Summary of the impact

This case study describes the impact of practice-led research in health and social care settings. There are three main areas of impact to this research:

1. Arts and Mental Health. Through Converge, Rowe has developed, applied and evaluated new approaches to arts and mental health practice. This work impacts directly on participants and on mental health policy and provision through close partnership with NHS staff and managers.
2. Arts in a hospital environment, particularly in renal dialysis.
3. The performance of personal stories in playback theatre. Rowe's book has been translated in to Arabic and Korean and is recommended by the International Playback Theatre Network.

Underpinning research

Research undertaken by Dr Nick Rowe (Senior Lecturer in the Faculty of Arts and the Faculty of Life and Health Sciences) is the focus of this case study. His work addresses the following questions:

a) How do we document and measure the effectiveness of arts and health interventions?

b) What constitutes safe and ethical practice in arts and health practice?

c) What are the demonstrable benefits of arts and health practice?

Specifically relating to the three areas of impact described above:

1. Arts and mental health

A major ongoing practice-led research project directed by Rowe is Converge, which since 2008 has offered education opportunities in the arts (specifically theatre, music and dance) to people who use mental health services. The research seeks to locate reflective practice alongside the development of person centred methodologies that utilise `distance travelled' to map the impact of arts participation (particularly over time) on mental health service users. Converge operates in close collaboration with Leeds and York Partnership NHS Trust with mental health service users participating as students and artists within a university context. Research into the impact and efficacy of this practice describes how such arts projects can challenge the corrosive effect of the mental illness label. Rowe's research also analyses how sustained contact with mental health service users in a theatre context reduces discrimination (see section 3.2, 3.3, 3.6 below). Recent work looks at the students' attitudes toward mental illness and how this may be influenced by contact in Converge (3.6)

2. Arts in a hospital environment

`Forgetting the Machine' (3.4) presents research conducted with the medical team at York Hospital and was designed to explore patients' perceptions of engaging in art work in a renal dialysis unit. The research found that while `absorbed' in art making, patients are for a time able to `forget the dialysis machine' and the reality of their illness. The study finds that engagement in artwork is more than just a distraction from the uncomfortable experience of dialysis. Art making engages patients intellectually, creatively and socially. It gives purpose to the time on dialysis, a sense of contributing to a joint task and promotes social interaction.

3. The performance of personal stories through playback theatre

Rowe's research in Playback Theatre interrogates key ethical questions within the practice of telling, representing and bearing witness to autobiographical narratives. His research developed new understandings of the conditions in which Playback Theatre can be conducted in a manner that is both ethically `safe' and valuable to its audience. This research relates to the use of Playback both with individuals in particular social contexts (for instance in hospital with mental health service users) and more generally.

References to the research

Key Research Grants

1) An investigation into the lived experience of haemodialysis patients participating in art work. 2009. The Yorkshire Kidney Research Fund. £10,496.

2) Building Bridges. 2010-11. HEFCE and UnLtd Social Entrepreneurship Funding. £15,000.

3) Studentship funding. Mapping Impact of Affect and Effect in Arts and Mental Health. 2013-17. Leeds and York NHS Trust. Period of Grant. £10,500.

Details of the impact

The research presented in this case study has multiple impacts. First, on institutions and professionals delivering health services; and second, on individuals, particularly mental health service users, engaging in arts and health projects. This impact is evidenced in a number of ways.

1. Arts and mental health

In the context of initiating change in the delivery and understanding of arts and mental health services, an indicator of the significance of the impact of Rowe's research is the sustained partnership with Leeds and York Partnerships NHS Foundation Trust around Converge. In 2013 the Trust is contributing a total of £20,500 toward Converge practice and research, including part- funding a PhD student to work alongside the project from 2013-17. This is an indication of recognition from a major mental health provider that Converge is an excellent example of contemporary recovery-orientated mental health work. The Trust also provides a senior occupational therapist to provide clinical support, as well as funding an occupational therapist to support service users to progress through arts activities provided by Converge. The Trust's recent `transformation plan' for mental health services in York includes mention of Converge as a partner provider.

Converge has impacted through public performances undertaken by Out of Character, a theatre company consisting of mental health users, and the Converge Choir. These include:

• May 2010: Out of Character performance at The Living and Learning, Learning and Teaching: Mental Health in Higher Education Conference organised by National Mental Health in Higher Education at Lancaster University.
• July 2010: Out of Character performed Tales from Kafka at York Theatre Royal to approximately 400 people over 4 nights.
• June 2012: Out of Character performed Henry IV by Luigi Pirandello at York Theatre Royal to approximately 300 people over 3 nights.
• May 2013: Out of Character performed their autobiographical show Speaking Ourselves at the launch of the York Early Intervention unit for psychosis.
• September 2013: Out of Character performed Speaking Ourselves at the National Richmond Fellowship Conference in York.
• May 2013: The Converge choir was invited to perform at the launch of the York Early Intervention unit for psychosis and in September 2013 it performed at the National Richmond Fellowship Conference in York.
• October 2013: Out of Character performed to nursing students at York University.

Audience feedback from these events include the comment, `Inspirational, actions are more powerful than words, which adds a creative dimension to mental health understanding and getting a range of messages across a wide audience.'

The second strand of impact is at the very significant level of individuals participating in the Converge project. This has made a significant impact on mental health service users in the York area. In 2011-12, 84 people who use mental health services completed Converge courses and the project achieved an 82% retention rate, which indicates the value that participants put on the experience in transforming their mental wellbeing. As Chris Butler, Chief Executive of Leeds and York NHS Trust writes, Converge `gives people with mental health problems the opportunity to explore and develop their creativity. For people with mental health problems it can be difficult to have the confidence to explore existing strengths or to discover new abilities and talents. Service users described how this had simply transformed their lives enabling them to achieve goals that at one time seemed impossible to reach' (5.1). Other corroborations of impact include that from the Joseph Rowntree Foundation (5.2).

Through dissemination events, Rowe's research has impacted on arts and mental health practice, informing delivery in this area. As John White, Pacific University, USA, writes, `Participants learned about theatre work with people who use mental health services and discussed ways to incorporate Nick's ideas into work with other populations. The presentation emphasized methods through which community organizations and educational institutions can work together for the benefit of community members and university students' (5.3). Converge has also provided a case study for the National Co-ordinating Centre for Public Engagement (5.4) and the International Health Humanities Network (5.5).

2. Arts in hospitals

Research conducted with the medical team at York Hospital was designed to explore patients' perceptions of engaging in arts work in a renal dialysis unit. The research has impacted on the development of arts practice in York Hospital. Dr Colin Jones, consultant on the renal dialysis unit at York Hospital reports that the research into the impact of arts in a hospital environment has `Increased people's realisation that the project was transformative and enabling rather than just a "bit of pampering" and that it has decreased cynicism amongst key players in the hospital and helped with funding bids.' The development of art work at the Colon-rectal unit is evidence of wider acceptance of arts approaches for in-patients at the Hospital (5.6).

3. Performing personal stories in playback theatre

In the context of Playback theatre, the original publication Playing the Other, also translated into Korean and Arabic, is a key text used significantly beyond the HE sector for drama practitioners, dramatherapists and health workers using drama in therapeutic settings. In a review in Theater Journal, Linda Park-Fuller writes:

`With this book, Nick Rowe substantially addresses two lines of scrutiny facing those who work with improvisational, audience-interactive, or auto/biographical theatre: (1) the need to theorize the work's theatrical values, and (2) obligations for the ethical deployment of materials that come raw from everyday life. He does this by rigorously testing, then blurring the binaries that undergird these dual demands. To illustrate requires a review of playback theatre (PT) and an introduction to Rowe's background and purpose'. (5.7)

The impact of the work is also evidenced through a range of `playback theatre' dissemination activities given across a range of beneficiaries. Specific examples include:

a) Presentation at the Developing Partnerships Conference, Middlesbrough (2009)

b) Playback Theatre in the Young Persons' Detention Centre, Wetherby, Yorkshire (2008)

c) Playback theatre in the Asylum Seekers' Centre, Middlesbrough (2009)

d) Playback Theatre performance for General Practitioner trainers in the North of England (2011).

Sources to corroborate the impact

5.1. Chief Executive, Leeds and York NHS Trust Available: http://chrisbutlerlpft.blogspot.co.uk/2012/05/create-challenge-inspire.html Statement from the Chief Executive of the Leeds and York Partnership NHS Trust's blog about Converge on 14^th May 2012:

5.2. Joseph Rowntree Foundation document: `How can universities support disadvantaged communities?' available at: http://www.jrf.org.uk/sites/files/jrf/disadvantaged-communities-and-universities-full.pdf

5.3. Head of Occupational Therapy Department, Pacific University, USA. Personal Testimony following key note address by Nick Rowe. Available at: http://www.pacificu.edu/ot/news/documents/newsletter-6-13-11-singlepage_000.pdf

5.4. Converge provides a case study for the National Co-ordinating Centre for Public Engagement: Available at: http://www.publicengagement.ac.uk/how/case-studies/converge

5.5. Converge provides a case study for the International Health Humanities Network. Available at: http://www.healthhumanities.org/impact/view/28

5.6. Renal Dialysis Unit, York Hospital

5.7 Linda Park-Fuller from Arizona State University, USA http://muse.jhu.edu/journals/tj/summary/v060/60.2.park-fuller.html