06 Aug Creativity, care, and community: an exploration of best practice
By Daisy Carter
The Five Year Forward View for Mental Health, a 2016 report from the independent Mental Health Taskforce to the NHS, outlined a need for wider action to address employment, housing, and social inclusion when tackling mental health. Poverty is a significant risk factor, and mental health problems are overrepresented in precarious employment, marginalised communities (such as BAME and LGBT groups), as well as in those in contact with the criminal justice system. The presence of trauma, poor housing, homelessness, and a learning disability or autism also increase incidences of mental health problems.
In a context of welfare cuts, a housing crisis, in-work poverty, hostile environment policies, cuts to SEN support, underfunded refuges, and a disparity in the use of force and sentencing for Black Britons compared to their white counterparts, these are not risk factors that can be located within the scope of the individual alone. And yet the process of seeking help is so often an isolating one. Responsibility is outsourced to the individual, to prove the scale of crisis and trauma, to continue to perform engagement as they are pushed from service to service, often without any meaningful involvement in the direction of their own care.
Community care: what does best practice look like?
I am interested in the intersections between mental health and social exclusion, the process of seeking help, and the potential for new models of community care to create spaces of meaningful engagement, where individuals are both supported and active participants in their own care.
I looked to Norwich based community arts organisation ArtatWork CIC, who support (amongst others) women with mental health issues and complex needs. The group uses visual arts to promote community and wellbeing, as well as to encourage creativity.
“Many women we work with are coping not only with their mental health, but with a multitude of obstacles such as Aspergers, poverty, trauma, physical health issues, domestic abuse, and caring responsibilities.” – Holly Sandiford, co-director of ArtatWork CIC.
Experience of service users: a case study
I interviewed a member of the group, who for this article we shall call Jenny.
I was moved by my conversation with Jenny: she detailed a shift from a total isolation of self, to feelings of connectedness, empowerment, and a sense of being cared for. The change her involvement in the group has offered indicates something like best practice: providing a space to feel valued by and close to others, alongside continued creative learning and input.
Jenny has multiple and complex needs. She had a traumatic childhood, and is a single mum to a daughter with autism characterized by pathological demand avoidance (PDA). The process of seeking help, both for herself and to support her to support her daughter, has been a painful process with negative impacts on her mental health.
Jenny articulates a story of exposure and isolation in contact with mental health providers, of being passed between siloed services, and of being directed towards inappropriate support that she felt forced to engage in, for fear of the rug being pulled completely. She talks about the group as a break from previous experiences: as a space for resilience building, non-judgement, creative exploration, emotional support, and being valued as an equal.
A lack of care ands its impact on health
When I asked Jenny about her previous experiences with mental health providers, she replied: “funny you should ask that, nobody wants to know.” ‘
She describes being in contact with all available services and charities. Prior to the process of seeking help, she was “coping”, but her contact with various providers pushed her to her lowest. She had “never felt so depressed”.
“You feel so exposed, you pour your heart out, and they do nothing with it… It’s the overall picture. The lack of care out there is made so clear to you. The message is: just get on with it.”
Exposing her most intimate needs, only to be ignored, passed on, and made to feel distinctly un-cared for, heightened her anxiety and paranoia, as well as leaving her drained and exhausted. A resounding sense that she should “just get on with it” isolated responsibility to feel better to her and her alone.
When reaching out to Children’s Services for help supporting her daughter, instead of feeling supported, she describes an incident of feeling threatened. “I just shut down” she tells me. The process of seeking help was cut short by a sense that she was being judged.
Inappropriate care and feeling stuck
She also talks of receiving care that felt was ill-fitting, and having to continue with that service for fear that non-engagement “goes down on your record.”
“I’ve exhausted counselling” she tells me. She describes being given “the wrong kind of counselling” for her particular needs. “You’re just telling your story all the time…they just sit, listen and watch.”
It was clear to Jenny that instead of an expectation to narrativize her trauma, she needed tangible advice and coping strategies. Her sense that she was receiving inappropriate care left her “stuck in a catch-22”: gaining little from the service but fearing being judged as noncompliant.
Jenny had very little input in the direction of her care: pushed away from services, or pushed towards help that was not the right fit. “You just dance to their tune” she says.
What can ‘getting it right’ look like?
By contrast, engagement with the community arts group is supported but self-led.
“It’s how you want to be with it…it’s different [to other services], you talk if you want to talk… the ball’s in your court.”
Participants might choose one day to participate loudly, and another to simply focus on a creative task, or pull one of the facilitators for a chat.
Members have an active role in the kind of creative activities they engage with as a group, and this has a positive impact on Jenny’s sense of self.
“They let us have in impact. It’s not tutor-student, there are no levels. Feeling valued is really important for your mental health”
There is a parity between service users and providers, a collectivity in decision-making and creative direction: all are co-architects of both their creative outcomes and a network of peer support.
“I don’t feel judged, and I always feel judged… We’re like a family. Everyone has the same issues, no one’s better than anyone… we’re all equal, and treated as such.”
The impact- of feeling supported, valued and connected without judgement- has offered a “breathing space” to Jenny. Her weekly participation offers the “strength to carry on.”
“When my day is really tough, or my daughter is having a breakdown, I focus on the days I come to the arts group.”
What can we learn?
Jenny’s experiences point to a model of community care, which offers support to marginalised and vulnerable people, as a space of connectedness and valuable engagement. ArtatWork facilitate activities where members are proud of and contribute to its outcomes. Dynamics of hierarchy are squashed, and service providers and users hold equality of esteem. An empowerment of self, that is not by-its-self, but part of a community who offer collective support, creative learning, and strength-building.
People facing social exclusion or isolation should be treated as valuable stakeholders in the direction of their own care, and made to feel as such. Assuming what people want or need makes them an outsider to their own recovery. And if in seeking care, people gain a heightened sense of not being cared for, the very process of seeking help can contribute to a worsening of mental health.
In the facilitation of safe space, where “the ball is in your court”, community providers can work to meet people where they are, to strengthen connection and resilience, before the point of crisis.
Histories, social realities, and material inequalities impact our health, and triggers are complex and far reaching. When society is ever more atomised, and individuals ever more isolated, community care providers can offer an important component of preventative planning against poor mental health.
But community providers cannot operate alone. Policy planning and investment needs to address the significant risk factors which heighten incidences of mental health problems, in particular the crises of precarious housing and employment.
My thanks to Holly Sandiford and to Jenny, for sharing their insight and experience.