Posts Tagged ‘Medicine’

Hearing Conservation Guidance for the Performing Arts: A Consultation

Tuesday, November 26th, 2019

BAPAM has produced new best practice guidance for hearing conservation in the performing arts. You can download the consultation document here.

The guidance is being consulted on until February 2020. All comments are very welcome and respondents are encouraged to discuss with colleagues and use this online survey to provide feedback. The final guidance document will take account of responses.

The document has been authored by:

Rob Shepheard, Consultant Audiologist
Dr. Finola Ryan, Occupational Health Doctor
Paul Checkley, Audiologist
Claire Cordeaux, Director, BAPAM

Summary of key recommendations

Healthy hearing is essential for musicians.

Education providers and industry organisations recognise the potential risk of sound exposure to performers and have a duty to identify hazards to health, and take appropriate steps to minimise the risk of causing harm.

Modification of environment, repertoire and rehearsal schedule all contribute to level of exposure and must be carefully planned in advance.

Hearing tests are vital for health surveillance. Early recognition of changes to musicians’ hearing is best identified with a hearing test called ‘Otoacoustic Emissions’.

Personal protection with custom moulded earplugs must be verified to ensure adequate protection.

Instruction and continuous education for all staff and students must be available and recorded.

Laryngeal Manual Therapy (LMT) and Head and Neck Massage: BAPAM Guidance

Tuesday, November 26th, 2019

In the light of recent press about a death following manipulation (www.bbc.co.uk/news/uk-england-york-north-yorkshire-50397867) and the publication of research last year on the dangers of head and neck massage if practised by improperly trained salon employees (“Crick” in Neck Followed by Massage Led to Stroke …), we at the British Association for Performing Arts Medicine, along with our clinical colleagues, thought it would be useful to provide guidance on Laryngeal Manual Therapy (LMT) and Head and Neck Massage, which is often used by professional voice users.

We recommend that manual therapy techniques applied to the head, neck and larynx should only be performed in clinical environments by the following registered professionals:

Physiotherapist – registered with the Chartered Society of Physiotherapists (CSP)

Osteopath – registered with the General Osteopathic Council (GOC)

Speech and Language Therapist – registered with the Royal College of Speech and Language Therapists (RCSLT)

Chiropractor – registered with the General Chiropractic Council (GCC)

Sports Therapist –registered with the Complementary and Natural Healthcare Council (CNHC), Federation of Holistic Therapists (FHT) or British Association of Sports Rehabilitators (BASRAT).

Massage Therapist –registered with the Complementary and Natural Healthcare Council (CNHC) or Federation of Holistic Therapists (FHT). Massage Therapists should be qualified to diploma level and registered with the CNHC or FHT, which are the only Registering bodies for Massage Therapy that are accredited by the UK Professional Standards Authority. While there are many organisations that provide training in massage, only some of them provide training at a level that provides a route to registration with CNHC or FHT.

Membership of a registering body accredited by the Professional Standards Authority is a guarantor of professional standards. It indicates that the practitioner operates within a structure that oversees qualifications, working practices, ethical behaviour etc. and can investigate complaints and impose sanctions on practitioners who fall short.

The BAPAM Directory also lists BAPAM-Registered Vocal Rehabilitation Coaches (VRCs). A VRC is a type of specialist voice coach who works as part of a multidisciplinary team that includes clinicians such as Speech and Language Therapists and Laryngologists. BAPAM-Registered VRCs have undertaken training to carry out palpation assessment. This is to assess tension only, and for onward referral, not to perform manipulations. Training in palpation assessment should be provided by a clinically qualified practitioner such as an Osteopath or Physiotherapist. Like clinical professionals, VRCs require clinical supervision from a Laryngologist, Speech and Language Therapist and sometimes a Psychotherapist.

Mental Health and Wellbeing Services for Performing Artists: Guidance for the Performing Arts Sector

Tuesday, July 30th, 2019

Consultation Paper

BAPAM is pleased to have brought together a working group of clinicians and performing arts organisations interested in addressing challenges to the mental health and wellbeing of those who work in the sector. The group has produced guidance to support the development and delivery of services specifically for performing arts professionals and students. The guidance is designed to be used by:

• organisations commissioning or wishing to commission mental health services for performing artists

• organisations and practitioners providing mental health and wellbeing services for performing artists

• education providers offering mental health and wellbeing support to students

• individuals and agencies wishing to support best practice for performing artists

• performers and other performing arts professionals wishing to understand the standard of practice they can expect from services.

This guidance has been developed by BAPAM’s Psychosocial Working Group. We aim to make a real difference to the quality of services available. The purpose of the group is to provide a forum in which approaches to prevention, care and support can be discussed, and clinical leadership can be provided for developing and maintaining an evidence-based service designed to support performing arts professionals and students with vocation-related mental health issues. The group has drawn on the clinical evidence base, including National Institute for Clinical Excellence (NICE) guidelines, which contain reviews of published evidence for healthcare interventions from clinical and cost-effectiveness perspectives, to produce this guidance for the performing arts sector. There are seven key areas of focus:

1. Preventing Mental Health Problems
2. Early Clinical Assessment
3. Brief Intervention
4. Peer Support
5. Ensure Links with the NHS
6. Multi-disciplinary Team Approach
7. Managing a Crisis

We are publishing this paper for consultation and welcome all comments which will be considered prior to the final launch.

Read or download the paper here:

Mental Health and Wellbeing Services for Performing Artists: Guidance for the Performing Arts Sector – A Consultation Paper

Comments can be posted via the online survey here: https://www.surveymonkey.co.uk/r/NKRFVGD

The consultation is open until 15 September 2019.

BAPAM Psychosocial Working Group

Tuesday, 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

Tuesday, 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

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

Friday, 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.

 

Trustee Recruitment

Tuesday, February 19th, 2019

We are are looking for skilled and experienced individuals to join our Board of Trustees and help guide the organisation in assuring service quality, developing new and existing partnerships and expanding our services throughout the performing arts industry.

To apply, please download the Application Pack and return it to BAPAM Director, Claire Cordeaux. You are welcome to contact us for further information.

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

Tuesday, February 5th, 2019

 

Wednesday 27th March 
Royal Society of Medicine
London

 

Registration for this event is now open.

Training arts professionals in healthy practice skills is vital, but we believe that healthy individuals also require systematic support from the industry that is built on their work. 

The majority of workers in the performing arts are freelancers and all are likely to, at some point in their career, experience an injury or have other health problems as a result of their work. The particular needs of those in this industry translate to other areas of the national workforce where, with the expansion of the ‘gig-economy’, traditional occupational health provision increasingly may not reach. 

The Occupational Medicine Section of the Royal Society of Medicine and the British Association for Performing Arts Medicine have therefore come together to run a one day educational meeting that will be of interest to a wide range of people with an interest in health and work.

Talks and panels feature leading arts industry and occupational health experts, academics and clinicians, and include consideration of the economic case for investing in health, health promotion, injury prevention and rehabilitation for self-employed workers, key and emerging occupational health issues in the arts sector.

Contributors include:

Professor Aaron Williamon, Royal College of Music, Centre for Performance Science

Zeb Soanes, BBC Radio 4 presenter

Jane Dyball, CEO of Music Publishers Association Group, winner of Music Week Women in Music Award for Outstanding Contribution

Professor Emma Redding, Head of Dance Science, Trinity Laban Conservatoire of Music and Dance

Colin Thomas, Chief Medical Officer, BBC

Colonel John Etherington, Director of Defence Rehabilitation and Consultant in Rheumatology and Rehabilitation, Defence Medical Rehabilitation Centre

More information and registration

Clinical Governance Toolkit

Tuesday, February 5th, 2019

Can BAPAM help your organisation ensure quality of clinical services for performing artists?

Performing arts organisations and businesses which commission or provide health services for artists, or are considering doing so, should comply with quality standards for healthcare to ensure the best service for beneficiaries, use resources effectively and help to manage any liabilities if things should go wrong.

We have just published a new Clinical Governance Toolkit which is available as a free resource.

BAPAM is a clinically led organisation working in the performing arts sector. We have a clinical governance framework in place and are registered with the Care Quality Commission (CQC).

We are available to:

Discuss quality issues in relation to an existing or planned service

Develop policy documents and reporting systems that allow you to continually monitor the quality of service delivery

Support the scrutiny of your service

We spoke to Dr Penny Wright, BAPAM Honorary Medical Director, to help demystify the topic of clinical governance.

Why is clinical governance important?

It’s a way of guaranteeing the quality of clinical services for patients: I think it’s most important to look at clinical governance from the patient’s point of view in the first instance. Patients often feel vulnerable when coming through the door, so they need to know they’re getting a service that is expert, that is going to come up with the right answer to their problem, backed up by evidence, in an environment which is caring and respectful of them, and where any risk is minimised. From the point of view of those us who are delivering those clinical services, the doctors and other clinicians and the organisations that they work for, making sure that services are of a high quality is also important: if we provide services that are either not of a good quality or not the right services, the ones our patients need, we’re risking the patient getting poor care and we’re risking wasting money and time. There are assumptions that because healthcare practitioners like doctors and nurses are caring and expertly trained, we always provide a good service, but we don’t actually know that (or even know what a ‘good service’ is) if we don’t monitor it and ask questions about how it could be better. Sometimes asking clinical governance questions can be very unpopular! But in the end, asking how we clinicians know that we are doing the right things – and whether we could do better – is in everybody’s best interests.

What does it mean for Performing Arts Medicine providers?

Providers such as BAPAM need to make sure that the service they’re providing is actually effective at treating performers, as they obviously have very special needs and issues. For example, there’s no point in providing performers with physiotherapy advice geared towards sedentary office workers. For care to be effective, providers first need to look at the quality and expertise of the people delivering it: the clinicians that you work with need to be well trained and they need to understand performers in order to provide all the right advice. It’s also about using an evidence base: if you provide a particular form of treatment to a performer, how do you know that it’s the right treatment, that it’s going to help? Underpinning everything has to be this constant questioning, which is ‘how do we know what is the best thing to do for this patient?’ So the evidence base I would say is part of clinical governance. In addition, for whoever is funding the service, “clinical effectiveness is cost effectiveness”, a treatment which works is also likely to be worth the money that it costs.

What does clinical governance mean for patients?

It provides reassurance that the care they’re getting is the right care for them; that it’s delivered in a way which is respectful and professional; and by people who have been appropriately trained. So in a way it is all about standards and, for performers, it’s about receiving career-specific care which is relevant for them in an environment where they feel more understood than they might do in the busy NHS, or in non-specialist freelance or private services.

How can an individual practitioners ensure clinical expertise when working with performers?

I think it’s a combination of training and experience. From the point of view of training, it doesn’t just mean going to conferences and training days, reading journals and things like that, it’s also about networking with specialists in the field and asking advice and learning from them. At BAPAM clinics, our clinicians are always happy to have colleagues sitting in with them. In Performing Arts Medicine in the UK, formal learning opportunities are currently limited but they are out there: there are courses and training days such as those we run at BAPAM, and there are a limited number of specialist journals, or relevant articles in general journals. There are also academic courses that people can go on, like the Performing Arts Medicine MSc at UCL. However, if you’ve got good basic clinical skills in your own area of practice you will also learn simply from seeing lots of performing arts patients: for instance you will learn about problems affecting clarinettists if you see a lot of clarinettists (with their instruments if necessary) and you’ve got the basic skills to ask the right questions about what’s happened to them and why.

Download the BAPAM Clinical Governance Toolkit

New BAPAM Clinics

Tuesday, February 5th, 2019

We now hold free Performing Arts Medicine clinics in London, Glasgow, Birmingham, Cardiff and Leeds. 

If you make a proportion of your living from, or study in the performing arts, and have a health problem related to your work, we can help you.

Our clinicians are experienced at dealing with the problems performing arts workers frequently face, and can help with an accurate diagnosis and advice including identifying efficient care pathways, both in the NHS and from other specialist individuals and services. The BAPAM team can also advise about the availability of financial support for people experiencing health problems affecting their ability to work or study.

To make an appointment, give us a call on 020 7404 8444.