Evolving Pathways – Personal, Emotional and Socio-Cultural Journeys
"This group affords young people who are largely very socially isolated the opportunity to socialise with their peers, to feel accepted as they are, to enjoy, and to achieve. Some of our young people struck up friendships and now keep in contact and see each other outside of the group…For many of our young people I think that this is the only group and opportunity of its kind that they would be able to currently access with their specific emotional wellbeing/mental health needs." Rebecca Hempe, Targeted Youth Support Worker, East Sussex CAMHS
Music in Mind aimed to promote regular engagement in musical activity to help young people with mental health needs access support, in order to assist them in their everyday lives. Many of the young people involved in the projects had serious mental health needs, some of which were life threatening.
Overview of the focus of the case study
The kinds of outcomes to which personal, emotional and sociocultural outcomes relate are somewhat difficult to draw a boundary around. However, there are a number of emergent examples participants either highlighted themselves or that were commented upon by others, including parents, tutors and support/clinical staff. Whilst it could be argued that these are somewhat subjective because they rely on a perception (rather than a measurement) of change, they are nevertheless important indications of beliefs, behaviours and actions at a given time and in a particular situation. The charity Mind describes mental health issues as potentially "affect[ing] the way you think, feel and behave". This case study highlights some of these perceived changes and observations.
The importance of regular commitment and engagement
Within the timespan and confines of the projects, there is clear evidence of some young people’s regular commitment to, and engagement with, the projects. For some young people, the music projects were attributed to them coming to centres on a more regular basis. This gave them more regular access to support mechanisms within the centres. Sustained attendance, whether at Chalkhill or at one of the non-residential projects, led to a number of reported and observed personal, emotional and sociocultural outcomes for the young people. It is difficult to ascertain whether young people who only attended occasionally or started and then stopped gained from the projects, as there is insufficient feedback.Negotiation and competing interests
Through all projects, participants were encouraged to follow their own musical interests and motivations; although sometimes in a group situation this meant that multiple and competing interests needed careful negotiation. This included the choice of instruments (sometimes on a rotation basis to meet all preferences) and also choice of activities and music.
Some young people reported that they enjoyed playing particular music that “would not have been my first choice”, (participant) and then being surprised that they enjoyed it so much. The positivity with which they spoke about this related to the sense of personal achievement which arose from the resultant audio recordings and performances, and the feeling of contributing competently to a band or group.
Many young people spoke about how music was important to them, particularly as a listener. Some discussed their musical preferences and how these related to a strong sense of identity. Some also discussed the importance of music as a mood regulator, including as a mechanism to purposely set or change their mood. Through regular attendance at the sessions, some young people really bonded with each other “through their own passion for certain music and sharing it with others” (Support worker).Self-belief
There are a significant number of comments from young people relating to feeling proud of the music, recordings and performances and also their positive feelings and elation, which often related to something that they didn’t necessarily believe was achievable at the outset.
There are also comments from young people expressing self-doubt and worry about how they would feel if they could not achieve something. This sometimes related to how this might damage their self-view and also how other important people in their lives might perceive them. Both of these points about self-belief clearly demonstrate the importance of tutors being flexible and building for success, whatever that might realistically look like for any particular young person at any given point in time and are linked to ‘fear of failure’ as defined by Conroy at al. (2004).
Functioning as a band and collaborative writing encouraged communication between individuals, some of whom knew each other before the music projects commenced (e.g. through attending the drop-in or timetabled sessions with CAMHS), but had not communicated frequently and had not previously collaborated. The need for effective collaboration as part of the musical process was pointed out as a positive across all projects. A young person at the East Sussex CAMHS project summed up their thoughts on the project, noting that is helped them “meet new people and work alongside others like I’ve never done before”.
The shared experience of creating something musical was a highlight for some of the participants. For example, a focus at some sessions in the Worthing and Bexhill projects was to play and create music together, supported by the tutor. Due to the fluid nature of the groups, at points they worked on cover versions and at other times they developed their own material.
"As primarily a one-to-one support worker in my current role, I have been able to observe how young people who I see one-to-one on my caseload can flourish in a group setting. I think the group having a creative element is vital to this, particularly initially when young people found it very difficult to talk to one another (largely de to their lack of confidence and, for many/all, their high levels of anxiety), so there were able to have meaningful occupation through music alongside being able to share and discuss their musical tastes as ways to get to know one another."
Rebecca Hempe, Targeted Youth Support Workers, CAMHS
Building trusting relationships and friendships
As a parent pointed out, the focus on group work, and working with the same tutor, made it easier for some young people to develop their communication skills, for example having to make eye contact or verbal communication (which some found difficult) and, over time, to get to know someone well and relax more in their company.
There are examples of participants forming new friendships and continuing to socialise outside of the groups. This is particularly noteworthy because some of the participants who attended the drop-in sessions openly discussed how difficult they found it to socialise and to find and keep friends.Needing support / recognition of challenges
Some of the young people spoke about the ‘security’ of having a parent or clinical support worker that they knew well in the sessions, and how this gave them the support and encouragement to get involved and try things out.
Conversely, some young people spoke about how the absence of not having a familiar adult that they knew well in the sessions sometimes caused them to be particularly anxious, especially when what they were being expected to do, seemed, at that point in time, to be unattainable and stressful. It was pointed out that when they had support in the room from, for example, a nurse or an occupational therapist, they were able to leave the room temporarily and not be on their own, which was important to them.
There are also examples of young people removing themselves from sessions temporarily, for example, going outside to the gardens. When support workers were not present, this was noted as causing worry to tutors, parents and other young people.
Feeling supported and respected by the tutors and peers was often flagged as important, as was the gaining of peer recognition as a musician. There are many examples of the young people showing their respect for each other and the tutor, and also the emergent positive feelings when they received it from others.
Some young people attended some of the sessions but other challenges sometime got in the way of regular attendance. However, this was recognised by the support workers and, in some of the projects, they tried to be an effective ‘bridge’ between the young people and the tutors/projects. For example, one support worker noted: “Teresa has enjoyed the group when she has attended but due to physical health difficulties and anxiety has found it difficult to attend at times.”Promoting a positive outlook
Examples were shared of the engagement during the musical activities gradually changing the conscious focus for some young people, at least temporarily. For example, 12-year old Yasmin initially focussed completely on self-harming, affecting her engagement with the sessions and was the focus of her discussions and thoughts. Over time, Yasmin got more involved in the weekly sessions and one of the bands, did not constantly talk about self-harming and became much more positive and “smiley” (Rhythmix tutor). Whilst this positive change cannot be directly attributed to attending the music sessions, it is clear that, over time, her engagement in the sessions became focussed on the musical behaviour.
A CAMHS support worker described how “Katrina had very high levels of anxiety and initially found it very difficult to attend the group and talk to others. By the end of this term she had not only found the confidence to support other new members of the group, but also built her confidence to join other youth groups and started part-time employment”. Such examples demonstrate the positive transferable possibilities.Attaching importance and ownership
There are some examples of music and Music in Mind sessions being important to participants, with multiple statements from participants about how much they looked forward to the sessions. There were also examples of participants talking about how important ‘their’ music is to them. These comments related to the ownership of the process, the musical outcomes, the sense of being a performer and the ways in which other people viewed and reacted to them and their music, along with the power they associated with writing their own lyrics and music. Some of the examples acknowledged the therapeutic function of music and lyric writing, as a release, a voice, a way to tell stories and a mood regulator.
Some models of music making are necessarily more collaborative than others. Where communication with other people (beyond the relationship between the young person and music tutor) is identified as a key desirable outcome, this could indicate potential opportunities to experiment with more collaborative models of delivery. However, a key tension here is that some young people only want to work on their own music and only want to work on their own, so if this is the case, finding ways to motivate them to come regularly to the centre and therefore gain access to specialist support is the most important factor. As one participant at the East Sussex CAMHS project noted, “It keeps me busy and gives me a reason to go out”.
Much is written about the tension between learning music for music’s sake and the advocacy for using music education and learning to promote transferable benefits. If music education (as these projects could be seen as providing) leads to young people ‘making music well’ (Finney, 2016), then the ‘transferable’ benefits (see Hallam’s 2015 synthesis of evidence supporting these in ‘The Power of Music’) or ‘soft’ outcomes, as they are sometimes called, come as part and parcel of this. These include, but are not limited to, raised self-esteem, positivity, self-image, self-confidence, friendships, and communication skills, all of which are noted at various points within these projects. Therefore, maintaining a focus on high quality and tailored musical learning experiences seems to be of critical importance.
Getting initial engagement in some of the projects and then sustaining it has been tricky, particularly those set up in places where there has not previously been a ‘music offer’. There are some barriers to engagement that have been identified - particularly around the confidence to put oneself into a potentially vulnerable position, finding such opportunities hard to take up for other reasons such as self-doubt, and not being used to having regular commitment to something. It is clear, however, that having a familiar and regular worker from the setting – a case worker, support staff, occupational therapist etc. is extremely helpful for helping potential participants join the projects and stay with them.
One young person suggested that some groups would benefit from having more young people in the sessions. She suggested that “running ‘taster’ sessions in places that teenagers with mental health problems go to anyway might be a good way to get more people interested”.
There are some similarities in the barriers identified regardless of whether the projects took place in a residential centre or through community provision. More work needs to be done exploring barriers to initial and sustained engaged and potential ways to help this, particularly in community settings. There are also some different challenges between residential centres and community provision.
Some young people experienced challenges outside of the projects that meant they stopped coming. It was sometimes difficult to get them back into the groups at a later stage, particularly because the social milieu, as a dynamic entity, had adapted without them being part of it. There is potentially some work to be done on re-integration strategies, although this also relies significantly on a wider support system being able to effectively work with the group and the young person re-connecting with the project.
Knowing what they are heading towards seems important for keeping participants interested and engaged. Having small steps along the way is equally important so that the tasks seem achievable and that they have regular points for “success” to be recognised and celebrated. Flexibility is key. Young people need support to join the projects, remain as regular attendees and also to be helped to re-connect after periods of absence, even if only one session. The role of support workers from the centres who can also help with the mental health needs is key in this. There are many hallmarks of potential ‘fear of failure’ (Conroy et al., 2004) cited throughout the findings of this work, particularly relating to uncertainty about the outcomes and relationships with others. This is something which may be worth flagging up to tutors in future training, as it is not clear whether or not they fully understand the importance of their part in breaking down learning to make sure it is always in small enough steps for all participants to feel successful whilst still leaving ‘ownership’ with the young people. Finding suitable opportunities for group activities around music outside of the sessions has been noted as a suggestion from CAMHS support workers. Are there way to “Incorporate the group’s interest in music in a different way, e.g. going to see a band play, or seeing a band set up, doing something musical without playing music?” [CAMHS support worker]. Inevitably this brings challenges of who will support the young people to do this on a financial, practical, social and emotional level. The depth and breadth of feedback and evaluation from tutors varied. It is therefore a risk that the feedback reported in this evaluation is skewed towards the positive experiences. However, Rhythmix have indicated that this is in hand with revised plans for further evaluation of their programmes, ensuring that required levels of criticality and reflection continue to evolve and refine their work over time.
Knowing what they are heading towards seems important for keeping participants interested and engaged. Having small steps along the way is equally important so that the tasks seem achievable and that they have regular points for “success” to be recognised and celebrated.
Flexibility is key. Young people need support to join the projects, remain as regular attendees and also to be helped to re-connect after periods of absence, even if only one session. The role of support workers from the centres who can also help with the mental health needs is key in this.
There are many hallmarks of potential ‘fear of failure’ (Conroy et al., 2004) cited throughout the findings of this work, particularly relating to uncertainty about the outcomes and relationships with others. This is something which may be worth flagging up to tutors in future training, as it is not clear whether or not they fully understand the importance of their part in breaking down learning to make sure it is always in small enough steps for all participants to feel successful whilst still leaving ‘ownership’ with the young people.
Finding suitable opportunities for group activities around music outside of the sessions has been noted as a suggestion from CAMHS support workers. Are there way to “Incorporate the group’s interest in music in a different way, e.g. going to see a band play, or seeing a band set up, doing something musical without playing music?” [CAMHS support worker]. Inevitably this brings challenges of who will support the young people to do this on a financial, practical, social and emotional level.
The depth and breadth of feedback and evaluation from tutors varied. It is therefore a risk that the feedback reported in this evaluation is skewed towards the positive experiences. However, Rhythmix have indicated that this is in hand with revised plans for further evaluation of their programmes, ensuring that required levels of criticality and reflection continue to evolve and refine their work over time.