Art offers ‘something extra’ to enhance health and well-being

Ballet dancer Deborah Bull left the Royal Opera House after 31 years to pursue her interest in arts and health at King’s College London. Now King’s is taking the research a step further to make programmes more accessible

Like many people with a long history in the cultural sector, my belief in the potential of art to make a difference runs deep.

My first memorable encounter with this possibility took place early in my dancing career, in the visitors’ room of an outer London hospice. I was there to demonstrate a daily ballet class and an extract from Swan Lake, in a project spearheaded by the Royal Ballet’s pioneering director of education, Darryl Jaffray.

Presenting dance in the ill-suited environment of a care setting was a logistical nightmare, but the project’s aim was simple: to take ballet to hospital and hospice patients who would otherwise be denied the chance to see live performance.

Over the course of the project’s existence, I danced in all sorts of locations: in reception areas, waiting rooms and even a chapel. This particular visit was made memorable not by the setting, but by a conversation afterwards with a patient recently admitted to the hospice. We talked about the ballet, my costume and my career. And, as I left, the matron told me they were the first words the patient had spoken since her arrival, several days earlier.

I was left with both a profound sense of the art experience having made a difference and a niggling curiosity as to how. What exactly was its impact? Would other encounters have achieved the same effects? How would you extract the ‘art’ component to measure its specific effect?

Without an integrated research element to the project, we would never know. Across my 31 years at the Royal Opera House – first as a dancer and then in the leadership team – I witnessed similar encounters with art that changed the way people felt and behaved, enhancing their well-being. Each time the impact was clear, but it wasn’t clear why.

This near-obsessive desire to understand, to be closer to evidence that might explain the impact of the art I’d practised for so long, underpinned my move in 2012 from the Royal Opera House to King’s College London.

The symbiosis between the arts and health is well understood at King’s. In 2001, it was the first UK university to establish a D’Oyly Carte Chair in Medicine and the Arts, with the post holder, Professor Brian Hurwitz, still the only member of an English department to be simultaneously a medical practitioner.

I discovered at King’s a growing number of academics working with artists and cultural organisations to generate, trial or communicate research, in a series of imaginative programmes led by my colleague Katherine Bond.

Art is also employed in education, complementing conventional teaching approaches and helping to develop critical thinking, communication skills, cultural competency and empathy in medical practitioners. Last year, we opened the Science Gallery London at King’s, bringing research to wider audiences through collaborations across arts and culture.

Building on these foundations, King’s was proud to act as research partner for the All-Party Parliamentary Group for Arts, Health and Wellbeing’s two-year inquiry into the evidence base linking arts engagement to physical and mental health.

Over the past few decades, the use of art in healthcare has dramatically increased. Projects have ranged across bespoke programmes for targeted patient groups, such as singing for chronic lung disease, or teaching magic tricks to improve motor skills in hemiplegia; the use of music for chronic pain; drama and art therapy for exploring mental health; stand-up comedy and gallery-based learning to develop empathy, reflection and communication skills in healthcare professionals; and video games to explain treatments, improving adherence to medication and promoting healthy behaviours.

Our ambition is to translate these already-proven programmes into sustainable, standardised and scalable health interventions

Arts-based interventions have moved from the fringes to a place where their potential impact on individuals and society is afforded serious consideration.

The APPG inquiry is the most recent in a series of reports over 20 years that has considered the impact of the arts on health at both individual and population levels. Some researchers have even put impressively high numbers on the savings arts interventions deliver, through reduced surgery visits or use of mental health services.

The APPG’s final report – Creative Health: The Arts for Health and Wellbeing, by Dr Rebecca Gordon-Nesbitt – provided the most comprehensive overview to date of research in this field. Crucially, it identified the need for proven interventions to be trialled at scale before they can be embedded in mainstream clinical care. Rolling them out on the scale necessary to achieve this ambition has so far been impossible: no funder, nor any organisation, has had the resources, or the appetite, to take on the challenge.

Until now. In partnership with UCL and King’s Health Partners, and supported by a £2 million Wellcome Trust award, King’s has launched the world’s largest ever study into the impact and scalability of arts interventions on physical and mental health. Led by Professor Carmine Pariante, a biological psychiatrist at King’s and Dr Daisy Fancourt, associate professor of psychobiology and epidemiology at UCL, the study will bring together a multidisciplinary team of artists, scientists and clinicians.

Working through the NHS foundation trusts that make up King’s Health Partners – Guy’s and St Thomas’, King’s College Hospital and the South London and Maudsley – three arts-based programmes will be offered to patients: Melodies for Mums with Breathe Arts Health Research, for post- natal depression; Dance for Parkinson’s with English National Ballet; and Stroke Odysseys with Rosetta Life, using movement, music, song and spoken word to enhance recovery for patients after strokes.

Our ambition is to translate these already-proven programmes into sustainable, standardised and scalable health interventions that make clinical and economic sense: strengthening the case for NHS clinical commissioning groups to recommend and fund them in the long-term and paving the way for other interventions to be tested in larger cohorts.

Given the pressures on health and social care, and the potential risks of long-term medication, any alternative intervention that can deliver better patient outcomes and cost savings to the NHS is going to be welcome.

As a long-time practitioner, I know the ‘magic of dance’ is purely an illusion, underpinned by biomechanics and the processes whereby humans orient themselves to a body in motion. Similarly, despite my passion, I know there is nothing magical about arts’ contribution to health. As Fancourt explains, arts interventions are effective because they address the psychological, physiological, social and behavioural, treating people holistically and recognising that health is determined by a range of social, economic and environmental factors.

This, in essence, is social prescribing, a term more familiar since its inclusion in the NHS Long Term Plan. Public Health England says social prescribing is “particularly useful for people who need more support with their mental health, have one or more long-term conditions, are lonely or isolated or have complex social needs that affect their well-being”.

Research proves that arts-based interventions, with their positive impact on social, psychological, biological and behavioural factors, can do all these things.

But so too can other activities on ‘social prescription’, such as gardening, volunteering, walking or community groups. I don’t believe in magic, but I do believe art can offer something extra. What that is, and exactly how it makes a difference, is a question that’s stayed with me for more than three decades. In three years’ time, when this study concludes, I hope I might be closer to an answer.

Deborah Bull is vice president and vice principal (London) and senior advisory fellow for culture at King’s College London and sits as a crossbench peer in the House of Lords

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