Where Music meets healthcare: developing the workforce
"It’s really important that you find the right people to support you. The debrief sessions with the therapist after each session were really helpful to me personally and to guide the programme. I recommend that there is a dedicated person in every session to support – hopefully the same one – so that you can build relationships and get continuity. " Jack Kingslake, Rhythmix Music Tutor
Across the Music in Mind programme, the importance of providing on-going workforce development and professional support is in-built and has underpinned the programme design.
This workforce development, from multiple perspectives, contributes towards the following initial project aim: to develop a greater understanding and specialist skill base amongst practitioners working with young people with mental health needs.
Additionally, some Rhythmix tutors have worked together in projects to provide opportunities to work alongside a more experienced tutor. Eight Rhythmix tutors also led and received 1:1 support on an area of specialism/need, such as music theory, different aspects of music technology and workshop skills. One tutor also had a 1:1 support session with a music therapist.
Within some projects, joint planning and debriefing with clinical staff such as occupational therapists, CAMHS nurses and early intervention support workers also provided occasional professional development opportunities for a limited number of tutors.Overview of the focus of the case study
From the perspective of the music tutors working on this programme, there have been multiple opportunities to learn more about mental health and how their work can facilitate and support young people with a variety of mental health needs. It has also provided opportunities for those in the healthcare and clinical roles to seriously consider the potential value of Music as part of a wider programme of intervention. This case study considers the impact of, and attitudes towards, different models of professional development prevalent through Music in Mind.
Specialised support and training
Tutors were given specialist input into working with young people with Mental Health needs via specialised courses. They particularly valued the break times on these courses because this time offered opportunities for them to speak with other tutors specifically about their experiences of working with young people with mental health needs in this specific role.
Some tutors were also fortunate to work alongside a professional from the centre or specialist support team such as an occupational therapist, nurse or behaviour specialist, for at least part of the time.
Tutors mentioned that the training had given them important information about the language around mental health and LBGTQ issues. The discussions on appropriate terminology reportedly stood some tutors in good stead to undertake the work and communicate competently through “having the right language to talk to people” Rhythmix tutor).Developing knowledge and skills
A view was expressed that some of this work ‘professionally challenged’ (Rhythmix Tutor) the music tutors in that it built upon their many years of experience of working with young people in other specific challenging circumstances. One tutor mentioned that they had initially been worried about taking this work on as they felt they may not be able to adapt easily to working with young people with wide-ranging mental health needs. However, due to the supportive nature of the context in which this tutor was placed, building on similar work in that setting on an on-going basis and the substantial period of time over which the project took place, this tutor felt well supported and expressed growing confidence about working with these young people.
Professional challenges were different in different settings and projects; however, the need to be flexible was common across all settings.Developing awareness and attitudes
One tutor stated that learning more about and working with young people with mental health needs had been “a real eye opener”, prompting much greater consideration and understanding of “the wide range of issues that young people with mental health issues have to deal with every single day”.
The training and on-going support in the workplace has reportedly been helpful in challenging stereotypes and misinformation, allaying initial worries about working with a new client group. It also provided tutors with the confidence that they have enough knowledge to work in this setting and with a client group they may not have specifically encountered previously, although some tutors noted the mental health needs of other groups in challenging circumstances they had previously worked with.
Some tutors now have much greater awareness of the needs around safeguarding and knowing how to access support channels quickly and appropriately. Song writing and lyric writing was central to the projects, and this raised awareness of the issues some young people chose to write about. For example, one music tutor said: “some of what they wrote was amazing, stunning but really deep and dark. It is so hard to tell whether it is really personal and deep insight and might be threatening or whether it is just normal teenage angst”.
There are some examples where the music projects changed the opinions of some of the staff working regularly in these mental health settings. For example one clinician described their initial attitudes changing from the music being a ‘distraction’ to one of respect and recognition of the value to participants’ wellbeing once the programme had been established and healthcare staff could see for themselves how some of the participants responded positively to this work.Collaborative working
Collaborative approaches to working were established in some projects. Meeting up with other professionals or support staff regularly involved with the young people in a particular setting after sessions for a debrief was considered helpful to tutors, although this was not common. This reportedly offered opportunities for tutors to extend their knowledge of working with particular young people and to developing their understanding more generally about working with young people with a wide range of mental health needs.
In some of the settings, the support staff got involved in the music making. Where this happened, the support was appreciated by tutors, young people and parents, and the recognition of how music was beneficial was more likely to be insightfully commented upon by the healthcare staff.
The programme has provided some tutors with opportunities to work over sustained periods of time in the same place and build professional relationships with a regular team of clinical and healthcare staff.
In some cases, the lack of continuity of staff, or significant staff changes, was unhelpful to the tutors in terms of building trust and communication.
Musical knowledge and skills identified on an individual needs basis were developed through some of the 1:1 sessions, which were then transferred into the projects.Musical challenge for tutors
Rhythmix tutors sometimes pushed out of their musical comfort zone and felt that this was good for them. Some participants really challenged tutors’ perceptions of what music they would be ‘into’, what they were open to, and what they wanted to work on.Valuing music
There are examples of professionals working in healthcare settings who are now more confident to both encourage and initiate music with young people in their care, which they attribute to working alongside the tutors and seeing the benefits. For example, an occupational therapist became more open to getting instruments out with the young people outside of the sessions.Building a team
Many tutors work on their own for the majority of the time. Events such as training, professional development and skills sharing help them to feel like part of a team and also to recognise how their work fits into a larger whole.Considerations for the future
Not all of the training offered was considered by tutors to be directly relevant / useful. In the future it is suggested that trainers need to adapt staff development sessions so that they are bespoke for a particular context and client group, helping tutors to recognise the relevance and to make explicit links with how it can be useful in their applied work.
Offering staff development over a period of time and avoiding one-off sessions would take a longer-term view of professional learning and provide a more inquiry-based learning structure for tutors who may not have a mentor to be able to work with on a regular basis.
Continuity of staff is really important to help build relationships; this is not always possible but should continue to be discussed at the commencement of all projects and implemented wherever possible.
There are a limited number of tutors in the local area who are experienced in working specifically in healthcare settings with young people with a wide range of mental health needs. Music in Mind has provided professional learning opportunities to some of Rhythmix’ most experienced tutors, and also given opportunities for them to share their expertise with each other. However, the pool of potential tutors still needs to be widened if this work is to be sustained and developed in the future. It is recommended that all future programmes of work continue to embed, and strengthen, a professional learning model that brings together music tutors and other professionals working with young people with mental health needs with a range of other support. The design of future professional development should encourage music tutors at all levels to develop their work over time within supportive, challenging and practice-orientated and evidence-based structures.
Much of the professional learning reported is from the perspective of the music tutors, rather than clinical staff. However, given that tutors frequently reported how busy and under pressure many healthcare workers were, it is unsurprising that this is the case. The question therefore remains what can be done to build ‘teams’ including the music tutor and those working with young people in a variety of different roles. This may also help to make those working in the clinical settings more open to the possibilities of music in therapeutic settings.
Two of the tutors mentioned the training on working with young people with mental health needs that they had undertaken. Through discussing experiences with other tutors, they considered some of the negative impacts of music, particularly around Emo culture and the self-harming culture – “…there are two sides of it, but if it breeds a sense of identity that glorifies self-harm and anxiety then we need to be aware of it” (Rhythmix tutor). This highlights the importance of having highly skilled tutors with “gravitas” (term given by a Rhythmix tutor) in order to be able to identify and professionally deal with some of the extremely challenging situations for young people which have come to light through this programme, in appropriate and professional ways.
Some areas of need for professional development emerge during a programme; for example, within Music in Mind a need emerged for some tutors to learn more about working with young people transitioning and they undertook a course with ‘Trans Awareness’ entitled “LGBTQ Awareness” which was particularly focussed on working with trans-gender young people. Having flexibility for professional development within any funded projects is essential in order for the projects to be responsive to emergent needs of the tutors and young people.