My Lords, I welcome the amendments in the names of the noble Lord, Lord Stevens, and the noble Baroness, Lady Hollins. The emphasis on prevention in her Amendment 13 is particularly important.
I will make two points. There is abundant evidence that the engagement of the creative imagination can benefit mental health through improving well-being, confidence and self-esteem. The Creative Health report of the All-Party Parliamentary Group on Arts, Health and Wellbeing discusses, for example, the work of Artlift, a charity founded by a GP, Dr Simon Opher, which delivers arts on prescription in Gloucestershire and Wiltshire. One participant said:
“I had split up from my partner, found myself without anywhere to live and couldn’t see my children. I couldn’t work as I wasn’t physically able to do the job and wasn’t in a position mentally or financially to start a building business again after going bankrupt. Since going to Artlift I have had several exhibitions of my work around Gloucester. I find that painting in the style that I do, in a very expressionistic way, seems to help me emotionally. I no longer take any medication and, although I am not without problems, I find that as long as I can paint I can cope. It doesn’t mean that depression has gone but I no longer have to keep going back to my GP for more anti-depressants, I just lock myself away and paint until I feel slightly better. I now mentor some people who have been through Artlift themselves and they come and use my studio a couple of times a week to get together, paint, draw and chat and I can see the benefit to them”.
The World Health Organization scoping review of 2019 synthesises evidence of the efficacy of the arts in preventing stress and anxiety and building self-esteem and self-confidence. A report to DCMS in April 2020 entitled Evidence Summary for Policy: The Role of Arts in Improving Health & Wellbeing, by Dr Daisy Fancourt of UCL et al, draws attention to
“a large literature of RCTs”— randomised controlled trials—
“on the treatment or management of mental illness through arts involvement”.
Creatively Minded, a Baring Foundation report of 2020, maps 170 examples of organisations running arts and mental health projects in the UK.
When the first lockdowns came in, Intermission Youth, a London-based charity, offered a range of online activities to support young people’s mental health, from festivals to drama workshops and even a full production of “The Tempest”. One participant said:
“The Tempest rehearsals have been my highlight. They allow me to work towards something. I see familiar faces. I create something practical. Even in a period of unknown, this has been a continuity, an anchor, which has given me structure”.
The engagement of the creative imagination is powerful not only in supporting people to recover from mental ill-health but in preventing it. The same applies to engagement with the natural environment. There is evidence that creative activities can prevent or alleviate symptoms of some of the chronic conditions that affect an ageing population and which are such a burden on the NHS. Music slows cognitive decline and alleviates symptoms of dementia.
Front-line staff, too, have needed additional support to sustain their mental health. At many hospitals around the country, arts teams have been supporting staff under immense strain during the pandemic. University College London Hospitals and the University Hospitals of Derby and Burton, for example, have offered art clubs and choirs to keep people going. At UCLH, 86% of staff who took part said it had provided them with respite, and 97% said it was important that the sessions should continue.
My second point is that such cultural interventions are cost effective. A cost-benefit analysis of Artlift over three years showed that, after six months of working with an artist, people made 37% fewer demands for GP appointments and their need for hospital admissions dropped by 27%. It is much cheaper, through the employment of link workers to support GPs in making such referrals, to engage people suffering from loneliness, anxiety or depression in creative and social activity than to put them on medication or refer them to specialist psychological treatments.
Increasing numbers of ICS leaders are recognising how creative health approaches can valuably support the NHS. Let us make sure that, in framing this legislation, we guarantee appropriate opportunities for social prescribing and other non-clinical interventions to make the full contribution of which they are capable to benefiting both mental and physical health.
The department has commissioned research and funded the National Academy for Social Prescribing and the provision of 1,000 link workers. It is not clear, however, that the department, NHS England or the Office for Health Improvement and Disparities have fully grasped the potential of creative health or that they mean to normalise creative health approaches within their vision and policies. I look forward to the Minister’s assurance that the Government do indeed intend this and will design integrated care structures to this end.