Originally published in The Guardian by Helen Russell.
In a whitewashed studio in northern Denmark, 11 unemployed strangers are embarking on a hearty rendition of Yellow Submarine. Jonas Thrysøe is not one of them. At least, not yet. The 36-year-old has agoraphobia, rarely leaves the house and can’t think of anything worse than a group singalong. And yet by the second chorus he is putty in the choirmaster’s hands. “I swore I’d just stand at the back and listen,” he says. “But the mood was infectious.”
Out of work and in his second year of sick leave because of anxiety and panic attacks, Thrysøe had become isolated. “I’d avoid situations where I thought I’d get anxious, until I ended up avoiding all situations. It was a vicious circle,” he says.
With a master’s degree in European studies, Thrysøe had dreamed of a career in Brussels or the Danish government. “But things got so bad I couldn’t even leave the house. It was … a kick in the groin,” he says.
Then the Kulturvitaminer (culture vitamins) programme came along, offering Thrysøe and other unemployed people in Aalborg with stress, anxiety or depression the chance to go on a crash culture course. Partly funded by the Danish health authority, and administered by the local jobcentre, the municipalities of Aalborg, Silkeborg, Nyborg and Vordingborg set up pilot schemes to encourage cultural participation for those unemployed or on state sick leave.
Mikael Odder Nielsen, the Aalborg course leader, says: “We wanted to see if we could make people’s mental health better, reduce social isolation and help them get back into the labour market via culture.”
Participants were invited to go on two or three cultural excursions a week for 10 weeks. This appealed to Thrysøe. “It was an activity that would get me out of the house, something that wasn’t a medical appointment, where I was treated as ‘normal’. Because I am not my anxiety, I’m me. And the course helped me feel like ‘me’ again,” he says.
Evy Mortenson, 49, was working in a kindergarten in 2013 when work-related stress resulted in unemployment, followed by periods of ill health and chronic insomnia for the next six years. “Before I went down with stress, I would often go to concerts and museums,” she says. “But then I stopped. Nothing made me happy or even made sense any more.”
After several temporary contracts but no improvement in her health, Mortenson’s caseworker at the jobcentre enrolled her for Kulturvitaminer. “As soon as I walked into the welcome meeting, I felt a sense of relief. It was a shared experience and there were no expectations, we were just all there together in a judgment-free space,” she says.
This was key, because many participants have not taken part in cultural activities for years, if ever, says Nielsen. “If you are depressed, culture is often the first thing you don’t bother with, you’re too preoccupied with getting through the day. My role is to get them used to this world again, or even introduce it for the first time,” he says.
If you’re you are depressed, culture is often the first thing you don’t bother with -, you’re too preoccupied with getting through the day.’
So far, 200 people, mostly women in their late 30s or 40s with family commitments, have taken part in the Aalborg programme. “They tell me, ‘I used to do this sort of thing a lot before I had kids.’ I tell them, ‘This sounds depressingly familiar’,” Nielsen says. “But there are men too, because it’s not a space where you have to talk all the time: you’re there to do and experience things.”
There are eight strands to Aalborg’s programme, including singing (which is proven to release dopamine and promote a sense of belonging when conducted among a group), visiting the city archive to learn about local history and genealogy, and music appreciation. “We use playlists developed by music therapists to give your brain a break, which in turn allows your body to take a break,” says Nielsen, adding that the music is intended to “reduce arousal” – it is “music that’s predictable, a bit boring, even”. Such as? “Jack Johnson.”
There are also visits to the theatre to watch new productions, and coaching sessions in which actors teach participants about body language to help with confidence in job interviews. The programme has an agreement with the Aalborg Symphony Orchestra in which participants are taken to watch rehearsals and performances, something that often leads to tears, says Nielsen. Researchers have found that watching music performed live reduces stress. Participants also visit the local art museum and take part in creative workshops, an activity proven to develop resilience. Participants are also encouraged to snuggle up under blankets in a dimly lit room in an Aalborg library while a librarian reads to them for two hours.
Most of the participants will not have had books read to them since childhood, so this can prove an emotional experience. Mortenson says: “I spent so much of my life reading to others, but this time I needed help and I felt taken care of. It was very powerful.”
Brain scans show that when people are immersed in a book, they mentally rehearse the activities, sights and sounds of a story, stimulating neural pathways, increasing empathy and improving wellbeing.
Participants are encouraged to talk about the books, “but not in a school-type way”, says Thrysøe. Finally, there are guided nature walks, because numerous studies have shown that spending time in nature is good for mental health. Nielsen says: “These are also valuable in terms of seeing how slowly things grow, in contrast to our busy modern lives.”
Culture as a cure is not a new idea. In 2008, the then UK health secretary, Alan Johnson, called for the arts to be part of mainstream healthcare, and in 2009, the Royal College of Psychiatrists recommended participation in the arts and developing creativity for the protection of mental health. A decade on, evidence for the impact of the arts on wellbeing is growing. Research shows that “art on prescription” is valued by referrers and participants alike, and is also cost-effective, with a reduction in the number of visits to the doctor and participants gaining transferable skills.
But provision in the UK remains patchy. In contrast, Australia has had a national arts and health framework to promote integration of the two since 2013, while Sweden leads the way in Scandinavia in terms of art on prescription. But Denmark is catching up, and the relationship between culture and health is increasingly being identified as an important factor in a sustainable Nordic welfare model. Anita Jensen, a postdoctoral researcher at Aalborg University, says: “We can see that it works for many people. It’s relatively inexpensive, with no known negative side-effects.”
The 10-week course costs 12,000 Danish krone (£1,440) per person, while a single session with a psychologist is about 1,000 krone and a week on sick leave costs about 4,000 krone, including benefits and cost to employers. “Because Denmark is a small country, we have a unique opportunity to make a difference by offering arts on prescription as a public health initiative,” says Jensen. Nielsen agrees. “We’re largely funded by the state, but the council can also decide that this is worthwhile and fund it independently from their own budgets when the pilot programme ends in November,” he says.
Mortenson says: “I’d like to see the whole world taking their culture vitamins. I’m not the same person as I was when I started this process. I listen to classical music every day now, I meet my culture group for outings, even though our 10-week programme has finished, and I have a support network with new interests. I’ve even applied for a job in an art museum.”
Thrysøe has also noticed a shift. He says: “The course altered my outlook – I’ve redefined what success looks like. I went from being very isolated to being ready for the job market and happier, too. It changed my life.”