutual recovery’ referred to the idea of how a mutual approach in the context of creative practices - one that promotes various kinds of connectedness, sharing and reciprocity - may not only affect recovery for those seeking help with mental health issues but also have wellbeing benefits, and possibly ‘disbenefits’, for others involved, particularly practitioners working in the area of mental health. As Professor Crawford and colleagues (2018, p. 5) write:
'Typically, recovery-based initiatives tend to focus exclusively on people identified as having mental health needs (service users) and overlook how hard-pressed informal carers and health, social care and education personnel may also need to ‘recover’ or be ‘recovered’ in terms of their own mental health and well-being.'
An outline of the Mutuality, Wellbeing and Mental Health Recovery project
Opportunities for mutuality are important for promoting wellbeing and mental health recovery. Yet research into creative arts adult community learning (ACL) and mental health participatory arts initiatives has not tended to focus on mutual creativity and learning between participants and mental health or arts practitioners. In addition, in both ACL and participatory arts contexts, there are debates about the appropriate balance between the mental health and wellbeing agenda and creative or educational goals.
These key points underpinned the Mutuality, Wellbeing and Mental Health Recovery project. Creative writing (including stories and poetry), jewellery-making, painting and drawing, and other visual arts were among the creative practices studied. Settings included both mental health targeted and non-targeted groups/organisations, with seven studied in total.
The project focused on the kinds of opportunities for and challenges to mutuality that are generated in creative arts ACL and mental health targeted participatory arts settings, and how these relate to conceptualisations of wellbeing and recovery based on the capabilities approach. Within this approach, understandings of wellbeing and recovery overlap, being concerned with what you are able to be, do and achieve (access to capabilities, or opportunities; see Lewis, 2012). Connectedness, in terms of personal relationships and wider social inclusion, for example through education, employment, housing and leisure, is important along with constructive activity, social contribution/citizenship, and achieving one’s potential. There is a focus on enhancing agency, or self-determination (see also Wallcraft and Hopper, 2015).
The project also explored how the goals of mutuality, wellbeing and recovery interact with educational goals and traditions in adult community learning and mental health participatory arts contexts.
The project was qualitative in nature and employed participant observation, interviews and focus/discussion groups as research methods.
In terms of opportunities for mutuality, the study found that creative arts ACL and participatory arts initiatives:
- facilitated social connection, friendship and social support, as well as sharedlearning, achievement and enjoyment, for a range of people involved, including participants, volunteers and practitioners.
- buffered loneliness among for those who had become isolated due to mental health issues or had restricted opportunities for social participation due to other long-term health problems, caring responsibilities or older age – something especially emphasised in the targeted settings.
- provided opportunities for being part of a creative community or group which were valued by practitioners, volunteers and other participants.developed creativity and agency as interrelated processes. These processes were found to be relational with creative capabilities and agency often enhanced through taking part in creative spaces with others.
- helped some participants to deal with difficult, oppressive or restrictive circumstances, including dealing with health issues and services, domestic abuse and informal caring responsibilities.
- helped break down social barriers and organisational hierarchies through shared creative practice, developing humanistic qualities of mutual acceptance and trust, a sense of connection and common creative or artistic identities among those involved.
Challenges to mutuality in these settings included:
- difficulties surrounding group participation;
- tensions between personal needs for social or creative distancing versus connection to others;
- personal and professional ‘boundaries’;
- professional values, organisational responsibilities and practical considerations;
- balancing efforts towards mutual acceptance and inclusion with maintaining a conducive working environment for everybody; and
- unstable funding.
The study also found that in creative arts ACL and participatory arts settings, educational and mental health and wellbeing goals may be viewed as complementary and there can be similarities and overlaps between educational processes and therapeutic ones. Nevertheless, tensions between these goals may arise and in ACL contexts, an explicit focus on wellbeing aims may risk overshadowing educational objectives.
Conclusions and implications
Creative arts initiatives can be an effective way of meeting growing calls for a shift of emphasis in mental health services provision towards social perspectives and a community development approach and of developing relationships and social support in the context of the wellbeing agenda. Both targeted and mainstream creative arts initiatives have a role in supporting mental health and wellbeing. There is also an important place for women-centred creative arts provision which facilitates the development of peer learning and support systems.
In creative arts ACL and participatory arts settings, a mutual approach based on shared creative practice among practitioners, volunteers and other participants can offer mental health and wellbeing-related benefits for everyone involved. However, creative arts community initiatives often need to achieve a balance between self-directed and collective practice/learning and ‘mutuality’ should not be expected or forced upon participants. Furthermore, to achieve a mutual approach involving shared creative practice among practitioners and other participants in creative arts ACL and mental health participatory arts settings, practitioners and volunteers need to be supported to negotiate the challenges involved. Indeed, the challenges of working in the area of mental health mean that mutual support among staff is essential for practitioner wellbeing.
Creative arts community-based initiatives should recognise the resources within client groups which can support educational and mental health and wellbeing objectives. However, staff facilitation remains important. In addition, the importance of relationships and social support to wellbeing and recovery means that continuity and stability of provision of creative arts ACL and participatory arts initiatives is necessary for maintaining outcomes in these domains.
Lastly, the findings indicate that it is often better for wellbeing aims to remain implicit in ACL settings. In addition, it should not be assumed that involvement in the creative arts, nor mutuality, is automatically beneficial to mental health and it is important to maintain broad ACL curricula.
Outputs from this project include briefings and reports. For further information, please visit the project web site or contact Dr Lydia Lewis, Institute of Education, University of Wolverhampton, Walsall Campus, Gorway Road, Walsall WS1 3BD. E-mail: Lydia.firstname.lastname@example.org; Tel. +44 (0)1902 323233 (Tues-Thurs).
For further information about the CPMR programme, please see:
Crawford, P., Hogan, S., Wilson, M., Williamon, A., Manning, N., Brown, B. and Lewis, L. (2018), Creative Practice as Mutual Recovery. Research Programme Final Report, University of Nottingham, April.
Lewis, L. (2012), The Capabilities Approach, Adult Community Learning and Mental Health, Community Development Journal special issue on mental health, 47(4): 522-37.
Wallcraft, J. and Hopper, K. (2015), The Capabilities Approach and the social model of mental health, in H. Spandler, J. Anderson and B. Sapey (eds.), Madness, Distress and the Politics of Disablement, Bristol: Policy Press, pp.83-98.
Dr Lydia Lewis, University of Wolverhampton (lead); Dr Helen Spandler, University of Central Lancashire; Howard Croft and Clare White, Workers’ Educational Association; Professor Jerry Tew, University of Birmingham; Dr Janet Wallcraft, Suresearch Mental Health Network and University of Wolverhampton; Tony Devaney, Suresearch; and Professor Kathryn Ecclestone, University of Sheffield.
We would like to thank the third sector organisations which collaborated in this research and to extend particular thanks to all the participants who gave their time and insights by taking part in interviews and the staff members who facilitated the fieldwork. We are also grateful to those in the study setting for accommodating the participant observation.
This research was funded by an AHRC/RCUK Connected Communities large grant, no. AH/K003364/1.