Introduction: Emerging evidence demonstrates the beneficial impact the arts can have on recovery from mental illness; however, creativity and artistic expression have rarely featured in Western medicine. In addition, further research is needed to explore the complex processes involved in personal recovery, in particular the often-overlooked identity change recovery process. Therefore, the current research aims to develop explanatory insights into how, why, and in what context community arts activities enables the identity change recovery process. Methods: A realist evaluation was conducted between January 2021 – December 2022 and included two studies. First a realist literature review was undertaken to test and refine an initial programme theory. The programme theory developed from the realist review was then tested against lived experiences in the second stage of the evaluation which involved a qualitatively driven, mixed methods study. Twelve participants with serious mental illness took part in either one or two arts elicitation interviews across a seven-month period and completed the Recovering Quality of Life Questionnaire. Four workers from partner organisations also took part in realist interviews. A multi-analytical approach was taken to analyse the data and develop programme theory. Results: Three programme theories were developed to explain how, why and in what context community arts enables the identity change recovery process from serious mental illness. Programme theory one explains how organisations establish a safe and empowering alternative community in which individuals engage with creative activities. Programme theory two presents four potential mechanism pathways that enable the identity change recovery process, alongside other recovery processes. The mechanism pathways reflect a transformative learning process through which individuals can reconnect to parts of their identity that have become overwhelmed by illness. Programme theory three demonstrates possible psychological resources that develop when engaging with recovery processes. In addition, programme theory three demonstrates that recovery is about ‘living well’ with serious mental illness and that definitive outcomes can vary widely between individuals. The Reconnective Communities Framework was developed from the programme theories to conceptualise a higher level of abstraction. Conclusion: Three key conclusions can be drawn from the results. First, community arts interventions develop a safe alternative community space, which is vital to intervention success. Furthermore, intervention context established at an organisational level is the only part of the recovery process that is within the control of intervention providers to determine. Second, the creative activity itself is an important component of non-clinical interventions, increasing the number of potential mechanisms activated, providing more opportunities for individuals to engage with recovery processes. Lastly, recovery from serious mental illness is experienced as ‘living well’ or stability, rather than improvements in measurable outcomes. In fact, definitive outcomes varied widely between individuals demonstrating that no one specific outcome can be predetermined to evaluate intervention success. It is recommended that context criteria is utilised to evaluate intervention efficacy, and further research is needed to determine the specific contextual features of different mental health interventions.
| Date of Award | 24 May 2024 |
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| Original language | English |
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| Sponsors | South West Yorkshire NHS Foundation Trust |
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| Supervisor | Susanna Kola-Palmer (Main Supervisor) |
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