Art and Mental Health

It is estimated that by the end of the decade, close to $60 billion will be spent on healthcare construction, which implies that close to $300 million will be spent on art in healthcare. In the current economic climate, this investment cannot go unchallenged. Does the investment in art reap tangible, measurable, and accountable benefits to a healthcare organization?

Only if we are able to make this case can art dodge the risk of being value engineered. Inclusion of art is of particular significance in mental health settings, where patients are “perceptually” vulnerable. In this context then, art must be chosen carefully, creatively, and conscientiously.

Prior studies on art, mental health, and healthcare settings

Today, there is a compelling body of evidence that makes a case for the impact of positive distractions, such as art, on clinical and behavioral outcomes, including reduced stress, anxiety, and pain perception. Many of these studies have been conducted in acute care settings in high-stress areas, such as ICUs, waiting rooms, and procedure rooms.

In the context of mental health, researchers have long speculated that the physical environment in which treatment occurs has an impact on both the treatment process and its outcome. The few empirical studies that evaluated the effects of psychoenvironmental design have shown a decrease in pathological behavior, selective behavior, and attitude changes among both staff and patients, with a significant decrease in the rate of patient violence, an increase in patient-staff interaction, and improved morale among both patients and staff.¹

However, a review of literature reveals there is a lack of studies in mental health settings that isolate the healing impact of particular environmental variables.² We conducted a study that addresses this criticism by investigating the impact of a focused intervention using visual art.

Our study

The objective of this study was to determine the impact of different art conditions on levels of patient agitation in a psychiatric holding facility. Three distinct art conditions—abstract art, abstract representational art, and realistic nature—were introduced inside a psychiatric holding unit lounge (Figure 1).

The nature art displayed was a realistic photograph that followed the description of a savannah scene and previous guidelines for appropriate healthcare art.² The abstract-representational image was a painting similar to the photograph in content, color, and composition; but it was rendered in an abstracted style. Previous research has been criticized for the use of computer-generated imagery that controls for color and composition as lacking in artistic merit. Addressing this criticism, a comparable high art piece by Vincent Van Gogh was selected. The final art image was a chaotic abstract painting by Jackson Pollock with contrasting colors and non-representational content. This image was selected to provide a stark contrast to the other two images (Figure 2).

During the study, nurses on the floor were asked to observe patient behavior. At the end of the three-month period, data from the hospital on PRN medication prescribed and patient census was collected; nurses were not informed at the time of the study that PRN data would be analyzed. PRN is the anti-anxiety medication that is given to patients on a need-only basis for elevated levels of agitation.

Since this is a medication that is not routinely prescribed, it is a robust and objective measure of agitation. Researchers compared the ratio of PRN medication to patient census across three different art conditions and a control condition (with no art). PRN costs were provided by the hospital per PRN incident. Costs were compared across different intervention conditions to make a case for the impact to the financial bottom line of the hospital.

Finally, focus groups with 22 nurses were conducted to secure qualitative information pertaining to patient behavior and the staff’s perception.