Using arts in the training of healthcare professionals

Today I 'attended' my very first webinar (- for the uninitiated, a seminar conducted over the Internet). Hosted by the European Forum for Primary Care the webinar featured Mehmet Akman (a Turkish academic working in the field of primary care and based at Marmara University School of Medicine) who spoke about 'Using arts in the training of primary care professionals'.

Mehmet's presentation was underpinned by four key points:
1. Art, especially literature, is helpful for handling values rather than facts, ambivalence rather than reductionism, dealing with a world where not everything can be explained by experiments;
2. Art creates a stimulating environment for professionals to express their feelings and thoughts regarding different aspects of human nature and themselves in a reflective manner;
3. Art has a potential to support developing an ability to respond to human needs during clinical work;
4. When used for professional development, arts can have instrumental functions (e.g. better recognition of visual signs, developing skills to deal with uncertainty,) and non-instrumental functions (e.g. personal development, new ways of thinking beyond the biomedical perspective.) The latter can be achieved through sessions in which the intrinsic value of art can be retained.

In the discussion that followed, it was acknowledged that Mehmet had focused on doctors working in primary care but that all of this could apply equally to other healthcare disciplines, other specialisms. I suggested that a logical consequence of using creative arts and humanities in the training of healthcare professionals was that these professionals might then go on to use these approaches in their direct clinical work with service users and carers. As one of the other participants pointed out, occupational therapy has a long and honourable tradition of using creative arts as part of practice. There is no reason why creativity can't be a positive influence in healthcare more generally and I'm grateful to Mehmet and his colleagues at the European Forum for Primary Care for reminding us of this.

Wellbeing in three strings – Dulcimers in Malvern

Elgar statue at Elgar's birthplace
(c) 2017 Tony Gillam 

This autumn I spent a musical weekend in Great Malvern, the picturesque Worcestershire town at the foot of the spectacular Malvern Hills. Malvern has a connection with the composer Edward Elgar (1857–1934.) His music is said to have been inspired by walking and cycling in the countryside around the hills, and the Post Office in Great Malvern was, in his day, a piano shop where he would give piano and violin lessons. He and his wife Alice are buried in St Wulstan's Church in nearby Little Malvern.

Malvern, then, was a fitting location for a weekend of music-making. The music, on this occasion, was not pianos and violins but dulcimers, the event being a gathering of the Nonsuch Dulcimer Club – a UK-based organisation for anyone interested in hammered or mountain dulcimers. Now, for the uninitiated, I should say a bit about these instruments. Dulcimers are part of the zither family of string instruments and are struck or plucked. The hammered dulcimer is a trapezoid shape and is played with 'hammers' of wood, cane or bamboo. A mountain dulcimer, on the other hand, is a completely different instrument. Sometimes called an Appalachian dulcimer (as it was developed in the Appalachian mountains in the late 18th century) it's a descendant of a variety of fretted zithers brought to America by European settlers. The mountain dulcimer is played on the lap and strummed or plucked. I've been playing the mountain dulcimer – not always very competently – for about thirty years and recently discovered (and became a member of) the Nonsuch Dulcimer Club.

Great Malvern from the Priory Tower

And what has all of this got to do with creativity, wellbeing and mental health? Well, quite a lot actually. First, there's the strange fact that, of the two hundred or so members, three – including myself – are both mental health nurses and mountain dulcimer players. But it goes deeper than this...

You may be familiar with the five-a-day campaign to encourage healthy eating. Taking its inspiration from this campaign, in 2008 the New Economics Foundation's Centre for Well-being developed a similar set of five evidence-based actions that the public could easily implement to improve personal wellbeing (Aked, Marks, Cordon, Thompson, 2008). Their wellbeing 'five-a-day' recommended five actions to be incorporated into day-to-day lives to promote wellbeing. They are:

•           Connect

•           Be active

•           Take notice

•           Keep learning

•           Give

My weekend in Malvern was a great example of all five. Over a weekend of workshops and concerts, we were able to connect with other dulcimer players. We made and renewed friendships. We were active – in the sense that we didn't just talk about the dulcimer but played it. Some took the opportunity for some walks in the beautiful surroundings of Malvern; some even danced. We took notice, of our surroundings, of our own and each other's playing. We kept learning new tunes, new techniques, (thanks to the skill of the talented tutors.) And we gave – we shared stories and songs, in an open stage concert, in snippets of useful information or insights.

An Appalachian or
mountain dulcimer

Malvern was originally a spa village and became a destination for the 'water cure'. First the Georgians, and then the Victorians flocked there for the curative and restorative qualities of its spring water. But the 'cure' of the dulcimer weekend was less to do with Malvern water (good as it still is) but with the enjoyment of a restorative dose of connection, activity and shared learning. Such brief periods of respite from the stressful humdrum of workaday life can enhance feelings of what Seligman (2011) calls positive emotion. This includes feelings of happiness, contentment, enjoyment, curiosity and engagement ...and all this from playing an instrument with only three strings.

References

Aked, J., Marks, N., Cordon, C. & Thompson, S. (2008). Five ways to wellbeing: The evidence. London: New Economics Foundation.

Seligman, M.E.P. (2011). Flourish: A new understanding of happiness and well-being – and how to achieve them. London: Nicholas Brealey Publishing.

Not just surviving but thriving

Mental health has been in the news recently with the publication of a report from the Department for Work and Pensions and Department of Health. Thriving at Work: a review of mental health and employers  sets out what employers can do to better support all employees – including those with mental health problems – to remain in and thrive through work. The 84 page document makes recommendations for employers, for the public sector and for government.  

What is interesting is the emphasis on thriving. The authors, (Lord Dennis Stevenson and Paul Farmer) state: "we start from the position that the correct way to view mental health is that we all have it and we fluctuate between thriving, struggling and being ill and possibly off work" (p.5). There are similarities, in this analysis, with Keyes' (2002) view of wellbeing as a continuum, with flourishing at one extreme and languishing at the other. We are flourishing – or thriving – when we are enjoying positive emotion and good psychological and social functioning, whereas languishing is associated with emptiness, stagnation and despair.

Earlier this year, to coincide with Mental Health Awareness Week, the Mental Health Foundation published its own report Surviving or Thriving? The state of the UK's mental health. The Mental Health Foundation is a UK charity dedicated to addressing the sources of mental health problems so people and communities can thrive. Like the Stevenson/Farmer review, Surviving or Thriving? makes some helpful recommendations, including 'ten steps we can all take to thrive' and 'five steps for a mentally thriving UK'.  Both reports are well worth a detailed read for, as Surviving or Thriving? warns:

"current levels of good mental health are disturbingly low. The barometer of success of any nation is the health and wellbeing of its people. We have a long way to go before we can say that we are a thriving nation. Although we have made great strides in the health of our bodies and our life expectancy, we now need to achieve the same for the good health of our minds" (p.6).

References

Keyes, C.L.M. (2002). The mental health continuum: from languishing to flourishing in life. Journal of Health and Social Behavior, 43, 207-222.

Stevenson, D & Farmer, P. (2017).  Thriving at work. The Stevenson / Farmer review of mental health and employers. London: Department for Work and Pensions and Department of Health.

Mental Health Foundation (2017). Surviving or Thriving? The state of the UK's mental health. London: Mental Health Foundation.