from both sides now: A reflection on the positioning of arts in health programmes in relation to healthcare organisations

Healthcare was not designed to accommodate arts programmes, not just architecturally but organisationally and culturally, and there are many points of tension between the way arts professionals and healthcare professionals operate.

‘I’ve looked at clouds from both sides now…’ sang Joni Mitchell and indeed, at the risk of sounding ancient, that’s how it has seemed for me in terms of my work in the area of arts in health to date. Since my first job after graduating from the National College of Art and Design whereby I was employed as a care assistant responsible for engaging people with enduring mental health problems in participatory arts, I have worked in a myriad of scenarios in this field. These range from managing arts organisations that partnered with healthcare organisations in delivering arts programmes, to managing arts in health organisations, to being employed by healthcare organisations and effectively becoming the public servant I never thought I would be when I first went to art college at the age of 17!

Working within a healthcare organisation involves working within systems and templates that were designed to deliver healthcare, not arts, and this experience has prompted me to ask: Which is better for arts in health programmes to progress and survive? To be located within the walls of the healthcare organisation with all the challenges and responsibilities that presents or in a not-for-profit art / arts and health organisation whereby arts practice is the sole focus?

In 2018, thanks to a Travel and Training Award from the Arts Council, I had the opportunity to visit three children’s hospitals in the UK – Alder Hey Children’s Hospital Liverpool, Great Ormond Street Hospital (GOSH) London and Edinburgh Children’s Hospital (EHC). While the first two are part of NHS Trusts, the Arts in Health programme at Edinburgh Children’s Hospital is part of the Charity that fundraises for that hospital and as such, the organisation is less hierarchical than the NHS, can facilitate quicker decision making and operate more autonomously.

For the most part, the arts in Ireland reside within the not-for-profit sector and are right at home there. Arts managers and artists are great at getting ideas, sourcing the funding, mobilising people towards a shared vision and working up to a massive crescendo before collapsing in a colourful heap afterwards with the photographs to show for it. The creative process itself is based on a series of quick and often intuitive decisions. Forgive the generalisations, but even if you are writing a novel and getting it published (a relatively slow process in the arts world), it can happen with fewer external approvals, interdependencies and sign offs needed than in the complex world of healthcare.

Healthcare organisations on the other hand need to be transparent and accountable in their decision making which means that decisions can only be made by those empowered to do so and are based on existing evidence. Healthcare was not designed to accommodate arts programmes, not just architecturally but organisationally and culturally, and there are many points of tension between the way arts professionals and healthcare professionals operate. In the arts, for example, we publicly celebrate and share the work of artists, all artists, including those participants of arts programmes that are health service users. Within healthcare, this challenges the principle of the confidentiality of the patient, as does our desire to document and share creative processes.

For healthcare managers, arts programmes can engender a fear of the unknown and this fear manifests itself differently in different organisations and with different gatekeepers. It can result in defensive behaviour and even a systemic blocking. Decisions can be stalled or not made at all leaving the artist wondering whatever happened to that great idea they once had. The artist is possibly most vulnerable when there is no healthcare professional on hand to champion the arts project, or a dedicated arts in health manager, or ideally both. The role of the arts in health manager is to navigate this complex terrain on behalf of both the artists and health service users, building trust between both parties, adopting the methods of healthcare as needed while speaking up on behalf of artists, protecting the intent of the arts practice and ensuring that it does not get blocked without good and expressed reasons or hijacked by other agendas.

Clear boundaries between arts and heath professionals are a good thing but in reality these often get established through a (sometimes fraught) push and pull process. The clearer everyone involved can be from the outset of a project around their intent, ways of working, their expectations and assumptions, the scope and risk of their work, and demonstrating how those risks have been mitigated, the lower the chance of a ‘never will I do that again!’ outcome. Sometimes I groan internally at the sound of my own bureaucratic speak when briefing artists. At other times, I don’t apologise. ‘If this is what it takes to get a great arts experience for patients…,’ I say to myself.

Working as an arts professional within a healthcare organisation can be a lonely place and space and time must be created for ideas-bouncing with like-minded individuals. As the ‘arts person’ in a non-arts environment, one is seen as the expert on everything from poster design to catchy titles, and yet one’s work can feel peripheral to the very real business of saving lives (until, that is, a patient, their family or a staff member tells you what a difference that arts experience made).

But these are small quibbles when locating arts programmes inside the walls of healthcare organisations offers the real possibility of the arts being embedded within the services provided to people. The arts programme can get written into the operational policies of the healthcare organisation and included on the risk register. This means it becomes part of the work and the responsibility of the whole organisation. It also means the arts programme is less vulnerable (but not immune!) when resources get scarce or other challenges arise. The effort required in arts professionals engaging with healthcare so that the arts is truly integrated (while not losing (its) heart), is the stuff of this strange hybrid practice that is arts and health.

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Mary Grehan is the Arts in Health Curator for Children’s Health Ireland. Previously she was Director of the Waterford Healing Arts Trust, Director of Tallaght Community Arts Centre and Curator of the National Maternity Hospital’s Centenary Arts Programme. Her Masters research was a comparative study between hospitals and galleries as sites for viewing art called ‘Mind Where You Look’. She has published widely in the field of arts in health and her debut novel was published by Penguin Ireland.