Rhythmix - Evaluation

Music and Healthcare - The Importance of Partnership Working

"Without the partnership, we would not be able to offer this creative means of communicating personal stories and thoughts on mental health. Rhythmix provides a unique service to CAMHS by linking us with musicians who are extremely skilled in communicating both their skills and passion for music, whilst containing high levels of anxiety and being able to let young people reach their potential even under difficult circumstances."
Rivkah Cummerson, Youth Engagement and Participation Manager at East Sussex CAMHS, Sussex NHS Foundation Partnerships Trust

Context of the work

Partnership working is at the core of Music in Mind. Building relationships between Rhythmix staff and tutors, and a wide range of clinical and support staff in the centres and services involved in the Music in Mind projects has been an important part of their inception and an on-going priority. It is also a critical aspect relating to the degree of on-going success of each project and Music in Mind overall.

Overview of the focus of the case study

The case studies provide compelling evidence of some young people thriving through their time with the Music in Mind programme and beyond. From supporting engagement in formal education, to gaining friends, attending centres more regularly and accepting help, becoming more self-confident and using the narrative of song writing to express emotions and feelings and many more outcomes, Music in Mind has facilitated this. The relationships that young people have formed with each other, with the music tutors and with the support staff are the central pillars of this development.

There are many examples of partnerships and collaborations evident throughout Music in Mind – including music tutors working with clinicians, nurses, occupational therapists, support staff, youth workers and other specialist staff. Parents and families are another very important part of these partnerships, offering support to their children and each other, and also seeking support and advice from the specialist staff. Within the residential provision, the nature of the partnership between the music provision within the statutory schooling and that provided within the Music in Mind project provides another key dimension.

Key outcomes

Involving young people at all stages

Working with young people and involving them in every stage, including consultation before the projects on what kind of opportunities they would like, is critical if they are to have ownership of the projects. There is much evidence that this strategy was followed in Music in Mind and was appreciated by participants.

Being clear about roles and contributions when working

Where roles of the music tutor and centre staff were discussed and communicated in advance, there was much clearer mutual understanding about the contribution of different adults within each project. In these cases, professionals working in musical, supportive and clinical roles have collaborated effectively to provide better support and outcomes for young people.

Occasionally CAMHS support services brought in volunteers and this communication did not always happen. Roles were not clear and this has sometimes limited the effectiveness of the sessions due to a lack of intuitive and on-hand support within the sessions at times when particular young people may need help or have specific issues within a session.

Some sessions included volunteers from CAMHS support services. On some occasions, it was reported that tutors were not clear about their roles and what the tutor could expect of the volunteer, sometimes being told that particular behaviours manifesting or issues arising within the session were not their remit to deal with.

The importance of having clinical staff in music sessions

The most effective projects had someone from within the centre who was invested in the programme and committed to making it work. They attended sessions regularly to meet the emotional needs of participants, offering all-round support and building multiple trusting relationships.

Young people expressed the importance to them of having the clinical staff engaging within the sessions and how this helped them to feel secure and able to focus on the musical activity. At times when there were no clinical or support staff in the sessions, some young people reported their general unease and worry for other young people in the groups when, for example, they were upset and removed themselves from the room.

When a key committed member of staff from the centre moved role or changed shift, the dynamic shifted and in almost all cases where this happened, the tutors were not involved in such fruitful collaborations following the change (and often reported that these support staff were not replaced).

Co-planning and reflecting

A hallmark of the most effective practice included a key person from the centre involved in each session and meeting for a reflection and planning session with the music tutors after or between sessions. This helped music tutor better understand the young people and their needs, and how to most effectively work with them. It also ensured that perspectives were shared and collectively understood.

Making young people aware of the opportunities

One of the projects finished early due to lack of participants – one reason given is that, reportedly due to internal issues with CAMHS in this locality, clinicians were not signposting the young people to the project.

Being aware of what else is available locally

Partnerships are also wider than this small group of people and organisations – one reason that one project ‘lost’ participants is because a professional studio nearby also had an alternative offer at the same time. Knowing what is going on locally and keeping other organisations informed of this work is very important.

Joining the music offer up with other work young people are involved in

A participant described how the music lessons in the general ‘curriculum’ sessions at Chalkhill (twice weekly, facilitated by a regular member of the centre’s education team) were used to develop ideas to take along to the Music in Mind sessions. They considered this joined up approach to be very beneficial in keeping the momentum of the work going and including everyone. Additionally, one of the occupational therapists was often present in the ‘school’ lessons and at the Rhythmix sessions and this reportedly helped with the continuity by providing ongoing support.

Some of the projects incorporated aspects of young people’s work from their normal school and college lives. For example, one group worked on an FE college student’s piece. Others worked towards performances at awards ceremonies and externally organised events.

Some young participants had instrumental lessons outside of the projects or were involved in other music groups. Participants talked about how the Rhythmix tutors helped them to develop their skills to be able to transfer to external groups and lessons.

Some of the projects provided performing opportunities attended or organised by CAMHS staff, for example the Surrey CAMHS group performing at an awards ceremony. Another group produced a song played at the CAMHS Download Show. The CAMHS support worker described that ‘sharing this with a wide audience has been a huge confidence boost to our young people. They have been pleasantly surprised and taken pride in hearing from myself that people who had attended the show had asked where they could get a copy of the song’.

Working with and supporting parents and families

Parents are often very important in the relationships and support mechanism. As one parent described, they are often very invested in doing the best they can for their child – taking them to the sessions and appointments, staying if they need to, and getting as much knowledge, help and support as they can.

Parents noted the importance and value of having clinical and support staff (such as nurses and occupational therapists) in the music sessions, pointing out that some young people were more inclined to get support from them in this environment and also that when they were not in the sessions, the tutors and young people were under more pressure. One parent mentioned the importance of the partnership role between the clinical staff and the music tutor, which meant that the sessions eventually stopped once the clinical support was withdrawn from sessions. This was reportedly due to financial constraints in providing clinical staff for the sessions.

At one of the projects, a CRB checked parent stayed in the sessions when the support of the nurses ceased because she recognised the value to her own child. However, this parent noted that this is not an acceptable arrangement because it places a lot of additional stress on the tutor and the parent, particularly knowing the vulnerable mental state of the participants.

A parent also discussed the high levels of support which parents need when their children are undergoing treatment for mental health needs. The parent pointed out the potential of offering some kind of parent education and support in another room at the time when the participants were undertaking the music sessions. Some themed parent education sessions were suggested, for example: dealing with anxiety, signs to look for, self-harm, confidence, first aid for mental health, depression and the potential benefits of giving young people opportunities to work in the community and feel self-worth.

A parent also noted the benefits of talking informally to other parents when they dropped their children off at the sessions, citing these discussions as useful for getting specific ‘tips’ that may have been given by clinical staff to other parents and also as general support from being with people who were possibly experiencing similar issues and concerns about their children.

Sussex NHS Partnership Trust also noted the value of, and need for, family and parent involvement but recognise the difficulties in staffing and funding this aspect of the work.

Future considerations

It is clear that these projects, when most successful, fill both a musical and a clinical need, and that, for some young people, it is the music that draws them in and makes the clinical intervention possible. Therefore running the projects in the absence of clinical staff (e.g. occupational therapist, nurse, CAMHS team member, psychologist) significantly cuts down on the therapeutic potential. A key outcome sought from work is “increased access to appropriate services for young people with mental health problems, resulting in improved mental health” – the findings clearly demonstrate the need for the music and clinical input to run side by side.

Given the importance of this collaborative model of organisational working, how can the model of working together within sessions and through the ongoing planning of projects be secured in future projects, particularly in a landscape where many services are having to make cutbacks to provision?

Can future funding provide financial assistance for a key person from the mental health team to regularly attend sessions and to plan, debrief and reflect collaboratively with the music tutor? If so, how can this be facilitated (e.g. as part of a funding strategy)?

What strategies need to be put in place for a wider range of professionals to be aware of the work and to signpost young people with mental health needs to it? One young person suggested that making a short film highlighting the work and the benefits and also holding some taster sessions in centres which young people with mental health needs often frequent, would be ways of spreading the word about the work.

What else is going on in the local area, particularly at the same time which might invariably be ‘competing’ for the same young people? How can this information be shared in a timely manner to make the most of all potential resources and opportunities? Music Education Hubs may have a role to play here.

How can the needs of parents be better supported through a music programme such as this? Is there potential for a parent education and support programme to run alongside?