BackgroundPromoting the social inclusion of mental health service users is a UK policy priority, but the development of outcome measures in this area is at an early stage Aim To develop a social inclusion measure for use in a study assessing the outcomes of arts participation for people with mental health needs. Method Concept and question development based on literature review, national and European surveys and results of a survey of arts and mental health projects. Measure piloted with 23 arts participants/service user researchers and field tested with 88 arts project participants returning questionnaires including the social inclusion measure, a measure of empowerment and the CORE mental health measure. Results Three scales were constructed measuring social acceptance, social isolation and social relations. Internal consistency was good for the individual scales and for the measure as a whole. Correlations with empowerment and CORE scores indicate reasonable predictive power for the population. ConclusionsTests to date indicate the measure is acceptable and measures relevant concepts with good internal consistency. Test-retest reliability and construct validity are not established and replication is required to confirm internal consistency and establish a normative profile for the population.
This paper draws on a qualitative study that was undertaken as part of a national research study to assess the impact of participatory arts provision for people with mental health needs. It explores how arts and mental health projects may facilitate some of the key elements of what has been termed a ‘recovery approach’ in mental health. It is argued that it is precisely these elements – the fostering of hope, creating a sense of meaning and purpose, developing new coping mechanisms and rebuilding identities – which are hard to standardize and measure, yet may be the most profound and significant outcomes of participation in such projects. Therefore, in the context of a growing emphasis on recovery‐orientated mental health services, while not necessarily being appropriate for all service users, arts and mental health initiatives could make an essential contribution to the future of mental health and social care provision.
Direct payments enable individuals to purchase their own care rather than have directly provided services. This article unpacks the complexities involved in the implementation of direct payments by addressing the need to reconcile the strong evidence of their benefits with emerging concerns about the wider consequences of their implementation. One practice that highlights the conflicts at the heart of direct payments is the employment of personal assistants. While directly employing personal assistants offers maximum benefit for recipients, it also produces the strongest concerns. Therefore, an understanding of the context of direct payments, specifically the practice of employing personal assistants, is used to explore these complexities in greater depth. The discussion concludes by arguing for a more critical awareness of the wider context in which direct payments are being developed in order to understand how this context can open up or limit opportunities for greater self-determination. It suggests a number of factors that need to be addressed to ensure that direct payments continue to be a progressive strategy. These include reconciling conflicting ideologies such as those advocating individual choice and/or collective provision; the need for political action to secure adequate resources; and the development of alternative strategies such as cooperatives to address the collective needs of direct payment recipients and workers.
Attention to fostering compassion would help to shift the language of "recovery" (or "well-being") beyond the twin dangers of rhetoric and/or imposing preconceived definitions, models or expectations of what recovery "should" be. Therefore, the development of compassionate contexts should have a stronger place in modern mental health practice and policy.
Participatory art projects for people with mental health needs typically claim outcomes such as improvements in confidence, self-esteem, social participation and mental health. However, such claims have rarely been subjected to robust outcome research. This paper reports outcomes from a survey of 44 female and 18 male new art project participants attending 22 art projects in England, carried out as part of a national evaluation. Outcomes were quantified through self-completed questionnaires on first entry to the project, during January to March of 2006, and 6 months later. The questionnaires included three measures: empowerment, mental health [Clinical Outcomes in Routine Evaluation (CORE)] and social inclusion. Paired t-tests were used to compare overall change, and mixed model repeated measures analysis of variance to compare subgroups, including age, gender, educational level, mental health and level of participation. Results showed significant improvements in empowerment (P = 0.01), mental health (P = 0.03) and social inclusion (P = 0.01). Participants with higher CORE scores, no new stress in their lives and positive impressions of the impact of arts on their life benefited most over all three measures. Positive impressions of the impact of arts were significantly associated with improvement on all three measures, but the largest effect was for empowerment (P = 0.002) rather than mental health or social inclusion. This study suggests that arts participation positively benefits people with mental health difficulties. Arts participation increased levels of empowerment and had potential to impact on mental health and social inclusion.
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