Summary of the impact

Research conducted at Strathclyde has shown that current pathways which focus on education and public information are failing to transform attitudes to mental health amongst low-income communities and black & ethnic minorities. Drawing on this research, an annual Mental Health Arts Festival has been created. Since 2008 the event has engaged over 40,000 people, and is now one of the largest arts and social justice festivals in Europe. The Festival has affected the ways in which these `hard to reach' groups are involved in addressing stigma and mental health, has changed approaches to the delivery of mental health awareness lessons in schools and communities, has led to NHS boards building the festival into their health improvement policies and strategies, and has been a central part of the Scottish Government's national anti-stigma `see me' campaign. The idea of a dedicated arts festival has been replicated elsewhere in the UK and internationally, and is transforming the attitudes and behaviour within black and minority ethnic and low-income communities to mental health.

Underpinning research

Context

Mental health is one of the top public health challenges in Europe, affecting more than a third of the population every year, and accounting for just under 40% of all years lived with disability. Whilst diagnosis, medical interventions, and treatment rates are improving, stigma, discrimination and exclusion remains an issue. National governments across Europe have developed education programmes and information distribution/campaigns to increase awareness of mental health in order to change people's attitudes and behaviour toward mental illnesses.

Key Research findings

Research at Strathclyde has shown that alternative approaches are needed to engage low-income and black and minority ethnic (BME) communities with mental health issues as current anti-stigma programmes are failing to reach and influence behaviour in these groups.

Four parallel research studies undertaken at Strathclyde in partnership with the NHS and local authorities have examined the prevalence of stigma and discrimination within both of these traditionally hard to reach communities, as well as with those communities with higher than average rates of mental health issues.

Using different geographical scales of analysis, the studies included research with low-income communities in East Glasgow [1], an exploration of patterns of stigma and discrimination and community responses with the 3 major black and minority ethnic (BME) communities across Glasgow [2, 3], and a systematic analysis, over a 5-year period, of the way in which the national media reports about people with severe mental health problems in Scotland [4]. The research also revealed the limited impact of current Government interventions within the groups in changing attitudes and behaviour. It was concluded that there was a risk that the Scottish Government's national programme and that of other European governments was worsening major pre-existing health inequalities within low income and BME communities.

In concluding that anti-stigma programmes were failing to bring about transformative change in low-income or BME communities, the research found that: there was inadequate investment in creating effective partnerships between the communities and professionals, and consequently was reinforcing exclusion [1,2]; many of the approaches adopted in practice in campaigns were socially and culturally inappropriate to enable information to reach all communities [3,4]; and in particular, that the focus on health and education, and the associated negative portrayal of mental ill-health [4,5] were key elements contributing to the disengagement of these communities.

The Strathclyde research indicated that to achieve a greater impact on, and reach into, BME and low-income communities alternative forms of engagement were desirable, replacing the current approach of providing information in writing or through adverts. Drawing on experiences in other contexts, it proposed the use of festivals and different art forms (such as narratives and cultural engagement) to explore mental illness and empower marginalised communities. Arts festivals, the research concluded, have the advantage of generating positive contact between marginalised groups and the wider population in relation to mental health, placing mental health issues within different socio-cultural contexts, and increasing knowledge of mental health issues. It also indicated that the process of co-production associated with such festivals encouraged dialogue, involved a wider range of communities and organisations, and reduced the risk of stigma and marginalisation when those with mental health issues and experiences were active participants.

Key researchers at University of Strathclyde

The research was conducted by Neil Quinn, Senior Lecturer in Social Work (2004 to present) and Lee Knifton, researcher at Mental Health Foundation and then from 2011 onwards, Senior Research Fellow at Strathclyde.

References to the research

References 2 and 3 are included in the REF2 submission UoA22.

Notes on quality: The research was published across peer-reviewed journals (1-4) and in a refereed international book (5). The research was funded by awards from Greater Glasgow and Clyde Health Board (1, 2) and jointly by the Health Board and Scottish Government under their national `see me' programme (3). The research is widely cited, especially (3) in international research on stigma.

Details of the impact

Process from research to impact

The research highlighted the potential value and benefits to be derived from Arts Festivals on mental health, and the desirability of an inclusive team to produce such an event. A broad-based alliance of partners in Glasgow then worked explicitly to include those with experiences of mental health issues in the development of an arts festival. This consortium involved the Scottish Government, NHS Boards, the national anti-stigma campaign (`see me'), national mental health voluntary sector partners, arts organisations, local authorities, human rights and equalities agencies, academics, and community activists and groups. This broad-based alliance of partners adopted as their starting point, the Strathclyde research conclusions that positive messages through culture and art were likely to deepen reach into the BME communities, to develop and fund an arts festival focussed on mental health. The festival was designed to promote positive attitudes towards mental health, mental illness, support and recovery, and so generate significant cultural change amongst opinion through the insights and influences of the creative arts. Evidence that the research was significant can be seen in the fact that the Scottish Government and NHS invited the Strathclyde researchers to chair the group.

Type of impact: The formation of a national Arts Festival has produced the following benefits

Annual cultural events:

The consortium created a month long annual festival (initially the Glasgow Mental Health Arts Festival but now Scotland wide) blending culture, contact and community development in order to engage and influence marginalised communities. The first was held in 2006, and each year the programme has led to the creation of 300 events each year using a range of art forms such as film, theatre, literature, visual arts, dance, and comedy (Source 1). In the last five years since 2008, the event has engaged over 40,000 people. It is one of the largest arts and social justice festivals in Europe (Source 2) supporting a network of 16 regional grassroots festival groups covering all of the major regions of the country, each having its own identity, structure and purpose. With local communities and mental health professionals organising events alongside music, drama and acting professionals, the Festival has involved high proportions of people living in poorer areas, minority ethnic groups and people with experience of mental health problems. Lee Knifton acted as Director of the Scottish Mental Health Festival in 2013.

The Scottish Mental Health Arts and Film Festival approach has been replicated by similar events in Northern Ireland (Source 3) and in Ireland (Source 4). An organiser of the Northern Ireland event has stated "The Scottish Mental Health Arts and Film Festival has been the inspiration and impetus for a similar Festival for Northern Ireland. The Scottish Festival's collaborative model of organisation, emphasis on inclusion, and incorporation of research on impact have provided the template for Northern Ireland" (Source 3).

Changing attitudes to mental illness: by challenging established norms, improving social welfare, contributing to campaigns for social change.

For example, at the North Lanarkshire festival in 2012, three community forums (Motherwell; Wishaw, Murdostoun and Fortissat; and Bellshill and District) pledged their involvement in anti-stigma action (Source 5), and enhanced cultural understanding of issues around stigma and mental health, for example increased positive attitudes to reduce stigma amongst audiences (Source 6). Referring to the Scottish Mental Health and Arts Festival, Isobel McCarthy, Mental Health and Wellbeing Development Officer for South Lanarkshire Council said "Working in partnership with our colleagues in NHS Lanarkshire, North Lanarkshire Council and a variety of local services to support the Scottish Mental Health Arts and Film Festival to create an exciting calendar of events this October (2012) has been a real privilege. The opportunities this has created for local people to engage in activities that support good mental health and wellbeing and promote recovery makes all the efforts worthwhile." (Source 10)

Influence on local communities and organisations:

This influence included new partnerships with teachers to deliver mental health awareness lessons in schools, with mental health groups to deliver training in workplaces, and with community groups to deliver a community conversation programme with BME communities (Source 7). Mental health arts festivals are being incorporated within cultural strategies in Glasgow and Renfrewshire, with a new planning group being established, `The Creative Forum', which includes a number of local partners (Source 8). This has been supported through the embedding of mental health in local socio-cultural contexts through the choice of local venues including pubs, prisons, shopping centres, shop windows, libraries and community centres. The festival programme in 2012 was extended to new regions and genres, achieved record attendances and media coverage, increased online engagement, and developed new partnerships and projects. (Source 9) There were more than 100 articles during the Festival period from publications including: The Scotsman; The Herald; The Edinburgh Evening News; The Daily Record; The Evening Times; The Skinny; STV Local and The List. There were also discussions on radio stations such as: BBC Radio Scotland; BBC 6 Music; The Vile Arts Radio Hour; and Radio Awaz, as well as a number of local radio stations. (Source 9)

Impacts on strategy of NHS and charitable bodies: influencing policy and practice leading to improved take-up or use of services, and improved health and welfare outcomes. Health Boards including NHS Greater Glasgow and Clyde, NHS Lanarkshire (Source 10), and NHS Lothian (Source 11) have built the festival into their health improvement policies and strategies. NHS Health Scotland has included the festival as part of its planning and funding arrangements since 2009, with the Scottish Government's National anti-stigma `see me' campaign adopting the festival as part of their national strategy (Source 12). The Campaign Implementation Manager for `see me' has stated that "One of the key elements of this success (of `see me') has been the unwavering partnership working bringing together numerous national and local organisations as well as hundreds of dedicated individuals" On the `see me' website (Source 13) it notes regarding the 2012 annual festival "This year's Scottish Mental Health Arts and Film Festival (SMHAFF) was the sixth time that the Festival brought together thousands of people to celebrate and explore the meanings of mental health. 'see me' is proud to say that we are one of the founding partners of SMHAFF and have been one of its main funders from the beginning."

The overall impact of the research into the prevalence of stigma and discrimination around mental health within traditionally hard to reach communities has led to an annual programme of cultural events, which is now emulated in other parts of the United Kingdom, and forms part of wider government and NHS strategies to promote positive attitudes to mental health.

Sources to corroborate the impact

1. For link to University of Strathclyde involvement in Scottish Mental Health and Arts Festival see
   http://www.mhfestival.com/about/partners
2. The Welsh Arts Festival, Unity, itself one of the largest festivals in Europe, involves about 8000 people (http://www.hijinx.org.uk/unity-2012/)
3. Statement from organiser of Northern Ireland Mental Health Film Festival
4. Events in Northern Ireland http://firstfortnight.ie/
5. eLanarkshire Mental Health Resources: http://www.elament.org.uk/news/2012/10/30/north-lanarkshire-community-forums-back-campaign-to-reduce-stigma-of-mental-ill-health.aspx
6. Analyses of participants conducted by Peter Byrne (East London NHS Foundation Trust and University College London) and by Rona Dougall (NHS Greater Glasgow and Clyde) for Royal College of Psychiatrists and NHS, funders of the Festival.
   http://www.tandfonline.com/doi/pdf/10.1080/17533015.2012.663766
7. Mental Health and Well-being in Greater Glasgow and Clyde Anti-Stigma Partnership (2009) http://library.nhsggc.org.uk/mediaAssets/Mental%20Health%20Partnership/Anti%20Stigma%20Catalogue%202009.pdf
8. Renfrewshire Council (2013) Scottish Mental Health Arts and film Festival, at
   http://www.renfrewshire.gov.uk/webcontent/home/services/social+care+and+health/mental+health/sw-mc-artsandfilm-festival
9. Scottish Mental Health Arts and Film Festival Report, at
   http://seemescotland.org.uk/images/pdfs/smhaff_2012_festival_report.pdf
10. NHS Lanarkshire (2013) Scottish Mental Health Arts and Film Festival 2013, at
    http://www.elament.org.uk/news.aspx?filterby=SMHAFF
11. NHS Lothian (2011) A sense of belonging: A joint strategy for improving the mental health and wellbeing of Lothian's population 2011-2016
    http://www.nhslothian.scot.nhs.uk/OurOrganisation/Strategies/Documents/SenseOfBelonging.pdf
12. Statement from Campaign Implementation Manager for `see me'
13. http://www.seemescotland.org.uk/latestnews/511-2012-smhaff-report