Hospice Care and Art Therapy - A Point of View

I worked as an art therapist for my local hospice for sixteen years, eventually leaving in 2008 having been awarded a Phd by the University of Sheffield focusing on art therapy, spirituality and palliative care. My research included nine case studies illustrated with selected drawings and paintings created by patients receiving palliative and end-of-life care. This was a satisfying conclusion to a wonderful and richly rewarding experience of working intimately with adults living with a diagnosis of a terminal illness and caring for them at the end of life.

In my local area there are several hospices, a Macmillan palliative care unit, comprehensive palliative care service’s available across all NHS Foundation Trusts and in the community. There is a regional specialist cancer treatment centre and a number of independent charities providing psychosocial support and a range of psychological therapies. To my knowledge, within a fifty mile radius of the city I live in, there is at this time certainly one art therapist working for a hospice and possibly a second working for an independent cancer support charity.

Why is art therapy not more widely employed in the hospice sector within my region? This is a question I have been wrestling with for the last eight years. The first and most obvious concern is to do with economics. The British government’s policy of austerity, financial constraints on hospice care and the intensely competitive world of fundraising by charities means that arguably, hospice managers have perhaps through necessity significantly narrowed down the fundamentals of what a hospice service provides and the disciplines and professions they choose to employ. When I worked at my local hospice, there was a time when the organisation employed two art therapists, two music therapists, a creative writer and an artist in residence along with a range of complementary therapists, all supporting the medical and nursing teams from within an holistic philosophy of multidisciplinary care. I am certain this constellation of creative disciplines is no longer common practice across the hospice community in my region.

A number of additional factors, apart from economics, has also had an impact on the interest in art therapy. The National Institute for Clinical Excellence (NICE) in the UK has had a massive influence on the guidance provided for the National Health Service (NHS) as to which psychological therapies are most appropriate for specific mental health conditions. These guidelines are based on the principles of scientific positivism which insists that all treatments have robust research evidence to demonstrate their efficacy for patients. The predominant psychological school of theory and practice considered to have unrivaled scientific evidence through the use of random controlled trials (RCT’s) is Cognitive Behavioral Therapy (CBT). This I believe has introduced a tightening of financial support for different types of psychological therapy and the corralling of people in need of mental health care and channeling them towards what is now referred to widely as Improving Access to Psychological Therapies (IAPT). See the link below.

Art therapists are now having to develop services independently of the NHS in the UK, for example, either collectively as not-for-profit social enterprises or self-employed as private practitioners. Art therapy has a long and consistent theoretical and practice-based tradition in the UK and there are numerous publications to support this. Art therapists have proven the benefits of art therapy time and time again with a wide range of clients in health, social care, the charitable sector, education and prisons. It is supported by a very different kind of evidence from that which is stipulated and defined by NICE. My own research utilized an ethnographic approach incorporating thick description, reflexivity and analysis to define the meaning-making taking place in art therapy critical for people living with a terminal illness. Qualitative research methods such as this are just as likely to serve the needs of art therapists with regard to building up evidence as any quantitative methodology that provides statistical outcomes to measure benefits.

Art therapy has a tremendous amount to offer people being cared for by hospices and palliative care services. There are currently many examples throughout the UK of art therapists working successfully in this field. You can find more information about this via the British Association of Art Therapists (BAAT) web site listed below. I hope there may be a revival of interest in art therapy within my own region but it will depend on the extent to which hospice managers and trustees appreciate the valuable contribution art therapy makes to care of the terminally ill and the dying and whether finances permit such investment. The bigger picture would suggest that there needs to be a re-visioning of how specialist psychological and emotional care is delivered and by who. Hospices seem to have adopted a default position that assumes the wide range of psychosocial needs of patients are either adequately taken care of by the largely specialist nursing and medical teams or is addressed by clinical psychologists seconded to hospices and paid for by external NHS services.

My experience of hospice culture was at a time of innovation and advancement in palliative care. Creativity, the arts and humanities were considered invaluable adjuncts to nursing and medical care. A key influence for me was the work of Michael Kearney and his book ‘A Place of Healing: Working with Suffering in Living and Dying’, published by OUP in 2000. Whole person care was at the heart of his approach with an emphasis on creative and imaginative ways of enabling the terminally ill and the dying to communicate their experience. Much of this creative and imaginative philosophy has been diminished by the pressure of economic constraints and possibly a narrowing of perspective with regard to the holistic care of people receiving palliative care. I hope that the art therapists currently making a fabulous contribution to the work of local hospices will weather these difficult times and that within my local region trustees and service managers may take a fresh look at the ways in which art therapy can make a huge difference to the quality of life of the patients in their care.

References

Pratt, M and Wood, J. M (1998) Art Therapy in Palliative Care: The Creative Response. London and New York: Routledge.

Bell, S (2008) Drawing on the End of Life: Art Therapy, Spirituality and Palliative Care. Unpublished PhD Thesis, University of Sheffield.