Aims: There has been a burgeoning interest in arts and the environment in healthcare. While research has been undertaken on the clinical impact of disciplines, relatively little research has studied the impact of broader arts for health interventions. This paper reports findings from a systematic review of the arts for health literature, encompassing research on the impact of visual art, design and the environment on the well-being of patients and staff in mental healthcare settings. Methods: A systematic review of over 600 papers published between 1985 and 2005 on the impact of arts, design and environments in mental healthcare was undertaken. The review includes a discussion of contextual and policy literature, as well as 19 reports of quantitative and qualitative studies that met our inclusion criteria. Results: The largest number of studies focused on the aspects of art, design and environment that were relevant to mental healthcare. These studies suggest that this can affect health, including physiological, psychological, clinical and behavioural effects. Exposure to stressful visual and aural environments may reduce levels of stress and enhance recovery. Architectural design consideration is important in mental health settings, especially for patients with conditions such as dementia that can make wayfinding difficult. Exposure to art in healthcare environments has been found to reduce anxiety and depression. Environment features have also been found to affect staff, and improvements in visual and acoustic conditions may reduce risks of errors in some care settings. Qualitative studies provide insights into factors affecting the impact of arts, including issues of power and control, perceptions and influence of key stakeholders, and user participation. A key issue to emerge from this study is that arts interventions do not necessarily address the lack of control exercised by patients in healthcare environments. Conclusions: While there is extensive literature on the impact of design, environment and the arts on health, there is still a need for further research that addresses methodological challenges of evaluating complex interventions. Our review found evidence that environmental enhancements can have a positive impact on health and well-being of staff and patients in mental healthcare. Arts, when considered within this framework of evidence-based design, can also contribute to well-being, offering reassurance and creating identity in healthcare settings. Further research is needed in this area, as well as research that explores the contribution of other models of art that do not fit within the framework of `evidence-based design'. Finally, responses to the arts are contingent on a number of complex social and political factors; further understanding of these is needed in order to inform future research and evaluation of the arts in healthcare.

Server training courses that are designed to reduce disorder have some potential, although there is a lack of evidence to support their use to reduce intoxication and the evidence base is weak.

BackgroundLicensed premises offer a valuable point of intervention to reduce alcohol-related harm.ObjectiveTo describe the research design for an exploratory trial examining the feasibility and acceptability of a premises-level intervention designed to reduce severe intoxication and related disorder. The study also aims to assess the feasibility of a potential future large scale effectiveness trial and provide information on key trial design parameters including inclusion criteria, premises recruitment methods, strategies to implement the intervention and trial design, outcome measures, data collection methods and intra-cluster correlations.DesignA randomised controlled trial in licensed premises that had experienced at least one assault in the year preceding the intervention, documented in police or hospital Emergency Department (ED) records. Premises were recruited from four study areas by piloting four recruitment strategies of varying intensity. Thirty two licensed premises were grouped into matched pairs to reduce potential bias and randomly allocated to the control or intervention condition. The study included a nested process evaluation to provide information on intervention acceptability and implementation. Outcome measures included police-recorded violent incidents, assault-related attendances at each premises' local ED and patron Breath Alcohol Concentration assessed on exiting and entering study premises.ResultsThe most successful recruitment method involved local police licensing officers and yielded a 100% success rate. Police-records of violence provided the most appropriate source of data about disorder at the premises level.ConclusionThe methodology of an exploratory trial is presented and despite challenges presented by the study environment it is argued an exploratory trial is warranted. Initial investigations in recruitment methods suggest that study premises should be recruited with the assistance of police officers. Police data were of sufficient quality to identify disorder and street surveys are a feasible method for measuring intoxication at the individual level.Trial registrationUKCRN 7090; ISRCTN: 80875696FundingMedical Research Council (G0701758) to Simon Moore, Simon Murphy, Laurence Moore and Jonathan Shepherd

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Whilst arts-based approaches are not free from risk, they offer an alternative form of knowledge as a necessary complement to the range of data available to policy makers.

BackgroundTo assess the feasibility of a randomised controlled trial of a licensed premises intervention to reduce severe intoxication and disorder; to establish effect sizes and identify appropriate approaches to the development and maintenance of a rigorous research design and intervention implementation.MethodsAn exploratory two-armed parallel randomised controlled trial with a nested process evaluation. An audit of risk factors and a tailored action plan for high risk premises, with three month follow up audit and feedback. Thirty-two premises that had experienced at least one assault in the year prior to the intervention were recruited, match paired and randomly allocated to control or intervention group. Police violence data and data from a street survey of study premises’ customers, including measures of breath alcohol concentration and surveyor rated customer intoxication, were used to assess effect sizes for a future definitive trial. A nested process evaluation explored implementation barriers and the fidelity of the intervention with key stakeholders and senior staff in intervention premises using semi-structured interviews.ResultsThe process evaluation indicated implementation barriers and low fidelity, with a reluctance to implement the intervention and to submit to a formal risk audit. Power calculations suggest the intervention effect on violence and subjective intoxication would be raised to significance with a study size of 517 premises.ConclusionsIt is methodologically feasible to conduct randomised controlled trials where licensed premises are the unit of allocation. However, lack of enthusiasm in senior premises staff indicates the need for intervention enforcement, rather than voluntary agreements, and on-going strategies to promote sustainability.Trial registrationUKCRN 7090; ISRCTN: 80875696

This paper describes and critically assesses the use and development of a model of participatory theatre to reappropriate the ways in which a place in the deindustrialized south Wales valleys is represented. Neo-liberal policies which focus on individual responsibility, conditionality, sanctions and incentives frame the production of statistics on health inequality and deprivation in particular ways. While 'place' can be a resource for expressing positive identities this presents people living in economically under-resourced areas with a problem if that place-based identity is also subject to vilification. In this paper we focus on three objectives: to explore negative stereotypes of a post-industrial community; to describe the methods and process of working alongside local people to offer alternative ways of understanding place; and to discuss the implications of using community theatre for policy and practice. We argue that theatre-based forms of place-making and dialogue can create spaces where policy issues, such as health and well-being, can be discussed in the context of everyday local concerns. Meanings in common are generated in ways that create affective understandings of place and the impact of economic change and crisis (Jones et al., 2013). These co-productive processes are uncertain, emergent, and risky and need to be managed carefully in the context of trustful relations.

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