Rethinking risk: a narrative approach

Purpose The assessment and management of risk is central to contemporary mental health practice. The emergence of recovery has contributed to demands for more service user centered approaches to risk. This paper examines the potential of narrative as a framework for understanding risk and safety in mental health care. Design/methodology/approach Narrative theory is adopted to structure a debate examining the potential role of a narrative approach to risk assessment and inform future practice. Findings There is a danger that even within services, people with mental health problems are understood in terms of their riskiness perpetuating an image of service users as ‘dangerous others’. This is confounded by a disconnection with individual context in the risk assessment process. Narrative centralizes the persons’ subjective experience and provides a contemporaneous self-account of their identity. This situates risk within a context and creates possibility for greater understanding of coping, strengths and resilience. Originality/value There has been a call for new ways of working with risk in mental health which facilitate safety and recovery. There is limited examination of what this might actually look like. This paper presents narrative as an approach that may achieve these aims

Promoting mental health through an inner city community arts programme: a narrative inquiry

The focus of this study is a community arts programme, Art in Mind, which is based in an inner-city area of an East Midlands city in the UK and was funded by the government's New Deal for the Communities. The aim of the qualitative research study was to gain understanding of the human processes involved in setting up such a project and to ascertain the subsequent benefits to participants. The research was conducted in two stages: stage one involved semi-structured interviews with seven of the original Art in Mind Steering Group members and stage two comprised interviews with eleven participants who were interviewed up to three times over a one-year period. Sixteen people were interviewed in total. The findings from participants are presented as a case-series. Interviewees included those who subsequently became members of the 'Lost Artists Club', one of the community-based activities that originated within the project and those who engaged with an 'Arts on Prescription' programme. In both stages, a total of 35 qualitative interviews were conducted. The concept of mental health promotion through the arts is examined in the context of national developments to promote social inclusion. The methodological framework for the research is a narrative inquiry and emphasis is given to the stories that are individually and collectively constructed and recounted by the participants. All the data were subject to a narrative analysis, incorporating thematic, event and relational analysis. Individual and collective narratives are presented. Findings from stage one of the research identify the personal motivations of Steering Group members to develop the programme. Findings from stage two of the research reveal that the project facilitated new personal, social and occupational opportunities for participants. Identity claims are strong, as people have re-constructed themselves as artists. Participants enjoy a sense of belonging and social identity with like-minded people

Rethinking risk: a narrative approach

PurposeThe assessment and management of risk is central to contemporary mental health practice. The emergence of recovery has contributed to demands for more service user centered approaches to risk. This paper examines the potential of narrative as a framework for understanding risk and safety in mental health care. Design/methodology/approachNarrative theory is adopted to structure a debate examining the potential role of a narrative approach to risk assessment and inform future practice.Findings There is a danger that even within services, people with mental health problems are understood in terms of their riskiness perpetuating an image of service users as ‘dangerous others’. This is confounded by a disconnection with individual context in the risk assessment process. Narrative centralizes the persons’ subjective experience and provides a contemporaneous self-account of their identity. This situates risk within a context and creates possibility for greater understanding of coping, strengths and resilience. Originality/value There has been a call for new ways of working with risk in mental health which facilitate safety and recovery. There is limited examination of what this might actually look like. This paper presents narrative as an approach that may achieve these aims

Participatory theatre and mental health recovery: a narrative inquiry

Aims: To identify the potential relationship between participation in theatre and mental health recovery. To give voice to the stories told by participants of Teater Vildenvei, a theatre company that has been part of the rehabilitation programme for mental health service users in Oslo since 1995. Methods: Twelve narrative interviews were conducted amongst participants of Teater Vildenvei and the data were subject to a narrative analysis process following the philosophy of Paul Ricoeur and the specific methods of thematic, event and relational analysis as identified by Riessman. Results: The narratives are considered in the theoretical light of the mental health recovery framework as identified by Leamy et al. Each participant had experienced a transformation in identity; the sense of belonging within the group was perceived as highly important to their mental health; engagement with the theatre company gives people something meaningful to do, a sense of hope and individuals feel empowered. Conclusions: This narrative inquiry gave opportunity for participants to elaborate on their stories of their engagement with Teater Vildenvei. It is through the richness of the data, that the depth of the significance of meaning that people ascribe to their stories demonstrates the potential power of participatory theatre for mental health recovery. Because of its effects, people make life-changing and life-saving claims

The art of recovery: outcomes from participatory arts activities for people using mental health services

Background: There is a growing evidence base for the use of participatory arts for the purposes of health promotion. In recent years, recovery approaches in mental healthcare have become commonplace in English speaking countries amongst others. There are few studies that bring together these two fields of practice. Aims: The two aims of this study were (a) to investigate the validity of the CHIME framework (Leamy et al, 2011) for characterising the experience of Participatory Arts and (b) to use the CHIME framework to investigate the relationship between participatory arts and mental health recovery. Method: The study employed a two-phase methodology: a rapid review of relevant literature followed by secondary analysis of qualitative data collected from 38 people who use mental health service who took part in participatory arts activities designed to improve mental health. Results: Each of the recovery processes identified by CHIME are present in the qualitative research literature as well as in the data of the secondary analysis. Conclusions: Participatory arts activities produce outcomes which support recovery, specifically including enhancing connectedness and improving hope. They can be recommended to people living with mental health problems

Arts on Prescription in Scandinavia: a review of current practice and future possibilities

Aims: This article reviews current practice relating to arts and culture on prescription in Sweden, Norway, Denmark and in the UK. It considers future possibilities and considers each of the Scandinavian countries from a culture and health policy and research perspective. The UK perhaps leads the field of Arts on Prescription practice and subsequent research is described in order to help identify what the Scandinavian countries might learn from the UK research. Method: The method adopted for the literature search, was a rapid review which included peer-reviewed and grey literature in English and the respective languages of Scandinavia. Results: The discussion considers the evidence to support social prescription and the obstacles of the implementation of Arts on Prescription in Scandinavian countries. Conclusion: The article concludes that of the Scandinavian countries, Sweden is ahead in terms of Arts on Prescription and has embraced the use of culture for health benefits on a different scale compared to Norway and Denmark. Denmark, in particular is behind in recognising ways in which art and culture can benefit patients and for wider public health promotion. All three countries may benefit from the evidence provided by UK researchers

Arts on Prescription in Scandinavia: a review of current practice and future possibilities

Aims: This article reviews current practice relating to arts and culture on prescription in Sweden, Norway, Denmark and in the UK. It considers future possibilities and considers each of the Scandinavian countries from a culture and health policy and research perspective. The UK perhaps leads the field of Arts on Prescription practice and subsequent research is described in order to help identify what the Scandinavian countries might learn from the UK research. Method: The method adopted for the literature search, was a rapid review which included peer-reviewed and grey literature in English and the respective languages of Scandinavia. Results: The discussion considers the evidence to support social prescription and the obstacles of the implementation of Arts on Prescription in Scandinavian countries. Conclusion: The article concludes that of the Scandinavian countries, Sweden is ahead in terms of Arts on Prescription and has embraced the use of culture for health benefits on a different scale compared to Norway and Denmark. Denmark, in particular is behind in recognising ways in which art and culture can benefit patients and for wider public health promotion. All three countries may benefit from the evidence provided by UK researchers

A community arts programme for older people: an evaluation

PurposeThis paper presents an evaluation of a community based arts programme for older people in Nottinghamshire.DesignThe evaluation was conducted using a combination of pre and post-initiative quantitative questionnaires and qualitative focus group interviews. This article focuses upon the findings from the focus groups.FindingsParticipants reported feeling more positively about ageing and being more motivated to pursue new opportunities at the end of the programme. Five themes emerged from the focus group interviews, namely i) age and ageing, ii)the finished product, iii) new opportunities, iv) aspirations and the future and v) personal benefits. These related to increased confidence, having greater creative expression, meaningful occupation and opportunities for socialisation.Social ImplicationsThe programme was found to be successful in helping individuals feel more positive about their age, to feel more confident and motivated, to engage with others through mutual creativity, as well as to challenge negative social stereotypes of older people.Originality/ValueThe paper will be of relevance and value to those working with older people and those with an interest in the arts. This evaluation demonstrates the diversity of the older population with older citizen’s voices being at the heart of the programme