South East Arts Inc. NSW Arts and Health Regional Strategy 2017 2022 - Prepared by Kerry Devine For South East Arts Inc. NSW

Page created by Carol Harrison
South East Arts Inc. NSW

Arts and Health Regional Strategy

                  2017 – 2022

                          Prepared by
                         Kerry Devine
                    South East Arts Inc. NSW

  South East Arts – (02) 6492 0711

Executive Summary          •   What is Arts and Health                        p3
                           •   Purpose of the Arts and Health Regional
                           •   Vision, Objectives and Key Goals
                           •   Strategic Regional Projects

Background                 •   Context                                        p6
                           •   Impetus for a regional strategy
                           •   Consultation process
                           •   Mapping NSW Public Health
                           •   Mapping artist networks

Arts and Health            •   Definitions                                    p 16
                                   o Health and wellbeing
                                   o Arts
                                   o Arts and health
                           •   The scope of arts and health
                           •   The impacts of arts and health approaches

NSW Health                 •   Current arts and health activity               P 22
                           •   Arts and Health Events in NSW
                           •   NSW Health policies and priorities

Consultation Findings      •   Key themes emerging from consultations with    P 24
                               NSW Health Service Managers:
                                   o Priority health needs
                                   o Potential arts and health activities

Recommendations            •   Consultant’s recommendations                   P31

Key Goals and Activities   •   Policy, programmatic and operational           P 33

Strategic Regional         •   Aboriginal Communities                         P36
Projects                   •   Young People
                           •   Older People

Appendices                 1. Arts and health strategy consultation brief     P 42
                           2. List of consultations and respondents
                           3. Selected arts and health documents,
                              resources and links
                           4. Selected Australian arts and health
                              organisations and networks
                           5. Examples of Australian and international arts
                              and health initiatives
                           6. Specific NSW Health goals and strategies
                           7. Link to population health facts for SNSWLHD
                           8. Summary of themes from additional
                           9. Examples of grants and funding sources

Executive Summary
What is Arts and Health?

Arts and Health is the practice of using the arts to improve health and wellbeing, as well as
enhancing health care experiences for patients and their support networks. Arts refers to
different ways of being creative (for example music, storytelling and writing, painting and
drawing, dance, performing). Health relates to physical, mental and social health and
wellbeing, both for individuals and communities.

The arts can play a significant role in promoting the health and wellbeing of patients, staff,
clients and visitors to health services and within the broader community. The incorporation
of the arts in the delivery of our health services provides an opportunity to promote healthy
living and illness prevention, provide support in the management of illness and chronic
disease, aid rehabilitation and recovery and provide comfort as part of end of life care.

Purpose of SWELL: Arts and Health Regional Strategy

The purpose of SWELL: Arts and Health Regional Strategy is to:
   • Provide South East Arts with a framework to support the growth of arts and health
      activities in the region.
   • Identify ways for regional arts professionals to collaborate in the development and
      delivery of projects and activities that facilitate important health and wellbeing
   • Build alliances between arts and health organisations and individuals to respond
      to the NSW Health and The Arts Framework.

South East Arts covers the three Local Government Areas (LGAs) of Bega Valley,
Eurobodalla and Snowy Monaro located within the Southern NSW Local Health District
(SNSWLHD). The scope of the strategy is considered across a range of service sectors
and program areas including hospitals, community health centres, multi-purpose
services, mental health and drug and alcohol services.

Strategic Vision

By 2022 there will be a diverse range of arts and health initiatives across the South East
region of NSW which assist to build stronger, healthier and happier communities, supported
by strong networks, resources and opportunities for participation and learning.

Objectives for South East Arts

South East Arts aims to:
    • Support the development of arts and health approaches and initiatives in health
       care settings across the region
    • Facilitate connections and alliances between the arts and cultural community and
       health services
    • Build the capacity of arts and health practitioners to make meaningful contributions
       to both artistic practice and health and wellbeing goals.

Key Goals for South East Arts

1. Expand core business to include a strategic focus on Health and The Arts over the
   5 years 2017-2021.

2. Play an active role in supporting the implementation of the NSW Health and The Arts
   Framework in the constituent health services of the SNSWLHD that falls within South
   East Arts boundaries.

3. Offer a range of consultancy services to its principal Health Service Manager
   stakeholders, the principles, elements and key activities of which will:
   • Align with the NSW Health and The Arts Framework
   • Enable collaborative partnership
   • Be supported initially through existing resources and as a result of internal
       integration of projects to take a greater health and arts focus.

   In particular, South East Arts will offer Health Service Managers a range of policy,
   programmatic and operational supports in the areas of:
   • Governance - support and participate in the regional governance framework for arts
       and health
   • Promotion and Advocacy - raise the profile of arts and health across the region
   • Resources and information exchange - build the knowledge, resource and social
       capital of the arts and health community across the region
   • Training and capacity building - develop the practice and partnership capacity of the
       creative sector and health professional working in the field of arts and health
   • Partnerships and funding - build the funding base and resource development
       opportunities for arts and health approaches in the region

3. Seek funding to employ an Arts and Health Project Officer to engage in a range of
   strategic, best-practice regional arts and health projects. These projects will align with a
   range of state and locally determined health priorities, focus particularly on the social
   determinants of health and target specific priority populations.

•   The cultural integrity, health and wellbeing of Aboriginal communities
    •   Mental health, wellbeing and resilience amongst young people
    •   Creative ageing for older people

Strategic Regional Projects

Aboriginal Communities        Aboriginal history and heritage
                                 • Develop visual and educative stories for health service sites,
To creatively transform               focusing on Aboriginal heritage, history and health, exploring
health service spaces to              the engagement of aboriginal people with hospitals and
embrace cultural healing              health services.
needs and practices
                              Places of Welcome
                                  • Partner local Aboriginal and non-Aboriginal artists, health
                                      workers and the wider community in the creation of artworks
                                      to create ‘spaces of welcome’ in health services. Outcomes
                                      could include Indigenous wayfinding and signage, public art
                                      installations, healing gardens, gathering spaces, exhibitions
                                      and performance pieces.

Young People                  Rhythm Nation
                                 • Music program that uses hand drumming to foster improved
To connect young people             levels of personal and social confidence and develop social
to creative arts                    skills. Based on the Holyoake DRUMBEAT program which was
experiences that build              originally designed to engage Aboriginal young people and
resilience, connection and          used by organisations and schools working with alienated and
support on life’s journey           socially dislocated individuals.

                              Theatre of the Edge
                                 • A mix of play, circus, magic, gritty drama and performance.
                                     Arts and health workers would ‘embed’ creative, mental and
                                     general health messages in group devised pieces, poetry
                                     slams and other contemporary performance forms for young

Older People                  Dance your Heart Out
                                 • Local musicians, dance teachers, artists, arts and health
To support vital and                 workers collaborating to offer a range of dance experiences
creative engagement with             such as partnered and formation dances, musical era dances,
life at any age                      curated music for dance parties, Dance-a-thons and festivals.

                              Music and Memory
                                 • A personalised music program for people with dementia
                                     specifically but also for people who are in pain, feeling
                                     depressed or isolated. Delivered in partnership with the Arts
                                     Health Institute.

South East NSW attracts and supports significant creative cultural endeavour - the potential
of which is an enormous resource for health care services seeking to address health and
wellbeing goals in ways that are imaginative, engaging, enlivening and transformative. The
role of creative arts and cultural development in promoting the health and wellbeing of
individuals and communities is well established internationally, with a substantial evidence-
based body of research demonstrating this.

As the peak body for arts and cultural development in the region, South East Arts can play a
key role in building networks between the arts and health sectors, establishing new and
innovative projects an activities, and assisting both the arts and health sectors with advice
on funding, training and resources sharing.

In 2015 South East Arts established a relationship with the Southern NSW Local Health
District (SNSWLHD) and commenced discussions about the role of arts and creative process
in delivering beneficial health and wellbeing outcomes. This was considered across a
number of the district’s many service sectors and program areas including hospitals,
community health centres, multi-purpose services, mental health and drug and alcohol

With the financial support and backing of the three Health Service Managers covering the
Eurobodalla, Bega Valley, Bombala, Cooma-Monaro and Snowy-Mountains shires (the latter
three shires of which amalgamated in May 2016 to become the Snowy-Monaro Regional
Council), South East Arts identified the need to establish an arts and health regional

A consultant was employed to undertake preliminary consultations (over a three-month
period) with the Health Service Managers and identified key contacts within the health and
arts sectors to build a picture of current needs and priorities and potential opportunities in
the future. Though beyond the initial scope of this strategy brief, conversations were
extended to include the views and perspectives of interested community members, and
various arts, health and welfare professionals within the private, local government and non-
government sectors.

This Arts and Health Regional Strategy represents the outcome of interest expressed by
those three Health Service Managers in how South East Arts might assist them in making
practice innovations in a range of service delivery and program areas (within hospital
settings especially and initially) backed by a large body of international empirical evidence
of the role of arts in health and wellbeing.

As a result of this initial activity, new relationships (and potential collaborations) have been
established and important ideas, resources and opportunities have been identified. This
initial and exploratory activity is a first step in building the capacity of both South East Arts
and the SNSWLHD to respond to potential initiatives arising from the endorsement (in July
2016) of the Report of the NSW Ministerial Taskforce on Health and the Arts (entitled ‘The
PAtH Forward: Partnering Arts to Health’), the key recommendations of which have been
adopted as part of the inaugural NSW Health and the Arts Framework, which in turn will
guide the integration of the arts into the NSW health care system by supporting
collaboration between local health services and the arts sectors.

South East Arts is committed to entering and making a real contribution to the dynamic field
and arts and health activity in partnership with key health services within the SNSWLHD.


South East Arts NSW Inc. (South East Arts) is a regional arts and cultural development
organisation (RADO) covering the LGAs of Bega Valley, Snowy Monaro and Eurobodalla.
Funded by NSW Arts and these LGAs, South East Arts develops, supports, and promotes
lively participation in a range of arts and culture activities and initiatives throughout the
NSW South East Region, with particular reference to:
• three spheres of engagement
        o Community arts at the grassroots
        o Professional and emerging artists
        o Projects of national significance
• and a strategic focus on:
        o Visual and performing arts
        o Aboriginal arts and cultural expression
        o Creative industries.

Over the past five years, South East Arts has developed a number of key policy platforms
and strategy documents that guide its operations, including the:
• SEA Strategic Plan (2016-2018)
• Aboriginal Arts and Cultural Action Plan (2012-2015)
• SEA SCREEN: South East NSW Screen Industry Development Strategy (2015-2018).

This Arts and Health Regional Strategy is a new area of potential core business for South
East Arts and clearly aligns with its overall strategic intent.

South East Arts services an area of 62, 2000 square kilometres, comprised of the three Local
Government Areas (LGAs) of the South East Region of NSW, with populations* of:
• Eurobodalla Shire Council 35, 741 pop
• Bega Valley Shire Council 31,950 pop
• Snowy Monaro Regional Council 18,491
*All figures based on the 2011 Census.

The impetus for South East Arts’s move into the domain of arts and health are many and
include the opportunities related to:
• Policy developments at the national and state level with the
       o 2013 endorsement by the Standing Council on Health and the Meeting of
           Cultural Ministers of the National Arts and Health Framework, which was
           developed to enhance the profile of arts and health in Australia and to promote
           greater integration of arts and health practice and approaches in health
           promotion, services, settings and facilities -

       o Release and endorsement of the findings of the NSW Taskforce on Health and
         Arts, who have developed a Health and Arts Framework for NSW Health – ‘The
         PAtH FORWARD (Partnering Arts to Health)’ - which focuses on the governance
         mechanisms, arts funding models and approaches to incorporating the arts into
         the design of health facilities and the delivery of health services.

       o The roll out of the National Disability Insurance Scheme (NDIS) which changes
         the funding and service delivery arrangements to people with disabilities, who
         will have greater choice and control over a range of supports (including arts-
         health) they receive

•   New infrastructure and service delivery developments in health services across the
    SNSWLHD including the new South Eastern Regional Hospital (SERH) in Bega, new
    oncology, renal, sub-acute and rehabilitation units at Moruya Hospital, the new super-
    clinic at Jindabyne and the redesign of the oncology unit, Emergency Department and
    Maternity units at Cooma Hospital.

•   Inspirational examples of other RADOs in the field of arts and health, most notably Arts
    Out West (in Central West NSW) who have who have developed an extensive and
    integrated Culture and Arts program into all aspects of the Lachlan Health Services,
    including the redevelopment of the Forbes and Parkes hospitals, the redevelopment of
    the Orange Hospital (incorporating the Bloomfield Psychiatric Hospital) and the new
    build of the Bathurst Hospital.

•   New relationships with arts and health peak bodies, including South East Arts’
    attendance at the creative ‘Future of Ageing Conference- 2016 Play Up Convention’ run
    by the Arts Health Institute (AHI)

•   The forthcoming Australian Regional Arts Conference ‘Artlands’ in Dubbo which will
    feature an arts and health keynote by Clive Parkinson, who is the Director of Arts for
    Health at Manchester Metropolitan University, a specialist research unit that explores
    the relationship between creativity, culture, the arts and health. He is a founding
    member of the National Alliance for Arts, Health and Wellbeing, and is currently a co-
    investigator on the Dementia & Imagination project in the UK, which is exploring the
    links between the visual arts, wellbeing and sense of community.

Impetus for a regional strategy

The inaugural NSW Health and the Arts Framework was launched in June 2016 and seeks to
provide guidance to the NSW Health Service, specifically Local Health Districts (LHDs) and
Speciality Health Networks (SHN) to:
   • improve the patient, staff and carer experience in health services through
        engagement with the Arts
   • Create a sense of place in health services, enhancing design and ‘wayfinding’ – the
        ways in which people orient themselves and navigate through a health service
   • Leverage the Arts as a mechanism for engaging communities with health services
   • Promote health messages through the Arts
   • Increase access to the Arts through health services
   • Foster sustainable partnerships between the health and arts sectors, and
   • Integrate the Arts into the design of new spaces.

South East Arts is responsive to advances and opportunities in the field of arts and cultural
development where, typically arts projects build social capacity, cohesion and
connectedness and where the ‘indirect’ impacts on health and wellbeing are unstated or
secondary goals. Moving into the new domain of health services shifts the focus squarely
onto the importance of social capacity building (positive relational experiences, creative and
expressive opportunities and supportive communities) as a major social determinant of
health. The focus now is ‘health and arts’ and the goal is about improving health outcomes
through ‘The Arts’ in its broadest sense.

Given the developments in NSW Health and the mix of policy and resources dynamism,
complexity and opportunity present in this multi-sector arts-health stakeholder

environment, it is envisaged that this Arts and Health Regional Strategy document will be
used in a number of ways. This includes:

•   Cover the period January 2017 - December 2022, with a pre-implementation phase
    commencing late 2016
•   Align with the National Arts and Health framework, the NSW Health and Arts Framework
    and other South East Arts policies to give clear direction and a phased approach to South
    East Arts and health agencies on how best to develop and/or pilot new arts and health
•   Support the new focus on arts and health in the SNSWLHD
•   Identify key health priority areas within the region where arts can have a positive impact
    and give direction to both South East Arts and the healthcare sector
•   Guide the development of initiatives in the arts and health sector
•   Inform, inspire, stimulate discussion amongst the arts community and health sector
    about examples of successful arts-health projects within Australia and internationally,
    that have the potential to be initiated within the region
•   Help locate, support and strengthen current and potential arts-health activities and
    partnerships across the region
•   Identify and assist ways for regional arts professionals to collaborate in the development
    and delivery of new project opportunities that are intended to deliver important arts
    practice health-wellbeing outcomes
•   Support artists to identify and diversify opportunities for paid work (commissions,
    workshops, mentoring) and potentially seek further training in the arts-health field
•   Assist arts practitioners/creatives and health professionals gain an appreciation of each
    other’s contexts, goals, culture and practices
•   Assist South East Arts determine its role relationship to the development and delivery of
    various arts and health projects (e.g. brokerage, advocacy, project management,
    promotional, advice)
•   Equip the alliance (partnering arts and health organisations) to respond to any initiatives
    and potential funding opportunities arising from recommendations released by the NSW
    Arts and Health Taskforce later in the year and/or other grants and partnering
•   Demonstrate to potential funding bodies that the SNSWLHD has a strategic regional
•   Act as a reference document for future project based South East Arts advisory groups
    and/or arts-health committees in different healthcare settings
•   Build a new and important database of key contacts, networks and resources for use
    by artists and health professionals in the service of arts-health projects.

Consultation Process

This Arts and Health regional strategy was developed with a particular scope within a time
limited period. It represents South East Arts first foray into the huge and dynamic field of
arts and health. As such it is necessarily partial, incomplete and ‘broad brush’ identifying
first layers of interest, networks, possibilities and providing opportunities for further
refinement and investigation, in later stages.

The initial focus of the consultations were the needs and ideas of the principal funders and
stakeholders for this strategy – the three SNSWLHD health service managers (HSM)
spanning five LGAs and based in Eurobodalla, Bega and Cooma. They then identified key
people and networks in the NSW Health department areas of service development,
community health, population health, mental health and aboriginal health. Conversations
then widened to key people with responsibility for and/or interest in arts and health within
local councils and not for profit organisations. The views of some individual artists and arts-
health professionals were also canvassed.

It is acknowledged that in the future, a more fully integrated Arts and Health regional
strategy would need to cover the needs of larger (and potentially more specialised)
populations and service delivery systems incorporating:
• Community health
• Mental health
• Aboriginal health
• Aged care
• Women’s health
• Disabilities
• Young people.

This strategy makes some reference to the key health policies for these groups and has
located some fine examples of arts and health initiatives in these areas, but in the main this
document is concerned with the potential integration of arts within primary health care

The elements of the consultation and strategy development process included:
• A communiqué to guide discussions and that was distributed through a number of
   websites (South East Arts, River of Art, Eurobodalla Arts Information Exchange) and e-
   networks (Eurobodalla social workers, interagency network) (see Appendix 1)
• Semi structured I:1, group and phone conversations with three HSMs, executive and staff
   of two regional arts organisations, health care professionals in the fields of Aboriginal
   health, population health and mental health, managers and staff of local councils and
   NGOs, artists, mental health professionals and music therapists (see Appendix 2)
• Responding to emails and expressions of interest in the strategy

•   Attendance at a Eurobodalla Health Arts Program meeting
•   Research and literature search on background materials, documents and examples of
    arts and health initiatives within Australia and internationally
•   Attendance at the ‘Future of Ageing Conference’ run by the Arts Health Institute.

All conversations covered the following areas of enquiry:
• Current nature of health services provision
• Current health service needs and priorities
• Examples of current or past arts (and health activities)
• Potential for arts and health activity
• Funding possibilities
• Assistance sought from South East Arts.

Mapping the NSW Public Health Sector

In order for South East Arts, artists and art organisations to orient to and collaborate with
and health care professionals, a ‘map’ of the NSW public health care sector is needed. This
is a big task as the nature, structure and functioning of the state and national health care
system is very complex. This section gives a general overview of the general service delivery
system. Later sections provide an overview of the policy context and key strategic goals and
drivers, which will inform any arts and health project in NSW Health.

Health Care services are funded in NSW at the
• Commonwealth level, which provides Medicare and subsidised insurance premiums to,
   and services are provided privately by:
       o Doctors and general practitioners in private practice specialists
       o Private level, where services are delivered by private agencies and not for profit
          (NFP) groups, and which includes some hospitals (paid by private insurance, and
       o State government level, where services include (amongst other things):
              § Hospitals
              § Ambulance
              § Community Health
              § Aboriginal Health
              § Mental Health
              § Forensics & Justice
              § Children’s health.

Formerly provided by the NSW Department of Health (and organised by areas, sub areas
and local health networks) health care is now delivered by the Ministry of Health (MoH)
(also known as NSW Health).

The Ministry is led by its Secretary, Mary Foley who reports to the Minister for Health -
Honourable Jillian Skinner MP, and the Minister for Mental Health, Minister for Medical
Research and Assistant Minister for Health - the Honourable Pru Goward MP.

The state/NSW public health system is the largest public service department with an annual
spending budget of over $20 billion. It employs over 102,000 employees and provides
services, research and teaching in hospitals, community health centres and small clinics and
also in the forensic and judiciary systems. NSW Health funds the running costs of state and
commonwealth services at a ratio of 60:40.

NSW Health comprises both the NSW MoH and various statutory organisations which make
up the NSW public health system and includes the:

•   NSW Ministry of Health
•   Local Health Districts (see below)
•   Justice Health & Forensic Mental Health Network
•   The Sydney Children’s Hospitals Network
•   Health Protection NSW
•   NSW Ambulance
•   NSW Health Pathology
•   Cancer Institute NSW
•   Clinical Excellence Commission
•   Health Education and Training Institute
•   Agency for Clinical Innovation
•   Bureau of Health Information
•   HealthShare NSW
•   eHealth NSW
•   Health Infrastructure.

Across NSW there are 15 Local Health Districts (LHDs) and Specialty Networks that have
responsibility and accountability for managing all aspects of hospital and health service
delivery under a Service Agreement between the MoH as purchaser and system
manager/regulator and the LHD Boards as providers of health services. The LHD Boards in
turn determine and manage a Performance Agreement with their Chief Executives.

The Southern NSW Local Health District (SNSWLHD) covers 10 Local Government Areas
(LGAs) extending from the NSW South Coast and Southern Tablelands, across the Great
Dividing Range and the Snowy Mountains and mostly surrounds the Australian Capital
Territory (ACT). The district includes the five shires covered by South East Arts (and this arts
and health regional strategy) – the Eurobodalla, Bega Valley, Bombala, Cooma-Monaro and
Snowy Mountains Shire Councils. (NB: Under a recent review of the viability of many local
government organisations - ‘Fit for the Future’ - the latter three shires have amalgamated to
form the Snowy-Monaro Regional Council)

The SNSWLHD provides health services for about 200, 000 residents and visitors in the
South East NSW and is the principal provider of state funded general public, community and
mental health services through its hospitals and community health centres that include
emergency, intensive care, coronary care, maternity, acute medical and surgical services
and primary and community services. (See )

In terms of other health care services, Aged Care is funded at a:
• Commonwealth level, that both governs, subsidises and oversights quality standards for
    services provided Not for Profit (NFP) organisations and the private sector
        o residential care and community care
        o NB: Many regional shires (e.g. Bega Valley, Eurobodalla) are funded by the
           Commonwealth to provide intensive home based care under brokerage type
           arrangements - ‘Community Options Packages’ and ‘Community Aged Care
           packages’ – which will now be amalgamated into the National Disability
           Insurance Scheme (NDIS) (which is due to be operative from the July 1st 2016).
• State level, where there is legislation that governs services that are provided by NFPs)
    and private organisations
        o E.g. retirement villages.

Disability services are also provided at a:
• State level - where the Department of Family and Community Services (FaCS) acts as a
    coordinating body and funds different service models
        o NB: With the introduction of the NDIS a declining number of services will be
            provided by NSW Health/FaCS as ‘packages’ of funding will be rolled out through
            the state government to LHDs
• Government level, which funds the NDIS and is not as active as a service provider or
    coordinating body.

In addition to direct service delivery of healthcare, there are a number of ‘health pathways’:
• In April 2015 ‘Coordinaire’ (a NFP organisation /venture backed by ‘Grand Pacific
    Health’, the University of Wollongong, PeopleCare and IRT) was the successful tender
    for the new South Eastern Primary Health Network (PHN)
        o NB: The PHNs are an initiative of the Commonwealth Department of Health).
            They are responsible for commissioning and brokering services
        o NB: Coordinaire replaced Medicare Locals (which provided services in community
            health and was established to assist with the ‘integration’ of services), which in
            turn had replaced the Divisions of General Practice (set up to support and
            expand the GP network).
• Grand Pacific Health trades as a service provider operating independently to Coordinaire
    and focuses on chronic disease management and care, mental health and Aboriginal

Mapping Artist Networks

This strategy recognises the challenging task of mapping the complete network of creatives
within the region, who might become involved in arts and health activities in healthcare
settings. An important future task will be to develop a comprehensive database/register of
interested people, groups and organisations who might be found through, drawn from or
• Professional, second career, amateur and hobby artists (curators, stage managers,
    choreographers, dancers, visual artists, performers, musicians, photographers,
    ceramicists, textile artists)
• Registered and informally trained/experienced arts-health practitioners drama teachers,
    art teachers, music and arts therapists
• Health and mental health professionals (psychologists, social workers, occupational
    therapists, nurses) with additional counselling and creative arts interest, experience and
• Arts and cultural organisations
• Festivals, galleries
• Arts directories and e-networks.

Arts and Health
Definitions of Health and Wellbeing

There are many definitions and understandings about what constitutes health - a relative
state of wholeness and balance in which an organism functions efficiently and
interacts/adapts smoothly with changing internal and external environmental conditions –
and wellbeing, which is a subjective experience that is often linked to happiness and life

The Australian Bureau of Statistics (ABS), in its monograph ‘Measuring Wellbeing’ (2001)
says that:

“Health is a concept that relates to and describes a person's state of being. It is therefore
highly subjective. Good health means different things to different people, and its meaning
varies according to individual and community expectations and context. Many people
consider themselves healthy if they are free of disease or disability. However, people who
have a disease or disability may also see themselves as being in good health if they are able
to manage their condition so that it does not impact greatly on their quality of life. People
living in areas where there are high levels of ill health, or extreme health problems, may see
themselves as relatively healthy, even if they have some illnesses or complaints. And people
with relatively minor ailments may perceive themselves to be in poor health if they are
aspiring to a greater level of wellbeing than is suggested merely by the absence of disease.

Health is often defined in terms of its negative aspect (e.g. ill-health), and a key focus of the
health area of concern is the presence or absence of sickness, disease, injury and disability
within the population. However, this is by no means the full story. The World Health
Organisation (WHO) definition of health suggests that health is a continuum, and extends
the notion of health to include states of positive wellbeing. Health is ‘a state of complete
physical, mental and social wellbeing and not merely the absence of disease or infirmity….

This definition also acknowledges that there are a number of dimensions to health - physical,
mental and social. Thus the optimal functioning of a person's physical body is only one
aspect of their health, and only one factor, in the domain of health, that determines their
wellbeing. A person's mental or psychological state is also an important aspect of their
health, and the quantity and quality of an individual's social connections and support
networks can fundamentally influence their health. Over a lifetime, reserves in one area of
health may be drawn on to supplement other areas in difficult times. For example, the
physical health deterioration experienced by older people can be partly ameliorated or
balanced by positive reserves of mental health, and/or a supportive social environment.”

The World Health Organisation (WHO) believes that expanding the health agenda away
from illness and disease (and the treatment/management of symptoms) to the social
determinants of health and the’ cause of the causes’ of ill health means:

•   Working in partnership at the local level to improve the social conditions in which
    people are born, live, grow, work and age
•   Addressing broader set of forces and systems (the social determinants) that shape the
    conditions of daily life including economic policies, political agendas, social justice and
    inequities that impact community social capital, education, employment and housing,
    social norms, health literacy etc.

The social determinants of health are mostly responsible for health inequities - the unfair
and avoidable differences in health status seen within and between countries. In Australia
country people are subject to the same types of social disadvantage as can occur in cities
(such as lower educational attainment, job uncertainties and unemployment, poor access to
appropriate housing etc.)

The National Rural Health Alliance however, says that in rural and remote communities, the
health effects of this disadvantage are compounded by poor access to communications
(such as high speed broadband, mobile phone coverage, public transport) and
environmental challenges (such as drought, floods and bushfire).

There are also many gendered and cultural perspectives on what constitutes health which
require further exploration. (See Appendix 3) For example, one definition of health for
Aboriginal people suggests that it refers to “not just the physical wellbeing of the individual
but the social, emotional and cultural wellbeing of the whole community. This is a whole-of-
life-view, and includes the cyclical concept of life-death-life.” National Aboriginal Health
Strategy 2013 – 2023.

Definition of Arts

The Regional Arts network defines ‘the arts’ as all those media used by people to express
themselves creatively, such as visual arts (painting, sculpture, graphic art etc.), photography,
dance, theatre, physical theatre (involving circus skills), music and song (classical, folk,
contemporary and traditional), crafts, literature (writing, prose, poetry etc.), film and
television production, design (graphic, fashion etc.) The arts also relate to arts practice
target groups including Indigenous arts and cultural practices, cultural and linguistically
diverse (CALD), youth, disability, children and general community (see Appendix 3).

South East Arts endorses the definitions of the NSW Health and The Arts Framework (2016):

“The Arts are defined broadly to encompass all art forms including:
o  Visual Arts – painting, drawing, installation, design, craft, sculpture
o  Digital Media – film, web animation, audio, iPad apps, new technologies
o  Performing Arts – theatre, music, dance, drama, comedy
o  Literary Arts – storytelling, creative and narrative writing, poetry
o  Built environment – architecture, spatial design, wayfinding, lighting, signage, gardens,
   social and cultural places.
Aboriginal arts and culture span all art forms, and are an essential component of The Arts in

Definitions of Arts and Health

The ‘arts and health’ movement is well established in the UK and the States, where there is
a substantial body of research evidence about how arts practices impact both clinical and
wellbeing outcomes. There are also a range of organisations across the world and within
Australia whose business is to support and promote arts and health. (see Appendix 4)

Within Australia there is growing interest in this field. In 2014, the Standing Council on
Health and the Meeting of Cultural Ministers released the National Arts and Health
Framework (, defining arts and
health thus:

 “Arts and health refers broadly to the practice of applying creative, participatory or
receptive arts interventions to health problems and health promoting settings to create
health and wellbeing across the spectrum of health practice from primary prevention
through to tertiary treatment.”.

The Institute for Creative Health has designed a simple and colourful information brochure
on arts and health, which says that:

•   Arts and Health is the practice of using the arts to improve health and wellbeing,
    prevent disease and enhance health care experiences for patients and their families. It is
    a specialty arts discipline which is recognised both in Australia and overseas
•   Arts refers to different ways of being creative (music, storytelling and writing, painting
    and drawing, dance, performing).
•   Health relates to physical, mental and social health and wellbeing, both for individuals
    and communities.
•   There is a large body of evidence that demonstrates how participation in arts activities
    helps people to feel better both physically and mentally
•   Studies have demonstrated that participation in art can
        o Reduce medication needs
        o Increase tolerance of symptoms/treatment
        o Provide comfort and reduce stress and anxiety
        o Improve communication with health professionals
        o Help to alleviate pain
        o Shorten lengths of stay in hospital

•   Arts and Health is for everyone
        o All ages
               § From very young children who are still developing to older people who
                   are dealing with physical and mental decline
        o All levels of health
               § You might want to stay healthy, get healthy or recover from ill health
        o All cultures
               § Respectful of all values, beliefs and cultural backgrounds
        o All levels of ability
               § No experience necessary and suitable for people with diverse physical
                   and mental capabilities
•   People that are involved with Arts and Health practice include:
        o Educators
        o Artists and Performers
        o Music Therapists
        o Counsellors
        o Medical, nursing and allied health staff
        o Architects and designers
        o Art Therapists

The Scope of Arts and Health

Arts and health practice covers all sorts of art forms including music, drama, dance, visual
arts, textile arts, literature and storytelling, spoken word, installation, graffiti and stencil
arts, multimedia, ceramics, photography, film, radio, poetry, singing, puppetry, building and
landscape design. (see Appendix 3)

It also incorporates multiple perspectives about and a variety of different approaches to the
nature and value of arts that might encompass the:
• western view and experience
• role of the storyteller and art maker in Aboriginal culture
• centrality of the oral tradition for different ethnic groups
• non representation of human figures and importance of calligraphy in Islamic cultures.

The contexts in which arts and health approaches are delivered can include:
• Art and health in primary and acute care settings
• Creative ageing in aged care facilities (residential and retirement centres, respite care,
   dementia units)
• Community arts and general health
• Therapeutic role of arts in mental health
• Health promotion and the arts
• Training of artists and health professionals for health and arts practices and project
• Public arts and creative design in health care settings.

The Impacts of Arts and Health Approaches

There is a huge body of empirical research on the positive impact of art-health initiatives in:
• Promoting health messages
• Supporting the healing and wellbeing of vulnerable individuals and groups
• Developing and sustaining communities
• Contributing to a key social determinant of health – connectedness. (see Appendix 4)

In addition to the data contained in the National Arts and Health Framework
( The Institute of Creative Health
has compiled a large data base that includes a report by the Arts Council England, which
provides a summary of 385 references from the medical literature regarding the effects of
the arts and humanities in:
• achieving clinical outcomes for the benefit of patients
• raising staff morale and job satisfaction
• widening the skills of nurses and doctors
• providing better quality of healthcare
• enhancing the quality of life of mental health users and
• helping mental health providers manage the service.

Regarding clinical outcomes, the report cites studies of the use of visual arts and music in
cancer care, cardiovascular care, neonatal intensive care, medical screenings and diagnoses,
pain management, and surgery.

Regarding staff outcomes, the report notes that the arts can be used in "nursing and
medical training to improve communication, empathy and understanding of patients'
needs", in creating a non-aggressive healthcare environment, and in the overall design of
healthcare services. One gap in the literature concerns the possible effects of the use of the
arts in the recruitment and retention of healthcare staff.

Regarding practitioner education and training, the report cites studies of the use of visual
arts, music and the humanities in:
• enhancing surgeons' mental task performance
• creating less stressful operating environments
• developing the observational, drawing and three-dimensional perception skills of
    medical practitioners
• increasing nurses' awareness of how to deal with illness and bereavement, an
• helping ensure thoughtful and humane responses by health practitioners to the medical,
    ethical and social needs of patients.

Regarding mental healthcare, the report indicates that the arts help "to improve the
communication skills of mental health users", provide patients with new ways of expressing
themselves, stimulate patients' creativity and enhance their self-esteem.

In Australia, the National Rural Health Alliance Inc. consistently supports close collaboration
between arts and health practitioners as a key element in building wellbeing and health for

Australians, particularly those in rural areas It recognises that the arts (in all its forms) are
valuable as:

•   a means of communication on health and health-related issues
•   therapy in a range of settings and for a variety of conditions, and widely used to
    complement treatment and management
•   and as a force for community development, to sustain communities and develop their
    capacity to deliver health-promoting lifestyles.

Exposure to The Arts has a profoundly beneficial impact, improving health and wellbeing
through enhancing the design and delivery of health services, and the accessibility and
influence of health promotion, health literacy and public health messaging. Agency for
Clinical Innovation, NSW Health

NSW Health
Current Arts and Health Activity

This strategy was initiated prior to the completion, release and endorsement of
recommendations from the NSW Health and Arts Taskforce, which have now formed the
basis of the inaugural NSW Health and Arts Framework.

Given the limited consultation time frame and the dynamic nature of arts activity and
practice, it was not possible to arrive at a complete mapping of the extent of arts and health
activity across part of the SNSWLHD region. However, a number of submissions and email
responses were received in response to the general invitation to comment on the
development of an arts and health regional strategy. There is huge interest in the field and a
sense that the benefits are vital and perhaps ‘self-evident’.

There are numerous examples that showcase examples of innovative Australian and
international arts and health projects. (see Appendix 5) Later sections provide some (partial
and impressionistic) examples of past and current arts and health projects, as given by
respondents during consultations.

There is clearly much to draw from and by inspired by. However, more work is needed to
map the spectrum of activity and to develop a register of artists, arts-health professionals
and facilitators, and arts-health projects and programs.

*Particular reference needs to be made of the inspirational work of Arts OutWest – another
Regional Arts Development Organisation (RADO) who have led the field in their partnership
with Lachlan Health Services in the development of a number of strategic and integrated
arts and cultural development programs (across 12 shires) at the hospitals of Orange,
Forbes and Parkes. Some of the elements of their arts and health program included:
• A focus on aged care, chronic health conditions, aboriginal health
• Art on walls
• Community exhibitions
• Workshops to enhance courtyards developed by an aboriginal education consultative
• artist run initiatives, and creative industries that have professional practice and
• creative environments
• educational programs on diversion activities, health prevention and promotion
• partnerships with Aboriginal infant health – belly casting
• film and hip hop workshops, graphic design workshops to develop posters,
• dance workshops for health workers, dieticians.

Arts and Health Events in NSW

At the time of this strategy development process, it is interesting to note the dynamism of
the field in the form of a range of relevant arts and health events.

•   A 4-day unit in August and September 2016 on ‘arts in health’ run by University of
    Sydney’s School of Public Health which will explore:

       o   Importance and transformative effects of arts in health
       o   Evaluation of art and health programs
       o   Arts-based programs for different user groups
       o   Role of art in developing empathy
       o   Does art help people develop empathy for others or for suffering?
       o   Ethical issues in developing arts and health approaches and programs

•   The 8th Annual International Arts and Health Conference ‘The Art of Good Health and
    Wellbeing’ will be held from 16-18 November 2016 at the Art Gallery of NSW, Sydney.
    The overarching theme of the conference is "Mental Health and Resilience through the
    Arts". Three key areas of practice and research will be explored: Mental Health and
    Resilience, Health and the Arts in Hospitals, Healthcare Services and Health Promotion,
    Creative Ageing
•   In 2017/18 The Australian Centre for Arts and Health (ACAH) and UNSW Art & Design
    are collaborating on a pioneering arts and health festival concept, with a special focus
    on mental health. Under development since 2014, the inaugural Asia Pacific Arts for
    Health Festivals are planned for October / November 2017 and 2018 - with the
    respective themes of "Arts and Anxiety" and "Arts and Dementia".
•   Artlands Conference 27-30 October 2016, sponsored by Regional Arts NSW, where the
    keynote address will be given by Clive Parkinson, Director of Arts for Health at
    Manchester Metropolitan University, a specialist research unit that explores the
    relationship between creativity, culture, the arts and health. He is a founding member of
    the National Alliance for Arts, Health and Wellbeing, and is currently a co-investigator on
    the Dementia & Imagination project in the UK, which is exploring the links between the
    visual arts, wellbeing and sense of community.

NSW Health Priorities – Policy Overview

Before exploring the results of specific consultations with health service managers and
other service providers and professionals across the region, the larger policy and strategic
context in which health service delivery planning goals are determined will be outlined.

For an overview of the policy context and health priorities of NSW Health see

Health priorities within the public health care system of the SNSWLHD are determined at a
number of different levels, each with an associated set of plans and strategic documents,
such as:
• State government priorities in health which includes (amongst others and of particular
   relevance for this arts and health regional strategy), the
       o NSW State Health Plan (Towards 2021)
       o NSW Rural Health Plan (Towards 2021)
       o Healthcare Professionals Workforce Plan (2012-2022)
       o NSW Healthy Eating and Active Living Strategy (2013-2018)
       o NSW Aboriginal Health Plan (2013-2023)
       o NSW Health Framework for Women’s Health (2013)
• Regional priorities, as expressed through the
       o Southern NSW Local Health District Strategic Plan (2013- 2016)
       o Southern NSW Local Health Care Services Plan (2013-2018).

Other health priorities of relevance to this strategy are contained in:
• reports by the NSW Mental Health Commission:
   o Living Well: A Strategic Plan for Mental Health in NSW (2014-2024)
   o Living Well: Putting People at the Centre of Mental Health Reform in NSW: A Report
   o Arts and Mental Health – A Submission to the Taskforce on Health and the Arts
•   The NSW Ageing Strategy (2016) developed by the Department of Family and
    Community Services (FACS) Ageing Disability and Home Care (ADHC).

Additionally, to support the development of regional and district wide goals and priorities,
the SNSWLHD provides extensive information and fact sheets on the health and
characteristics of the southern NSW district including information on:
• Population size, predicted growth, age distribution and potentially vulnerable
• Health behaviours, risk factors, hospitalisations and deaths
• Aboriginal Population health characteristics, health indicators and social determinants of
• Smoking in southern NSW
• Social health atlas 2013 for district LGAs that includes education, income support,
    housing, employment, disability etc.
See -

Consultation Findings
Key Themes Emerging from Consultations

It is within the context of multiple, complex and intersecting policy and strategic planning,
service development and clinical documents, that consultation about local and specific
health care needs and priorities was sought.

Not surprisingly perhaps – given the complexity of the primary and secondary health service
system across a number of public health, non-government, NFPs, private and local
government sectors - the consultations yielded both overlapping and specific concerns in
terms of what were considered the most pressing health priorities, around which an arts
and health initiatives might be developed.

For the purposes of this report, the priority health care needs and potential arts and health
projects identified by the three Health Service Managers and other key NSW Health staff are
summarised below.

A summary of themes emerging from conversations with people and services from local
government, creative/arts practitioners, NGOs, health professionals, other regional arts
development organisations and interested community members is contained in Appendix 8.

High Country Region (Cooma- Monaro, Snowy River, Bombala Health Services)

Antje Badger is the Health Services Manager for Cooma-Monaro based at the Cooma
Hospital and is currently engaged in:
    • The building and redevelopment of a number of health services (the design of a new
        community health centre at Jindabyne, the redesign of ED, maternity, oncology and
        ambulance units at Cooma Hospital)
    • The management of residential aged care, acute beds and the ED at Bombala and a
        wellness centre at Delegate
    • A number of tri-partisan university/health projects aim to improve leadership and
        clinical outcomes in the areas of
            o staff handover communications
            o compassionate and caring cultures
            o patient safety
            o timely access to care for patients with mental illness
    • Reviewing the outcomes of a Patient Experience Symposium.

Working creatively to support the development of an efficient, communicative and patient
centred organisational culture that has improved clinical outcomes is important, as is
designing environments that support recovery, health and wellbeing. Supporting paid and
volunteer staff to work creatively with special needs patients (dementia) and reducing

stress/ offering support in ‘Reach’, the carers program, are also important goals. Any future
arts and health initiatives would need to contribute to outcomes in those areas.

Examples of current projects and ideas for (and support needs in developing/implementing)
future arts and health projects within the Cooma-Monaro sub region are detailed below:

Current Arts and Health Initiatives
• Has relaxing community gardens at Cooma Hospital
• There is art work, community gardens and community support at Bombala
• Has developed and shown a humorous in-house video promoting escalating care,
   resulting in 50% reduction in complaints and harmful incidents

Ideas for Future Arts and Health Activities
• Develop an arts and health strategy that
       o Includes a visual arts and environment program for each health setting
       o Is incorporated strategically and operationally into participating health
       o Articulates collaboration and partnership arrangements
       o Has a collections and curatorial policy
• Incorporate creative arts practices and public art in new facilities and building
   redesign (the new community health centre at Jindabyne, the redesign of various
   units at the Cooma Hospital)
• Engage staff in creative arts activities to support team building, organisational change,
   clinical practice development and new program activities for specific target
   groups/patients and units (especially for patients in rehabilitation, mental health and
   dementia units)
• Engage the wider community in fund raising and commissioning of art works
• South East Arts to act as a knowledge bank of ideas and help realise strategic goals of
   health service

Consultations with the Nicola Yates, Manager of Community Mental Health and Lorraine
Du Bois, Manager, Population Health based in Cooma indicated that:
• The focus of mental health priorities (as identified in the all of government strategy
   ‘Living Well’) are to
        o Improve community resilience to deal with mental health issues
        o Promote recovery
        o To understand, support and promote community infrastructure
• The key to wellbeing is stability, reach and engagement, good functional relationships
   and self-support
• The key focus in health promotions is in:
        o Tackling health issues that cause the greatest incidence of costly chronic disease
        o Falls prevention in the elderly
        o Child and adult obesity
        o Tobacco control

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