Draft:Art on prescription

Art on prescription (or art on referral) occurs when trusted individuals (usually health professionals) signpost a person to art-based community events, such as singing in choirs, dance, visual arts and crafts, or attending art galleries and museums. Art on prescription is part of social prescribing, where individuals are referred to a wide range of community based services and support (e.g., nature walks, cookery lessons, yoga) with the expectation that this will improve their psychosocial wellbeing.. Social prescribing is based on a holistic definition of health, where health does not simply consist of the absence of disease, but includes social, psychological and spiritual wellbeing (WHO, 1948). Hence, social prescribing aims to improve holistic health and mitigate the impacts of health inequalities

Arts on prescription involves being referred to a programme of art workshops (typically two hours a week, for 8-12 weeks) . It is important to note that the practice differs both from art classes and from art therapy. Unlike art therapy or art psychotherapy the focus on art on prescription is not to use the art as a vehicle to give insight to and share experiences (facilitating the process of psychotherapy). Unlike art classes the focus is not to develop specific artistic skills with the goal of becoming a 'good artist'. Rather, in art on prescription, the focus is on play, exploration, enjoying the process of art making, and doing so in a non-judgemental and 'safe space', which is enabled by an arts for health facilitator

While art on prescription is not a new idea (the first programme occurring in 1994 in Stockport, UK), in recent years both arts on prescription and social prescribing have been developing worldwide. For example, in its ‘long term plan’ the NHS in the UK planned to recruit 1,000 social prescribing ‘link workers’ and to have these handling about 900,000 patient appointments per year by 2023-24 . Accordingly, the evidence base to support the efficacy of arts on prescription has been accruing in this timeframe.

A recent systematic review of arts on prescription research reported on 25 studies . A narrative synthesis of qualitative research reported that arts on prescription had been reported by participants to help with their psychological wellbeing (e.g., increasing confidence and self-esteem), with their social wellbeing (e.g., feeling supported by others), and provided progression opportunities (e.g., helped people gain the confidence to try new opportunities in their lives). A meta-analysis of quantitative outcomes reported an overall significant increase in wellbeing over the course of art on prescription programmes. Further, heterogeneous studies gave tentative support for a role of art on prescription in helping to reduce symptoms of anxiety and depression.

However, despite these promising outcomes the systematic review and an additional critical paper on art on prescription note caveats and barriers to delivery. These include: problems with the evidence base, including an overreliance on generic measures of wellbeing, rather than specific symptoms or experiences (e.g., depression or social isolation) and a reliance on observational pre-post designs with no control groups, making it difficult to attribute changes in wellbeing directly to arts on prescription. Further issues included problems with practice and delivery, such as a lack of clarity about what different art on prescription programmes do, how the arts for health facilitators deliver sessions, etc., which makes it difficult to develop and share 'best practice'. Further issues, highlighted by Bungay et al. (2023) are more systemic and include vagueness about health care responsibility as individuals pass through stages of the referral process and programmes, and poor communication between different stakeholders in the process (e.g., general practitioners, community navigators and community programmes).

Overall, arts on prescription offers individuals a change to improve their wellbeing by enjoying the arts in a supportive group. While research supports its efficacy (Jensen et al., 2024) further, controlled, research is required, as is work to develop ethical and practice guidelines and training for practitioners, and network models for wider health care systems.