Arts on Prescription in the Baltic Sea Region Concept

• AoP in the Baltic Sea Region is for people with mild to moderate mental health issues such as stress, anxiety or depression, or for those at risk of developing mental health issues for instance, due to loneliness.
• It is a cross-sectoral programme provided by local and regional public authorities. It is implemented through municipal or regional interdisciplinary collaboration, involving relevant sectors such as the culture, health, and social sector.
• All professionals involved in the programme are paid fairly, including link workers and culture and arts facilitators. This is done to ensure a high level of professionalism and training, while also acknowledging the value they provide. It is particularly important that culture and arts facilitators are given proper remuneration. 
• Joining an AoP programme is free of charge or very low cost for the participants, to ensure wider accessibility.
• The programme consists of varying arts categories (between 3-5), meaning the participants engage in various genres during the programme.
• A programme cycle is 8-12 weeks and offers activities one or two times a week. It is recommended a programme cycle is a minimum of 8 weeks in order to foster social engagement and a sense of belonging. Also, an 8-week compared to a 12-week programme cycle may allow more people to participate on a yearly basis.
• The cultural and artistic activities are participatory, facilitated, and experienced in a group setting. Simply giving participants access to a local museum or theatre experience is not considered to be an AoP programme in accordance with the Baltic Sea Region concept.
• The programme concept aims at creating a ‘diagnosis-free space’ meeting the individual for who they are, and not focusing on challenges they may have. However, it is not forbidden to speak of these challenges as the AoP activities create a non-judgmental environment, free from stigma, where the individuals feel safe expressing themselves through the arts and where their unique needs and goals can be addressed.
• AoP in the Baltic Sea Region is a non-therapy programme, although participation and immersion in the arts in itself may have therapeutic effects. While scientific evidence indicates the arts can have a positive effect on health and well-being, the findings cannot be interpreted to suggest the arts are a substitute for or equivalent to professional therapy, or medical treatment.
• AoP is not just an arts course. While the main goal of the AoP programme is not necessarily for the target audience to learn master or excel in different genres of the arts, it still provides the opportunity for participants to develop new  skills. The main aim of the AoP programme is for the participants to benefit from the positive health and social effects creative activities provide. Therefore, AoP activities content and expected results can differ significantly from those of an art or music class open to general participation.
• It is based on voluntary participation and not necessarily a part of the participants’ health or social pathway. As a non-therapy programme, it does not have to include correspondence regarding the participants’ engagement, health progress or other reports, back to referral channels such as health care or social providers.
• AoP is not part of the wellness industry, but a community-based intervention to promote mental health and wellbeing through the arts and social engagement. The intervention is based on scientifically proven positive effects of arts on mental health and wellbeing, and it’s impact is well documented.

Therefore, when introducing the AoP concept to potential stakeholders and participants it is important to use terms such as: prevention, safe space, wellbeing, social connections, creativity and to avoid terms such as: therapy, healing, art class, and wellness. 

The referral channels do not only consist of primary health care providers such as physicians or clinical personal. Social and other public services are also involved and there can also be a self-referral option to persons who wish to participate. By doing so we aim to extend access to the AoP programme to people with mental health issues or at risk of developing mental health issues such as stress, anxiety or depression.

The participants’ suitability for particpating in an AoP programme is ensured by the professional assessment done by referral channels and the link worker.  

In the Baltic Sea Region AoP programme the link worker plays an essential role in managing the programme and supporting the participants.

The term link worker is often described as a person who connects people to community-based services depending on their needs. In many social prescribing services, the link workers together with the individual carry out an assessment of the individuals health, social, economic needs, wishes and future goals. Thereafter, the link worker and the individual prepare a pathway plan based on these needs and can help the individual to achieve their future goals. The link worker then links the individual to community resources and/or group-based programmes.

In the Baltic Sea Region AoP programme the link workers function is to link individuals to community-based culture activities. The link worker in the Baltic Sea Region is the contact person for all individuals taking part in the AoP programme. Once the referral channels have referred the participant, it is the function of the link worker to determine if the AoP programme is suitable for each individual participant. The link worker is there to support participants wellbeing during the 8–12-week AoP programme and generally participates in the programmes activities with the participants to support them and the arts and culture facilitators in the best possible way.

A more in-depth knowledge and practical experience of the link workers role is addressed in the themes Organisational Framework and Developing your AoP Programme.

The AoP programme can be designed for various audiences with different backgrounds, experiences, needs and preferences. However, in the Baltic Sea Region AoP programme concept focus is on persons with mild to moderate mental health problems such as stress, anxiety, or depression, or those at risk of developing mental health problems, for instance, due to loneliness.

The target audience in the Baltic Sea Region AoP programme concept can include:

• older adults, who may experience loneliness anxiety or/and depression in connection with aging or loss of close relationships;
• young people who may feel stressed with school or career/work-related mental health problems;
• adults struggling with balancing work and family life, as well as those who may have experienced a life crisis for example bereavement, divorce, or illness.

The main expected outcome for participants who participate in an AoP programme is improved mental health and wellbeing. We expect the AoP programme to benefit the participants by:

• Increasing self-esteem, self-confidence, sense of control, and empowerment.
• Reducing anxiety, depression, stress.
• Strengthening motivation, meaning in life, hope, and optimism.
• Increasing sociability to reduce feelings of loneliness and increase wider community connectedness and belonging. 
• Providing opportunities for creative activity in a safe and supportive space, empowering individuals to manage/master their emotional needs and improve their quality of life. Among other things, this is done by creating a ‘diagnosis-free space’ to approach the individuals for who they are and not focusing on the type of diagnosis they may have or the conditions they might be at risk of developing.
• Creating a non- judgmental environment where individuals feel safe to express themselves and where their unique needs and goals can be addressed.
• Increasing creative potential among participants which unlocks opportunities for imagination, aesthetic and emotional expression that leads to stress reduction, improved self-esteem and social connections/relationships.

Permanent AoP programmes in a region or municipality benefit a larger number of citizens, hereby creating a greater societal impact. Improved mental health, increased social interactions and a general increase in mental and social wellbeing can reduce the burden on municipal and regional healthcare services e.g. decreasing visits to general practitioners.