An exploration of the role of visual arts projects for refugee well-being

Art therapy and other art-for-health initiatives are part of UK health and social care
policy, as well as international humanitarian services for people fleeing persecution.
There are currently unprecedented numbers of refugees and high levels of mental
distress have been identified in this population. The non-verbal and symbolic
potential for expression within art-making may provide a unique form of beneficial
initiative. Through a critical realist perspective this thesis adds to the body of
knowledge about art-based projects for refugee well-being.
A mixed-methods systematic review was conducted in 2018. The quantitative data
(k=2) showed that group art therapy is an effective intervention for reducing
symptoms of mental distress in refugee children. The qualitative synthesis (k=24)
presents a way to conceptualise the kinds of outcomes people experience from
different modes of art-based engagement. Themes were developed through the
qualitative data synthesis, including Beautifully handmade, Seeing with fresh eyes,
Honour the past: forget the past, Telling the story and Being part of the world and
Learning and working together. Accordingly, an interplay of creative, personal and
social elements is proposed to occur is such activities. While different art-based
approaches are identified: art therapy, facilitated art-making and independent art
practice, these are shown to engender similar human experiences.
This thesis builds on previous research on the use of colouring books for well-being.
A mixed-methods randomised controlled study demonstrates their efficacy as a selfsustained
well-being activity over one week. This study compared the effect of
colouring pre-drawn mandala patterns with free-form drawing and a control group.
The study included 69 university students and staff. The Warwick-Edinburgh Mental
Well-being Scale (WEMWBS) and the Depression Anxiety and Stress Scale (DASS)
were used. A large and significant effect size was found for WEMWBS and a dose
response was demonstrated in the colouring condition.
A feasibility project was then run at a refugee drop-in centre, where colouring books
and colouring pages were provided on a weekly basis for seven weeks. While
colouring books have been provided to refugees previously, this thesis demonstrates the potential well-being value of such provision, and the likely uptake of colouring
books by this population. Data are presented from four refugees and four staff
members. Accordingly, this thesis shows that colouring books are acceptable to
refugees.
Thematic analysis and qualitative content analysis were used to explore the
qualitative data from both primary research studies. Colouring was found to be a
relaxing activity by participants in both studies. Participants valued both the process
of colouring and the final product. Both reflection and distraction are presented as
potential mechanisms involved in improving well-being through colouring. Some
participants found the colouring evoked memories, some used the process to
express emotions and others found the colouring gave them a welcome diversion
from other thoughts. Colouring at the refugee centres also provided an impetus for
inter-personal relationships, such as colouring with friends.
Art-based approaches are explored as a range of useful and acceptable
interventions to improve the well-being of refugees. Consideration is given to the
variety of contextual factors that influence the creative and relational elements that
are considered central to these interventions. Art-based projects operate within
complex social and political systems. Identifying cultural norms and exploring power
dynamics can contribute to the understanding and development of initiatives seeking
to improve individual well-being, and effect wider collective social and political
change.

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