• An exploration of the role of visual arts projects for refugee well-being

      Hogan, Susan; Sheffield, David; Phillips, Katherine (University of Derby, 2020-03-14)
      Art therapy and other art-for-health initiatives are part of UK health and social care policy, as well as international humanitarian services for people fleeing persecution. There are currently unprecedented numbers of refugees and high levels of mental distress have been identified in this population. The non-verbal and symbolic potential for expression within art-making may provide a unique form of beneficial initiative. Through a critical realist perspective this thesis adds to the body of knowledge about art-based projects for refugee well-being. A mixed-methods systematic review was conducted in 2018. The quantitative data (k=2) showed that group art therapy is an effective intervention for reducing symptoms of mental distress in refugee children. The qualitative synthesis (k=24) presents a way to conceptualise the kinds of outcomes people experience from different modes of art-based engagement. Themes were developed through the qualitative data synthesis, including Beautifully handmade, Seeing with fresh eyes, Honour the past: forget the past, Telling the story and Being part of the world and Learning and working together. Accordingly, an interplay of creative, personal and social elements is proposed to occur is such activities. While different art-based approaches are identified: art therapy, facilitated art-making and independent art practice, these are shown to engender similar human experiences. This thesis builds on previous research on the use of colouring books for well-being. A mixed-methods randomised controlled study demonstrates their efficacy as a selfsustained well-being activity over one week. This study compared the effect of colouring pre-drawn mandala patterns with free-form drawing and a control group. The study included 69 university students and staff. The Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and the Depression Anxiety and Stress Scale (DASS) were used. A large and significant effect size was found for WEMWBS and a dose response was demonstrated in the colouring condition. A feasibility project was then run at a refugee drop-in centre, where colouring books and colouring pages were provided on a weekly basis for seven weeks. While colouring books have been provided to refugees previously, this thesis demonstrates the potential well-being value of such provision, and the likely uptake of colouring books by this population. Data are presented from four refugees and four staff members. Accordingly, this thesis shows that colouring books are acceptable to refugees. Thematic analysis and qualitative content analysis were used to explore the qualitative data from both primary research studies. Colouring was found to be a relaxing activity by participants in both studies. Participants valued both the process of colouring and the final product. Both reflection and distraction are presented as potential mechanisms involved in improving well-being through colouring. Some participants found the colouring evoked memories, some used the process to express emotions and others found the colouring gave them a welcome diversion from other thoughts. Colouring at the refugee centres also provided an impetus for inter-personal relationships, such as colouring with friends. Art-based approaches are explored as a range of useful and acceptable interventions to improve the well-being of refugees. Consideration is given to the variety of contextual factors that influence the creative and relational elements that are considered central to these interventions. Art-based projects operate within complex social and political systems. Identifying cultural norms and exploring power dynamics can contribute to the understanding and development of initiatives seeking to improve individual well-being, and effect wider collective social and political change.