Music Exploration Programme at Wexford Mental Health Association

Participants

Participants include service users, residents and staff from the following settings within the Mental Health Services in County Wexford:

• Croi an tobar, Oylegate (MHID Unit)
• Havenview, Enniscorthy (MHID Unit)
• 58 Westlands, Wexford town (MHID Unit)
• 56 Westlands Residential/Hostel
• KTAC, Rehab Group,Enniscorthy
• Selskar Unit (Psychiatry of Later Life), Farnogue Hospital
• Millview Residential, Enniscorthy
• Tus Nua, short term Residential, Enniscorthy
• Tara House, Gorey
• Maryville, New Ross
• Enniscorthy Community Group, LINK
• Wexford Community Group, Henrietta St, Wexford
• CAMHS, Wexford Town
• The Willows Residential, Ardamine, Gorey

Aims

• Promoting the role of music in recovery from mental health difficulties
• Providing workshops that enhance wellbeing through music
• Promoting community integration by preparing clients to join choirs and community orchestras in their area through 1:1 and group tuition
• Providing opportunity for engagement in meaningful activity, enhancing social interaction and quality of life.
• Opportunity to learn new instruments, rediscover music skills and exposure to orchestral music
• Provide opportunity to develop musical skills and confidence to join community music groups/choirs throughout the county
• Social interaction through weekly group and organised social outings such as informal sessions in local pubs/other venues
• Meeting new people and having fun!

Methods

The Music Exploration Programme began in 2016, with a mix of performance and participatory workshops at two long stay residential units, Millview and Havenview in Enniscorthy, and is now currently running in up to 12 units and four community groups.

The objectives and approaches of the music programme in the residential units and community groups are:

• To present specially designed music group sessions of the highest quality to clients within HSE residential units and Community Groups within the Mental Health Services
• To engender a sense of occasion within the context of clients’ daily routine
• To unlock the creativity of clients in long-term residential settings by giving them the opportunity to improvise, perform, interact and compose their own music
• To build upon and enhance social awareness among both clients themselves and between clients and staff
• To explore and examine the value of music as a tool in activating reminiscence among clients
• To provide people living in mental healthcare environments with access to live music experiences and music of a high quality.

Enhancing Quality of Life
Emily wanted to explore the programme’s impact of enhancing quality of life for all residents attending the music group. These factors were:

• Promotion of creativity – to provide the participants with an opportunity to express and explore their creativity
• Encouraging communication – to use the music group to stimulate communication among the residents and between residents and staff
• Engendering a sense of occasion – to create a sense of a special occasion and an event to look forward to within residents’ normal routine such as the informal sessions in Houlihan’s Pub, Enniscorthy, Christmas party performances or some of the more formal concerts in Slaney Manor and St Iberius Church.
• Enjoyment – to provide the participants with an enjoyable experience and a break from their everyday routine.

Some testimonials:

‘There’s a man here who can hardly move. But he tapped out a rhythm on the drum. We were amazed… There is definitely more communication between the residents as a result of the sessions.’  – Nurse, Selskar Unit

‘The music itself is a means of communication without using speech or language. The variation in the normal routine is what many older people said they liked best about the sessions.’ –  Nurse, Croi an Tobair

‘It was something I looked forward to very much. I thought about it all week.’ – J, Resident of Selskar Unit

‘I love performing and singing each week. I feel so good after the group. Sometimes I feel down before it begins and then I get a great boost and feel so much better after taking part in the fun activities.’ – M, Resident of 58 Westlands, Wexford Town

‘The music sessions picked up the morale of the place. Often the residents don’t converse outside of the music group and spend a lot of time in their rooms on their own. It generates conversation among residents before and after participation in such a fun, engaging activity. We also like that it’s not just a “sing song”, residents get to try out new instruments and are challenged to participate in new activities out of their comfort zone.’ – Nurse, Millview Residential Unit

Attitudes to Participation
There was an even division of opinion between the residents who enjoyed both performing and listening, those who preferred the instruments, and those who preferred only to listen.

Most people enjoyed using the instruments and talking about it brought out some of the most enthusiastic comments. Some people surprised themselves after achieving a task on an instrument after one lesson. Some of the residents said that making music together brought about a sense of community and greater interaction.

Several of the residents were musicians or singers themselves and quite a number were members of pipe bands, school bands and even showbands back in the 1960s.

It was clear from the first week working with residents in the music group that there were expectations, preferences, talents and knowledge that needed to be acknowledged and explored in more detail. Many of the residents wished to perform through song or to be an audience to more familiar music. In such a new project, there will inevitably be tension accommodating such wishes, to retain interest and goodwill of participants, and to achieve the goals of challenging all residents and stimulating creativity. Emily and guest facilitators were sensitive to this.

Facilitators need to display the following:

• To recognise the preferences and skills of the residents
• To keep sessions flexible and responsive
• To be skilled at listening and responding.

The music programme can be a complex intervention at times, in that it utilises a range of components to promote health. Such components include a therapeutic relationship, a range of active and receptive musical activities and verbal reflection. These are provided flexibly in response to the individual or group and are often led by the client. Activities include improvisation, songwriting and use of pre-known music, with opportunities for verbal reflection.

In receptive music group work, we listen to selected pieces of music and reflect on clients’ experiences afterwards. After finding an issue as a focus for the session, the client listens again to specially selected music and verbalises his/her experiences during the listening. Emily accompanies the client empathically, by affirming and exploring the clients’ experiences. Emily writes a log of the clients’  experiences/images and it helps to integrate the preconscious images into the clients’ self-identity.

Activities of the groups include:

• Exploring and learning instruments, fun ice-breakers, rhythm games, boomwhackers, handbells, percussion instruments, ukulele, keyboard, violin, tin whistle, drumming
• Vocal technique, choral work
• Song writing/composition
• Improvisation
• Relaxation techniques using music
• Learning to read music
• Musical appreciation, listening to and learning about all genres of music
• Lyric analysis
• Working toward and participating in public performances
• Accessing community events
• Integration into community orchestras/choirs/groups
• Developing participants’ confidence, self-expression, social engagement, sense of achievement
• Exposure to professional musicians through mentoring and guest facilitators
• Regular performance opportunities (optional)
• Ongoing service development component and sourcing of additional grant funding for the instrument bank and guest musicians.

Emily designs programmes for the residential units and community groups that are engaging, increase quality of life, and recognise participants’ individuality. During the music sessions she includes both active forms of musical engagement such as songwriting, singing, and playing musical instruments, as well as receptive forms of musical engagement such as listening to live or pre-recorded music.

The programme embraces partnerships with community musicians and the County Council Arts Office (Creative Communities Programme), for example, working with singer songwriter Jimi Cullen, contemporary dancer Dee Grant, traditional sean-nós singer Aileen Lambert and assistant artist Luke Cosgrave. Emily has also embarked on partnerships with Music Generation Wexford on two occasions. Emily and two facilitators from Music Generation delivered songwriting workshops to teenagers who attend CAMHS and the workshops were held at The National Opera House.

Instrument Bank 
The instrument bank at WMHA has grown and expanded significantly since 2017 with some very generous donations from primary schools, secondary schools, music schools, private teachers etc. We also received some funding from Wexford County Council Arts Department in 2018 to purchase some of the newer instruments. The instruments are allocated to clients on a loan scheme until they purchase their own instrument.

Artistic Outputs

• Four-month Contemporary Dance Project (2018) with Deirdre Grant and workshop in Garter Lane, Waterford at the Well Fest 2019 with Best Foot Forward Community Dance Group and social care students from WIT. Emily and Deirdre delivered an online workshop to WIT students about their work in Arts and Health.
• Embody Project (2019) with choreographer Deirdre Grant, music facilitator Emily Redmond, psychologist Dr Denise Rogers and filmmaker Terence White. This project was carried out at 3 MHID Units in Co Wexford and a short film was created.
• In 2017, Emily established a choir within the mental health services in the county called Inner Harmony. The choir is made up of clients from New Ross, Gorey, Wexford Town and Enniscorthy.
• Formal concerts regularly from 2016-2023 where Inner Harmony collaborated with some of the following groups for performances; Enniscorthy Choral Society, Rowe St Choir, Extreme Rhythm, County Wexford Youth Orchestra, The Session Sisters, Sopranos Ellie Bowers Jolley, Patricia Goggins, Ruth Gallagher, uileann piper Mark Redmond, pianists Eithne Corrigan and Yvonne Collier, Stagefright, Valda Choir, The Loch Garman Band etc.
• Six-month songwriting project with Jimi Cullen in 2017 and 2019.
• Inner Harmony CD launch at WMHA and exposure on South East Radio.
• Whatever Exhibition – Arts Ability (music clips, a video and compositions can be viewed here).
• Rainbows and Bandaged Skies Exhibition.
• WRIDS art exhibition launch, which Inner Harmony performed at.
• Vocal workshops with Chorus Director of Wexford Festival Opera, Ellie Bowers Jolley (Come and Sing Company, London). These workshops were funded through the mentorship strand of the Arts Ability Programme.
• Jazz workshop with Kevin Lawlor from The County Wexford School of Music / Wexford Arts Centre.
• Vocal workshops with Ruth Gallagher, Paula Cox and Patricia Goggins.
• Annual Busking Day in Wexford Town where service users perform with Emily and other guest artists to raise funds for WMHA.

Evaluation Methodology

• Quarterly reports
• Music group audits
• Notes for care plans – written up by Emily, doctors and relevant occupational therapists
• Annual report submitted to Wexford Mental Health Association by the Music Exploration Officer
• Reports submitted to the Arts Officer at Wexford County Council each month and before each steering group meeting
• Monthly reports submitted to WMHA Board meetings
• Questionnaires for staff, family members and clients.

Evaluation Outcomes

Initial Steps before the Music Programme began:

1. Needs assessment of service users completed in 2015
2. Proposal and costing submitted for two-year programme
3. HSE Section 39 funding agreement with Wexford Mental Health Association
4. Recruitment/Contracting MEO
5. Induction and coordination of HSE/WMHA resources to support roll out i.e. administration, MTA, OT, Nursing
6. Supervision structure
7. Project management meetings
8. Accountability: quarterly reviews including assessing engagement and value for money, attendance, cost, HSE resources, WMHA resources, review of progress and planning for next quarter.

Programme Development Process:

• Review and financial report submitted each year, project met outcomes within budget.
• Project demonstrating value for money based on attendance, engagement etc.
• Project structure proving effective i.e. partnership based, regularly reviewed, skill mix, OT managed/supervised, MTA hours contributed, valued and supported by nursing staff, WMHA administered.
• Estimated costs for year ahead completed by October each year and relevant adjustments made.
• MEO actively recording progress in activities and other relevant feedback into individual care plans.
• Maintenance of programme delivery, existing community partnerships, HSE and WMHA resources.
• Ongoing evaluations and quarterly reviews.
• Consultations with relevant organisations to determine sustainability plan.

Social support in recovery
Service users supported by clinical staff and at a stage in their recovery that enables them to live in the community, were keen to engage in activities that could help them improve their sense of mental wellbeing and re-engagement with others.

Emily placed an emphasis on supporting clients’ social needs and their gradually increasing empowerment in choice and directing their lives. She had an extremely positive response after the first few weeks of the programme and she was able to get a sense of clients’ interests and what direction to take the groups.

Often service users need support and interventions to help them re-build or develop aspects of wellbeing in their lives. One of the initial aims was to prove that clients who actively engage in group singing / drum circles/ instrumental lessons can benefit in the following ways:

• Positive feelings
• Expectation and hope
• Self-belief
• Abilities and skills
• Social support and network
• Organisation and structure

How group singing/instrumental classes can help promote mental wellbeing:
Group singing can help to address all the social needs identified above, of service users living in the community, with support, and ready to engage socially.

Positive feelings: Results from our regular questionnaires have shown us that singing has been a joyful and uplifting experience within the groups over the last few years. It generates a sense of positive mood, happiness and enjoyment. Such positive feelings also counteract feelings of stress or anxiety and help to distract people from internal negative thoughts and feelings.

Expectation and hope: Participants look forward to drumming/singing with others and trying out new instruments and musical activities each week. They can become highlights of the week and positive memories remain alive for hours and days afterwards. Where an activity involves working towards a goal such as a performance, there are enhanced expectations of rewarding outcomes. We have witnessed some beautiful moments during and after our concerts and performances with Inner Harmony.

Self-belief: A change of identity can occur for people with mental health issues by participating in group singing, from thinking of themselves as singers/musicians, rather than patients. This can raise a sense of self-esteem and confidence, and performance events can bring a sense of social recognition and status. Performances help to reduce stigma and labelling by others.

Abilities and skills: Confidence is brought about by the ability to repeat previously learned tasks or skills (including social skills), with a high degree of accuracy. We have seen this leading up to any of our performances, formal and informal. Successful skills have helped to improve success in new, related skills, when tried for the first time. Learning new songs or harmonising parts of songs has helped concentration and focus, and stimulated learning and memory. Concentration has also provided a distraction from other concerns.

Social support and networking: Singing in a group has offered service users the opportunity to build social relationships, encouraged social inclusion and raised the status of the members, and created an opportunity for communities to come together within the county (Wexford, Enniscorthy, Gorey and New Ross).

Organisation and structure: Structure is something that is easily lost when ill. Clients can feel adrift and disconnected. Having the purpose and goal of attending a weekly group can be motivating and create an anchor upon which other weekly activities might build.

The weekly music sessions enable people to sometimes put words together in ways that are hard for them to do otherwise. The music seems to get through to clients and in many ways, it enables them to get through to us as facilitators which may be very hard to do with any other modality.

Music gives everyone a chance to express themselves, to share their souls, to share their feelings with each other. Over the past seven years, I have watched new friendships blossom within the groups and a yearning to socialise with each other outside of the music group also.

The music group has several significant purposes:

1. Shifting one’s attention from problems to solutions.
2. Offering a vital rhythmic structure for relaxation and breathing.
3. Helping service users visualise positive imagery that evokes pleasure and happiness.
4. Allowing service users to feel part of a team.
5. Changing mood.

Below you will see some personal accounts, detailing some of the experiences and findings in the residential units/community groups over the last few years.

Testimonials

‘Even though I have only attended 3 or 4 of Emily’s group classes so far, I want to thank her for introducing me back to the beauty and power of music. Her creative, dynamic, and fun teaching style has enabled me to express myself in ways words alone cannot. Her passion and unwavering support has been a source of inspiration to me. I am so grateful to be given the opportunity to join this wonderful group.’ – R, Community Group participant, Wexford

‘I never in my life time imagined I would be holding a guitar and learning a song.’ – M, resident from Havenview Residential Unit, Enniscorthy

‘Despite being very psychotic with thought blocking, this group has been most beneficial for K. He becomes enlivened, interested and discusses his music preferences each week. Most of the week this may be the only time K engages in an activity.’ – Nursing staff, Millview Residential Unit, Enniscorthy

‘Last night’s concert was amazing and it is so easy to see the value and benefit of the weekly music groups to everyone, all you had to do was see the smiles on people’s faces when they had completed their piece and the sense of achievement they felt.’ – CNM2 Millview, Enniscorthy

A note from psychiatrist Dr Goggins after a resident passed away in 2018:

‘I know that GR attended a number of individual music sessions with you in recent months and these sessions really helped him to re-connect with his previous interest in choral singing and involvement in a choir. I’ve been told that he regularly sang independently around the unit and other residents commented on how this was great to see. I think your input really enhanced his quality of life in recent months.

You went above and beyond to engage him, sitting with him and giving him lots of individual attention, reminiscing on his choral days in London. The recording of you accompanying him with Ave Verum and Panis Angelicus was breathtaking. You had a very positive impact on his life in recent months, so I just wanted to say thank you for that. It’s not easy when someone you have been working with passes away.’

Documentation and Dissemination

The reports and audits outlined in the Evaluation Methodology section above allow Emily and supporting staff to analyse the benefits/impact of the music programme and to use the findings as the basis for effective future delivery of music in such settings.

Emily has regular team meetings with all Occupational Therapists regarding group and 1:1 scheduling, clients’ needs/progress and to raise awareness among both the medical and caring professions as to the benefits of our long running music programme. A member of staff is appointed at each of the residential units to work with the facilitator and be the main point of contact for the unit along with specific OTs.

The Therapeutic Programme Fund Report from 2020 (Section 39 grant) provides an overview of the funding allocation from the HSE for the Music Exploration Programme.

The WMHA Music Exploration Programme has received coverage in local press and radio, and has been featured at national events, including Mental Health Ireland and Réalta’s Arts + Health Check Up, Check In.

Partners

Health Service Executive (HSE)
Arts Ability Programme – Wexford County Council
Wexford Mental Health Association