Dr Theo Stickley: A Little Rant about Evidence

Dr Theo Stickley

Dr Theodore Stickley Academic Lead for Mental Health and Learning Disabilities Associate Professor of Mental Health School of Health Sciences Faculty of Medicine & Health Sciences University of Nottingham

I am going to have a little rant about what counts as evidence. I’ve worked in mental health care for many years as a nurse and more recently as an academic. Over the years I’ve seen the rise and rise of “Evidence Based Medicine”. Don’t get me wrong, in principle it is no bad thing. If I get diagnosed with cancer (as my brother sadly did) I would want the very best treatment based upon the very best research evidence. With cancer, heart disease and most other physical health problems the UK is one of the best countries in the world for evidence based treatments. Before I begin to talk about evidence for arts and mental health, I wish to talk about evidence for mental health care. As I mentioned, I worked as a mental health nurse for years and I currently teach mental health nursing. So of all people, I should be aware of the evidence that supports mental health nurse interventions. Generally, I am, I’ve published scholarly articles, I’ve edited a book called “Theories for Mental Health Nursing”. But when I think back to my MH nursing practice, there is scant evidence to support what I did for 95% of the time, that is IF we judge my practice on the standards applied to Evidence Based Medicine. In the world of EBM, interventions are based upon meta-analysis of data, preferably provided by randomised controlled trials. The vast majority of the work I did as a MH nurse was conducted in the mysterious world of human relationships. It is impossible to conduct a RCT on the therapeutic effects of going to the shops with someone, or sitting and chatting about football for half an hour. Does this mean MH nursing is not “evidence-based”? of course not (I actually did much more than going to the shops or chatting about football, but you get my drift…). Mental health nursing has its own evidence-base and can be found in many journals such as the “Journal of Psychiatric and Mental Health Nursing” or “Mental Health Practice” published by the RCN. It’s just that the vast majority of the evidence is not the kind of evidence defined by the medical profession. This is the problem when we begin to talk about evidence for arts and health. The following passage is a quote from the introduction of my book called “Qualitative Research in arts and Mental Health” published by PCCS Books: .

“There is a great deal of evidence continually being produced that supports Arts and Health practice. However, what constitutes evidence in terms of scientific inquiry is often beyond the reach of Arts and Health projects and researchers (e.g. randomised controlled trials). There is however plenty of evidence for the efficacy of participatory arts in terms of personal and social outcomes, however, until the right kind of evidence is produced for the National Health Service, the evidence that is produced often remains marginalised and will continue to be subject to criticism with the scientifically dominated healthcare arena. Arts practitioners may become easily discouraged when the evidence they produce is dismissed by healthcare budget holders, because this evidence does not meet the acceptable standards. It is at this point I would like to call upon the common-sense argument. Let’s imagine Dr Bloggs, a successful medical consultant that holds a ten million pound NHS budget. Before he will fund an Arts on Prescription programme he demands to see the evidence of its effectiveness and is given a qualitative research report. There is much what he considers to be ‘anecdotal’ evidence – stories of how people enjoy it and appear to ‘get something’ from it. He looks for the ‘hard’ evidence – the costs savings to GPs, the recovery rates and hospital bed-use reductions. He dismisses the evidence he has given because it is not a double-blind trial. He will then drive home in his car listening to music. He arrives home and is welcomed by the paintings on his walls. He and his wife visit the ballet in the evening, he reads from a novel before sleeping. If questioned about his engagement with art and culture, he would inevitably greatly value what he almost takes for granted. By his choices in life, Dr Bloggs provides evidence of the value of engaging with arts and culture. He doesn’t first measure the effect of the arts on his life before he engages with something, he knows, by common-sense that the arts are good for him.

Ultimately, we are unlikely to win the common-sense argument in terms of being able to see the arts mainstreamed in healthcare. So, we continue to research the Arts and Health and document the findings from this research in journals and books such as this in the hope that one day, common-sense will prevail and creative approaches in mental health will become more valued and embedded in practice. This does not mean that we should not research and evaluate our practice; on the contrary, the more we document Arts and Health work, the more the evidence grows”. There are hundreds of us around the world publishing research evidence for arts and health but I realise that for many people, if they do not have access to a university portal they cannot access research articles. With this in mind, if anyone wants a copy of any of my articles, they can email me: theo.stickley@nottingham.ac.uk and I will gladly email a PDF of the article.

I estimate that I have seven years left before I retire. It is my intention to create as much noise as possible about this issue. I have advocated creative approaches in mental health for over 20 years and there has been positive change but there is still a long way to go. Two years ago we set up a community choir during the day time. You can look it up on facebook, it’s called Nottingham People’s Choir. We don’t say anything about “mental health”, it’s a place for people to come and enjoy themselves. About 35 people go every week, you can see the joy people experience singing with each other. People have made new friends and are so happy when they perform. To fund the choir, it’s peanuts compared to the millions wasted on medication that’s 50% flushed down the toilet. One day I believe, common-sense will prevail, but we must not be shy about the evidence we are producing with every project we run.

Theo Stickley, Nottingham, March 2015

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