Zambia Therapeutic Art (ZTA) is a Scottish charity which aims to improve care for Mental Health service users in Zambia by designing, developing and delivering practice based training in the therapeutic use of ‘art’ to health and social care staff; working to ensure its ongoing sustainability; monitoring and evaluating the continuing practice; and conducting research on this topic.
Background Lesley Hill and Joanna Pearce, UK Art Therapists have developed and delivered training for Mental Health professionals and trainees in the Therapeutic use of Art in Zambia since 2011. A total of 562 mental health professionals and trainees have received training inputs. The ZTA Course – which was designed and shaped from learning year on year ‘what works’ has been completed by 150 of these trainees. Enthusiasm for The ZTA Course, based on its demonstrated potential for enhancing patient care has led to a request by key stakeholders in Zambian Mental Health that it be included in all pre-service curricula of Mental Health Professionals.
Mental health care in Zambia Mental health services in Zambia are recognised as significantly under resourced. There is little specialist provision at community level with services tending to be centralised to hospital facilities in Lusaka. The lack of resources impacts on staffing levels and treatment options; which are almost entirely pharmacological. Legislation is seriously outdated: A new Mental Health Bill is in process. Issues around the rights of mental health patients and stigma are well documented. The Ministry of Health (MoH) and key training institutions recognise these gaps and difficulties so welcome evidence based psychosocial initiatives such as The Zambia Therapeutic Art (ZTA) Course which can work in alignment with national and international guidelines and policies.
A good fit – The Therapeutic Art Course and the Zambian context Therapeutic Art training rapidly up-skills the trainees, building on their existing knowledge and skills; and through its practice based approach enables trainees to independently use Therapeutic Art skills as a new skill in their ‘toolbox’ following the course. The short nature of the course (current format - 24 hours over 6 weeks) minimises the impacts of withdrawing hospital staff from their work – in respect of the challenges to staffing levels in mental health care. The course is designed to be accessible for mental health professionals at all levels – ward assistants, mental health nurses, physiotherapists, counsellors, psychologists, doctors, clinical officers, clinical neuropsychology trainees, MSc mental health nurses, and MMed psychiatrists: This increases the opportunity for patients to access Therapeutic Art and provides a commonality of understanding of the approach across all staff levels. Trainees are trained in their normal work/study time and workplace – avoiding expensive training overheads and enabling opportunities to use skills learned in their everyday work with patients, during the 6 week training period.
Development of ‘The Therapeutic Art Course’
2011-2013 Chipata General Hospital, Eastern Province
Lesley Hill delivered training via a 5 day workshop to mental health and social care professionals and worked in the mental health unit using ‘art’ with patients (2011/12). Lesley Hill and Joanna Pearce evaluated this training one year on (2013), and building on this designed and piloted a ‘practice based brief training’ for nurse students on placement in the mental health unit. Outcomes of the training programme as identified by participants – indicative of improved care;
Enhances communication - giving the patient a voice
Enables students to have a sense of the patient as a person with a history and value in their communities
Provides the patient an opportunity for creativity and expression, increasing confidence and enhancing the sense of self
Provides a distraction from symptoms, reducing stress
Improves attitudes in students towards patients
Assists diagnosis and treatment planning
Assists well-being and recovery
Reduces stigma and increases compassion
These preliminary findings were shared at a workshop at ‘The Global Allied Health Professional Conference’ in Edinburgh in 2013.
2014 – 2015 University Teaching Hospital (UTH) Psychiatry Department, Chainama Hills College Hospital and Chainama Hills College of Health Sciences, Lusaka These organisations are the core training institutions for mental health professionals and are linked to the University of Zambia. The Zambia Therapeutic Art Course was delivered to a wide range of professionals including mental health nurses, trainee psychiatrists, MSc clinical neuropsychology students, physiotherapists, doctors, psychologists, ward assistants, social workers and psychosocial counsellors. Evaluation on completion of the course involved trainees noting the most significant changes which they experienced;
Experiencing the enhanced therapeutic relationship and understanding the positive implications of this for their understanding of their patients and their capacity to communicate their stories and feelings.
Experiencing the power of art making in this context to improve thinking, enhance mood and access memory leading to better communication.
Recognising the implications for improved treatment planning and management as well as rehabilitation and recovery.
2016 Operational planning Inspired by the success of the course in rapidly up-skilling staff and trainees and enhancing patient care; UTH, Chainama Hills College Hospital and College, and the MoH requested that the Zambia Therapeutic Art course be provided as part of all pre-service mental health training. A scoping exercise was conducted in 2016 to help ZTA learn how best this may be taken forward. In pursuit of in-country sustainability, consideration was given to a Training for Trainers (ToT) programme to scale up delivery of the course along with ongoing support, supervision, evaluation and research from ZTA until the course was sufficiently embedded (see separate report for details).
2017 Training trainers ToT/ Research and publications The first stage of a ToT pilot was completed in Feb 2017 in parallel with delivery of the ZTA course in UTH and Chainama Hospital. Three Zambian Professionals were recruited from the 2016 cohort of trainees, and competed ToT Stage 1 – shadowing, learning and discussion phase. In October 2017 they will undertake Stage 2 - deliver the training course independently and be assessed as a trainer by ZTA. Condensing the ZTA course into a 1 week full-time course will be a part of this pilot when delivered outwith Lusaka.
Forward planning includes completion of the ToT pilot and evaluation and learning for future capacity building. It is hoped that opportunities may exist to enable trained Zambians to skill share in other African countries such as Malawi which has a similar mental health profile as Zambia. Interest in accessing ‘The ZTA course’ has also been expressed from Mental Health and Public Health personnel in Ghana.
Acknowledgments ZTA trustees and trainers all work on a voluntary basis for this project. They greatly appreciate the support from Multi-Agency International Training and Support (MAITS) for support for trainers’ expenses, year on year. ZTA also greatly appreciates the support for its programmes from the Ministry of Health, Psychiatry Department at UTH, Chainama Hills Hospital and Chianama Hills College of Health Science.
Zambia Therapeutic Art is a registered Scottish charity (SC045462)