Introduction to Music in Mind
Music in Mind is Rhythmix’s innovative music making programme for young people with mental health problems. The programme uses music making with the aim of enhancing life chances and offering tangible help to young people aged 11 to 18 years with mental health needs. Young people and children with mental health problems often experience significant issues in life, either causing or as a result of mental health issues. By giving these young people an opportunity to gain real vocational skills and have a positive creative outlet through music making opportunities, Music in Mind offered a structured programme with the aim of helping participants gain the self-belief and skills necessary to move forward in life. Music in Mind was initially funded by Comic Relief, with additional funding from the Amy Winehouse Foundation and, as it moves into a new phase, receives funding from Youth Music. Music In Mind partners include: Chalkhill Child and Adolescent Mental Health Unit, East Sussex Child and Adolescent Mental Health Services (CAMHS), Targeted Youth Support Emotional Wellbeing Teams, Worthing CAMHS, Surrey CAMHS Youth Advisors (CYA), and the Early Intervention in Psychosis Service. From April 2013-March 2016, Music in Mind worked with young people in centres across Sussex, Kent and Surrey.Music In Mind aims to:
A number of key interim indicators were established and these form the basis of the evidence sought and emergent throughout the evaluation of the programme.
Introduction to Rhythmix
Rhythmix is a music, social welfare and education charity based in the South East of England, providing a year round programme covering a breadth of music making activity involving people of all ages and backgrounds. Rhythmix is one of the most established and highly regarded music organisations working in this field. Rhythmix has a 15-year history of regionally and nationally acclaimed work that demonstrates flexibility, belief, imagination, partnership and connection.
Rhythmix believes in the power of music to transform lives and that everyone should have the chance to express themselves through music. Music making gives people the opportunity to gain independence, an insight into their skills, hone their talents and a chance to engage with professional musicians. Trained music leaders who work as professional musicians lead all Rhythmix sessions.
Rhythmix aims to meet young people where their interests are, and then move them to a place where they can expand and improve their musical abilities, giving them an insight into their personal capabilities in a way that the traditional education system and past interactions with adults may not have provided for them. It aims to provide young people with mental health problems ways to see their capabilities and new possibilities for the future.
Established in 1985, Comic Relief is a major UK charity seeking to "bring about real and lasting change by tackling the root causes of poverty and social injustice" (Comic Relief website). They provide grants for organisations in the UK and internationally around five themes: better futures, healthier finances, safer lives, stronger communities and fairer society. Comic Relief supported Music in Mind with a grant of £51,304 across a 3-year period (1st April 2013 - 31st March 2016).
The Amy Winehouse Foundation was set up by Amy’s family following her tragic death in 2011. It "works to prevent the effects of drug and alcohol misuse on young people’ and ‘aim(s) to support, inform and inspire vulnerable and disadvantaged young people to help them reach their full potential" (AWF website). The foundation awarded a grant of £19,570 to Rhythmix to allow them to extend the work and the reach of the Music in Mind programme (Sept 2014 - Sept 2015).
Youth Music is a national charity investing in music-making projects for children and young people experiencing challenging circumstances. They believe everyone should have the chance to make music. The foundation awarded a grant of £180,000 to Rhythmix for the wellbeing programme which covers Music in Mind and Wishing Well. This grant overlaps the Comic Relief programme by 6 months and extends the work to extend beyond the end of the Comic Relief grant (July 2015 - July 2017).
Music in Mind is undertaken in partnership with the following organisations: Brighton & Hove Music and Arts, Soundcity (Brighton and Hove Music Education Hub), Surrey Arts, Surrey Music Education Hub, East Sussex Music, East Sussex Music Education Hub, West Sussex Music Trust and West Sussex Music Education Hub. .
Each project had a dual focus on making music together, often through forming bands and offering creative opportunities for young people to develop their song writing and lyric writing skills, leading to a combination of audio recordings and performances. There were also opportunities in most projects for young people to develop their music technology skills. Whilst most of the focus within the sessions was on collaboration, many of the tutors also worked on an individual basis with some of the young people at regular times during the programme. The young people mostly decided the focus of the sessions and material.
Brief overview of the projects
Chalkhill is a children and adolescent hospital and pupil referral unit in Haywards Heath, West Sussex. The centre caters for both residential and day-care patients. According to Ofsted (2012:3)
Most young people attending Chalkhill are aged between 11 and 19 years. Pupils are referred to the service because they have a range of, or combination of, extremely complex medical and/or mental health difficulties. These include acute psychosis, mood and conduct disorders, bipolar disorder, clinical depression and obsessive compulsive disorder. Many pupils have serious eating disorders… The average length of stay is 22 days.
Music in Mind was based on the growing recognition of the need for specific music sessions for young people at Chalkhill and the increasing demand upon their mental health services. It represents some of the most challenging work Rhythmix has undertaken in this area as it takes place in a secure residential clinical setting. Most weeks a core of around 4-8 participants attended the sessions; at points there were up to 10. The nature of the provision at the centre means that there are always young people arriving and being discharged, and young people do not always know how long they are likely to stay.
Rhythmix worked with East Sussex CAMHS in Eastbourne. Referrals to the East Sussex programmes came via the CAMHS Youth Participation Officer. She also liaised with the clinicians to advocate the use of participatory music making, bringing the opportunities available through Music in Mind to their awareness with the ambition that they would signpost it to young people in their care and encourage participation. The Youth Participation Officer also supported the most vulnerable young people by attending most of the sessions with them and meeting with the young people and their carers before the sessions and during the process as required to facilitate their participation. As the project progressed the Targeted Youth Support Emotional Wellbeing Team (TYS) were brought on as an additional partner. The TYS provides a focused response to young people who present to the service with poor emotional health or emergent mental health issues. This service focuses on cases who, without a timely intervention, are likely to require statutory intervention in the future. During the summer term of 2015 the group explored original songwriting - creating and recording their own track. Their finished track ‘White Forest’ was played at the CAMHS event, ‘A Voice That’s Mine’ in Eastbourne.
Two additional school holiday sessions were run by tutors in order to offer support to young people during the long breaks. These were attended by a combination of young people who came regularly to weekly sessions and to others who were signposted by the Youth Participation Officer.
The programme in Bexhill was planned and delivered with the Early Intervention Partnership. The Early Intervention Partnership aims to provide appropriate support for 14 to 35 year olds experiencing psychosis for the first time in order to address issues and problems at an early stage and before more serious illness develops.
During the spring and summer of 2015, Rhythmix tutors worked with young people under the care of Surrey CAMHS Youth Advisory Service (CYA). This particular group are involved in ‘Youth Voice’ development, through which they contribute to the decision making processes within the service from a young user’s perspective. The project culminated in a performance of the song they jointly created at the CYA Conference and Awards, where the young people performed live to an audience of over 300 people.
Following a request from a young person transitioning from a residential placement at Chalkhill Education Centre back to her family home, Rhythmix set up a project of work in collaboration with West Sussex CAMHS in Worthing. This project ran for one year.
Rhythmix worked with Brighton and Hove CAMHS for three terms from Autumn 2013 and a new collaborative project in a different location in the city started up at the beginning of 2016.
Specific aims sought by this external evaluation are:
Brief overview of the evaluation
The evaluation uses narrative data from a variety of sources and perspectives, including young people’s conversations with support staff and Rhythmix tutors, written and spoken narratives and observations from tutors and support staff, and interviews across the duration of the project with tutors, support staff, Rhythmix staff and parents. To protect the identity of all young people, names have been changed throughout the report.
However, it must be noted that, whilst there are many examples of evidence which points towards increased access to provision and a range of outcomes, young people involved with CAMHS undergo a number of different interventions, along with changing relationships, life events and other dynamic factors. Therefore, making attribution of any changes specifically to Music in Mind is very challenging. Hence, a multi-method approach to data collection was adopted where possible in order to maximise the capacity to triangulate findings (i.e. from multiple perspectives) in order to strengthen validity, reliability and rigour. Additionally, much of the data relates to young people who participated relatively consistently over the course of a term or longer. Therefore this does not capture the thoughts and actions of some young people who, for a variety of reasons, were not regular attendees at the projects, those who dropped out in the early stages and those who were recommended to join the projects but did not. Nevertheless, there is much to discuss from the data set reported on in the case studies which offers perspectives relating to current and future challenges and barriers.
The data and discussion is organised around key interlinking topics relating to the aims of the programme. It is presented as a series of case studies, with a final discussion section considering some of the overarching themes and how these may tentatively link to or complement existing knowledge and practice in other community music/education health and wellbeing settings.
Brief overview of child and adolescent mental health
According to Young Minds (2016:website), "more than 850,000 children and young people in the UK have been diagnosed with a mental health condition", which is around one in ten young people aged 5 to 16 (Knapp et al., 2016).
‘Mental health problems’ is an umbrella term for many conditions; the charity Mind categorises these as: types of depression, stress and anxiety, sleep, suicide and self harm, eating and body image, types of personality disorder, mania and bipolar, psychosis, hearing voices and schizophrenia, and ‘other’ including a number of conditions which do not fit comfortably under the other headings, for example, dissociative disorders, loneliness, obsessive compulsive disorder, paranoia, phobias, drugs and post-traumatic stress.
Mental health needs and services are organised in levels (sometimes known as tiers). Figure 1 demonstrates how "each level indicates a rising or escalating level of need across a wide range of indicators relating to an individual child, young person or their family" (East Sussex CZone).
Current figures around provision of mental health services paint a gloomy picture, showing that expenditure, budgets and services are being cut despite rising demand (Knapp et al., 2016). As reported by Frith (2016), "Child and adolescent mental health services are often described as the ‘Cinderella of the Cinderella service’, receiving less than 1% of NHS funding". Recent research from CentreForum shows that,
child and adolescent mental health services (CAMHS) are, on average, turning away nearly a quarter (23 per cent) of children referred to them for treatment by concerned parents, GPs, teachers and others. This was often because their condition was not considered serious enough, or not considered suitable for specialist mental health treatment (Frith, 2016: 5).
Frith’s report also shows that the situation is particularly worrying in the South of England compared to the North, with less overall spending on mental health provision and greater demand for services. Only around 25% of children and young people with mental health problems are considered to be ‘in treatment’. Within this group, there is reported drop out and disengagement, particularly at transition points such as childhood to adolescence and into adult services.
Knapp et al. (2016) report that that "55% of 12–15 year olds with mental health issues at baseline had no contact with services in connection with their mental health needs" (p. 10), also reporting that ‘75% of mental illness in adult life (excluding dementia) starts during adolescence’ (ibid). Birth cohort studies from Richards and Abbott (2009:2) offer a longitudinal view, demonstrating that,
Mental health problems in childhood and adolescence are common and they cast a long shadow over our lives. They affect not only our mental health as adults but also our chances of doing well at school and in work, of forming strong families and of becoming good citizens.
All of this evidence points to the need for early diagnosis and early intervention, yet CentreForum’s recent research shows that "Only 0.7 per cent of NHS funding is spent on young people’s mental health, and only 16 per cent of this funding is on early intervention" (Frith, 2016: 6). It is therefore sadly a reality that mental health services and funding in England have become increasingly under strain throughout the duration of Music in Mind.
At the same time, there has been a move towards more collaborative models of working, and a particular interest or focus on ‘health and wellbeing’ from multiple perspectives, and the potential role that the creative arts can play in a range of ways. Much of the more in-depth work at the moment comes from the perspective of Music Therapy, where therapists have a long tradition of successfully weaving together clinical and musical elements (Andsell, 2015). However, much of the work done within community music has links, deliberate or otherwise, to young people with mental health needs. This is often from a participation perspective (Higgins, 2012), rather than seeking specific medical or clinical outcomes. It is an emerging field with significant cross-disciplinary interest (Andsell and DeNora, 2013); ironic therefore that as the demand for mental health services rises and the potential power of music comes into the spotlight, such collaborative approaches become harder to justify in terms of capital spending. It is perhaps therefore timely for Comic Relief, Rhythmix and their NHS partners in Sussex and Surrey to be undertaking such an important piece of work.
Dr Alison Daubney is a freelance researcher, evaluator and music educator. She has worked alongside Rhythmix since 2008. Ally has undertaken and led research and external evaluations, and produced reports, articles and resources for many local, regional, national and international organisations and funding bodies spanning the creative arts, musical and cultural learning in formal and non-‐formal education and community settings. Ally is a part-‐time Teaching Fellow at the University of Sussex and an Associate Researcher at the University of Cambridge. Much of her work has an international perspective; she has undertaken research, led curriculum development and professional development in many countries, the more unusual of which include Kazakhstan, Mongolia and Romania. Ally is on the steering group of SoundCity: Brighton and Hove and also sits (on behalf of the Incorporated Society of Musicians) on the Education Subject Advisory Group, set up by the Department for Education.
Gregory Daubney, MSc. is the founder of the psychological skills development company ‘Winning Essence’. He has been a freelance psychology practitioner for over 8 years and he provides psychological support services to sport performers of all ages, backgrounds and skill level from beginner to elite to aid emotional and psychological wellbeing and improve performance. His background is in experimental psychology with an emphasis on the biological bases of mental disorders. Greg is a graduate member of the British Psychological Society.
Music in Mind has provided further opportunities for Ally and Greg to collaborate, bringing together their joint interests in education and learning, creativity and psychology.