Joining the Dots: The social value of creative interventions in mental health care (2012-2016)

The ICC is collaborating with Mersey Care NHS Trust on a four year research programme examining the social and economic value of creative interventions in mental health care. ‘Joining the Dots’ was developed in response to a desire within both partner organisations to begin to consider more thoroughly and pragmatically the added value of cross-sector, collaborative, creative and cultural work within the context of mental health care.

Mersey Care NHS Trust has a number of existing strategic relationships with arts and cultural partners in the Liverpool city region, several of which are profiled in the ‘Shift Happens’ report (see ‘Project Downloads’ box), which documents the impact of these partnerships and relevant commissioned activities upon service users and the organisational culture and practices of Mersey Care.  Such outcomes include transformative effects upon service users’ sense of identity; personal safety and comfort in care settings; improved effectiveness of care in planning and practice; improved ‘social profitability’ and quality of service provision.

There is a pressing objective however – for both cultural and mental health care sectors – to consider on a more long-term basis the holistic value of such partnerships from both strategic and operational perspectives, including the relative added value of collaborative working. During initial conversations with Mersey Care colleagues, the concept of Holistic Management was put forward as a potential analytical framework. This relates to the application of a ‘systems thinking’ approach to resource management, designed to explore whether decision-making becomes more economically, socially and environmentally effective when based on a shared ‘holistic goal’ between different organisations and services.

Joining the Dots research will consider therefore the longer-term holistic resourcefulness and value of cross-sector cultural activity in the Liverpool city region. The research now builds upon findings and recommendations made during ‘phase 1’ of the programme (2012-13, see below), with a particular focus upon the social and economic advantages of collaborative working in mental health care. These may range for example from pragmatic cost savings derived from co-located services, to a more strategic consideration of the long-term service value of creative interventions in clinical settings (e.g. artist in residency schemes). To this end, Mersey Care NHS Trust is interested in exploring the value of the full range of cultural and creative approaches and experiences used within the context of its work, including ‘grassroots’ community-based activities and more formal service level agreements and partnerships with established cultural organisations within the city of Liverpool.

There are three elements to this work:

Social and economic value research: this includes new empirical research on the value of Mersey Care’s full range of creative partnerships and interventions, including the development of a coherent valuation framework.

Policy and practice application: the team will work closely with relevant stakeholders within the city to ensure that research correlates with the development of relevant policy and practice processes including commissioning and collective decision making.

Professional learning and cultural value: the Joining the Dots programme also provides a platform for debate and discussion on the contribution of cross-sector working to the articulation of cultural value and to the development of professional practice within arts and cultural communities.

The research programme was developed by ICC’s Head of Research Kerry Wilson, in consultation with ICC Chairman Professor Phil Redmond and Mersey Care colleagues. Phase 2 is led by ICC Research Fellow Gayle Whelan (from March 2014), who has considerable experience in community asset mapping, Social Return on Investment (SROI) and evaluation research methodologies. The programme is furthermore complemented by other ICC projects led by Kerry under the banner of the Cultural Value and Public Policy research theme, including successive evaluation studies of House of Memories, the dementia care training programme developed by National Museums Liverpool, and new research funded by the Arts and Humanities Research Council on the efficacy of arts-based social prescribing in mental health care.

Phase 1: review of the literature on economic benefits of collaborative cultural activity 2012-13

In order to develop a sound theoretical context for the research, one of the first objectives was to commission a comprehensive review of approaches to economic evaluation conventionally applied within arts and cultural fields. The brief stated that secondary research should include a meta-analysis of existing cultural evidence within given parameters. The review covered existing research and evaluation of collaborative cultural activities and interventions, including academic outputs and reports and papers from a range of sectors (sometimes described as ‘grey literature’). The meta-analysis was designed to consider for example:

• The most commonly used indicators of cultural impact in collaborative settings;
• The scale of economic impact relative to cultural activity;
• Methods for evaluating/measuring impact and their relative effectiveness;
• The context and conditions within which economic impact (e.g. cost savings) is most likely to occur;
• Any gaps in the existing evidence base relating to the economic implications of collaborative cultural activity.

Building upon the ICC’s core assertion that culture is the sum of our shared creativity, that being everything we do together, the broadest possible definition of cultural activity would preferably be applied to the Joining the Dots project. This encompasses activities that ‘allow the expression of identity, a sense of self, [at] the level at which social groups develop distinct patterns of life’ (Mitchell, 2000), as well as the artefacts produced from these patterns of life- the music, the plays, the images etc.

In a collaborative context, this can include examples along the continuum of cultural activity from grassroots initiatives to ‘organised’ culture. These were categorised according to types of activity (cultural heritage/history; informal leisure pursuits; literature/literary culture; performing arts; visual arts; media/film; music) and/or organisations involved (museums; community groups/assets; libraries; theatres; galleries; cinemas; social/performance venues). The focus for the review where possible was the value created by such activities and/or organisations when working in collaboration with ‘other’ service providers and sectors.

Mersey Care Research Associate Justine Karpusheff was commissioned by the ICC in July 2012 to undertake the review, which points to a clear gap in the field regarding the assessment of social and economic value in cross-sector collaborative contexts. Justine’s report profiles established economic ‘impact’ and ‘value’ research techniques, including their relative adaptability and effectiveness with respect to the overarching aims and objectives of the Joining the Dots programme. The review found a lack of consensus, not only with regards to the use of these frameworks as a fundamental issue, but also, even where models had been used, to which might be the most appropriate for exploration of cultural activity. This is exacerbated by a scarcity of economic studies in cross-sectoral settings. Where these have been undertaken, the unit of analysis is invariably a single organisation or sector.

The conclusions of this review are that collaborative contexts offer particular challenges to exploration of economic assessment. In addition to attributing contribution, methods need to develop with partnerships, moving from one-off assessments to ongoing integrative evaluation. Methods also need to be able to account for and work with multiple notions of value and be able to express findings for different stakeholders’ needs, as well as facilitating the emergence of shared agendas. This suggests that models such as SROI may be more suitable where the focus is longer-term cultural activity.

Gayle is now working in close collaboration with Mersey Care NHS Trust on ‘phase 2’ of the programme, following recommendations made by Justine within ‘Understanding the Benefits for Mr Kite: A review of the literature on the economic benefits of collaborative cultural activity’ (please see ‘Project Downloads’ box for PDF report).

Mitchell, D. (2000) ‘Cultural Geography’. Oxford, Blackwell Publishers.