Summary of the impact

Arts for Health is a global leader in the research and development of arts and health. In 2003, it secured HM Treasury funding to research the impact of the arts on health and well-being. The Invest to Save: Arts in Health (ISP) research aimed to strengthen the capacity of the north-west regions' arts/health community, building the evidence base around the effectiveness of creativity, culture and the arts on health outcomes. The research evidenced reduced levels of stress, anxiety and depression and increased levels of eudemonic (active) well-being in those engaging with the arts, and has national and international policy dimensions.

Underpinning research

The research unit, Hospital Arts, was established in 1974 by Peter Senior (MMU until 2006) the objectives were to humanise NHS environments. In 1988, it was formally adopted by Manchester Metropolitan University (MMU) and became Arts for Health: the first department of its sort internationally and for which Senior was awarded the MBE and the Chevalier des Arts et des Lettres. Senior was responsible for early research including Helping to Heal: The Arts in Health Care (1993); Patient Focused Architecture for Health Care (1996); The Exeter (Hospitals) Evaluation in 1999 and the first international conference in the field at MMU in the same year. Clive Parkinson (MMU 2004 - present) led the transition of this MIRIAD based research unit, from a focus on the clinical environment, to a public health research agenda.

Parkinson led the Invest to Save: Arts in Health (ISP) research project across the North West of England between 2003 and 2007. Funded by HM Treasury to £385,000, this research established a partnership between MMU, the Department of Health and Arts Council England. It was chaired by Professor Hyatt (1991 - present), with strategic support from the Regional Director of Public Health and Chief Medical Officer (NW) and the CEO Arts Council England (NW).

The ISP interrogated available literature around practice and evaluation in arts and health, publishing a literature review in 2006, which identified opportunities for research sites across the region. A round-table event in 2007 brought leaders in the field together to establish a mixed methodological framework to enable quantitative and qualitative data collection. This first stage of the research was captured in the report called Towards Transformation [1], which informed the basis of co-designed elements of the research.

Appreciative Inquiry, semi-structured interviews and measurement instruments for general health, anxiety, depression and life satisfaction were employed. The research utilised a realistic evaluation methodology (Pawson & Tilly, 1997) to explore and develop the theories of practitioners, participants and policy makers, measuring the impact and benefit of aspects of the work that projects felt were important, gathering stakeholders, project teams and participants perspectives on arts interventions — including views on impact on health and well-being.

The research team worked with six established projects in the region across three clusters: older people, mental ill health and the built environment. Research findings evidenced reduced levels of stress, anxiety and depression across all study groups and through the Ryff Scale of Psychological Wellbeing, observed increases in levels of eudemonic well-being in those engaging with the arts. The impact on older people was significant and has informed further work. This represented a shift in research focus, from a deficit model to an assets-based approach. The data has informed further interrogation by other research institutes and in January 2013 the Royal Society of Public Health journal published an analysis by Swindells et al. Quantitative findings, statistical analysis and datasets that balance the mixed methodological approach, and all supplementary material² are at: http://www.miriad.mmu.ac.uk/investtosave/reports/

The research team includes Clive Parkinson (MMU 2003 until present), Peter Senior (MMU retired in 2006), Amanda Kilroy (MMU until 2008), Charlotte Garner (MMU until 2008)

References to the research

Details of the impact

The Invest to Save Project (ISP) enabled Arts for Health (AfH) to build on its legacy of Hospital Arts R&D and refocus on public health, capitalising on patronage from Sam Taylor-Wood and Melvyn Bragg. The ISP featuring prominently in a Department of Health (DoH) working group report (2006) [A] commissioned by NHS Chief Executive, Sir Nigel Crisp, the subsequent DoH publication, Prospectus for Arts and Health (2007) and Arts Council England Strategy for Arts, Health and Wellbeing [B and C] These publications disseminated the research to reach a broader audience.

The ISP was championed by Earl Howe and Lord Howarth and was central to a debate in House of Lords (March 2008) [D]. In September 2008, Clive Parkinson met with the Secretary of State for Health (SoS) to discuss MMU's research in the context of a speech that the Secretary was giving on mental health, social inclusion and museums and galleries at the Wallace Collection [E]. Parkinson is now working with supporters within the House of Lords [F] to establish an All Party Parliamentary Group for Arts and Health.

Parkinson was invited to deliver his paper, Invest to Save: Arts in Health, Research and Development in the North West of England [3], to a number of national/international conferences. Keynote at the International Symposium on Arts Health, Australia 2008 (and briefing the Australian Minister for Health on UK developments); European Capital of Culture in Vilnius 2009; British Association of Arts Therapists Research Network 2010 and UK Faculty of Public Health's annual conference 2010. In 2011, the paper was disseminated to Australian Parliament through a presentation to special committee. Arts and Health Australia presented him with the International Leadership in Arts and Health Award 2011.

Commissioned by Arts Development UK to write Big Society, the Arts, Health and Wellbeing, Parkinson drew together strands from research and political agendas which were prominently cited alongside ISP in the Royal Society for the Arts (RSA) publication; Arts Funding, Austerity and the Big Society (available at: http://bit.ly/eKzJmv ). The Chief Executive of the RSA explains the link, "I made specific reference to your research into the relationship between art, wellbeing and autonomy. Your further suggestion that people disconnected from civic society, might be empowered through cultural engagement, is a compelling argument and one that is particularly relevant in our current political climate." [G]

Between 2009 and 2012, Parkinson was awarded £64k partnership funding, to continue the legacy of ISP, from Department of Health and Arts Council England, developing North West Arts and Health Network, and facilitating outward-facing public events at MMU. With over 5000 members extending beyond the region, in countries as diverse as Cambodia and Afghanistan, over 1000 members co-authored a Manifesto for Arts and Health which places AfH firmly in a contemporary political landscape and which Lord Howarth, described as, "an enthralling statement," and poet Simon Armitage, as something `that gives us worth as humans.' [H]

British Council requested Parkinson to present his work to Lithuanian Government and recruited him as expert consultant, he is advising on arts/health research and development in Lithuania. His paper Civil Society, the Arts and Public Health sets context for Lithuanian Cultural Ministries first research report on arts and health; Menas žmogaus gerovei^h (Art for Wellbeing) 2012. In June 2013, he presented to Lithuanian Ministers for Health, Culture, Social Care, Employment, Education, Science, and Presidents Office to develop joint arts/health initiative over 2013/14.[I]

Plenary speaker at five international conferences in Australia, two opening addresses, the first; Towards Sentience, forms book chapter in The Handbook of Interior Architecture and Design (Routledge 2013). The second, Inequalities, the Arts and Public Health: Towards an International Conversation, adapted for Arts and Health: An International Journal for Research, Policy and Practice, Routledge (August 2013).

Parkinson has worked with Asia Europe Foundation as part of trans-disciplinary team, exploring Global Pandemic Preparedness, specifically how arts can enable visual communication around complex health messages [J]. He is elected chair of National Alliance for Arts, Health and Wellbeing leading into first International Arts and Health Conference in the UK (July 2013) since the 1999 MMU event. Parkinson was keynote speaker at the first ESRC funded, UK Research Network for Arts, Health and Wellbeing [K] seminar. He was interviewed by BBC R4's Today-Programme about arts/health research in April 2013 [L]. In July 2013 Parkinson, as chair of National Alliance for Arts, Health and Wellbeing, and particularly for his international work, was cited in a debate on the Arts Contribution to Education, Health and Emotional Wellbeing^l in the House of Lords [M]

Derbyshire Community Health Services NHS Trust (DCHS) commissioned Arts for Health to explore implications of the ISP across the NHS Trust (£60k). The report, Fully Engaged and Culturally Connected [5] identified synergies between cultural partners and health/social needs, enabling on-going cross-fertilisation of research and practice, and development of Manchester School of Art staff and student placements within NHS.

Arts for Health with Bangor and Newcastle Universities, awarded £1.2million for three-year research programme called Dementia and Imagination, to explore the impact of visual arts on wellbeing, and investigate the arts as a vehicle for developing dementia friendly communities, in line with government policy.

In conclusion, Arts for Health started in Manchester in the 1970s at MMU and is now a globally recognised movement.

Sources to corroborate the impact

[A] Report of the Department of Health Working Group on Arts and Health (citation page 13)
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_073589.pdf
This report concluded that it `believes that the messages are clear — that arts and health have a clear contribution to make and offer major opportunities in the delivery of better health, wellbeing and improved experience for patients, service users and staff alike. The Department of Health has an important role to play in promoting and supporting the development of arts in health, working in partnership with others.'

[B] Arts Council England, The Arts, Health and Wellbeing, a National Strategy, 2007, ISBN: 978-0- 7287-1338-3 (MMU citation on pages 30 - 31)
http://www.artscouncil.org.uk/publication_archive/the-arts-health-and-well-being/

[C] Department of Health with Arts Council England, Prospectus for Arts and Health, April 2007, ISBN: 978-0-7287-1339-0 (citation pages 27, 110 )
http://www.artscouncil.org.uk/publication_archive/a-prospectus-for-arts-and-health/

[D] Hansard 1, Arts and Healthcare Debate, (House of Lords) Thursday 6 March 2008 (699) (6.3.08) GC218-21) (citation, column GC220)
http://www.publications.parliament.uk/pa/ld200708/ldhansrd/text/80306-gc0007.htm
"Last September, MMU published a fascinating study called Towards Transformation: Exploring the Impact of Culture, Creativity and The Arts on Health and Wellbeing. The key point that it makes is that artistic activities, such as painting, singing, gardening or dancing, enhance people's sense of self-esteem, not only in mental health but across the board. It is that enhancement of self- esteem that affects a person's sense of purpose about life in general, which in turn creates in them a desire to take control, to change and to make healthier choices. Artistic activity can bring about a more balanced perspective on life, thereby enabling people to move away from dependence on healthcare and much more towards self-reliance. We think immediately of Derek Wanless's fully engaged scenario, and the arts should be seen as one important catalyst for delivering that scenario."

[E] Secretary of State for Health, Alan Johnson speech at the Wallace Collection, September 2008 http://www.artsforhealth.org/news/alan-johnson-speech.pdf and full testimonial on file from

[F] Testimonial on file from Peer in the House of Lords corroborating MMU's influence on national policy around arts and health

[G] John Knell and Matthew Taylor, Arts Funding, Austerity and the Big Society, remaking the case for the arts, The RSA February 2011 (citation pages 23/24) http://bit.ly/eKzJmv plus testimonial available on file from Chief Executive, RSA from September 2013 on the influence of MMU research on this document

[H] Manifesto for Arts, Health and Well-being (part one)
ISBN: 978-1-900756-66-2 http://issuu.com/kamaone/docs/manifesto2011/3 Manifesto for Arts, Health and Well-being (part two)
http://issuu.com/kamaone/docs/manifesto2?mode=window&backgroundColor=%23222222
ISBN:978-1-900756-70-9

[I] Menas žmogaus gerovei (Art for Wellbeing), Lietuvos Respublikos Kultūros Ministerija, (Published by the Republic of Lithuania Ministry for Culture) 2012, ISBN 978-609-95448-1-6 http://www.artsforhealth.org/resources/Menas_zmogaus_gerovei.pdf and further evidence on file to corroborate MMU involvement.

[J] Digital Artifact on the Asia Europe Foundation, public health and cultural web-portal. ASEF — ASAP Scenarios http://asef.org/ebooks/public-health/scenarios/index.html

[K] The Arts, Health and Wellbeing Research Network is an ESRC funded UK-wide research network. Clive Parkinson was their first speaker on March 7^th 2013.
http://artsandhealthresearch.ac.uk/artshealthandwellbeing/documents/seminar-programme-notts-march-2013.pdf In his application to the ESRC, Dr Theo Stickley described the ISP as offering, `what is probably the only general model of the relationships between the arts and wellbeing in which they propose that a holistic approach to the person interacts with a facilitative environment to generate an openness to change.'

[L] BBC Radio 4, Today Programme, 19th April 2013 http://www.bbc.co.uk/news/entertainment-arts-22212531 and http://www.bbc.co.uk/news/health-22189774

[M] The Arts: Contribution to Education, Health and Emotional Well-being
House of Lords Debate, 25 July 2013 : Column 1524 `The National Alliance for Arts, Health and Wellbeing was formed last year to represent practitioners across the English regions. It is available to engage with policymakers and decision-takers. Its work is international. At its recent conference in Bristol, people from 22 countries came together to share their experiences and ideas. The chairman of the national alliance, Clive Parkinson from Manchester Metropolitan University, has been engaging with Governments across Europe in this field.'
http://www.publications.parliament.uk/pa/ld201314/ldhansrd/text/130725-0003.htm