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RADIO SCIENCE UNIT
CASE NOTES
Programme 7. - Art and Health
RADIO 4
TUESDAY 01/11/06 1630-1700
PRESENTER:
MARK PORTER
REPORTER: LESLEY HILTON
CONTRIBUTORS:
MIKE WHITE
TABITHA TUCKET
MARGARET FRAME
PAUL ROBERTSON
PHILIP HOWE
JAMES BRAITHWAITE
EMMA WILLIAMS
JOHN RYAN
GEOFF ROWE
PRODUCER:
KATIE HICKMAN
NOT CHECKED AS BROADCAST
PORTER
Hello. In today's programme I'll be looking at how the arts - music, sculpture, paintings and even comedy - are being harnessed to improve health. From helping patients in intensive care, to a health promotion campaign encouraging men to go to the doctor.
But do initiatives like these work? And given the current financial constraints facing the NHS, are they drawing on scarce resources that could be better used elsewhere?
My guest today is Mike White who is Director of Projects at the Centre for Arts and Humanities in Health and Medicine.
Mike, perhaps we should start by talking about the work at the centre, what's it for?
WHITE
Well the centre was set up six years ago by the Vice-Chancellor of Durham University, Sir Kenneth Calman, who was previously the government's chief medical officer. And in his professional career as a cancer surgeon he became increasingly concerned in how you develop social skills and empathy in medical students. And he had this vision of a centre that would on the one hand look at the role of medical humanities in the training of medical students but also look at the new and growing field of arts in healthcare, which has extended now beyond hospitals into primary care, community health development, public health.
PORTER
So the centre's six years old but the relationship between arts and health and medicine is not new is it?
WHITE
It goes back to classical times, I mean the Greeks would take patients from the hospitals into the amphitheatre to hear performances of drama because it was felt that the cathartic effect of that was good for their health.
PORTER
During the advent of modern medicine in recent times has probably driven us slightly away from that, have we become too focused on the pathology of the patient as a whole?
WHITE
I think so and I think that as a result you have NHS trusts in their annual reports are saying that 1 in 5 complaints that they receive from patients is to do with the feeling that they've not been treated with dignity. So looking at this question of dignity within healthcare is firstly within the relationship between the healthcare professional and the patient but it also extends into the quality of the environment. It's not simply about prettifying hospitals with artworks.
PORTER
Well South Tyneside District Hospital in South Shields is one hospital that believes music helps patients - in outpatient clinics, wards and even on the intensive care unit. Lesley Hilton went to find out more about the Music for Health project.
ACTUALITY
Any kinds of music you'd like - we could give you classical or songs from the shows or jazz?
Blues?
MUSIC
HILTON
Another waiting room, another request. South Tyneside Hospital, along with others in the region, has been receiving the attentions of the Music for Health project for some time now.
MUSIC
Musician Tabitha Tucket and singer Margaret Frame are both professionals in the music business but they take their work at the hospitals very seriously. And they don't just play to help pass the time in waiting rooms, they visit the wards and even intensive care units. Margaret says patients might not always be able to applaud their performance but they still show their appreciation.
FRAME
Sometimes we might get quite subtle reactions, you'll suddenly notice that somebody's foot's tapping or they're mouthing the words if they can't actually sing and we've seen that in people like joining in in that sort of way which is really nice.
HILTON
So why does Margaret think that people want to listen to live music while they're in hospital?
MUSIC
FRAME
Quite often people want music to help them with their emotions and sometimes they might actually want sad music if they're feeling quite tearful and it releases the emotion. But sometimes people want - they may want to be relaxed or they may want to be cheered up and we've even seen people dancing when we've been playing.
HILTON
The relaxing effect of the music on the patients can also be used to help them deal more easily with unpleasant medical procedures, as Tabitha Tucket explains.
TUCKET
We have been used a number of times for patients who are working to come off ventilated breathing and to try to engage them in the music completely distracts their attention and within minutes they're breathing unaided without really noticing. And with staff where we have a good relationship they will wait until our visits to try that procedure.
HILTON
Philip Howe is the senior charge nurse in the intensive care unit and believes the music really does make a difference.
HOWE
We've had patients in and I can think of one in particular, who was very afraid and very anxious about things and that manifested itself really by - he was always agitated and fidgety, his heart rate was always above what we might have expected. He always needed a bit of extra sedation to keep him settled and calm. But on a Tuesday when we used to have the musicians in after they'd gone it was obvious that he was feeling a little bit better, a little bit more calm and a little bit more relaxed. And certainly when he was able to indicate through nods or winking or waving his hand he was giving us the thumbs up, so he was obviously enjoying it.
FRAME
People talk a lot about being distracted from the things that they're worried about. Certainly from observations people do seem to be a lot calmer and more relaxed and more cheerful.
MUSIC
VOX POPS OF PATIENTS
It's lovely, really lovely, yeah, and I think it helps take your mind off things as well, yeah.
Enjoyed it, very nice, very nice. Sitting waiting in the waiting room just what you want.
MUSIC
FRAME
I think it can also prompt interaction that can speed people's recovery, for example it prompts people to communicate, to speak, which is quite helpful in stroke recovery and in elderly care, where I think isolation and lack of social interaction is a serious issue.
MUSIC
PORTER
Duo Tabitha Tucket and Margaret Frame playing for patients at South Tyneside District Hospital. But is there hard evidence to back their input and if music does help patients, do we know how?
Mike White from the Centre for Arts and Humanities in Health and Medicine is still with me, and we are joined by Paul Robertson, who's visiting professor of music and medicine at the Peninsula Medical School, and by James Braithwaite who has experienced the benefits first hand.
Paul, starting with you - sounds lovely, but what evidence do we have that music has any therapeutic effect?
ROBERTSON
Well first of all Chelsea and Westminster Hospital did a big study and more than 80% of the patients there acknowledged very favourably that live music, they felt, helped them and benefited them. And we know increasingly we have an understanding of what's going on in the brain and physiology has been listening to and responding to music.
PORTER
Yes because we heard in the package there that it's used as a distraction, it's an aid to relaxation - is that the only way it's working or is it having some other therapeutic effect?
ROBERTSON
Well I think it definitely does those things but it runs …
PORTER
Which are important of course.
ROBERTSON
Very important and therefore I don't neglect the importance of those but I think it runs much deeper than that. We might want to ask ourselves you know why as social human animals music is so hardwired into us, it is, I mean you can't really be human without being musical, we're musical effectively from before birth. And of the higher mammals we're the only ones who will entrain rhythmically, in other words when rhythmic music is present we will move to it unconsciously. Now that actually ties into the opioid system of the brain and a whole other set of neurotransmitters, which deliver wellbeing, a sense of identity, social identity, so that if you can call it distraction, it's at a very high level, it's actually reshaping our internal experience of ourselves.
PORTER
Cues that could almost be more important when you're in the impersonal environment of a hospital where you're depersonalised aren't you.
ROBERTSON
Well indeed and that's one of the things as a musician, professional musician, I spent many years performing really quite serious works of a string quartet in hospitals and it was very marked how people when facing their own mortality can listen with an intensity that you rarely experience even in the concert hall. We may also mention that part of the importance of the delivery is not only to the patient, remember a hospital is an environment, it's a social environment, staff too need a quality of life. It's been well established that staff retention and recruitment is significantly improved when the arts are present, it actually makes a better working environment and clearly makes a better communication and emotional quality of that environment as well.
PORTER
James, as a patient you've been on the other end of this, you've been on the receiving end as such, tell us your story.
BRAITHWAITE
When I ended up on the ward, a psychiatric ward, you have so many thoughts going through your head about - worried about this and worried about where you're going to go and etc. etc. etc. The second time I actually brought a walkman in with me and the thing about the walkman is that it's like - an analogy is like if you have a shipwreck the music is a piece of wood …
PORTER
Flotsam floating - that you're handing on to.
BRAITHWAITE
And you're holding on to it. And the thing about music is you need that to sustain because it goes deep, it identifies what you're going through - you might be singing along with it, you might be listening to the words, it's another language where you might not be able to converse or speak to a doctor or how you're feeling etc.
PORTER
Paul, I want to say James brought his walkman in there and we were looking at South Tyneside where the music's live, what is it - does it matter whether it's live, could we pipe music through the hospital or is it the performance aspect that's important?
ROBERTSON
Well in my belief live music making has a number of dimensions of richness that's greater than a recording. But the important thing is that music is something that albeit unconsciously we nearly all use as a self-medication, we know that if we expose ourselves to a particular piece of music, particularly a favourite piece of music, we're going to be taken to that place again emotionally and if the emotional connotations are positive, even if you're in a really deep and dark place, it's like a remembrance of where I was and where I could be again.
PORTER
James, you're involved with the charity Sound Minds, what does that involve?
BRAITHWAITE
Well it's a music project and it was borne from people when they were on the wards and we set up a music group, people would just come along, play instruments and from there it just grew into a studio which is in Battersea at the moment and they've got about five bands - one reggae, one classical …
PORTER
Is this for people with mental health issues to be involved in to play or to listen to?
BRAITHWAITE
Both.
PORTER
I mean looking back on your exposure to music, do you think it helped you?
BRAITHWAITE
Oh definitely, definitely. It takes you out of yourself like the professor was saying about live bands, it's absolutely essential because you feel, you're excited about going to see a live band, you can get off the wards if you need to, you can sing along - it's something to take your mind off what you're going through, there's another world out there.
ROBERTSON
I'd also like to make the point that we don't necessarily have to assume that the only beneficial music when you're ill is simple jolly stuff, the complexity can be part of the gift. When you're unwell and particularly when you're unwell within a medical system you're involved in a process which is very hard to escape from, that's part of the grimness of it. What we discovered is that playing really quite complex, dark, ambiguous music can be incredibly rewarding for the listener because it meant that they were free to travel, they were free to find their own messages, they were free to step in and out. And that actually that's a kind of - I suppose really we'd have to say it's a kind of spiritual freedom which is part of what makes being alive very valuable.
PORTER
There's a paper in the British Journal of Psychiatry actually published this morning looking at the treatment of using music in the treatment of schizophrenia where people are encouraged to take part, to play music, and it seems to have a beneficial effect.
Mike, I'll bring you in here, the art therapy is probably the best known intervention of this type in mental health isn't it, it's been used for some time in psychiatry?
WHITE
Yes it has a slightly older history than the modern arts and health movement. And the art therapies are now - all of them except dance - are now accredited professions within healthcare and they work within a medical model and they are an ancillary form of treatment if you like. Whilst respecting the whole person they work very much with individuals but they focus down on the sick or dysfunctional part. Arts in health, on the other hand, is simply artists who place their work in healthcare and they work in the opposite direction - they want to get away from the sick and dysfunctional part of an individual, to looking at taking a holistic approach, if you like, to their healthcare needs and increasingly working in the area of participatory arts, so it becomes group based work. There can be inherently therapeutic qualities in the arts and I guess dance is the obvious example of that. But this participatory work in a sense it offers an activity around which conversations develop between members of the group and healthcare workers who are working with them and it allows, if you like, for a non-hierarchical kind of dialogue to take place. And I think it's proving itself to be extremely effective within community healthcare contexts.
PORTER
Let's look at the artwork used on hospital wards. Do you think we underestimate the importance of our environment - the clinical environment - I mean we concentrate too much on the pathology and what's wrong with the patient rather than where we're seeing them and how we're seeing them?
WHITE
Well I think absolutely because I think the quality of colour within the healthcare environment is important. We know that blues and greens have the most restful effect within the colour spectrum, that the creation of artworks at all eye levels, if you like, within a building open up people's perception of the healthcare environment. And on a very almost mundane but I think significant level I've gone round hospitals in the evening, during evening visiting time, and that's the time where you really do see patients coming off wards with their families, walking down corridors and examining the paintings and prints which the hospital has acquired or has on loan. So I think it does have a subtle effect on the daily working life of a healthcare unit.
PORTER
Well we may appreciate now that the clinical environment can have a significant impact on health and well-being, but you wouldn't guess it from visiting most NHS institutions. Not so the new Bristol Children's Hospital which was designed from scratch to feel secure and familiar to children and their parents. I met up with arts coordinator Emma Williams in the hospital's foyer, which looks more like the entrance to Disneyland than a flagship hospital.
WILLIAMS
Well we're very lucky here at Bristol Children's Hospital because it's a purpose built children's hospital with art integrated throughout.
PORTER
And actually you can see that can't you when you arrive outside.
WILLIAMS
You can, the sculpture tells you that the arts matter here.
PORTER
In primary colours, the building doesn't really look like a hospital, it looks more like a play school. And we're sitting in the foyer, the main lobby of the hospital here, and there are birds flying above us, there's a huge clock over there with dolphins going in and out.
WILLIAMS
You'll see the floors, doors, reception desks - they've all been art enhanced to give the patient an extra feel of we care.
PORTER
And is it just about we care or does it help reassure people to come into a non-clinical environment or a less clinical environment?
WILLIAMS
There was a lot of consultation and a lot of research done before the hospital opened and the children had a voice in really what was coming here. A lot of anxiety when children and parents and families come in to the hospital and to have distraction around them is really, really important.
PORTER
But how do you - I mean obviously these things are expensive and they're unnecessary in terms of absolute building, I mean you can have a plain white walled building and it would be fine for medical purposes, and given that we're under quite a lot of pressure in the NHS, do you have to fight to get the budget to spend money on these sorts of projects?
WILLIAMS
It's not taking any money away from NHS beds, it's from charitable trusts, I get quite cross about people saying that it's taking away from bed space - it's not. It's an added extra which kind of really adds something very special.
PORTER
And do you get much positive feedback from the patients themselves, the children themselves?
WILLIAMS
I get loads of feedback from the children themselves. I mean there's a lot of interactive artworks around and just pressing buttons and stuff, you know, they really enjoy it and the families as well, they're wandering around the hospital, you know a lot of time at night time and there's things for them to do, things for them to see.
PORTER
There's obviously a lot of murals and statues and interesting things and sculptures going on here but what about basic colours?
WILLIAMS
Well there was a lot of research done into kind of choosing the colours for each of the floors and it was understood that we needed to be off primary and so slightly more pastelly but very particular colours were chosen. We had a purple floor and once the users were actually in it and the doctors apparently it had an adverse effect on the children and so the colour was changed quite rapidly.
PORTER
An adverse effect in what way?
WILLIAMS
The children really, really didn't like it.
PORTER
But presumably the influence of art on patients' wellbeing and their families isn't just the environment, you can actually be proactive as well.
WILLIAMS
Absolutely and here at Bristol we've got a full participatory arts programme which includes performing arts festivals, we've got workshops, we have bedside entertainment - we have a whole programme that spans throughout the year.
PORTER
And is this art therapy or is it just designed to be generally therapeutic?
WILLIAMS
We have got a music therapist but we actually just have artists that come in mostly and they're not therapists but they have therapeutic effects, not only for the patients but also for the families.
PORTER
You're listening to Case Notes, I'm Dr Mark Porter and we're looking at the role of arts in health and medicine.
Mike White, since my visit to Bristol the health service in that part of the country has come in for some criticism for spending nearly half a million pounds on sculptures in mental health units across the region, at the same time as it emerged that it's one of the worst funded authorities in the country. Is the evidence of benefit for the role of arts in health strong enough to spend scarce resources on the arts.
WHITE
That evidence base is still being assembled. I think you have to look beyond simply what is the direct benefit issue to looking at actually how these arts programmes are created within hospitals. They start with a starter budget within their capital funds and they then work with the contractors who are working on the build, the private sector, charitable trusts, the Arts Council and through that they raise significant sums for an arts programme to come about. They're not doing it because they want to turn their hospitals into galleries, it's a concern to provide a quality environment which speaks, if you like, subconsciously about the quality of care and the mission of the hospital itself.
PORTER
Well we heard there from Bristol that a lot of the funding for the extras, if you like, came from charity. I suppose the problem that a lot of people have is they go there - I went to Southampton General Hospital recently and the taxi driver, as I was pulling up, said oh look they're building this fantastic hospital, look at all the money they've wasted on those silver balls. And it was a modern artwork outside the front door. And people do see it in their mind that it's art work or herceptin for instance and I think partly one of the problems of that is, is that we don't have enough - we don't hear a lot about the benefits of art, do you think we could do more to promote the message?
WHITE
I think that we do have to be more proactive and I don't think that one needs to be apologetic about it, I think that art or the arts essentially concerned with all the values that also inform the healthcare system.
PORTER
Paul, there can't be many professors of music throughout the country - music and medicine - are there?
ROBERTSON
I believe I'm the only one but I hope the first of many. The only point I'd make, which is slightly simplistic, but is to be provocative to an extent, is biomedics runs on a 1% effectiveness, if you can show 1% effectiveness in delivery you can justify the marketing of your drug. When it comes to music, music and depression and anxiety, we know that it delivers up to a 30% effectiveness. Now part of this, let's be really blunt, is we don't have the economic drivers and the profit motives that will really push forward the kind of evidence base we need. The experience is there, culturally we owe it to ourselves as a society that we now really establish the truth of this and utilise it because we're missing a magnificent resource.
PORTER
One area we haven't touched on is the role of the arts in health education. "Hurt until it laughs" is part of an initiative in Leicester targeting health promotion messages at notoriously unreceptive audiences - in this case using comedy to reach men.
The show is written and performed by stand-up comedian up John Ryan, and produced by Geoff Rowe, who runs the Leicester Comedy Festival. I joined them in a smoky bar to see if their message hit home.
CLIP FROM ACT
RYAN
There's always a bit of a belief about that - if you can people to laugh you can get them to listen. And so on the one hand you try and hold their attention with peppering with amusing anecdotes and funny observations, but then you're also trying to get a point across which they'll hopefully listen to you once they trust you.
PORTER
Well give me some example of sort of key messages that you're using then.
ROWE
Things like if you're ill go to the doctor rather than go to a friend or just imagining what might be wrong with you. I think the main thing is to talk to professionals about your health advice really, it's been staggering - the research that we did to come up with the show revealed a whole host of ways in which men get their health advice and health information, very few of them get them from doctors.
PORTER
Certainly as a GP when they turn up they're turning up late and out of desperation really and they often need an excuse to come in and see us as well, you know oh well the Missus sent me and oh I read this in this newspaper article. If they won't come along and see us in the doctor's, why would they come and see your show?
ROWE
It's about the way in which we communicate the messages. People will come and see a comedian, they think that's a good thing to do, whereas they might be a bit more hesitant about going to see a doctor.
PORTER
It's subliminally slipping the messages in.
RYAN
I think also though because I will talk about my own experience and I think that people then realise that I'm not just there to take the mickey, I'm actually trying to shed light on something and show something and I think that almost by me being vulnerable people - they like that. I was brought up in an Irish Catholic family where the men were proper men - they drank, smoked and they laboured. And now over the last sort of few years as they've come to their mid-50s and onwards they're all suffering because of it. And one of the stories I tell is about my godfather, who's my role model, and how I coped with his death and it's not particularly funny but people I think enjoy actually hearing someone breaking down the barrier, making the first move.
ACTUALITY
He was about 51 I think when he got a bad pain in his jaw and he went to the dentist. Eventually the dentist sent him to the doctor's, the doctor obviously sent him straight to the hospital, they cut half his tongue out and some of his jaw within a week as he had oral cancer. And died within about a month, I think it was, he died. And I said to him - What happened, where did it go wrong? This is no word of a lie, he looked straight at me and said - I was alright till I went to the doctor's.
PORTER
Did you recognise that sort of stereotypical image of the bloke?
PATRON
I did and it touched a nerve with me because my dad got diabetes and died from a heart attack he needn't have died of. My brother got oral cancer, having drunk and smoked his way through life and he died when he didn't have to because he didn't go to the doctor's until too late. And my husband has prostate cancer which is detectable and diagnosable and wasn't diagnosed. So I really have a big thing about saying that men - they should get to the doctor. So I thought it was great.
PORTER
So what did you think of it?
PATRON
I thought it was excellent, I thought it was very thought provoking and challenging and very, very funny.
PORTER
I mean for you the mix of - the mix of humour and serious message works yeah?
PATRON
Oh it does, I think it's always a good way to get a message across by making people laugh I think at the same time.
PORTER
Are you two - are you clean living guys?
RYAN
We're not a couple. Boom, boom.
PORTER
Do you practice what you preach? When was the last time you saw the doctor?
RYAN
There's nothing wrong with me.
PORTER
John Ryan talking to me at the Bamboo Bar in Leicester.
Mike, do you think that's a sensible approach, is it a good way to target men for instance?
WHITE
I think so because I think that if a lot of the diseases of our time come from bad cultural habits - smoking, alcoholism, obesity and so on - then getting in there at the level of culture and working within that to change …
PORTER
In the viper's den.
WHITE
Yeah in the viper's den, I think that's the way forward.
PORTER
I mean my concern having watched it, I thought it was very good but it's a very small scale, you need an awful lot of shows that size to reach enough men to make a difference.
WHITE
Yeah I think so but I think that the characteristic of arts and health work is that it's not about one grand construction, it's many small ground works and that the advantage of small scale is that you are up close and personal in this work. But what I would like to see is that we can scale this up in some way so that we can look at arts on the level of campaigns around health issues. We have wonderful national events now in things like the Great North Run and the London Marathon and I think it would be terrific to see a national arts day that was focused around health.
PORTER
Mike White we must leave it there, thank you very much.
If you'd like more information on John Ryan's show, or anything else mentioned in the programme then our website has useful contacts and addresses and, of course, you can listen to any part of the programme again by clicking on the listen again facility. And if you don't have access to the web you can call the Action Line on 0800 044 044.
Next week's programme is the last in the current series and is all about ears - including a look at the latest digital hearing aids available on the NHS, and a new treatment for Meniere's disease.
Ends
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