• NHS England's multidisciplinary approach means sometimes prescribing art classes in the place of antidepressants

  • Dr Christiana Spens responds to the backlash against this plan, arguing for the power of art therapy

  • We have art therapists available on Welldoing here

Recently, it was reported that NHS England plan to help patients come off antidepressants, opiates and benzodiazepines, to avoid “a US-style opioid crisis” and as part of this reform, to offer other therapeutic alternatives such as art and music classes. 

While it seems hyperbolic to equate the UK’s situation with that of the US, given that the prescription of opiates, benzos and z-drugs have actually declined in the past decade, and anti-depressants cannot really be equated with opiates in their effects or dangers, it remains true that the UK population is somewhat dependent on these medications, in the sense that 1 in 4 adults have been prescribed at least one of these drugs in a given year. 

Within that figure, 12% of the country’s adult population have been prescribed antidepressants, and it seems that it is overprescribing of SSRIs that NHS England want to crack down on. This seems a sensible plan, especially in the context of very limited access to other mental health support such as psychotherapy, psychiatric assessments and treatment, and substance abuse treatment. If patients are going to their doctors with mental health issues and only being given antidepressant medications as an option, then clearly many individuals will be failed by the system, and require a better range of options to support their mental health.

Interestingly, although NHS England recommended a multidisciplinary approach to mental health treatment, as part of a wider plan to reduce the overprescribing and dependence on antidepressants, in particular, there has been a negative backlash against lesser-practiced alternatives, with some commentators ridiculing the idea that art therapy, in particular, might be a beneficial and effective alternative to antidepressents for some patients.

But while SSRIs are effective for many people, they simply don’t work for everyone, and even if they do, may prove difficult to withdraw from in the longer term. I have myself tried three types of antidepressants in the past, with two making me much worse, and another having very little effect at all. Partly because I had no access to psychotherapy at the time, I turned to writing and art to help me through my own darkest times — and these all helped massively in my recovery and day-to-day management of symptoms.

As I discuss in my book on trauma, art and recovery, The Feardrawing, writing and painting enabled me to gradually recover from birth trauma and PTSD, combining elements of meditation with an engagement with past traumatic memories, explored at my own pace through visual art practice. While my ‘therapy’ was informal and self-driven, it was inspired by methods that my PhD supervisor, psychologist Dr. Orla Lunch, had told me about — involving trials of using photography therapy to treat individuals with PTSD following political violence in Northern Ireland, and complex cultural narratives that complicated recovery.

Every case is different of course, and while painting and drawing might have worked for me, in alleviating symptoms of PTSD in particular, and music or writing may help others, there will clearly be cases where antidepressants are required, ideally with some form of therapy alongside that treatment. The idea that art therapy should totally replace antidepressants is naïve; these are therapies that can work alongside one another, depending on the patient and their particular needs and situation. Antidepressants can be lifesaving in some situations, but other times they do not necessarily work well, or the side effects outweigh the positive effects. In these cases, considering other treatments such as art therapy may prove enlightening and considerably beneficial for patients.

It is easy to think of art therapy as not a real therapy, or as futile in the face of serious mental illness and crises, but I think this is a mistake, and a patronising one. The idea that only antidepressants can make life bearable when one suffers from severe depression, for example, is simply not true. While it is brilliant if that treatment works for some patients — and where, therefore, it would seem unfair to try to wean someone off a treatment that helps them, just for the sake of it — there should be more options for patients whose depression, PTSD or anxiety, in particular, do not respond to those medications or who require other therapies to support those treatments.

For some, art therapy will be more beneficial, lifesaving and effective than SSRIs, opiates or other proposed medications such as medicinal cannabis, and it should be taken seriously rather than being dismissed. Moreover, there should be no pressure to choose one therapy or treatment over another; surely the best course of action is to provide a selection of good options in a holistic programme that allows for individual complexities and differences? While I relied on art practice for a long time, when I did finally have the chance to have weekly psychotherapy sessions, I found that these combined well with my art practice and enabled me to better understand its meaning in my life and how it helped me function day-to-day.

The backlash to the proposal of art therapy to support mental health has revealed a snobbery against forms of therapy that are not well understood or practiced in the UK today, and a stubborn assumption that pharmaceutical solutions are always the best solutions to psychiatric issues, and that there is a hierarchy of treatments as a result. But, in my opinion, NHS England’s enthusiasm for what they call a ‘multidisciplinary approach’ to mental health treatment is a welcome one that could save and improve the lives of many if implemented carefully and funded appropriately. 

Art therapy, like ‘social prescribing’ of gardening sessions and other community-based activities, can combine therapy, socialisation and ritual in ways that genuinely help people manage their mental health issues, which are so often exacerbated by social and class issues as well as physiological problems. To give these areas a little more attention, and to open up communities to their benefits, is something to embrace.

Dr. Christiana Spens is the author of The Fear 

You can purchase it here using discount code welldoing20 for 20% off

Further reading

Bringing art to therapy and me to life

7 ways art therapy helped me

Why art and therapy complement one another

Depression isn't caused by low serotonin: do we ditch antidepressants?