What do you think of when you hear the term ‘hard to reach’ groups?
The term is generally used to describe members of society that service providers, organisations and institutions find ‘difficult to engage’. You may have seen the term in a local council report, your strategic management document or a care plan – or even heard it in conversation with your colleagues.
As a survivor of the mental health system and a project manager within the field of the arts and mental health, I hear the term applied to people diagnosed with personality disorder, psychosis and complex needs and have also heard it in relation to young people, older people and those from black and minority ethnic backgrounds. It is also often used to describe people with disabilities, homeless people, drug and alcohol dependants, religious and faith groups and those who are lesbian, gay, bisexual and transgender.
Does the term ‘difficult to engage’ say more about the methods being used than the people it is used to describe? Do those who use the term stop to ask “what helps?” and “what doesn’t help?”, or do they rely on using prescriptions and procedures, medications and methodology that all too often fall short in addressing the individuals’ fundamental needs?
“What helps . . . and what doesn’t help?” was the focus of a recent mental health event at The Centre of Excellence in Interdisciplinary Mental Health in Edgbaston. Organised by Sue Imlack of the West Midlands Personality Disorder Service User Network, and designed for users of the mental health service recently given the diagnosis of Personality Disorder, or who think it may apply to them, I facilitated an arts in health workshop during the event.
I asked the delegate group, comprising more than thirty users of the mental health service, to consider the question “What helps . . . and what doesn’t help?” in relation to mental health service providers and within other meaningful relationships. The delegates were asked to respond to a selection of images with both positive and negative words and then form into groups to create collective collages inspired by their responses.
I asked the groups to feedback to their fellow delegates at the end of the exercise. The images produced were both emotionally articulate and visually literate. Within just one and a half hours of creative activity the participants had shared complex thoughts, touched upon pre-verbal emotions and undergone a group process with people they had never met before.
These complex experiences were depicted and verbalised in striking ways –
• An image of a baby was described as “dreaming of the time when it was in the womb”
and spoke of safety, security and peace.
• An image of a cow in the desert was described as “negative – because the cow does not have any grass” and spoke of lack, neglect and unmet needs.
My experience of those who took part in the workshop was not of people who were difficult to engage. On the contrary, my experience was of people engaging with one another – and reaching back to me – through a simple yet effective creative activity designed to encourage self-expression and communication.
I wonder, then, if everyone who uses the terms ‘hard to reach’ and ‘difficult to engage’ questioned their own practice a little more, whether the term would disappear from our language altogether.
Deborah Living is project manager of the Connect Through Art project with Full Potential Arts and is a freelance arts in health facilitator. The views expressed by Deborah in this article do not represent those of either Full Potential Arts or the West Midlands Personality Disorder Service User Network.