The Alchemy Project

Image credit Pari Naderi
Image credit Pari Naderi

In 2015 The Alchemy Project undertook an innovative action research project pioneering the delivery of two, dance-led interventions, working intensively over 4 weeks, with two cohorts of young adults accessing Early Intervention in Psychosis Services through the South London and Maudsley NHS Foundation Trust (SLaM).

The interventions in 2015 followed on from a pilot project in 2013; entitled SeaBreeze. The pilot demonstrated that the methodology at the heart of the interventions was capable of achieving clinically significant results in terms of improvements in the mental wellbeing of the participants. Before this pilot, contemporary dance had never been used before in a front-line mental health service within SLaM and was considered both radical and unchartered territory in 2013.

One of the objectives of the 2015 action research project was to engage an independent evaluator in order to establish if the positive pilot findings could be repeated. Optimity Matrix was engaged to undertake this evaluation, in the context of an Early Intervention team. In the published report of the 2015 interventions the research has shown that dance acts as a powerful catalyst in the recovery of service users’ mental health in Early Intervention in Psychosis.

The action research project was made possible with funding from Guy’s & St Thomas’ Charity, Maudsley Charity and Arts Council England and with the support of South London and Maudsley NHS Foundation Trust; Early Intervention in Psychosis Services, SLaM Arts Strategy and Rethink Mental Illness.

Description of the arts activity

The Alchemy Project delivered two interventions in 2015 each of which concluded with a professionally produced performance of the choreography ‘El Camino,’ a choreography that was specifically commissioned to be suitable for young adults accessing Early Intervention in Psychosis services. Over two separate periods of 4 weeks the project team, which included within it professionals dance artists and healthcare professionals, worked with two different groups of 18 individuals (including peer mentors) referred to Early Intervention in Psychosis Services through SLaM. The final performances took place at well-respected public dance spaces - The Shaw Theatre in March 2015 and the Lilian Baylis Studio, Sadler’s Wells Theatre in July 2015 for an invited audience of arts professionals, healthcare workers, commissioners, stakeholders, students, and friends and families of the participants.

We use a distinctive methodology that is modelled on professional contemporary dance training and performance. Those who are referred to one of our projects work full-time over an intensive four-week period concluding with a performance in a professional theatre. Dance facilitates huge shifts in the way participants meet new people, build new relationships, find motivation and go on to experience a real sense of achievement in accomplishing something new and of high quality. The project becomes a springboard for people to think more positively about what they can do in their lives and this is critical to supporting their recovery. During the course of the four week project, participants learn how to dance, rehearse and perform an original dance work to an invited audience in a professional theatre setting.

We do not focus on mental health conditions, labels or people’s ‘deficits.’ Rather, we work with them as dancers and enable them to become a dance company working towards a performance. As Dr Lauren Gavaghan explains: “these dancers, when they walk in the room, are no longer patients, they are no longer people with an illness, they are dancers in a dance company and I think there is an incredible impact from just that-so people are really pushed to their full potential. Rather than concentrating on deficit and illness, The Alchemy Project focuses on what people can do and can achieve.

We drive towards high artistic standards and have high expectations of what can be achieved. Over time, we have found that groups (whatever the setting) will reach whatever standards are set, hence the reason we set the bar high. Our work has shown that the group will always come with you and there is a satisfaction in their knowing they have been pushed to achieve at an unexpected level. So often, the people we work with can be made to believe that they cannot achieve amazing things.
Dance creates social and physical connection between individuals and helps to counteract the feelings of isolation and fragmentation often common in people living with mental health problems. We work together as an integrated team of dance and support staff to create a welcoming, supportive and safe space for participants. We engage the group in trust-building and team-building exercises and share healthy breakfasts and lunches. At every stage the aim is to develop a strong sense of community as a dance company.

Touch, connecting with and trusting other people is key, Dr Lauren Gavaghan explains: “As a psychiatrist we don’t tend to pay much attention to this idea of touch, which is perhaps quite normal, but I think in dance, touch is an absolutely integral part of the practice and in the studio we touch each other very naturally, very often. I think it’s this sense of sort of closeness between human beings, or being in a group amongst a group of human beings which actually is incredibly valuable in terms of reducing this sense of isolation and aloneness that often comes with mental illness.”
The performance challenges perception and stigma and shows what can be achieved through dance. At the end of the four weeks participants confidently stand on a public stage as dancers and perform together as a dance company. They are seen and witnessed by an audience comprising healthcare professionals, families and friends in a new light; capable, confident, expressive and dynamic.

One of our participants commented that the process had been a powerful shift for him “dancing feels amazing, it’s nothing like I’ve really experienced before, it’s very liberating both in terms of mind and body. You’re just there, very much present in the space when you’re dancing and, for me, my head’s always full of rubbish, full of things going round and round and round and I never really get a break from it but when you’re dancing your just there in the space and that’s a very special feeling.”

Details of the project participants

The Alchemy Project Pastoral Manager engaged with Care Co-Ordinators working in the Early Intervention in Psychosis teams (EIS) at SLaM to recruit service users (18-35 years) who were in recovery and whom it was felt would benefit from this intensive intervention. All interventions had a mix of male and female young adults recruited; in particular there was an emphasis on ensuring males were engaged in the project. At the start of the intervention, many of the individuals referred to the project felt isolated and struggled with interpersonal relationships; they also struggled with their bodily awareness and physical fitness which tended to have a negative impact upon their overall levels of confidence and as a result, many often found it hard to get up in the morning and maintain energy and optimism. Alongside the participants referred were a small number of peer mentors, individuals with an interest in this area of work and some background or training in dance. Peer mentors provide support, focus and energy. No distinction is made between the peer mentors and the participants, with all group members being considered as equals throughout the project. Clinicians and vocational support workers were also involved, helping to ensure individuals were supported, in order that ongoing longer term dialogue could be facilitated, focusing on individual goals and ambitions.

Project management

Key roles within The Alchemy Project are that of The Project Director and Executive Producer who jointly oversee its development and delivery; the first from an artistic and procedural perspective and the latter from a financial and operational perspective. Supporting this senior team are a Dance Director and Dance Artists who lead the day-to-day work in the dance studio and a Pastoral Support Manager, who leads on recruitment of participants and is concerned with meeting participants’ pastoral needs during engagement in the intervention and also liaising with their care coordinators. Technical and creative team members interface with the project to deliver the concluding performance.

Quality is assured through the rigorous and consistent application of the core methodology, careful recruitment and comprehensive induction procedures for project personnel and associates, meticulous planning and setting up of the project infrastructure and resources; and a defined set of rules that everyone has to observe when at work or in the project space. Activity is monitored and reviewed on a daily basis by the project team. A vocational support worker from an EIS team is embedded within the delivery team to provide specialist support where needed, monitor participants’ wellbeing and to foster the link back to the Early Intervention teams. EIS team Care Coordinators work in partnership with The Alchemy Project delivery team to support the promotion of attendance and punctuality, which are essential for individual and collective success.
Potential participants are identified and referred from the caseloads of EIS Team Care Coordinators; they are encouraged to attend a recruitment session with a member of staff at the Early Intervention Team offices or through a home visit, if appropriate, where they can meet a member of The Alchemy Project team and find out more about the project. Referral and consent forms are completed. Potential participants are then invited to come along to a taster session before starting the project. There is also an opportunity to meet and talk with project alumni who are available to share their experiences and answer any questions.

The participants’ personal details are kept confidential and their medical history is only shared with The Alchemy Project delivery team members on a need to know basis. The final performance is to an invited audience to assist in preserving the confidentiality of the participants and photographs and any documentation are for internal use only, unless consent has been given otherwise.

Currently the intervention is free to participants and current funding allows for their daily travel to the project base to be refunded by the project. They are also provided with breakfast and lunch each day of the intervention.
A distinctive feature of The Alchemy Project has been the collaboration from the very beginning with leading clinicians Dr Matthew Taylor (Consultant Psychiatrist and Associate Clinical Director for Early Intervention) and Dr Lauren Gavaghan. Taking into account the contributions made by a wide range of healthcare professionals across the service this has been very much a joint venture with everyone playing a crucial role.

Evaluation methods and findings

The interventions have been independently evaluated by public health consultants Optimity Matrix. The research has demonstrated that the dance methodology at the heart of the intervention in the early stages of psychosis delivers clinically significant results in terms of demonstrating increased well-being of participants. Through the deployment/application of the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS), the evaluation has demonstrated that the interventions delivered substantial improvements in the mental well-being scores in each of the two cohorts: cohort 1 demonstrated increased mean well-being scores from 47.1 at baseline to 55.0 (+7.9) at endpoint and Cohort 2 from 51.3 at baseline to 55.0 at endpoint (+3.7). These findings are consistent with those of the Pilot scores from 46.7 at baseline to 53.4 at endpoint (+6.7).
There were also improvements in other measures including communication skills, resilience, concentration and focus, level of trust in others, working with others as part of a team and in quality of life (EQ-5D). These findings are vitally important, given that improving wellbeing through recovery after episodes of psychosis is a common goal of Early Intervention Services.

Furthermore Dr Matthew Taylor explains the significance of the evaluation findings:

“Among the quantitative analyses, what strikes me most is the impact of the Alchemy Project on positive mental wellbeing. Wellbeing is an important concept in modern mental health care, and the WEMWBS measure in particular is increasingly used in Public Health and around the NHS as an outcome measure. I think there are two key issues to be borne in mind with its interpretation.

  1. Small numerical increases in WEMWBS score are important: Across the whole population nationally, less than 15 points separate the average wellbeing scores of those with self-rated 'very poor' and 'very good' health.
  2. It is generally very hard to substantially improve wellbeing, particularly for those with psychosis: in recent pilot by NHS England of a shorter version of WEMWBS, on average people with psychosis saw scores increase by 1.2 points through an episode of care, less than those with other mental health conditions.
    The recent local evaluation of WELLFOCUS groups, specifically aiming to improve wellbeing for people with psychosis, observed an average increase of 0.26 points in those participating.

Exercise groups run by MIND and Rethink for people with a mix of mental health problems achieved an increase of three points over three months

In that context increasing WEBWBS wellbeing scores up to the mid-50s for three separate cohorts is a particularly striking achievement. The Alchemy Project is offering something that is not provided by conventional services, and it seems to be getting results that other approaches do not deliver.”

The dance methodology can positively affect clients’ mental health and wellbeing, enabling and facilitating recovery. Involvement in The Alchemy Project does not define participants by their illness and instead provides a focus, structure and process that enable people to move beyond the typical lived experience of this constituency and challenge their expectations of themselves. The physical activity of dancing addresses symptoms of mental health illness and/or medication such as apathy, lethargy, lack of motivation and rebalances the mind-body relationship.

If we truly want to change the life course for young people who develop a psychotic illness, then we must think of the longer term. We must aim to engage young people in ways that are both acceptable and exciting for them, and through means that will truly reconnect them, not simply with healthcare professionals, but with others, their peers, their own families, networks and communities, which sadly tend to fragment in the midst of what can often be a very challenging time. It is not enough to treat their psychotic symptoms with medication, as without this reconnection to a network, the persons own valuable resources are not harnessed and utilised. Dance, and in particular an intervention such as The Alchemy Project can work in synchrony with medical treatment, as has been shown, and can be a powerful catalyst for this reconnection and the need for stepping beyond the illness, and back into life once again.

It is necessary for service models to change, to reflect our changing world and also the changing landscape of the NHS. It is necessary to think about creative ways in which we may provide a truly holistic service for young people, and to do this early on in an illness trajectory, such that their illnesses and labels do not become their identity and so that young people can move more quickly out of mental health services and into productive life once again.

Alongside the interventions a 40 minute documentary film about The Alchemy Project was produced which includes contributions from leading clinicians, testimonies from some of the participants, as well as insights and information from the project delivery team. The film was conceived to serve as a tool to share the project with those unable to experience it first hand and as a legacy resource.

Guy’s & St Thomas’ Charity information about The Alchemy Project includes Optimity Matrix published evaluation report: https://www.gsttcharity.org.uk/what-we-do/our-impact/stories/alchemy-pro...
Dr Lauren Gavaghan blog about The Alchemy Project: http://www.rcpsych.ac.uk/discoverpsychiatry/blogzone/thealchemyproject.aspx
Carly Annable-Coop and Dr Lauren Gavaghan
August 2016

Supported using public funding by the Arts Council England