Spitting bars in Brighton

In July, the city of Brighton and Hove will host the European Congress of Psychology under the banner of 'Psychology: Uniting Communities for a Sustainable World', in what might appear a perfect match of aim and location. But Psychologists can look under the surface…

As the only place in the country with a Green MP – the venerable Caroline Lucas – the city of Brighton and Hove wears its sustainability badge with pride. It is host to two universities with thriving Psychology departments, whose students contribute to a young, dynamic population of just over a quarter of a million people, with 45 per cent of the population under 35 (ONS Census 2021). Delegates to the European Congress of Psychology will be able to enjoy the wonderful seaside, the beautiful South Downs National Park, a vibrant cultural scene and a quirky array of independent shops. Some may even choose to wash it all down with a shot of Tuaca, Brighton's very own adopted liqueur.

Brighton and Hove is also famous for is its diversity and inclusivity, particularly with regard to LGBTQIA+. For over 200 years, it has been a relatively safe and welcoming place, with the first recorded queer history coinciding with the influx of soldiers during the Napoleonic wars and the building of the Royal Pavilion. Lesbian and Gay pubs and clubs began to emerge during the 1930s and have continued to flourish ever since. However, just like our pebbly beach, the beautiful and welcoming surroundings can mask pain underfoot.

The city may have the only Green MP in the country, but please don't ask about our recycling services or our public transport and cycle paths. And despite being inclusive and LGBTIA+ -friendly, the city's diversity has limits: terms and conditions apply. For example, ethnicity. In the last Census, 86 per cent of the population defined themselves as White, higher than the 81 per cent average for England and Wales. Brighton and Hove is an expensive place to live, with housing and hospitality prices on a par with much of London, but without the London weighting applied to earnings. 

The Brighton and Hove Food Partnership annual survey published in September 2022, found that over 5000 people in the city make use of Food Banks each week, up 30 per cent over the previous nine years. The trauma of chronic hunger and food insecurity is impacting on things such as depression, anxiety and cognitive function in children, and chronic illness and mental health in adults. The recent fuel poverty crisis would only have made things worse.  

So Brighton and Hove has a large affluent, professional population, but with pockets of deep deprivation. In areas such as Whitehawk in the East of the city, 77 per cent of households experience deprivation on at least one indices (ONS census 2021); 29 per cent of children live in low-income families (compared to 19 per cent in England), 28 per cent of people have no qualifications (18 per cent in England,) and 29 per cent live with limiting long-term illness (17 per cent in England). Brighton and Hove also has the highest percentage of 15-year-olds in the country who are current smokers, including cannabis; significantly higher numbers of people using opioids or crack cocaine, and the city is regarded as one of the UK's drug hot spots (Birchall et al., 2018).  

Why is this of interest to Psychologists? 

In 2018, Brighton and Hove City Council launched an ambitious aim to become a nationally recognised Centre of Excellence for Arts in Health, outlining plans to promote the use of arts in supporting wellbeing and reducing health inequalities.  

There is plenty to support this aim. Firstly, we now have a large body of evidence from an All-Party Parliamentary Inquiry (2017), a systematic review by WhatWorks in Wellbeing (2018), and a scoping review by the European regional office of the World Health Organisation (2019), all of which highlight the positive impacts of engagement with the arts across a wide range of indices. These include things such as reduced depression and anxiety, increased self-esteem, self-confidence and resilience, plus improvements to interpersonal factors, such as empathy, cooperativity, connectedness and belonging. 

Secondly, Brighton and Hove already has a vibrant cultural scene, annually hosting the UK's second largest Arts festival (after Edinburgh), along with approximately 60 other festivals each year. Alongside this, the city has a far higher than the national average number of people participating in the arts, including those engaged professionally in arts-based activities (Birchall et al., 2018).  

The foundations are there to establish the city as a Centre of Excellence for arts and wellbeing. However, there are two key challenges. Firstly, to find ways to bridge the participation gap and engage those who have less ability or willingness to access the arts, whether due to lack of time, money, accessibility, interest, a sense of exclusivity etc. Here, psychologists can play a role in highlighting and addressing these issues, through work such as that of Dr Helen Johnson from the University of Brighton and Nicolette Monney (2021) in an economically-deprived community in Hove. 

The second challenge is to find ways to leverage arts participation as a gateway to therapeutic interventions for otherwise hard-to-reach populations. 

One such population is young men, who can comprise a highly vulnerable group, often experiencing high levels of complex needs which can both reflect and mask troubled backgrounds, difficult circumstances and mental distress (Conrad & White, 2010). Suicide is the single biggest killer of men aged under 35 in the UK and 75 per cent of all suicides in the UK are of young men (ONS, 2019). However, young men have long been denoted as a 'hard to reach' population (Curtis et al., 2004), less likely to access and engage with talking therapies or seek help and support from statutory services (Rice et al., 2017). Indeed young men experiencing mental distress report the lowest rates of professional help-seeking of any demographic group across the lifespan (Rickwood, 2012).  

All of this indicates a vital need for innovative approaches to overcoming barriers to help-seeking and alternatives to traditional talking therapies, in order to improve wellbeing and save lives.

Room to Rant

One such project is Room to Rant, run by a grass-roots youth music organisation called Audioactive in collaboration with YMCA Downslink – the biggest third-sector provider of young people's mental health provision in Sussex. Room to Rant (R2R) works with those who identify as male, aged 16-25, offering rap workshops facilitated by professional artist practitioners plus a counsellor who attends each week and offers one-to-one sessions and signposts to other services where needed.  

In weekly workshops, the young men are mentored through their artistic development while being offered numerous opportunities and avenues for sharing their fears, feelings and difficulties. Billed as a space to 'get things off your chest', the focus is on rapping, rather than on any pressure to disclose and share for therapeutic purposes.   

The usual format for the two-hour sessions includes 'freestyle' rap sessions, a shared meal of pizza, a checking-in with each individual around the room, a writing challenge to a sample of music chosen by one of the participants, and a performance of what's been written. The writing challenges are designed by the facilitators in discussion with the counsellor and adapted to meet the needs and interests of the people who attend, as well as being responsive to anything that emerges during the sessions.  

A pilot run of workshops found that most of the participants had experienced physical, emotional or sexual abuse in childhood and a higher-than-average percentage had been in the care system. Many were currently or had recently been homeless or in insecure housing, and most had extensive debts and financial stresses. Almost all had adopted coping strategies which impacted negatively on themselves and those around them, including drug and alcohol dependencies arising out of their trauma. Many faced extensive barriers to social inclusion, such as mental health issues, poor communication skills and illiteracy, all of which had significant impacts on their wellbeing.

Everyone involved in the project had a keen sense of the positive impacts on the lives and wellbeing of the young men who attended. However, this proved to be difficult to analyse and demonstrate via the quantitative tools that are most favoured by funding bodies (Walker et al., 2017). Without further funding, the future of the project was in jeopardy. AudioActive decided to contact the Psychology team at the University of Brighton in order to request an evaluation. That's where I came in. 

Tuneless, can't do this…

My aim was to develop an evaluative framework which was nuanced and sensitive, to be able to capture the complex and turbulent trajectories of the lives of these young men and the depth and breadth of the impacts of the project on their wellbeing.  

The project evaluation was designed in consultation with eight previous members of Room to Rant and the workshop facilitators. Out of this came a form of mixed methods approach, which Mason (2006) calls a Palette of Methods, along with the stipulation that if I wished to observe the sessions, I would have to participate. This meant me going along every week and writing and performing rap.

As a middle-aged woman, this could not have been further from my comfort zone.  The closest I get to 'spitting bars' is shouting my drinks order in the pub, and I haven't written a line of poetry since my teens (sample line: 'Who will save me from this viper's nest, so my pain and fury can be laid to rest?'). I think it's fair to say I showed little promise. 

And so, with deep trepidation, I began attending. Hampered by lockdown, venue changes and a lack of talent, things got off to a shaky start. It's hard to be an unobtrusive observer when you are a good 30 years older than most others in the room, and a different gender. Indeed the first bars I wrote reflect this (and show no improvement from my teenage years):

'Sitting here clueless,
Tuneless,
Can't do this.
Everybody else womb-less'

By the end of the 15 participant observations, I can't say I was any better at writing and rapping, but the encouragement and feedback from the facilitators and other participants were truly extraordinary. I found the activities to be genuinely uplifting and confidence-boosting, in a way I would never have anticipated. 

A vehicle for the truth

As these participants are typically seen as 'hard to reach' and reluctant to engage with any form of therapeutic work, it is useful to identify the routes and reasons for joining the workshops. What was clear was that the main draw was the opportunity to practice and improve their MC skills, but the addition of the therapeutic element made these stand out from other rap workshops and piqued their interest. Most of the participants were already involved with other AudioActive projects which created positive expectations and importantly, secured their trust.

In their review of the research on 'hard to reach' communities Boag-Munroe and Evangelou (2012) identify the need to build trust prior to any attempt to secure engagement, rather than viewing it as an optional extra which may develop after engagement has been established. To this end, the strong, positive reputation of AudioActive and the building of relationships with Audioactive staff had a key role in bringing the young men into the workshops. 

The young men who came to the workshops made full use of the various avenues for sharing difficult thoughts, feelings and experiences, whether it be through the check-ins, the rapping and/or in private with the counsellor. The unique structure of the workshops enabled relationship-building, established trust, and promoted a culture of honesty. In this way, rap music was co-opted as a vehicle for accessing and expressing the truth. And rather than undermining or emasculating their sense of self as young men, being open and vulnerable became a statement of strength, authenticity and courage.

Most of the participants made use of the option of private sessions with the counsellor, who attended and participated each week, thereby building trust and relationship. Vitally, there was a minimal waiting list and an above-average number of sessions, so people could be seen as soon as they were ready, and there was real potential for effective intervention and progress. This was particularly valuable given that not only is this a group typically reluctant to engage with talking therapies, but also a group whose age locates them at the margins of mental health service provision, often falling through the gap between CAMHS and adult services. It was clear that R2R acts a safety valve for those who typically avoid disclosure to other agencies and services, and that the facilitators and counsellors were well-placed to pick up safeguarding issues and trigger emergency referrals that could be life-saving. 

Overall, Room to Rant successfully creates an inclusive and nurturing space in which young men with complex and multiple needs engage in activities which are creative and therapeutic, and this overcomes the usual obstacles to engaging with therapeutic services. Using rap as a culturally credible vehicle for openness and honesty, the young men make full use of a variety of avenues to share their fears and difficulties, thereby effecting a broad range of improvements to their wellbeing.

Far from unique

Brighton and Hove is a fun, beautiful and culturally vibrant city with much to offer, but also with large parts of its population experiencing considerable financial struggles, social exclusion, substance dependency, and pockets of deep deprivation. In that, it is far from unique. At a time when levels of distress and difficulty are greatly increasing while funding for services is plummeting, Psychologists can play a vital role in helping to identify which community-based organisations offer real benefits and what lessons can be learnt for others. Psychologists can help to steer, train and evaluate, with well-designed evaluations often meaning the difference between services getting funded or cut. In that, we have an important part to play in helping the wellbeing of our populations, including those otherwise deemed 'hard to reach'. 

Orly Klein is a Senior Lecturer at the University of Brighton. [email protected]

Photo caption: Overlooked? Whitehawk FC ground… Whitehawk is an area of Brighton and Hove which has high levels of deprivation

Key sources

All-Party Parliamentary Group on Arts, Health and Wellbeing. Inquiry report (July 2017) Creative Health: The Arts for Health and Wellbeing. 

Birchall, Val; Brindley, David; Clarke, Kerry; Collins, Shanni; Condon, Ruth; Cottam, Rachel; Cuming, Katie; Gilchrist, Kate; Golding, David; Hacker, Jenny; Hardcastle, Barbara; Harding, Rachael; Katsourides, Ellie; Robinson, Emily; Stacey, Julie & Wilkinson, Peter (2018). The art of good health. Annual report, Director of Public Health Brighton and Hove, BHCC Public Health Annual Report 2018.pdf (brighton-hove.gov.uk)

Boag-Munroe, G. & Evangelou, M. 2012, "From hard to reach to how to reach: A systematic review of the literature on hard-to-reach families", Research papers in education, vol. 27, no. 2, pp. 209-239.

Brighton and Hove Food Partnership Annual Report 2022 

Conrad, D. & White, A. 2010, Promoting men's mental health, Radcliffe, Oxford.

Curtis, K., Roberts, H., Copperman, J., Downie, A., & Liabo, K. (2004). How come I don't get asked no questions?' researching `hard to reach' children and teenagers. Child & Family Social Work, 9(2), 167-175. 

Fancourt, Daisy & Finn, Saoirse (2019). What is the evidence on the role of the arts in improving health and well-being? A scoping review. World Health Organization, Health Evidence Network Synthesis, Report 67,

Johnson, Helen Fiona & Monney, Nicole (2021). Using the arts to support the arts: A creative, community-university partnership approach to building arts inclusivity in economically-deprived communities [61 paragraphs]. Forum Qualitative Sozialforschung / Forum: Qualitative Social Research, 22(3), Art. 2.

Klein, Orly & Walker, Carl (2022) An Evaluation of Room to Rant.

Langevang, T. 2007, "Movements in Time and Space: Using Multiple Methods in Research with Young People in Accra, Ghana", Children's geographies, vol. 5, no. 3, pp. 267-282.

Mason, J. 2006, "Mixing methods in a qualitatively driven way", Qualitative research : QR, vol. 6, no. 1, pp. 9-25.

Rice, S.M., Telford, N.R., Rickwood, D.J. & Parker, A.G. 2018, "Young men's access to community-based mental health care: qualitative analysis of barriers and facilitators", Journal of mental health (Abingdon, England), vol. 27, no. 1, pp. 59-65.

Rickwood, D. 2012, "Entering the e-spectrum: An examination of new interventions for youth mental health", Youth studies Australia, vol. 31, no. 4, pp. 18-27.

Tomlinson, Alan; Jack Lane; Guy Julie; Lily Grigsby Duffy, Anette Payne; Dr Louise Mansfield; Tess Kay; Alistair John; Catherine Meads; Norma Daykin; Kerry Ball; Christine Tapson; Paul Dolan; Stefano Testoni; Christina Victor (2018) A systematic review of the subjective wellbeing outcomes of engaging with visual arts for adults ("working-age", 15-64 years) with diagnosed mental health conditions 

Walker, C., Hart, A. & Hanna, Paul 2017, Building a new community psychology of mental health: spaces, places, people and activities, Palgrave Macmillan, London.