Category: Guest Blog

By Sarah Edmonds and Dr. Heather F. McClintock PhD MSPH MSW 

This is the sixth part of a IH Blog series, Global Mental Health: Burden, Initiatives and Special Topics.

Part VI – Special Topic: Creative Writing and Mental Health 

Standard treatments approaches (counseling and/or medication) for addressing mental health issues are important, yet alternative approaches and strategies are growing in popularity. One alternative approach is Creative Art Therapy (CAT) which encompasses the use of many creative mediums (e.g. visual art, music, dance, and writing). The literature base indicates that CAT may be low-risk and high benefit for persons with severe mental illness. However, further methodologically rigorous studies are needed to substantiate the effectiveness of these approaches. 

Writing is one medium that has been widely used and studied in application as a tool for enhancing mental health through different forms aimed at self-improvement such as journaling, diaries, and dream logs. In contrast, the usage of writing as a craft through the creative process is an approach that has received relatively little attention. This approach involves persons writing for an outside audience at the point of creation rather than solely for the writer’s own benefit or reflection. Writing as a craft gives the writer the ability to form life and order out of thoughts and chaotic experiences. Some work has shown that a creative approach can help patients build their sense of “self” potentially helping them cope with difficult experiences. Improved confidence is a key mechanism through which creative writing may influence mental health. Research has shown that creative writing can help in building a sense of confidence, community, and connection among marginalized groups.

As a creative writer (SE), the statement “We create as a means of understanding the world around us and our place in it” is often used to describe why our creative process works in helping us deal with social issues or the emotional turmoil we feel in our own lives. As a woman with a minor physical disability, my fiction writing deals frequently with characters thriving despite sexism and ableism. The creative process whether applied through writing or other art forms aids us in coping and understanding our experiences enhancing our mental health. My friend, an eco-artist by profession, uses biodegradable materials and often inoculates her work with mushroom mycelia so that it grows and decays as is the process of all living things.

Other writers and artists that I know also say that “it’s always been easier for me to express emotions or come to terms with different things that have happened in my life through the written word,” “it’s something like meditation. I’m able to block out everything else and focus solely on what I’m creating. It’s like nothing else matters or exists,” and that “I feel like I would probably be in a worse spot mentally if I wasn’t creating.”

Based on my (SE) experiences as well as recent research, creative writing as a craft may have the potential to be a powerful tool for individuals to improve and maintain their mental health and wellness. As seen in a study conducted across the UK, creative writing workshops open to both residents and refugees allowed deeper connections between refugees and those whose community they were trying to become a part of. Also, it has been suggested that, in cases such as cultivating the mental health of people in protracted conflict areas such as the West Bank, creative expression and communication is a better stress-management tool than the current foreign aid systems that may not consider cultural biases in their methodology. The benefits of creative arts, in general, can also be seen through the work of organizations such as Colors of Connection’s project Courage in Congo that uses community-based art programs to provide therapeutically—as well as economically—beneficial skills to adolescents who are at risk or are victims of sexual and gender-based violence (SGBV). By making the program community-based, it also works towards fighting the social biases the community has against women and young girls.

Whether someone had a rough day at school, is struggling with a severe mental illness, or lives in a community that is unsafe or unwelcoming, the ability to craft narrative and shape events through words that are solely their own gives people a much-needed sense of strength and autonomy. Creative writing gives us the power to find a sense of self, the power to create a safe space in an unforgiving world, and the power to take control over who we are and how we connect to everything and everyone around us.

About the Authors:

Sarah Edmonds

Sarah Edmonds is a Dual Master of Arts in English and Master of Fine Arts in Creative Writing student at Arcadia University. She has won awards for her work in film at festivals such as the BareBones International Film and Music Festival. Her creative work focuses on giving voice to underrepresented groups; she is currently working on a short documentary about biracial women’s identity struggles in the United States. While working with the Carroll County Media Center, she produced local news and interview segments about substance abuse and mental health awareness. Her main goal in her professional and creative work is to open dialogues about topics that normally carry social stigma so that no one ever has to be afraid to get help or to be who they truly are.

Dr. Heather F. McClintock PhD MSPH MSW

Dr. McClintock is an IH Section Member and Assistant Professor in the Department of Public Health, College of Health Sciences at Arcadia University. She earned her Master of Science in Public Health from the Department of Global Health and Population at the Harvard School of Public Health. Dr. McClintock received her PhD in Epidemiology from the University of Pennsylvania with a focus on health behavior and promotion. Her research broadly focuses on the prevention, treatment, and management of chronic disease and disability globally. Recent research aims to examine health literacy and intimate partner violence in Sub-Saharan Africa. Prior to completing her doctorate she served as a Program Officer at the United States Committee for Refugees and Immigrants and a Senior Project Manager in the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania. At the University of Pennsylvania she led several research initiatives that involved improving patient compliance and access to quality healthcare services including the Spectrum of Depression in Later Life Study and Integrating Management for Depression and Type 2 Diabetes Mellitus Study.

This is the fifth part of an IH Blog series, Global Mental Health: Burden, Initiatives and Special Topics.

In the context of a pandemic, access to and the quality of mental health care is paramount. Effective and feasible delivery models for mental health care service provision are critical for meeting growing demands for care. Many new and innovative models have been proposed and integrated approaches have been identified as potentially effective strategies to address this growing need. The goal of integrated mental health care is to enhance accessible, affordable, cost-effective mental health services for individuals. There are a range of different integrated care models including collaborative care, hub-based systems, and patient-centered medical homes. Collaborative care, for example, is an integrated care program that combines behavioral health care management and consultations with mental health specialists in the primary care setting. 

Mental health care provision in the context of primary care settings is important because primary care is the first point of contact for patients in the healthcare system. The Declaration of Alma-Ata, adopted at the 1978 International Conference on Primary Health Care organized by UNICEF and WHO, identified primary health care as a central function of health systems and the key to attaining the goal of ‘Health for All.’ Forty years later, at the Global Conference on Primary Health Care, primary care was re-emphasized as the most effective way to sustainably solve today’s health challenges, partly through the provision of integrated services. The promotion, maintenance and improvement of mental health is explicitly included in the 2018 Declaration as a service that primary health care should provide to patients. 

Mental illness is frequently comorbid with a long list of chronic illnesses and disorders. Depression is common among people who have cancer, coronary heart disease, diabetes, multiple sclerosis, HIV/AIDS, and rheumatoid arthritis, among other chronic illnesses. Some disorders increase the risk of depression. At the early stages of Parkinson’s disease dopamine decreases which can cause depression. Chronic stress, whether it be illness-related or social stress, can trigger anxiety and depression. Researchers have found high levels of the stress hormone, cortisol, to disrupt neuroplasticity in brain structures that are functionally abnormal in depression, such as the hippocampus. Medication used to treat certain chronic disorders can lead to depressive symptoms. Nifedipine, used in the treatment of cardiovascular conditions, has been linked with the induction of depression. Even drugs used to treat and prevent asthma have been found to have psychiatric side effects. Bronchodilators mimic adrenaline and trigger the body’s sympathetic “fight or flight” nervous system response. This response causes one to feel anxious and panicky. Montelukast is another asthma medication that has neuropsychiatric side-effects in children and has recently elicited the FDA to require a stronger box warning of the side-effect. 

Conversely, adults with serious mental illnesses are at greater risk for chronic physical illnesses and other medical conditions, such as stroke and cardiovascular disease, than the general population. One explanation for this association is that individuals with mental illness can have a harder time caring for themselves, seeking care, eating well, exercising and taking medication as prescribed. Scientists have found that depression increases inflammation, reduces heart rate variability, and disturbs the metabolic system. 

Ethiopia, India, Nepal, Nigeria, South Africa and Uganda have strengthened integrated mental health care through the World Health Organization’s mhGAP program. Through the mhGAP program, primary care providers are trained to identify and manage mental disorders, prescribe psychotropic medication, and provide evidence-based psychosocial interventions. For integrated mental health care to fully flourish, change needs to come from within the medical sector, as well as outside of it, in the policy sector. The Netherlands, since the early 2000s, has worked to integrate mental health care into a number of health care settings, including hospitals and community health centers. They also introduced an innovative bundled payment system in 2007 to promote and incentivize integrated care. 

There are many challenges inherent in implementing integrated care models. Countries face resource constraints including workforce shortages. Primary care providers can be trained to provide mental health care, but they must be supported by secondary mental health professionals who are the experts in their field. Finally, to ensure optimal success and sustainability, countries must enact legislation that fosters the development of infrastructure that supports integrated mental health care. 

About the Authors:

Elena Schatell MPH (c) MMS (c)

Elena Schatell is a current student at Arcadia University enrolled in the Dual Master of Public Health/Master of Medical Science in Physician Assistant Program. She aims to promote public health in underserved communities as a future physician assistant. Her current public health interests include access to mental health services, stigma surrounding mental illness, and the relationship between faith and mental health. She has interned at the National Alliance for Mental Illness (NAMI) national office in Arlington, Virginia, working closely with the Advocacy and Public Policy team on conducting research on service barriers and state mental health policy. During her time at NAMI, she also authored articles for the Advocate magazine and blog.

Dr. Heather F. McClintock PhD MSPH MSW

Dr. McClintock is an IH Section Member and Assistant Professor in the Department of Public Health, College of Health Sciences at Arcadia University. She earned her Master of Science in Public Health from the Department of Global Health and Population at the Harvard School of Public Health. Dr. McClintock received her PhD in Epidemiology from the University of Pennsylvania with a focus on health behavior and promotion. Her research broadly focuses on the prevention, treatment, and management of chronic disease and disability globally. Recent research aims to understand and reduce the burden of intimate partner violence in Sub-Saharan Africa. Prior to completing her doctorate she served as a Program Officer at the United States Committee for Refugees and Immigrants and a Senior Project Manager in the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania. At the University of Pennsylvania she led several research initiatives that involved improving patient compliance and access to quality healthcare services including the Spectrum of Depression in Later Life Study and Integrating Management for Depression and Type 2 Diabetes Mellitus Study.