Balancing Needs for Staff and Musical Participants in Mental Health Facilities by Isaac Boothman (Plugin Project blog)

From May to December 2024, I’ve been working on a project called Plugin - where we at Quench Arts visit young patients in inpatient psychiatric wards, and help them make music to help improve their emotional and social confidence as well as giving hands-on songwriting and technical experience. Sometimes our musicians, aged 18-25, would have had some past experience with music and wanted to reconnect to a bit of their life gone by - and sometimes music was a new area and distraction at a seriously limiting and constraining point in their life. People of all walks of life and dispositions find themselves sectioned, recovering, and hopefully rehabilitating - in an environment of the wards that challenges everyone.

The conflicting needs of the situation make music sessions, and life, quite unpredictable. You can find musicians wanting quality time in a safe environment, ward managers needing safe staffing levels and accessible spaces, healthcare assistants (or HCAs) needing clear instructions on hour 10 of a 12 hour shift, nurses needing cover to make their routines possible, and patients themselves of course have every variety in terms of what they need to feel safe, stimulated and supported.

In thinking about inclusive arts work and how to make sessions accessible for participants, we often talk about ‘access friction’ - where the needs of parties can conflict and no clear adjustment will help all parties. For instance, a sensory-seeking autistic musician and a sensory avoidant autistic musician could have very different ideal environments, and as a facilitator we need to address this conflict in different ways - by working out where the ‘smooth’ shared activities could be, negotiating how and when it’s possible to remove access barriers for one or both individuals at different times. As facilitators, working with stretched systems and people who often don’t know how they best thrive, work and recover, this means we must always be flexible, whether we’re dealing with a newly arisen mental health need for a musician, or just trying to not make an HCA’s worklife difficult.

Our best work in this environment came from a couple of working practices. Firstly, we tried to be a non-demanding presence in the space, whom they aren’t compelled to oblige or obey. It’s fine if people say no, or don’t like us - as we were among the only safe-ish people they could refuse an invitation from (though we always kept inviting where possible). Related to this was that we always got better engagement when going along with HCA’s to find people from their rooms. Being a consistently cheerful presence builds up a different relationship and gives a different impression than being told ‘hey, the music session’s on’, and worked in our favour lots of times.

Secondly, we always needed to be clear, factually, about what we needed on the nurses terms, and never presuming. You might have a nurse-in charge from another ward, or maybe nobody you know is even free to give you a handover. Rolling shift patterns and high turnover in hospitals means not every member of staff who needs to know will know about your project - so we’d hone our script down to a very clear “hello, how are you doing - is there anyone floating to be in the room with us until half past today? And is there anyone who can give us a handover on how everyone’s doing?” each time. HCAs are not mind-readers. Of course, we always needed to be polite, always say hi, always invite, and always introduce ourselves.

Finally, in terms of the sessions themselves, we would try and vary our offer in the moment. Sometimes you need to have a very flexible one-to-one, where as a music facilitator you adapt to what the patients want (are we having a jam or a songwriting session? Are we going to have a ‘lesson’ or chat?), or curate a set experience where the participants’ responses can still be their own and spontaneous, but the stress and uncertainty of thinking is taken out of the equation. Sometimes just setting up a prop, and letting patients feel like they are helping us with a task is the thing that gets them involved and invested in a session and creates little interactions that we can build on for the future.