Striking the right notes

Live entertainment in hospitals and music therapy courses can improve patients' physical and mental health, writes Arminta Wallace

Almost every day, we hear stories of staff cutbacks, funding shortfalls and superbugs in Irish hospitals. It's a steady drip of doom and gloom that suggests that if our healthcare system were to be set to music, it would be an unwieldy symphony in a minor key. But even the saddest symphonies have the occasional bright moment - and in hospitals, clinics and daycare centres around Ireland, a quiet revolution has been taking place that has given patients and healthcare practitioners plenty to sing about. It involves the use of music in a therapeutic context. And, like all the best medicine, it appears to go down extremely well.

"Music hits virtually every cognitive button there is," says Prof Desmond O'Neill of the Adelaide and Meath Hospital in Tallaght. "Tapping feet, movement, memory, emotions, conceptualisation, interpersonal relationships - you name it, music facilitates it. And as regards neurological disease, there's absolutely no doubt that it plays a key role for people who have a language disorder and can't do narrative. It has fantastic potential, both for affecting people and for allowing them to express themselves. It's no wonder, really, that Schopenhauer called it the greatest of all art forms."

It's also a wide church. The use of music in hospitals ranges across a wide spectrum, from pure entertainment at one end - a local group singing Christmas carols in a daycare centre- to music therapy, a specific form of medical intervention by trained professionals that is comparable to speech and language therapy, or physiotherapy, at the other.

IN A HEALTHCARE environment, where funding is in short supply and every cent counts, distinctions along this spectrum are important and impact studies, to measure the effectiveness of creative arts therapies, are vital. Four years ago, the Adelaide and Meath Hospital appointed an arts officer, Hilary Moss, to promote and explore the role of the arts in the health arena. Since taking up her appointment, Moss has been involved in diverse projects, from a high-tech DVD installation, to art exhibitions in its permanent exhibition space, from puppetry workshops in the paediatric waiting room to the publication of a book of poems by patients in cardiac rehabilitation, psychiatry, national children's hospital and age-related healthcare.

Moss was also instrumental in setting up a year-long residency for the Irish Chamber Orchestra at the hospital, the first of its kind in Ireland. A trained music therapist, Moss is passionate about the importance of arts therapies in hospitals - and is determined to prove that they pay for their keep. In a report entitled A Cure for the Soul?Moss collated the data from a detailed questionnaire given to 93 patients, staff and visitors after the concerts.

The comments are intriguing. They range from "The music was beautiful, what a great surprise . . . I feel uplifted because I was worried about my husband" to "I had never heard classical music before or seen it on TV. I thought the musicians would be old and I wasn't expecting youngsters to be playing" and "Would have been nice to have a bit of Strauss".

Music isn't always just relaxing and uplifting, of course: the emotions evoked by a particular piece can be different for different people. It's not surprising, then, that some people reported that live music made them feel lonely. One man cried during a traditional tune because he used to dance but was no longer able to; another woman remarked her husband used to play the concertina, but that he had died recently. Which, as Desmond O'Neill points out, is perfectly fine - as long as there are trained professionals on hand to help pick up the emotional pieces.

"Virtually everything we do in medicine has a downside - and sometimes a surprising downside," he says. "For example, oestrogens are good to protect you against heart disease, but when you've actually got heart disease, oestrogen is harmful to you. It depends where you are."

This is, he insists, why evaluation procedures and the development of best-practice principles are so important. They will, in turn, contribute to higher standards in the whole area of arts therapies in hospitals. "In the medical profession you've got to make your case, and I suppose the thing is that the case for arts therapies hasn't been made yet," he says. "There's a small corner of art therapy which says that what we're doing is too complex and individualised to measure an outcome, and I'm afraid that just doesn't wash. For any young discipline there's a period where it learns how to develop these measures.

"We've also got to erode the barriers that exist at the moment - the belief in some quarters that this is fluffy, huggy stuff. Clinicians have to address everything, from the molecules and the brain cells to the whole person, and we really have to make sure we get that balance right."

At present, the use of music in Irish hospitals is raising almost as many questions as it answers. What, if there is one, is the relationship between the presence of an orchestra in a hospital atrium and the employment of a music therapist who works on a regular basis with patients who have serious neurological problems? Is it "therapeutic" for people in A&E to be able to tap their feet while somebody plays a guitar and sings? And - most importantly of all, in an increasingly dissonant financial climate - who's going to pay the piper? As the Government prepares for next year's Budget over the coming weeks, the symphony of the healthcare services may well take an even more complex turn. It would be a shame if the fact that such questions are being raised were to result in glum silence all around.

It's not strictly to do with music, but some fascinating insights on the relationship between art, creativity and health - with a special emphasis on the older person - are bound to emerge from the Medicine and the Arts lecture series that is being held at the National Gallery of Ireland this month. On November 15th, Dr Thomas Dormandy will speak about great artists in their old age; on November 22nd, Prof Philippe Abastado will give a talk on ageing and the self-portrait; and on November 29th, Prof Pat Thane will address "the art of ageing". All talks begin at 6.30pm in the gallery's lecture theatre, and admission is free.

KEVIN O'SHANAHAN IS a musician. He is also a trained psychiatric nurse - in fact, he specifically sought out this particular professional qualification so that he could spend his life helping people via the medium of music. "For years I played drums in bands," he says. "Then I did some community outreach work with the Spraoi festival in Waterford. I was asked to work with teenagers with emotional problems, and you know teenage kids - it can be difficult to get them to engage with you. I found it fascinating how you could develop a relationship through music." Under the aegis of Waterford Healing Arts Trust, O'Shanahan is musician-in-residence at the acute psychiatric unit in Waterford Regional Hospital. This month, thanks to funding from the HSE, he and three other musicians - Liam Merriman, Mary Prendergast and Una McSweeney - will embark on a second phase of this project, running workshops at St Otteran's psychiatric hospital. "To be honest, my job only makes sense to me in terms of the music," O'Shanahan says. "My goal going into a group is to involve people musically. It's not about entertainment, it's about participation."

Last year O'Shanahan took part in a European exchange programme organised by the French group Musique et Santé. The French have been employing musicians in the health sector for many years, and have developed a relaxed, yet impressively professional, approach to the whole topic. "In France they've developed a way of working in hospitals where the focus is on communication with the client, or the patient," O'Shanahan says. "In France it's treated very seriously, and is a mainstream activity in a lot of hospitals. What we're trying to do is bring it to Ireland."

Working with the highly experienced French musicians constituted a steep and exhilarating learning curve, he says. "I learned how to design workshops in a way that gives people the confidence to become involved. If you go in with two other musicians and play a fantastic half-hour of music, people can be totally intimidated, because they say, 'My God, these are great musicians - what could I possibly do here?' So from the start, it's all about trying to involve people. We do this through rhythm games, shakers and other percussion instruments, and the voice, of course, which is massively important."

There's often, he says, a certain amount of tension at the beginning of a workshop. Patients don't know what to expect, and may adopt a defensive attitude bordering on hostility. "If the workshop is facilitated properly," he says, "there's a gradual blending, and by the end we often have a feeling of celebration. Recently a man in the acute unit came in and was sitting with us. He looked quite nervous, but he got involved in some activities and eventually volunteered to sing a song.

"When he finished it, he said to the whole group: 'If you'd told me this morning that I was going to do that, I'd have said you're crazy.' My job is to create the conditions that allow people to take that kind of risk."

O'SHANAHAN AND HIS fellow musicians try to tailor their repertoire to suit the age group involved - a task that isn't necessarily as easy as it sounds. "I've been asked for Bob Marley, I've been asked for African folk songs, I've been asked for Garth Brooks," he says. "Recently I was asked for Closer to Fineby the Indigo Girls - by a man in his 60s. What I've noticed with the folk songs is that everyone seems to know them. One day there was a group of young lads in the acute unit singing I'll Tell Me Ma- and they knew all the words, which surprised me."

In other situations, he says, calming music is what's required. "We had a man recently in the acute unit who was elated and not very appropriate in conversation. Whatever was in the music we played helped to calm him and allow him to communicate in a much more appropriate way. Music can help people bring order to chaos. By its nature, it's about organising sounds; noise is when they're unordered, when there's no pattern. And yet, despite the order, there's a strong emotional side to music. Of all the sessions I've ever done this was the most dramatic. By the end of it, the man was a different person."

Having said that, O'Shanahan doesn't claim to effect magical "cures". "We don't consider ourselves therapists," he says. "We're musicians. But what we're trying to do is create a therapeutic space. We feel that there's great benefit there, in terms of gain to people's self-esteem, social skills and so on. And we're arguing that, in the wider context of healthcare, this is very important - and totally overlooked."