Supporting youth mental health with arts-based strategies: a global perspective.

The devastating impact of youth mental health concerns is increasingly evident on a global scale. This crisis calls for innovative solutions that are sufficiently accessible, scalable, and cost-effective to support diverse communities around the world. One such solution involves engagement in the arts: incorporating and building upon existing local resources and cultural practices to bolster youth mental health. In this article, we describe the global youth mental health crisis and note major gaps in the knowledge and resources needed to address it. We then discuss the potential for arts- and culture-based strategies to help meet this challenge, review the mounting evidence regarding art's ability to support mental health, and call for action to undertake critical research and its translation into accessible community practices. Four steps are suggested: (1) elevate and prioritize youth voice, (2) develop core outcome measures, (3) identify and analyze successful models around the globe, and (4) generate clear funding pathways for research and translational efforts. Worldwide implementation of arts- and culture-based strategies to address youth mental health will provide critical resources to support the health, wellbeing and flourishing of countless youth across the globe.

An Evidence-Based Framework for the Use of Arts and Culture in Public Health.

OBJECTIVES: In recent years, increasing efforts have been made to apply arts- and culture-based strategies to public health concerns. Accumulating studies point to the value of these strategies for addressing social determinants of health in ways that center communities, cultures, and lived experiences. However, this work has lacked a common framework to support application and advancement. The objectives of this study were to examine knowledge, experience, and evidence related to the uses of arts and culture in public health in the United States and to develop a pilot version of an evidence-based framework to guide cross-sector development and research. METHODS: Using a convergent mixed-methods design with sequential elements, this study drew upon findings from a national field survey, seven focus groups, eight structured working-group dialogues, and a five-day structured dialogue and writing process with 12 interdisciplinary thought leaders. Data were integrated to develop a pilot evidence-based framework. RESULTS: The study identified six broad ways in which arts and culture can be used in public health and 59 specific outcomes that can be addressed through arts and cultural strategies. The framework identifies evidence supporting the effects of arts and culture on each outcome, along with mechanisms that may mediate or moderate these effects. CONCLUSION: The pilot framework clearly links arts and culture practices with public health outcomes. In doing so, it provides both a resource for current practice and a model for the continued development of interdisciplinary tools that support health researchers and practitioners in utilizing arts and culture resources to advance community health and health equity.

Innovating Health Research Methods, Part II: Arts-Based Methods Improve Research Data, Trauma-Responsiveness, and Reciprocity.

Accumulating US studies indicate gender inequities in youth violence research and responses. Improving youth health thus requires greater understanding of how girls and young women perceive and experience violence, and gathering such data demands research methods that are trauma-informed and assets-based. This mixed-methods study addresses these dual needs. To support gender equity in youth violence research, it incorporated 4 violence surveys and 3 arts-based methods to examine girls' and young women's experiences and perceptions of violence. Then, to advance trauma-informed, assets-based research, it used study findings to generate an assessment of all methods employed. Results are presented in a 2-part article, with Part I (published separately) conveying findings about the population's experiences, needs, and assets related to violence and safety. Part II (here) details the development of the arts-based methods, assesses them alongside the surveys, and compares the effectiveness of all methods. Despite overlap across methods, the arts-based strategies offered critical knowledge that was missed by surveys, including actionable data about the population's priorities, experiences, and recommendations. The arts-based methods were also trauma-informed and offered reciprocity via assets-based, community-centered programs and platforms. This study provides justification and a template for further integration of creative practices into research, and for continued innovation to advance access, data quality, and health equity.

Innovating Health Research Methods, Part I: A Mixed-Methods Study of Experiences and Perceptions of Violence Among Girls and Young Women.

Accumulating US studies indicate gender inequities in youth violence research and responses. Improving youth health thus requires greater understanding of how girls and young women perceive and experience violence, and gathering such data demands research methods that are trauma-informed and assets-based. This mixed-methods study addresses these dual needs. To support gender equity in youth violence research, it incorporated 4 violence surveys and 3 arts-based methods to examine girls' and young women's experiences and perceptions of violence. Then, to advance trauma-informed, assets-based research, it used study findings to generate an assessment of all methods employed. Results are presented in a 2-part article, with Part II (published separately) detailing the arts-based strategies and assessing all methods. Part I (below) conveys findings from all data sources regarding population experiences, needs, and assets related to violence and safety. Girls and young women reported extensive experiences with violence, and mental health was a prominent challenge, likely exacerbated by persisting threats. Participants' priorities included domestic and intimate partner violence, social isolation, and the necessity of action and change. This study confirms the value of mixed-methods, gender-responsive youth violence research, and of providing processes by which youth can share their stories on and in their own terms. It also provides a template for further use of creative practices to improve data; apply trauma-informed, assets-based strategies; and advance health equity.

The State of Music-Based Interventions for Mental Illness: Thought Leaders on Barriers, Opportunities, and the Value of Interdisciplinarity.

Hundreds of studies regarding music's effects on mental health have accumulated across multiple disciplines; however, access to and application of music as a support for mental health remains limited, due in part to the multidisciplinary nature of related research and difficulties synthesizing findings. This qualitative study is the first to address these barriers by gathering current thought leaders and stakeholders at intersections of music and mental health, representing multiple disciplines and backgrounds, to (1) document understandings of and recommendations for the field, and (2) examine how views converge or conflict. Participants (n = 36) viewed preliminary results of a global scoping review, then engaged in focus groups which were transcribed and de-identified for analysis. An interdisciplinary research team coded and iteratively analyzed transcripts. Six themes emerged: Barriers to Quality/Improved Research, Disciplinary Differences, Research Recommendations, Implementation and Access, Public Perception and Education, and Need for Training. Discussions offered wide-ranging observations and recommendations while revealing challenges and opportunities related to interdisciplinary work. Findings indicate broad agreement regarding current barriers and opportunities at intersections of music and mental health. While highlighting challenges, participants also indicated multiple avenues for advancing research quality, intervention effectiveness, and equitable access to music as a support for mental health. Responding to the study's illumination of the benefits and challenges of interdisciplinary work, four brief recommendations are offered to support future efforts.

Generating youth dialogue through the literary arts: A citywide youth health collaboration in the U.S.

A process and outcomes evaluation was conducted of a citywide literary-arts initiative designed to reduce stigma, amplify underrepresented narratives, and generate dialogue about violence. Over 4 months, students in 85 middle schools read a novel addressing mental health and violence-related themes. As a collaboration between a public school district and public library system, the program's classroom activities emphasized dialogue, while coordinated library events supported community engagement. Students completed pre/postsurveys (total n = 1487); school program leaders (n = 39) and public librarians (n = 14) completed postsurveys. Half of student respondents reported personal encounters with violence. Most said the novel influenced their thinking; students with personal experiences of violence reported greater influence than those without. Highest rates of dialogue were seen among students who read the novel in full, and over half of postsurvey respondents wanted more dialogue opportunities. Leaders and librarians indicated that the program was smoothly integrated with existing curricula, but also offered recommendations for improved processes. Findings suggest that this intervention was effective at stimulating dialogue while providing assets-based opportunities for youth to share experiences and concerns. Current program processes indicate promise for further engagement and impact, with some modifications. To this end, authors draw upon evaluation findings and youth development literature to offer recommendations for program development and replication in other regions.

Arts Engagement as a Health Behavior: An Opportunity to Address Mental Health Inequities.

The significance of mental health inequities globally is illustrated by higher rates of anxiety and depression amongst racial and ethnic minority populations as well as individuals of lower socioeconomic status. The COVID-19 pandemic has further exacerbated these pre-existing mental health inequities. With rising mental health concerns, arts engagement offers an accessible, equitable opportunity to combat mental health inequities and impact upstream determinants of health. As the field of public health continues to shift its focus toward social ecological strategies, the social ecological model of health offers an approach that prioritizes social and structural determinants of health. To capture the impacts of arts engagement, this paper creates an applied social ecological model of health while aiming to advocate that engaging in the arts is a protective and rehabilitative behavior for mental health.

Arts and Culture: A Necessary Component to Address Unmet Social Needs and Advance Individual and Community Well-Being.

U.S. healthcare institutions increasingly integrate screenings for social needs into standard care, and help meet those needs by referring patients to community-based resources. However, community arts/culture assets are not commonly included among those resources. Given growing evidence of the positive health impacts of arts/culture, and given that access to these benefits remains inequitable, this article argues for the integration of arts/culture resources into healthcare referral networks. It highlights two early models, the CultureRx initiative in Massachusetts and Creative Forces, both of which piloted this integration with promising results. It also offers suggestions for better utilizing local arts/culture assets, emphasizing that these existing community resources can and should be applied to advance whole-person strategies and better address social drivers of health.

The impact thinking framework: a process for advancing research-to-practice initiatives in neuroaesthetics.

Neuroaesthetics research explores brain, body and behavioral responses to engagement with the arts and other aesthetic sensory experiences. Evidence indicates that such experiences can help address various psychological, neurological and physiological disorders, and that they can support mental and physical well-being and learning in the general population. The interdisciplinary nature of this work contributes to its impact and promise; however, it also creates challenges as various disciplines approach and define research and practice in varied ways. Recent field-wide reports have noted that a consensus translational framework is needed to support further neuroaesthetics research that can deliver meaningful knowledge and interventions. The Impact Thinking Framework (ITF) was designed to meet this need. Through a description of the framework's nine iterative steps and a presentation of three case studies, this paper posits that the ITF can support researchers and practitioners in understanding and applying aesthetic experiences and the arts to advance health, well-being, and learning.

Effects of Setting on Psychedelic Experiences, Therapies, and Outcomes: A Rapid Scoping Review of the Literature.

The health and well-being impacts of art and aesthetic experiences have been rigorously studied by a range of disciplines, including cognitive neuroscience, psychiatry, public health, and translational clinical research. These experiences, encompassed in the concepts of set and setting, have long been claimed to be pivotal in determining the acute and enduring effects of psychedelic experiences. Responding to the field's longstanding emphasis on the role and value of setting, a rapid scoping review was undertaken to identify the extent to which effects of setting and aesthetics on psychedelic experiences and therapies have been explicitly studied. It offers an analysis of the strengths and limitations of the extant literature and discusses evidentiary gaps as well as evidentiary opportunities for the field. The 43 included studies indicate apparent consensus regarding the importance of setting in psychedelic therapies, as well as consistent interest in theorizing about these effects. However, this consensus has yet to generate consistent, prospective, rigorous tests of setting and its complexities. As a result, the field continues to lack understanding or agreement regarding the effects of various specific elements of setting, the mechanisms by which they affect outcomes, for whom these effects occur, under what circumstances, given what conditions, and other critical factors. Further studies of setting and aesthetics in the context of psychedelic therapies are likely to not only improve these therapies and their delivery, but also inform considerations of setting and aesthetics for non-psychedelic interventions.

Social prescription in the US: A pilot evaluation of Mass Cultural Council's "CultureRx".

Introduction: As the field of public health strives to address the impacts of social determinants of health, it has seen increasing interest in community-referral practices that expand health care beyond clinical spaces. However, community arts and culture organizations are rarely included in these practices, despite accumulating evidence of associated health benefits. In addition, such inclusion has not been formally studied. In response, this article offers an evaluation of "CultureRx" in Massachusetts (MA): the first US model of arts on prescription. The program is a partnership between 20 healthcare providers and 12 cultural organizations, in which providers can offer "prescriptions" to cultural experiences to support patients' health. Methods: Evaluation was undertaken to illuminate participant experiences, program successes and barriers, and recommendations for further development. The cultural organizations collected participant data (n = 84) and completed surveys about their own experiences (n = 12). Authors conducted semi-structured focus groups and interviews with healthcare providers (n = 33). Data analysis was customized for each dataset. Results: Findings indicate that participants enjoyed and hoped to repeat their prescribed experiences, which they saw as beneficial to wellbeing. Providers identified the program as a new and critical addition to their toolkits; they also indicated it had a positive effect on their own wellbeing. Cultural organizations reported varied challenges, learnings, and recommendations. Conclusion: The CultureRx pilot suggests that integrating arts/culture assets into health and social care approaches can enrich and improve traditional US models of community referral. By including arts/culture resources when addressing social determinants of health, communities will be better positioned to equitably and holistically advance health.

The Use of Music in the Treatment and Management of Serious Mental Illness: A Global Scoping Review of the Literature.

Mental and substance use disorders have been identified as the leading cause of global disability, and the global burden of mental illness is concentrated among those experiencing disability due to serious mental illness (SMI). Music has been studied as a support for SMIs for decades, with promising results; however, a lack of synthesized evidence has precluded increased uptake of and access to music-based approaches. The purpose of this scoping review was to identify the types and quantity of research at intersections of music and SMIs, document evidentiary gaps and opportunities, and generate recommendations for improving research and practice. Studies were included if they reported on music's utilization in treating or mitigating symptoms related to five SMIs: schizophrenia, bipolar disorder, generalized anxiety disorder, major depressive disorder, or post-traumatic stress disorder. Eight databases were searched; screening resulted in 349 included studies for data extraction. Schizophrenia was the most studied SMI, with bipolar disorder studied the least. Demographics, settings, and activity details were found to be inconsistently and insufficiently reported; however, listening to recorded music emerged as the most common musical activity, and activity details appeared to have been affected by the conditions under study. RCTs were the predominant study design, and 271 unique measures were utilized across 289 primary studies. Over two-thirds of primary studies (68.5%) reported positive results, with 2.8% reporting worse results than the comparator, and 12% producing indeterminate results. A key finding is that evidence synthesis is precluded by insufficient reporting, widely varied outcomes and measures, and intervention complexity; as a result, widespread changes are necessary to reduce heterogeneity (as feasible), increase replicability and transferability, and improve understandings of mechanisms and causal pathways. To that end, five detailed recommendations are offered to support the sharing and development of information across disciplines.

Public Health's Next Step in Advancing Equity: Re-evaluating Epistemological Assumptions to Move Social Determinants From Theory to Practice.

The field of public health has increasingly promoted a social ecological approach to health, shifting from an individual, biomedical paradigm to a recognition of social and structural determinants of health and health equity. Yet despite this shift, public health research and practice continue to privilege individual- and interpersonal-level measurements and interventions. Rather than adapting public health practice to social ecological theory, the field has layered new concepts ("root causes," "social determinants") onto a biomedical paradigm-attempting to answer questions presented by the social ecological schema with practices developed in response to biomedicine. This stymies health equity work before it begins-limiting the field's ability to broaden conceptions of well-being, redress histories of inequitable knowledge valuation, and advance systems-level change. To respond effectively to our knowledge of social determinants, public health must resolve the ongoing disconnect between social ecological theory and biomedically-driven practice. To that end, this article issues a clarion call to complete the shift from a biomedical to a social ecological paradigm, and provides a basis for moving theory into practice. It examines biomedicine's foundations and limitations, glosses existing critiques of the paradigm, and describes health equity challenges presented by over-reliance on conventional practices. It then offers theoretical and epistemological direction for developing innovative social ecological strategies that advance health equity.