Contemporary Dance and Injury workshop

May 31st, 2019

A day dedicated to contemporary dance and injury management is taking place in the capital on 9th June. 

The event geared specifically for the dance community will take place at Core Clapton in East London. The workshops will be led by dance professionals, plus interactive demonstration on managing potential injuries common amongst dancers by one of the resident osteopaths at the centre.

For more information on the individual workshop leaders and how to book. Head to their website by clicking here

Musical theatre acts raise mental health awareness in the industry

May 24th, 2019

A group of singers who have featured in musicals in London and around the UK will be getting together for a special cabaret show to raise funds for BAPAM.

The aim of Music for the Mind – which takes place on Tuesday 4th June – is to help tackle mental health in the performing arts industry and help us in our work to support performers’ mental health.

 

Performers can see health professionals like GPs or a clinical psychologist for a free assessment for advice on mental health issues affecting them and their work.

The group of singers will be singing songs from pop to rock to soul to musical theatre.
The event starts at 7:30pm and takes place at SingEasy @ Pianoworks, West End, London, WC2H 7DH
Click here to find the list of full performers and to book tickets…

Fundraising concert for BAPAM featuring two Harpsichords

May 23rd, 2019

BAPAM relies heavily on the generosity of key funders for delivering specialised services to the performing arts community. We are also equally grateful for many individuals and local groups who also support us through fundraising at events such concerts and talks.

On Saturday 15th June at 5pm two eminent keyboard players David Hill and David Ponsford will be supporting BAPAM through a fundraising concert at a venue near the Cotswolds.

They will be playing a programme of J.S.Bach trio sonatas arranged for two harpsichords, which will include Sonatas 1,3,5 and 6.

The event has been generously organised by BAPAM’s Honorary Medical Director Dr Penny Wright and will take place at Syde Manor, Gloucestershire, GL53 9PN.

For more details/travel directions and to reserve a place, please email info@bapam.org.uk

Performing Arts Medicine (PAM) day 2019

May 21st, 2019

There’s less than a month to go until a one-day course providing an introduction to Performing Arts Medicine. The annual PAM day is aimed at health professionals, performers, those studying and working in health sciences and performance academies.

PAM day will be held on Saturday 15th June at Institute of Sports Exercise and Health in London. It is organised by those involved in the Performing Arts Medicine MSc at UCL which is run by the Division of Surgery and Interventional Science.

So, what can you expect from the day? Well experts closely involved in the sector – including several BAPAM practitioners – will be leading sessions on a wide range of topics from clinical assessment of musician’s injury to performance anxiety and hypermobility in dance.

The MSc at UCL is a unique programme providing specialised training to those interested or already involved in offering health services to this very special sector of instrumental musicians, singers, dancers, actors and other performing artists.

BAPAM is closely involved with the MSc and our clinicians and registered practitioners are integral to the delivery of UCL’s Performing Arts Medicine MSc. Programme lead of the MSc and organiser of the PAM day Dr Hara Trouli is also an assessing clinician at BAPAM.

Director Claire Cordeaux says, “we are delighted to have been involved with the MSc from the start and it is wonderful to see how it is developing. We are proud to support this programme by offering clinical observation opportunities and enormously grateful to the graduates who go on to work with us.”

BAPAM Registered Practitioners may count attendance at this event as one of their mandatory biennial Performing Arts Medicine Training Days. As this event is administered by UCL, tickets must be booked directly with UCL and discounts for BAPAM Practitioners are not available.  To book tickets click here

NHS Specialist Voice Clinics Vocal Rehabilitation Coach Pilot

May 10th, 2019

BAPAM is excited to announce the start of a new pilot project, in which we are funding a Vocal Rehabilitation Coach (VRC) to work alongside clinicians in NHS Professional Voice User Clinics.

Vocal health problems in singers and actors are often multifactorial, requiring a specialised multi-disciplinary approach to diagnosis, in order to get patients onto the right pathways of treatment and rehabilitation and back to performing as quickly as possible. Over the last two years, we have been working with a group of clinical experts in this area, including Laryngologists and Voice-specialist Speech and Language Therapists, who have advised us that adding a Vocal Coach into this team – an experienced singing teacher with understanding of the clinical processes in vocal health – would further help the diagnosis and rehabilitation of performer patients. Lewisham and Greenwich NHS Trust already employ a Vocal Rehabilitation Coach and BAPAM has agreed to fund a VRC post across up to three NHS hospitals for a pilot year, with funding support from PPL, Help Musicians UK, Musicians’ Union and Equity, following which the pilot will be independently evaluated to assess the requirements for the VRC role and the effectiveness of this model in the care of performers. Dane Chalfin, an experienced VRC and singing teacher, is taking on the role for the initial 12 months’ pilot. The first of these BAPAM-funded clinics has just started at Wythenshawe Hospital, part of Manchester University NHS Foundation Trust. Guy’s and St. Thomas’ NHS Foundation Trust is expecting to start to offer this additional service from September, and a third NHS Trust is expected to be confirmed soon.

BAPAM undertook a survey across existing specialist Voice Clinics in order to develop the competencies required to work in this new role and these were reviewed and approved by our Vocal Health clinical experts and adopted by the BAPAM Medical Committee. There is currently no professional body able to provide formal registration of VRCs and BAPAM hopes that by facilitating a process whereby experienced vocal coaches can demonstrate that they meet a set of competencies, we can help provide a level of confidence in this role both to the NHS and to performers themselves, and reassure our funders that we are investing in the best services. Four practitioners who meet these competencies have so far been approved to join a new section of the BAPAM Directory of Practitioners as VRCs, and we are hoping to expand this number in the near future. We can provide guidance to practitioners interested in this field towards appropriate training that may be required to meet our competences.

We hope that this pilot will provide some initial evidence to support the involvement of practitioners with an educational background in the rehabilitation of performers and, specifically, the wider adoption of this practice to improve patient care in vocal health. If the pilot is successful, we hope to be able to secure funding to support substantive VRC appointments going forward via an open appointments process. This work takes place against a backdrop of developing education and science in vocal health, with practitioners at the UCL Performing Arts Medicine MSc and the MA in Vocal Pedagogy at the University of Wales undertaking exciting new studies which are increasing our understanding in this area of performing arts health. BAPAM is pleased to be able to make this small contribution to continuing improvement in vocal health for performers.

Further enquiries are welcome via info@bapam.org.uk

Related information:

BAPAM VRC Competencies

BAPAM Psychosocial Working Group

May 7th, 2019

BAPAM has convened a Psychosocial Working Group to bring together clinicians including doctors, clinical psychologists, psychotherapists and counsellors, charities working with performing arts professionals to support mental health, and academics conducting key research.

The group provides a forum in which approaches to care and support can be discussed, and clinical leadership can be provided for developing and instantiating a service designed to support performing arts workers with issues related to vocation-related physical and mental health issues. We are using the NHS-approved evidence base produced by the National Institute for Clinical Excellence (NICE), who review the published evidence for healthcare interventions from a clinical and a cost-effectiveness perspective, to map the services available to performing artists against the clinical evidence for best practice and identify gaps in those services.

The prevalence of mental health problems is considerably higher in the performing arts community than in the general population, and suicide rates are well above the national average. There is an acute awareness of the problems within the performing arts industry and many artists have been sharing their mental health experience in the context of their work.

The group has mapped many of the initiatives developed to support performers including Help Musicians UK’s Music Minds Matter helpline, Theatre Helpline, Music Support, which has a particular focus on addictions, Equity supported Wellbeing Drop-in sessions at the Actors Centre,  Music & You, Music for Mental Wealth and BAPAM’s own free service, which provides clinical assessments for performers across the UK. In addition, there is a growing number of practitioners who have trained to work in this area, building on insights gained from previous careers in the arts industries, for example, the Music Industry Therapist Collective.

We are grateful to have had so many valuable insights from practitioners and agencies involved in this important work and together we’ve begun identifying what is available, what is missing and how we should work together to support a comprehensive approach to mental health services for performers.

Mental illness is not a straightforward condition. Some people will experience just one episode of mental ill-health in their lives. Of those who receive a brief intervention, half will recover and never have another one. Others, however, experience recurrent episodes and will continue to do so through their lives even though they may be well for significant periods of time. It is essential that performing arts professionals experiencing challenges to their mental health receive accurate diagnoses as quickly as possible to ensure they access the right care. Where brief interventions are indicated, these should be delivered by practitioners who have a track record of working with performing arts clients. Healthcare practitioners, however they are employed, need to be able to access professional support from mental health specialists to ensure they are making the right diagnoses and to refer on if necessary.

Discussions to date have identified many areas for action, but the immediate areas to take forward have been identified as follows:

  1. Development of guidance for the performing arts industry covering points of best practice for performers, care providers and all organisations commissioning care for performers
  2. Rapid access to clinical assessment to determine the best care pathway
  3. Provision of brief interventions tailored to the needs of performing artists,  focusing on performance anxiety
  4. Access to mental health specialists (e.g. psychiatrists and clinical psychologists) for advice on the management of patients’ complex needs, for practitioners working outside the NHS
  5. An annual CPD event for psychosocial practitioners working in, and developing their career in performing arts health care
  6. A collective effort to support fundraising which aims to meet identified gaps for all practitioners

Event Report: Occupational Health in the Performing Arts Industry – The Original Gig Economy

May 7th, 2019

Health in the performing arts industry – whose responsibility?

Every year BAPAM helps with hundreds of inquiries about health problems related to working in the performing arts. These include musculoskeletal problems caused by strain and intensive use of parts of the body, vocal health issues which need specialist diagnosis and treatment, psychosocial problems including performance anxiety, stress related to the uncertain nature of the work (82% of the workforce are freelance) and more complex and enduring mental health conditions as well as hearing health problems. Performers, in common with other freelancers, tend to ignore health problems and seek help at a very late stage.  The research shows that, at any one time, 75% of performers will have a health problem.

We were delighted when the Royal Society of Medicine chose to partner with BAPAM on a professional development event held on March 27, 2019 to consider occupational health in the performing arts sector and its relationship to the wider ‘gig economy’. We were lucky to have a stellar line up of speakers from the arts, academic and clinical worlds to provide a range of perspectives on this question.

Kicking off the conference, Jane Dyball, former CEO of the Music Publishers Association outlined the complexity of the industry and the relationship of an artist to industry bodies at different times of their career. In the early stages, the artist may be very dependent on promoters, venues, managers, but that relationship changes when they are successful so that those bodies are dependent on the artist for their own success.

Dr. Colin Thomas, Chief Medical Officer of the BBC, added to the picture as he described the plethora of jobs undertaken by freelancers in broadcasting and the difficult balance between their tax status as self-employed workers and the duty of care issues that organisations owe to both employees and freelancers.

Zeb Soanes, BBC Radio 4 broadcaster and BAPAM Patron, described the moment when he suffered paralysis of one of his vocal cords and his journey back to full health and employment. He spoke with courage of the isolation and anxiety of losing your identity and the difficulties of accessing the right care in this very specialist area.

Professor Aaron Williamon of the Royal College of Music’s Centre for Performance Science, described results from recent research which demonstrated the lack of general fitness, particularly amongst student musicians.

In the afternoon we heard examples of good practice from Peter Garden of the Royal Liverpool Philharmonic and Professor Emma Redding, Head of Dance Science at Trinity Laban. Peter outlined Liverpool Philharmonic’s approach to developing and supporting performance excellence through providing health and wellbeing services to orchestra musicians. He and the Board have seen the impact of this investment on enhanced performance, improved employee satisfaction and engagement, and positive signs of reduced reliance on freelancers to cover sickness absence due to playing-related musculoskeletal injuries. Professor Redding outlined the advances in healthy practice in dance education and how a specialist health insurance scheme is helping to provide access to occupational health services.

Dr Rob Hampton, RCGP representative at Public Health England and a practising GP, described his own caseload and the difficulties for freelancers in accessing support with work-related health problems, the impact on the NHS and the evidence that working itself improves health. Dr John Etherington, NHS lead for rehabilitation, drew on research on performance enhancement in the military and in sport to demonstrate that effective training for the physical and vocation-related psychological demands as well as good rehabilitation after an injury can significantly improve health.

In this conference, the problems were clearly laid out and examples of solutions are available, but whose responsibility is it to drive the improvements? With over £5bn in UK annual revenue coming from the performing arts, it doesn’t seem sensible NOT to look after the health of the workforce, and leaving this role to charities on their own is not a sustainable solution.

Here are some thoughts from the BAPAM team on how the current position might be improved. First of all, to answer the question, who is responsible for improving performing arts health?

  1. Employers and Education Providers. These bodies do have a duty of care to employees and students. Liverpool Philharmonic has demonstrated the economic and artistic case for employers investing in healthcare. Many employers can and do support occupational health for performers. A consistent approach here would improve the health of 18% of the workforce. There are 50,000 students in performing arts education and Professor Williamon’s research, the practice in Dance Education and the work of the Healthy Conservatoires Network demonstrate what can and should be done to develop healthy behaviours in students and ready them for the realities of working life.
  2. The Freelance Performer. The performer is responsible for their own health (however, see point 3 below), including seeking help at an early stage and following the health behaviours which are evidenced to reduce the likelihood of health problems. Freelance performers who have learned these behaviours in education should be equipped for the working environment, but many performers have not had access to performance education. The provision of educational sessions and written and online materials together with peer support networks is crucial for this group. The Musicians’ Union, ISM, Equity, Help Musicians, Music Support as well as BAPAM and many other individual coaches and writers are currently offering support in this area.
  3. The Performance Environment. Research evidence tells us that good self-care is best achieved within organisational structures that support individual wellbeing. While other organisations in the industry may not have a direct responsibility for performers, they do have a responsibility for ensuring that the environment enables the performer to carry out their personal health responsibility. In addition to statutory health and safety duties, a culture and environment that encourages and supports healthy practice will help performers. As a very basic example, hydration is vital for performers – if there is no water available in a venue, it becomes difficult for the performer to practise this behaviour. What if the acoustics are so bad in a venue that the only way performers can hear themselves is turning the amps up excessively? What if there is a culture in your organisation that discriminates against certain groups or individuals, contributing to negative social relationships and mental health problems? What if the people you depend on don’t know where to go for help when they need it?

If this is a structure we can organise around, then what would a Health Manifesto for the Performing Arts look like?

  1. Everyone in the performing arts world needs to understand what healthy practice means, from the educator to the employer, individual performance professionals and any organisation or individual working in the business (managers, promoters, agents, labels etc).
  2. Everyone needs to know where and how to get clinical help when they need it.
  3. All funding options should be explored to develop a system-wide approach to providing for the health needs of performers, combining charitable funding sources with other sources of support including industry-specific insurance schemes, access to work funding etc.

We welcome responses by email at info@bapam.org.uk

Hand Surgeon and Professor of Piano joint BAPAM clinic

May 1st, 2019

There are intrinsic relationships between health and performance excellence, and educational and clinical expertise in the performing arts. In overcoming medical problems, specialist diagnostic and medical expertise can be complemented by performance technique and lifestyle and health-related guidance. In a new joint clinic at BAPAM, Mr Mark Phillips, Hand Surgeon, and Penelope Roskell, Professor of Piano at Trinity Laban, are exploring this opportunity for clinicians and educators to provide each other with unique insight and feedback. We asked them to tell us more about this innovative approach.

Could you explain the idea behind the joint clinic and why you decided to do it?

Mark Phillips: In my experience when treating musicians I found quite an overlap between the physician’s knowledge and the specialist physiotherapist/hand therapist’s knowledge, who’s an expert in musicians. But I soon realised there was a huge gap for the third element which is filled by the expert tutor on that instrument. I happen to be a trumpet player so as a musician I have some insight into the patient but that’s not enough when it comes to some of the issues they face. I can relate to some of the psychological performance issues, but the expectation patients have is of someone that can really understand how the technical demands of the instrument interface with the physiological problems they’re having and anatomical problems they may have and the outcome of the clinical assessment.

Penelope Roskell: The knowledge we have between us is enormous. My students have included musicians with injuries for 40 years, and so we fill in the gaps. Seeing musicians together in a joint clinic is very important because you can then see the whole picture and then decide on the best way forward. Sometimes it may be steroid injection and sometimes it may be surgery. But sometimes it may be that a tweak or a change of technique will solve that problem and reduce the need for further intervention. So, seeing them together we can get to the root cause, which we can’t always do if seeing them independently.

How do you decide if a patient would benefit from this dual approach? What can a patient expect at a typical joint session? How do you each approach the patient?

How do you prepare for a joint clinic session?

Mark Philips: Normally I will contact Penelope to say I’ve got a patient or she may say she has a student. We will both select patients for this clinic.

Penelope Roskell: Sometimes Mark will send me over a video of that person playing, so I’ll have a chance to look at it and pick out the obvious problems about what I think may be causing it. I’ll also have a clinic letter which will give some sort of background.

Mr Phillips: We then meet up for a coffee and chat about the patient. So then the patient comes in, and if it’s my patient I present it to Penelope and on one occasion Penelope presented the patient. And then we do the history in the normal way, present findings and run through it all. I then suggest what may be the anatomical or physiological problem and how that relates to this person’s technique. The technique may have worked well for a long time but now there’s a problem which is unique to them. Looking at the technique can help if I’m referring to Penelope. Or similarly if Penelope is referring to me is there a way that some of my interventions such as hand therapy or injections or my approach to examination would throw some light on the matter. It’s that overlap which is invaluable really.

Penelope Roskell: So for instance one of my students came to the last clinic and she had problems for the last year and had come to me for that reason. And Mark gave her quite a different diagnosis to what she had been given in the past, which then informed me. So now we are working slightly differently in the lessons that I have with her privately, having now had this intervention from Mark and he also suggested a steroid injection which we are waiting to see the results to. We can then see the whole picture about the ways forward, because there isn’t always one solution. A patient may need a steroid injection or piano playing adjustments to the technique.

Mark Phillips: It’s multi-faceted, there may be Alexander Technique, hand therapy and it may be someone looking at their posture. I learn so much by looking at Penelope tutoring at the piano in terms of elbow position, shoulder position and what impact that has in terms of the way the fingers lie on the key for example. Each presentation has its own unique cocktail of remedies really.

There are complex multi-faceted problems by the time they come here and it comes down to how we triage these patients essentially. I don’t bring every pianist to this clinic.

Penelope Roskell: It’s inevitably going to be someone with a piano related injury. If they’ve broken their wrist by falling down the stairs then they should go straight Mark. Whereas it’s different when it’s something like accumulated stress from years of playing with a technique which is a tiny bit off balance. They may be very experienced players and their technique has lasted them well, but there’s something that just tips it over.

Mark Phillips: What I see in my patients is that half of them have the same problem as everybody else and that may affect how they use their instrument. And the other half have instrument related problems and it may be a combination of the two. And say if someone broke their wrist a year ago and it may be throwing out their elbow, their shoulder or their posture and it may well be a good way down the line that it’ll come to me that a session with Penelope would be helpful. Because it may be to do with their elbow and shoulder which may be making some notes inaccessible and we can work around. They’re so unique each of these cases an each of them would have their own relative roles for the two of us sitting together and discussing the case. It would be good to extend this to guitar, violin and cello and get tutors to do a similar thing. And it’s pretty unique, I don’t think there’s anyone else out there in the world doing it.

What do you feel are the benefits of having an educator in a clinical setting?

Penelope Roskell: It is a very formal environment which is a positive thing and it focusses everything which is very important.

It is a sort of pilot, it’s the first of its kind and I think it is very valuable and let’s hope that other clinics may take the idea from this and develop that further.

What are the direct benefits for patients of having the educator and clinician in the same room in a clinical setting?

Mark Phillips: We often find that patients are often reticent about coming to these clinics. They really don’t want to look at their own techniques and I suppose they remember back to days when they were being tutored and they feel self-conscious. They have to want to come to this clinic and to be looked at. It isn’t like going for a piano lesson or being taught. We are looking to see whether there’s anything about their technique that may be in anyway connected to the clinical problem they have. So we’re not trying to look at the way they play from any other perspective than that. People play in lots of different ways. Also videos are really useful, anyone with a smartphone can record themselves. When we look at them we can slow them down, go back over a sequence, look at it carefully, look at it together and see how that relates to their clinical problem.

Penelope Roskell: There is something different about the joint clinics, because I’m there involved in the consultation I’m able to ask them questions from my own point of view so that I’m well informed as to how best to help them in the future. Because a piano teacher is not qualified to diagnose and that is absolutely number one and nor am I qualified to answer questions that students sometimes ask me, like should I have that steroid injection or that operation and it’s not for me to advise on that but in this situation between the three of us we can discuss the best way forward viewing it from all the different angles.

Any challenges you are finding with the joint approach?

Mark Phillips: It’s 30 minutes long, which is short. We are just getting into our flow by half an hour.

We haven’t had a chance to find out what patients think, especially how they feel about the added value of seeing us both together.

The four patients we have seen in this format have individually expressed to us they thought it was a good session and it stimulated a lot of discussion and ideas. It would be great in the future to include a hand therapist and do a proper multi-disciplinary clinic. Hand surgeons always work very closely with hand therapists. Because there are so many different joints in the hand and different diagnoses. In the hand you’ve got unique problems to one finger or there will be a combination of problems. So your hand therapy is always bespoke, it’s all tailor made to that patient so you have to discuss each patient individually and with musicians it’s even more so.

Certainly with the three most commonest instruments this is going to be a major area of growth in the next ten years and it’s very exciting.

During the half an hour the patients sense the trust we have with each other (Penelope: we work very well as a team, we both have a lot of respect for each other’s knowledge. So I think they go away feeling they’re whole picture has been seen and assessed and we are seeing them as an individual with a problem that can be resolved.)

All patients have been bought over by the end of the 30 minute sessions. You can see the reticence and slight nervousness at the start of the half an hour turning into trust and outpouring of confidence and sharing of the problem and by half an hour we are in to the nitty gritty aren’t we. The output of that is usually I will see them again or Penelope will see them again.

What they can do is continue seeing Penelope for a while and see me in the clinic two months later and see how things have been going on in the meantime. And because we know each other well we can send secure emails back and forth and stay in touch.

New Clinics in Liverpool and Belfast

April 17th, 2019

As part of our commitment to reach and support performers throughout the UK, we are pleased and excited to announce new regional clinics, this time in Liverpool and Belfast starting in May 2019. 

BAPAM are delighted to be working with the Royal Liverpool Philharmonic Orchestra, who will host the clinic at the Philharmonic Hall, and Dr Marie McKavanagh, a Performing Arts Medicine specialist GP (and musician).

Liverpool Philharmonic have pioneered an exemplary approach to developing and supporting performance excellence through providing specialist health and wellbeing services to orchestra musicians. The positive effects of this investment are proving that performer wellbeing and artistic excellence are interlinked. Taking care of both also makes good business sense. Performers are healthier, happier, take less time off sick and are better prepared for elite performance. Through their key support for the new BAPAM clinic, Liverpool Philharmonic are now helping to bring this approach to the whole performing arts community.

The first clinic will be held on Wednesday 1st May. 

Belfast

BAPAM are also delighted to be working with the Oh Yeah Centre, Belfast’s music hub, who will host the clinic, providing vital support for a healthy and vibrant performing arts community.

The clinic is led by Dr Christine Hunter, a BAPAM and  NHS GP and Medical Adviser to the Ulster Orchestra.

BAPAM’s Belfast Clinic will be held monthly from May 22

Who is the clinic for?

If you make a proportion of your living from, or study in the performing arts, and have a physical or psychological health problem related to your work, BAPAM can help you. BAPAM clinicians can provide an accurate diagnosis and information to help you overcome problems. The BAPAM team can identify the best sources of ongoing care, both in the NHS and from other specialists, and advise you about sources of financial support for people experiencing health problems affecting their ability to work or study.

Other regional clinics:

Glasgow: Friday 10th May, 7th June

Leeds: Thursday 2nd May

How to book a FREE confidential appointment?

Call 020 7404 8444 to register | Or email info@bapam.org.uk

The Relationship Between Occupational Demands and Well-Being of Performing Artists: A Systematic Review

March 29th, 2019

Simone Willis,  a Performance Science researcher at Cardiff Metropolitan University, has shared with us this recently published paper on the relationship between occupational stress and well-being in performing artists. The aim of this systematic review was to evaluate and synthesise data arising from 20 previous studies. The article is open access and can be read here in Frontiers of Psychology.

The review highlights the need for more high quality research on the relationship between occupational stress and well-being.