Role of Arts in Health and Well-being

What role can the arts have in making someone feel better?
Respond to and critique this idea, exploring notions of “well-being”, illness and health and using 2 or three examples of practice.
I will respond to this question by first examining the language and definition of well-being and health.  I will then explore the question further with specific regard to the way applied arts can benefit community health, those at risk of social exclusion and intergenerational social harmony.  I will also reflect upon arts funding within a community well-being context, particularly; the difficulty of evaluating arts-based health projects, the decrease in core funding for education and social services and how the lack of “diversity” or depravation within a community can actually in itself lead to deprivation.

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Using two examples of applied theatre in the Scottish Borders I will argue that the arts can help make participants feel better in a personal, non-medical sense. Through my analysis, I will conclude that the arts can be greatly beneficial to users but only within a strong, vibrant and holistic health service that properly funds and values the impact of artistic service providers.  I will argue that the Arts, when applied in the correct context with trained professionals, have the power to make people feel better in many complex and subtle ways.  Through my work as a youth theatre director and media tutor I see, first-hand, the benefit to, for example, participant’s self-confidence and self-esteem that can be achieved through ensemble drama and community arts projects.  I am also aware that the effect is not universal.  Therefore, whilst I will contend that Applied Theatre cannot be used to halt the effect of medical diagnoses, it can be used to shape the individual’s response to their symptoms, their feelings about it and how society can build more resilient and empowered communities.
As John Ashton, former president of the Faculty of Public health wrote in Let’s Invest in Real Health:
“To make the best of our health and well-being, we need to make it intrinsic to the way we think and live. Our understanding of what good health means should run through our lives like the writing on a stick of Blackpool rock.” Ashton, 2014.
Like the letters in the rock Ashton refers to, I believe that all aspects of understanding how people can be “healthier” must be delicately woven into everyday life.  A holistic approach, empowering individuals to better understand their own “well-being”.  Societies that are educated from an early age about physical. mental, emotional, social and spiritual well-being.
Defining what “well-being” is however, can be elusive.  As Dr Katharine Low suggests:
“the notion of “well-being “is controversial.  Politicians and policy makers frequently refer to notions of well-being, but the goals and understandings of the term are quite different, as are their uses of the concept.“ Low, 2017, Performing Arts and Well-being
Much like the language used to describe an individual’s response to their own feelings of personal well-being, the concept of “well-being” is a personal response and varies between individuals, As Dr Low suggests, sometimes no common language exists to define a word that means different things to everyone.
Clarifying what “good health” means has long been difficult to define.  In Scotland the Getting it Right for Every Child (GIRFEC) approach is modelled on the United Nations Conventions on the Rights of the Child (UNCRC) and aims to provide support for all children and young people in Scotland. 
The GIRFEC model “supports children and young people so that they can grow up feeling loved, safe and respected and can realise their full potential. At home, in school or the wider community, every child and young person should be: Safe, healthy, achieving, nurtured, active, respected, responsible and included (SHANARRI)” https://www.gov.scot/policies/girfec/principles-and-values/
The GIRFEC approach is reflected in all government policies which directly involve children, young people and their families and is cascaded down through government services, education and is adopted by all those who work with children and families.  In my view, by embedding the GIRFEC concept within all aspects of Scottish children’s lives the government have created a framework that both; allows partners to more clearly understand the objectives of the government and sets a very prescriptive and narrow set of restrictions on organisations working within the arts education sector.  As a practitioner I find it useful to have guidelines on working with young people but as a working professional it can sometimes be frustrating having to justify artistic decisions against targeted outcomes to receive funding.
Using the GIRFEC model, agencies that work within the arts and health field are more easily able to align outcomes and  bjectives from projects as everyone is using the same language around the “well-being” of the child.
Understanding how health, illness and “well-being” are different yet intrinsically connected is important when discussing how the arts can be used to help make someone feel better.   I don’t infer that applied arts can be used as “medicine” to treat ill health but rather to inform, to educate and to engage. 
“Health” is another slippery concept. The World Health Organisation defines health as:
“A state of complete physical, mental and social well-being and not merely an absence of disease or infirmity” WHO constitution, 1948)
Yet, this definition does not really consider the individual’s response to their symptoms and general feeling of health and has not been amended since 1948. Individuals with the same symptoms may react and “feel” differently about their diagnoses.
“Whether or not someone is ill, is something the person concerned ultimately must decide for him- or her-self. But whether that person has a disease or is sick is something doctors and others may dispute.” Kenneth Boyd, 2000.
Boyd is distinguishing between “well-being”, the self determination of illness and the “medical” description of health. For example; a doctor may ask an individual to describe the pain they are experiencing on a scale of 1-10 to help diagnose, this self-diagnosis can only be applied to the individual and cannot be used in any forensic way.  My wife has given birth, her 10 and mine on the scale would be different and couldn’t really be compared.
In an arts and health environment, it is possible to alleviate physical and emotional symptoms of disease through the delivery of the ‘art’ itself; individuals recovering from a disease could for example regain greater mobility and motor skills as result of participating in circus skills and clowning workshops.  Simple exercises such as pretending to walk a tight rope can help improve someone’s balance and coordination and can help increase the distance and time someone can walk unaided., learning to juggle can help an individual’s motor skills and reflexes and clowning can help an individual greater understand how others are feeling. The combination of having fun, learning new skills and engaging in an activity not normally associated with older people, in addition to cardiovascular and physical exercise, is a small example of how increasing resilience within an individual be helped by the arts and that in turn can have a wider impact on the community through lowering reliance on services. 
“a general definition of good health is impossible since health is always experienced and the value of each of us sets on different aspects will vary” Matarsso, 2010.
Rather or in conclusion, to truly or better understand health, we must acknowledge that every individual is the keeper of their own interpretation of symptoms, feelings and “well-being”.  It is therefore my contention that applied arts must be bespoke, targeted and user-led if it is to have any impact on health.
Accordingly, I will now examine two examples of Applied Theatre whose practice I believe achieves these aims and also begin to explore the funding of Applied Arts projects.
“I Mind o’ that” is an intergenerational reminiscence project run by Borders Youth Theatre (BYT).  Working with rurally isolated communities in south east Scotland, BYT, supported by local windfarm goodwill funds, partners with a primary school and a local older people’s group to produce a piece of theatre based on the young people’s interpretation of the older people’s childhood memories.  The project, which runs for twelve weeks, sees the young people interview the older folk, record their memories and stories and produce a booklet of reminiscences that will be used to devise and produce a performance for the school and wider community.  The project compliments the Curriculum, is GIRFEC compliant, by covering aspects such as communication, comprehension and community as well as drama, music, media and technology.  The project, which is led by a youth drama worker and a retired head teacher, is now in its sixth year and has reached 12 primary schools and nearly 300 rurally isolated people.  Those living in rural areas often experience social isolation and poverty due to issues relating to lower population density, the disparate nature of rural settlements and geographical isolation.  In addition, issues such as low wages, higher fuel cost and infrequent local transport services can impact higher on groups such as older and younger people.
For many of the participants this is the first time they have interacted with the other constituency. 
“I never talked to older people about their life in the past” (Pupil, Liliesleaf Primary School)
“I enjoyed reminiscing with young people” (Resident, Liliesleaf)
Over the weeks bonds emerge and both groups arrive early and are very excited to see the other.  Often these are tiny communities and older individuals can experience feelings of isolation and loneliness.  Simply knowing someone’s name and having spoken to them breaks down a barrier.  Being able to say hello, by name, to people who pass in the street is a tiny but very important way in which a community can feel safer and more together. The benefits to the young people in terms of boosting self-esteem and confidence as well as learning new skills can be seen, and the older people also reported feeling more active and more prepared to try new things, but the main benefit is to the wider community; Both constituents of the reminisces projects view themselves as helping the other although the project is never pitched to them as that. So, by participating, both constituents get the sense of civic networking and belonging without feeling they are doing “worthwhile and worthy” work.  Both groups are equal participants, but both groups feel they are participating for the benefit of the other.  In seeing their childhood memories restaged by children, the older people feel better about themselves and their place in the community.

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A similar project saw the Voice of My Own (VOMO) video project work with young people at risk of offending and exclusion in high schools in the Scottish Borders. The project had a restorative justice approach; allowing the young people to understand the effect of their offending behaviour upon the community and individuals and also helping the partners to reduce the anti-social and risk-taking behaviour of the service users.   The participants visited the local police station and met with police officers who had been arresting them, by simply having a conversation the participants come to realise that the individual police officers are helpful and friendly and want the best for them and their community.  
Using film as a means of social engagement the project brought together local businesses, social services and the police to help create positive community links with young people.  A small moment, such as a young person at risk of offending behaviour playing a game of pool with an officer who has previously arrested them can create a positive link; both the officer and the young person are more able to see the other’s perspective, a dialogue can be opened in a non-threatening manner to discuss the causes of the young person’s offending behaviour and thus signpost them to additional services from which they may benefit.  The final work was filmed on location in a local shop that had been experiencing issues with shop lifting and anti-social behaviour. 
The community benefits from better cohesion because the project helps to create more resilient individuals who feel valued and part of a stronger community and the funders and partners achieve their outcomes in line with national strategy.  In a wider health context by helping create more resilient and empowered individuals the overall burden to overly subscribed services, such as befriending or additional learning support, and to NHS and police services can be reduced.
By using the arts, in this instance film making, informal learning, such as learning how all the members of the team need to cooperate to achieve the objective, is able to take place in non-traditional settings.  Using applied arts can engage those disadvantaged and at risk who would otherwise not have the opportunity with an activity that is of interest to them and empower them to have a voice of their own.
Through improving the individual’s sense of “feeling good” and by raising aspiration and reducing future potential support requirements, such as youth offending services and social services, I argue that the wider community can benefit in many ways including: lower offending rates, reduction in anti-social behaviour, improved life style choices and an overall reduction in state and third sector dependence and expenditure.  I will later argue that funding for such projects is difficult to obtain and often bound by targets and directed too specifically.
By engaging participants in positive, user led activities designed to boost self-esteem, confidence and coping strategies the arts can help transform people’s feeling of “well-being”.  By offering a creative voice to those often unable or unwilling to express their feelings and opinions or in isolated circumstances the arts can help people feel better and to alleviate feelings associated with illness.
Those working in the field of Applied Theatre have an acute awareness that whilst the benefits to the way people feel about themselves are provable and worthwhile we must remain realistic about the impact our work can have in areas of medical health and curing disease.  Rather our work can benefit users towards leading a healthier lifestyle, helping individuals make informed and appropriate decisions and ultimately helping to create a more joined up and cohesive community.
Only by understanding that we need to treat people holistically, as John Ashton purports, within a wider National setting, such as GIRFEC aims to achieve and using a wide range of methods that complement existing services rather than seeking to replace them, like the “I Mind of That” project and the VOMO film club, will we truly be able to say that we are healthy.
Having investigated the examples above, I surmise that they illustrate the potential benefits and limitations of Applied Arts to Health and “Well-being” in as much as those words can mean following my earlier conclusions that the work must be bespoke, targeted and user-led. I will now reflect upon the area of arts funding. 
In a period of enforced and political austerity, it is even more incumbent on those working within the field of applied arts and health to maximise the potential benefit to individuals.  However, this must not be at the expense of the quality and purpose of the work; local authorities and funding bodies are increasingly forced to work towards the governments strategic aims.  In order to qualify for just £7200 from the local council Arts project, LIVE Borders, BYT, a volunteer run charity must now, in addition to reporting quarterly to LIVE Borders Board about all their activities, complete comprehensive reports on how their work impacts and actively seeks to engage with young people transitioning from school, disadvantaged or non-engaging young people and looked after children. Not only does this place additional burden on already dedicated volunteers, it risks BYT adapting the way they work to meet the requirements sufficient to receive funding.  Using, for example, the GIRFEC model, to help determine need has real benefits however it also excludes companies and charities that don’t align with the SHANARRI targets. 
Target based outcomes are difficult to evaluate within the arts as “change” can be difficult to evaluate and very “personal”. 
Another example of this is funding bodies relying on traditional methods to determine need; the Scottish Index of Multiple Depravation 2016 is an extremely useful tool with which to determine areas requiring additional support, the interactive map allows the user to see at a glance which areas and categories funders are likely to use to determine need; crime, housing and health.  This also means, at a glance, one can see the areas that are disadvantaged in other ways that are not priorities on the index such as those I mentioned in the section above about the “I Mind o That” project.   In rurally isolated areas there may not be the base poverty experienced in cities, no area of Rural Scotland is within the bottom 10% of the most deprived decile on SIMD, but other disadvantages are in play such as lack of arts opportunities, lack of transport, lack of further education opportunities and low wages. 
 All young people who live in the Scottish Borders for example are disadvantaged according to the geographical access domain rating on the SIMD, but this ranks very low on funders priorities. In the 2011 Census, the Scottish Borders has a population that is 98.7% white.  This fact alone excludes charities working within the region from accessing key UK Government, Creative Scotland and Lotto funding as they are seen as “non-inclusive”.   The only SIMD funding organisations can properly access in the Scottish Borders is via the three areas in the region that rank below the 5th decile.  This leads to the absurd situation where a very small number of people are targeted for all the resources allocated.  During one period last year in one of the three small areas on the SIMD lower decile in the Borders, there were applied arts practice in dance, drama, film, graffiti, poetry, music and art all running simultaneously.  Those identified as potentially benefiting from services are often “frequent flyers”, individuals who have complex and long-standing issues within their lives that cannot be solved by the arts alone.  Too often the only service these individuals in need of support receive is from arts workers which falls woefully short of helping to fix the individual and rather creates resentment and a non-productive work atmosphere. The organisations delivering the projects are forced, if they want to stay afloat, to tailor their work and effectively manipulate their bid to secure the funding.
These absurd situations are a hinderance to arts workers and perpetuate the “victim” mentality within the service users who are on a continuous carousel of intervention service which creates dependency and ultimately does nothing to empower the individual or benefit the community.
I argue that if funders, such as LIVE Borders are doing to BYT as noted above, continually focus their resources and time upon “disadvantaged” people they are disadvantaging the majority.  Rather than continuing to be channelled towards government outcomes with projects that target reluctant users I advocate a wider approach to public arts designed to integrate creativity and fun into every aspect of society; mass participation, cross generation projects that bring together different groups of the community.
In closing, having firstly attempted to define the terms health, illness and “well-being, I have argued that the arts cannot heal the symptoms of disease and should not be used instead of essential health services, but that the Applied Arts can make someone “feel better”, can improve their own sense of well-being, can augment and complement existing services and can educate in a more holistic way.
Finally, I argue that it is imperative upon those who work in the area of Applied Theatre to maintain belief in the value of their work and to not yield to the pressures of compromising its integrity in order to secure funding. 
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https://www.who.int/about/mission/en/