Referring back - the challenges of accessing support for participants in crisis

Room for Art has been my lifeline…(it) has helped to minimise my social isolation and the effects of my depression which has been very bad at times…this is vital to my health – Room for Art participant

Room for Art is our art and social prescribing project that has been inspiring participants to be creative for the past five years, with the aim of improving people’s health and wellbeing, to reduce health inequalities and allow access for all to art activities. The project provides weekly visual arts workshops facilitated by professional artists on to adults in five different venues throughout Edinburgh. The workshop participants are referred by GPs, Community Link Workers (CLW), health and social care agencies, third sector organisations and through self-referral.

Social Prescribing is a holistic intervention set up with the aim of promoting improved health and wellbeing, whilst taking the pressure off primary care and moving away from the model of treating everything with drugs. There is no widely agreed definition of social prescribing, interventions can take many forms and are open to different adaptations, most commonly to fit local services. The Community Link Worker (CLW) role is often referred to as ‘bridging the gap’ between primary care and the community and third sector. 

Our participants attend to make art but they may also be experiencing mental health challenges, long-term physical health conditions, are socially isolated and/or experience loneliness. Many have caring responsibilities and are experiencing challenging living and housing conditions. They include people with disabilities and people who are financially vulnerable.  

The challenges of accessing support

The people we work with deserve proper support, and often both the emotional and practical needs of the group exceed the capacity of the artist…we are not just providing art classes, we are providing safe spaces where vulnerable people feel listened to and supported – Room for Art Artist

During our work on Room for Art, we have identified a lack of access to support and referral routes when participants need help and are in crisis. Sadly, this situation has been exacerbated by the COVID-19 pandemic. Over the years, participants have let us know that services were being reduced and/or harder to access and have disclosed a number of issues where they need further support; self-harming, challenges with housing, caring responsibilities, historical abuse, suicidal ideation to name a few.  

Room for Art staff are increasingly asked to advocate for participants and to attempt to contact their GP or Social Care Direct on their behalf. This could be due to a crisis situation or the participant not feeling confident or equipped to tell their story or to ask for support. This is difficult: 

·       Often there is no route past the receptionist or messages are left and not acknowledged. 

·       There have been incidents of disclosure where a conversation had to be reported and logged with an external agency- with some workers this was acknowledged, but with others there was no response. 

·       There have been incidents where care workers and services were contacted to raise a concern about a participant (under their direction and with their permission) and staff have been asked who they are and why they are contacting them.

This is particularly concerning when we are making contact about a serious concern that needs to be logged.

We continue to adapt our work to respond to need and combat these challenges; ensuring we have more support in workshops, further development of our partnerships and raising awareness to promote understanding of our work, especially within health and social care. There is a limit to what our staff can do, but we are set up to support health and wellbeing and a social prescribing project that works with vulnerable people must have a duty of care to signpost participants to a service that can help. We have seen social prescribing grow over the last couple of years but we have found that wider, structural issues have made this signposting one of the most challenging aspects of our work. Key support for the voluntary and community sectors is required to best support people referred to us.

What is the solution?

Just knowing that there is someone you can chat to if you need to, and that that support is there is incredibly helpful and reassuring. And is one of the key things that makes room for art more than just an art group and helps make it a safe supportive place – Room for Art participant

Ideally Room for Art needs Community Link Worker or health and social care help to fulfil this duty of care; to be able to refer participants back to receive support, but currently this is not a service provided in every locality. Where there are participants who have access to a CLW- this is a direct route that is helpful and there is comfort that the participant will be receiving appropriate support. Unfortunately, this is not a route for all participants.

We do have relationships with CLWs and attends forum meetings. The existing Social Prescribing Forums are geared towards establishing new projects and linking projects to CLWs, rather than discussing issues arising in long running projects. CLWs do not currently have the capacity to support Room for Art participants – they are sympathetic when these issues are discussed but are not able to provide an immediate solution. We are continuing discussions and have a positive dialogue and respect their honesty and support and plans for more CLWs in the future with greater resource. Although we are still searching for an answer for participants in crisis.

‘Social prescribing on its own won’t solve anything. It has got to be part of a bigger system, which connects the community and the assets to the services and support. And that service and support is bigger than just social prescribing’ (Webster, Kings Fund). 

We do not wish to turn anyone away from attending Room for Art workshops, but it is essential that staff are able to access support systems. This raises an important question of where a social prescribing project, based in the community, with a small charity or an arts organisation, fits into the health and social care system. For an intervention that is designed to relieve the burden on primary care it is disappointing that the only route back is through a GP or Social Care Direct. Support in crisis is not the responsibility of the CLWs. How do we best access support from other services for our participants?

This blog has come out of a report funded by the Baring Foundation by Community Development Consultant Louise Donoghue, exploring how we can best support our participants to access the services and care that they need within the framework of social prescribing.  Full report available here

19 July 2022 by

Art in Healthcare