Workshop 3, ‘Partnerships’,

posted by Josie Billington.

Our third and final workshop took place on 7 March 2023 on the theme of ‘Partnerships’. We were delighted to welcome three contributions which focussed on extensive and varying experiences of establishing successful collaborations between arts activity and health provision.

  Professor Lisa Shaw gave a fascinating account of the evolution of the Cinema, Memory and Wellbeing Toolkit, which was developed to help care home staff and independent carers get optimum benefit from the experience of communal film viewing involving older people.

The toolkit began life when Lisa and her collaborator, and fellow specialist in Film Studies at the University of Liverpool, Professor Julia Hallam – neither of whom had any previous background in health research - consulted with managers and care practitioners at a local nursing home based in the city. They found that, while big screen TVs and DVD collections were readily available, film-showings were often too long and under-stimulating for residents. As an alternative, Professors Shaw and Hallam developed a DVD of very short sound and image clips, with interactive prompts and props, combining amateur footage of familiar landmarks and everyday life in the city in the last century, with music and dance sequences from Hollywood feature films of the same period. The scenes of local life and the colour and spectacle of the entertainment, resonated strongly with the residents, capturing their imaginations, and evoking vivid memories and a sense of joy and belonging. Younger carers especially, many of whom were new to the role and the region, particularly valued an inspiring resource that they could learn to use very quickly. 

The project extended its partnerships to include: cultural organisations - National Museums Liverpool and the 1939 Plaza Cinema - which enabled a scaling up of the project, including a Carmen Miranda tea dance at an annual carnival led by the Brazilian community; and a historical archive in Manchester which further developed the multi-cultural dimension of the resource and expanded its reach across care homes in North-West England. Lisa’s background in Brazilian studies also gave her access to health professional contacts in Brazil. Together they set up a twice-weekly film club in a church hall next to a GP practice for 80 local inhabitants over the age of 65. In a research innovation, the audience’s verbal participation and physical reactions (laughter, singing, movement to music, dressing as famous stars) were video-recorded as evidence. The outcome was the creation of a Portuguese version of the toolkit and a mutually positive impact on the community health workers and the people in their care.

‘What I’ve learned from this experience,’ said Lisa ‘is that potential partnerships are everywhere. They're all around us all the time and they often emerge quite unexpectedly. Through friendships, informal contacts, and the larger networks they are part of, you bring together collective expertise and interests to create something that starts small and grows.’ Lisa also urged the importance of pro-active networking, including publicising activity through public events, local press and social media. This proved particularly important during the COVID-19 lockdowns when Lisa and her team developed, in partnership with an NHS Trust, a toolkit pack, with laminated images and a DVD, for use in dementia care wards, and publicised widely their delivery of the intervention via Zoom and Facebook to older people in Britain and Brazil.

Our second speaker was cellist, and music and health practitioner, Georgina Aasgaard. An orchestral player ‘by trade’, over the last twenty years, inspired by ‘a real passion for taking music from the stage to more intimate situations’, Georgina has worked as part of a Musician in Residence programme in partnership with Royal Liverpool Philharmonic, Alder Hey Children’s Hospital and Mersey Care NHS Foundation Trust among others. Having started out as a 12-week pilot in a hospital psychiatric unit, the programme is now delivering across 24 NHS settings throughout the Liverpool City Region, benefiting an estimated 17,000 service-users and their families, in brain injury, adult mental health, dementia wards, drug and alcohol rehabilitation, learning disability and community and secure units. The programme  endeavours to reduce the stigma surrounding mental health difficulties by improving access to meaningful occupation and a sense of achievement as part of a collaborative community. Above all, the residency creates a safe space for self-expression. ‘The most important thing is giving people voice and choice through music, the freedom to have an opinion, a say. My first question is always what do people need? How can I cater to what matters to you right here, right now?’ Georgina treated us to some excerpts of the amazing original compositions developed through improvisation in these sessions, captured both in performance and on CD.

Reflecting on the meaning of ‘partnership’, Georgina commented:

‘I had no prior experience of, nor training in, mental health care settings. Straightaway, I perceived the importance of working as a team. There are two very different institutions involved, a cultural organisation and health provider, and so much is about understanding each other’s contexts - clinicians, orchestral musicians, nurses, occupational therapists, service-user participants, other arts practitioners and therapists.  Over the years, partnership has really been about reshaping and remapping everything  we do to be able to grow together.

Georgina also pointed to some of the challenges to successful partnerships. Issues around sustaining funding, and maintaining the support of all staff (from strategic management to clinical and community care staff) within a shared culture of equal teamwork, can affect the quality of the collaboration and points to the importance of inclusiveness of stakeholder perspectives in planning and coordination.

As a result of her extensive experience as a practitioner, Georgina has, over the last two years, extended her activity into research. Supported by a Pre-Doctoral Fellowship award from the National Institute of Health Research, she has been exploring the value of introducing a non-clinical music intervention (one delivered by musicians who are not trained music therapists and do not pursue a long term therapeutic goal) into a mental health setting. ‘What interests me keenly is the reciprocity of the creative process whereby the musician can help identify the participants’ needs and celebrate their individuality in a safe, non-judgmental and non-hierarchical environment, enabling meaningful communication and community – connection, togetherness.’

  Our final presentation came from Sally Rimkeit, a Medical Specialist in Psychogeriatrics in Wellington, New Zealand,  and author and linguist Dr. Gillian Claridge.   Sally and Jill are lead collaborators on the Reading and Dementia Programme at the University of Otago and editors of Dovetale Press, a small publishing company dedicated to creating books for people living with dementia. While many of the latter have been avid readers throughout their lives it is often erroneously assumed by care providers that children’s books  are more suitable – a strategy which tends to infantalise rather than stimulate. ‘We thought it was tragic that people with dementia are very often written off as not being able to read simply because they can't remember what they've just been reading.’ Sally and Gill conducted an experiment by giving a group of people living with moderate to severe dementia three versions of Charles Dickens’ classic tale A Christmas Carol - the original Dickens, a children's version, and Gill’s adaptation with simplified language and pictures. There was overwhelming preference for the original Dickens version, because the readers ‘loved the language – the music of the language, the rhythm, the wonderful phraseology’.

Thus, the Press has published beautifully illustrated adaptations of literary fiction which re-tell classic stories in episodic form - each double-page spread is a stand-alone reading experience as well as a step in the overall narrative - preserving as much as possible of the original language. This was crucial, Sally explained, from a cognitive point of view. ‘There are wonderful brain imaging studies which show that when you read Shakespeare, the brain lights up. When you read just expository language, you know, a washing machine manual, it doesn't do that.’

The Press has been supported by partnerships with, and funding from, Ryman Health Care, and Bupa New Zealand - two of the bigger companies providing aged care facilities in Australasia. The adaptations also carry forewords from Alzheimer's New Zealand, the primary advocacy group for people living with dementia in the country. Bupa also supported an academic study assessing whether sharing the Dovetale books in reading groups in dementia care homes could improve the quality of life of residents. The international Randomised Controlled Trial, with partners in Australia and the UK, ran a seven-week intervention, consisting of a twice-weekly reading group, in fifteen care homes, using standard measures of quality of life in older people. Early analysis of the data from the study, which is still underway, shows improved quality of life for those participating in reading groups compared to control participants and the hypothesis is that the results will be comparable to those for Cognitive Stimulation Therapy (CST), the gold standard psychosocial intervention for people living with dementia.

A sense of community strongly emerged, there and then, between the workshop contributors through mutual admiration and recognition of the rewards of working in often austere mental health settings. Sally, from her clinical background, was struck by the value of Lisa’s and Georgina’s interventions in stimulating much more than memory and expression -  ‘The whole brain is working with these creative activities which is much better than any medicine we can give’ – and emphasised the importance of Georgina’s co-creative approach in overcoming the tendency for those in institutionalised mental health care units to be considered ‘invalid’ in all senses. ‘In making art,’ said Sally,  ‘there is no “othering”: we’re all creative, we all work together.’ Gill and Lisa exchanged their common experience of the power of creative practice to open ‘meaningful connection across barriers’. Dovetale Press has now formed partnerships with libraries to reach people of diverse culture living with dementia within the community. Gill showed footage of a reading group of men and women of white settler and Maori descent sharing their distinctive experiences of courtship and marriage while reading Little Women. Lisa’s Cinema and Memory project in Brazil serendipitously included care home residents from prosperous elite backgrounds and older people from poorer localities. Two groups, who had remained separate all their lives, were brought together into community through shared memories of a song or a star.

There were other commonalities across the projects, too. All three had successfully taken cultural practices or artefacts already in existence into contexts where they had not been used before, as a result of partnerships which had grown from the ground upward. Moreover, these partnerships and activities were made possible or were strengthened because each of the contributors had in some way moved out of their original professional sphere, from practitioner to researcher in the case of Georgina, and from researcher to practitioner in the case of Lisa and Gill (who delivered the interventions they had developed). Paul Crawford, Professor of Humanities at the University of Nottingham, and a member of our project’s advisory board whom we were very glad to welcome to our workshop series, commented that: ‘A lot of partnerships come from the right people in the wrong places, people with mixed backgrounds or a kind doubleness. Sometimes these people become profound bridges in terms of developing projects.’ This was an inspiring conclusion to an uplifting workshop and the SHARED team offers its sincere thanks to our contributors and all involved in making it a success!