A systematic review of the subjective wellbeing outcomes of engaging with visual arts for adults (“working-age”, 15-64 years) with diagnosed mental health conditions

The importance of the visual arts in contributing to the wellbeing of adults with mental health conditions has been little documented beyond some insightful and influential interventions and exploratory studies. Initiatives such as Arts on Prescription projects have, in the UK provided examples of the positive effects that engagement in artistic and creative activity can have, and some of these have been documented in small-scale studies of interventions. Most of the evidence has been perceived as positive but of limited scale. In this context, this review was carried out to examine in a more focused way the ‘subjective wellbeing’ (SWB) outcomes of engagement with the visual arts for adults with a background history of mental health conditions. SWB embraces both the positive and negative feelings that arise in individuals based on their view of the world, how they think about themselves and others, and what they do in the interactions and practices of everyday life. Adult subjects in the studies included in this review were of ‘working-age’ (15-64 years). The focus of the review and the precise research question were agreed at inception sessions of the research team, and in collaborative engagement with stakeholders in the areas of policy, service-delivery, project and evaluation commissioning, and research and scholarship in the spheres of the visual arts and mental health. Published studies from the past 10 years were studied for the review, and their findings synthesised and integrated into an evaluation of the state of knowledge in the field, in terms of the specifics of the research questions. We found that there is limited high-quality evidence, though case studies from the UK have provided important and consistent findings, corroborated by grey literature that has reported on interventions and projects. The review includes published findings based on data on/from 163 participants across four countries – Australia, Sweden, the UK, and the USA. Overall, female respondents outnumbered male respondents. A wide variety of wellbeing measures were used in some quantitative, statistical studies. In-depth interviews dominated the qualitative studies, giving voice to the experiences of individual subjects. The visual arts practices that featured in the studies included forms of painting or drawing, art appreciation with selected art forms, artmaking culminating in an exhibition, and more general creative and craft activities that included visual artefacts such as ceramics or sculpture. Evidence we include from recent unpublished reports (grey literature) was produced by or for visual arts organisations since 2014. Participants in the evaluations were both male and female and were engaged in UK-based arts interventions, many via community arts or ‘Arts on Prescription’ types of intervention. Overall, the evidence available in this review has shown that engagement in the visual arts for adults with mental health conditions can reduce reported levels of depression and anxiety; increase self-respect, self-worth and self-esteem; encourage and stimulate re-engagement with the wider, everyday social world; and support in participants a potential renegotiation of identity through practice-based forms of making or doing. The most effective ‘working ways to wellbeing’ are also confirmed in processes of implementation that ensure provision of secure safe-space and havens for interventions; that recognise the value of non-stigmatising settings; and that support and sustain collaborative facilitation of programmes and sessions. 4 Some negative dimensions of engagement with the visual arts were also identified, including stress and pressure felt to complete activities or commit to artmaking, and the very real fear that the end of an intervention would mean the return to a world of anxiety, decreasing confidence and social isolation. The review shows that for adults starting visual arts activities or programmes, the subjective wellbeing outcomes are, for the majority of participants, positive. This applies to men and women alike across the studies. The most convincing evidence has emerged from focused qualitative research designs, and makes clear that the most effective work in the field continues to lack the necessary resources and infrastructure that would ensure sustainable practices and interventions. Overall, there is some evidence of benefit in a weak field that could be strengthened by fuller monitoring of cohorts to evaluate the long-term effects of participants’ engagement with the visual arts.