Can you kazoo?
“Music can in such a simple way help to overcome these feelings of frustration and humiliation. Music is the most effective and often the only way to stimulate a response. It seems to reach into their very souls and unlocks that door behind which a frightened, intimidated and humiliated person hides. Life at times is just too awful to face for most of them.” – Helena Muller, founder of Lost Chord, an innovative music charity.
Most people enjoy music. For some of us it’s a major feature of every day, for others something to enjoy on a special occasion. Music, along with the TV (see Idea #23 The Media), is one of the best resources for patients, who can engage actively or passively, in most emotional states, in most areas of the ward including the garden. Indeed, music is one of the best ways of helping patients manage difficult mood states. Like the weather, football and soaps, music is a great source of common ground for people whether it’s the pleasure of chatting about a shared love of Adele or learning about the roots of hip-hop.
One of the many delights of music is that it can be enjoyed alone, or with other patients, staff and visitors, Skype even allows patients to share some music time with friends and relatives (including their kids) who are at home. And music is completely adaptable for occasion, mood and participants.
Music, including music therapy can help with:
- communication and social skills
- confidence and self-esteem
- the ability to manage feelings
- increased self-awareness and awareness of others
- reduced anxiety, tension or challenging behaviour
- stirring, validating and enjoying or at least helping to cope with long-term memories
The research findings are compelling:
- Improved brain functioning, including better concentration and sharper thinking
- Breathing and heart improvements, with relaxation and anti-stress physical benefits
- Emotional state benefits including increased melatonin, a hormone associated with mood regulation, lower aggression, reduced depression and enhanced sleep.
- Other benefits: lowering blood pressure (which can also reduce the risk of stroke and other health problems over time), boosting immunity, easing muscle tension, improvements in speech.
Personal preferences in music are very much shaped by our age, mother tongue and country or region where we grew up. The ward music library needs to reflect this, although there are of course teenagers who love Puccini and great-grandparents who love Puff Daddy, so it’s nice to have a range of styles. Religious music is very soothing for many people, and again the CDs or MP3 tracks available should be relevant to people from different faith communities. Musicals and pop classics are also very popular.
- The Trust has close links with a local community radio station. The Chief Executive has his own weekly show raising mental health awareness and interviewing star staff.
- The PIER (Psychosis Intervention and Early Recovery) team have a recording studio.
- Music in unit reception area! Lovely. Very welcoming.
- Older People’s wards, a record player and LPs of music enjoyed by their patient group. The Older People’s wards regularly hold informal tea-dance afternoons for patients and their family where war-time songs are played and everyone enjoys tea and cakes.
- Three units from the Older Adult Service hold a weekly Music Group in the Library. This provides opportunities for social engagement, dancing and singing. Once a month the CDs are replaced with a live singer and keyboard player who has collaborated with the patients to provide live music that they enjoy and a song book.
- Christmas carols with ex-patients being invited.
- “Jamming session”. There is a drum machine, keyboard, electric guitar and vocal recording equipment, available to use at whatever musical level the service users may be at (professional or experimental!!). The group is facilitated by an OT and a sessional worker – who makes the recordings happen. The service users are encouraged to utilise the instruments at the level they know or they can learn how to play an instrument. There is also an opportunity to sing or rap over backing tracks, either with written lyrics or in a free-style format. The group has created both individual songs and collaborative pieces with everyone playing instruments.
- Amazingly, the hospital has its own recording studio where patients can make their own CDs or demo tapes. Despite complex copyright laws, people can make 1 copy and the hospital is exempt from the Performing Rights’ Society license because the CD is used for therapeutic purposes. For patients who want to do serious practice and composition, the computer room has a keyboard connected to a computer.
- Music encouraged without disturbing others. music group available. Headphones provided if safe for patient.
- De-escalation room with (staff-operated) option to have music playing through wireless speakers
- Offering a choice of music for relatives visiting a very quiet (even asleep!) or distracted patient.
- All patents are provided with CD players on admission.
- We have a synthesizer out at all times for anyone to access. It’s usually used with headphones but occasionally for all to hear. Great spontaneous, interesting and self-soothing resource.
- We try to make the guitars freely available on the ward as much as much as possible.
- I write raps. A member of staff let me use YouTube on his phone to practice rapping to instrumentals.
- A wonderful member of staff sang to me which helped me focus away from my voices.
- When I felt like self harming I would listen to my favourite music on my iPod, which usually worked for me.
- I used the ward computer to watch my favourite band on youtube. It was great to be interested in music again and doing something I really enjoy.
- A patient had a guitar and we had a good sing song. I haven’t done anything like this for years – it really lifted me.
- We had weekly karaoke nights. I used to listen at first but then decided to “have a go”. I didn’t realise I could sing and it was good fun especially when the staff joined in.
- Sometimes when I couldn’t find physical freedom I used to create emotional freedom by just meditating or listening to music.
- It can be hard to find any headspace on the ward given that there are few rooms available. But I found ways to have personal space, like listening to my iPod. This was my form of healthy escapism.
Singing, playing instruments, tapping a rhythm with a foot or finger, all great ways of creating music. Music-making can be seen as communication between the players, and between players and audience. It’s a bit like a dialogue – someone plays a note or a phrase or sings some words, and the other musicians respond to what they’ve heard and felt, as exemplified by jazz and jamming.
Music is incredibly evocative, and often a real pleasure for people with dementia, although of course it can also bring up strong feelings of loss and confusion. A music session is an opportunity for these emotions to surface, be validated and soothed.
There’s a whole bunch of different instruments well suited to being played on wards.
- Electronic keyboard – frankly, a real must for all wards
- Guitar – bit daunting for people who don’t play one, but fab for those who do and lovely for everyone else to sing, clap or even sleep along to.
- Hand bells
- Penny whistle (both of which will be very familiar to listeners of Radio 4’s hilarious I’m Sorry I Haven’t a Clue)
The easy and cheap:
- Ukelele (well, it’s easier than a guitar and cooler, in a post-modern way.)
Lovely but need specially buying:
- African drums
- Electronic drum-set. We can’t enthuse about these enough, but we’ll try. They’re sooooooooooooo wonderful. They’re laid out and played like a conventional rock drum set, but can be listened to on headphones. Or through a speaker if a drumming legend rocks up on your ward. There’s a compact, easily portable version:
Or if you’ve got the space on the ward or OT department:
Boomwhackers produce musical tones when struck together, on the floor, or against nearly any surface. They can also be struck with mallets in different configurations, in specialized holders (homemade or available from the manufacturer), similar to a horizontally-aligned xylophone. Boomwhackers are often used by performance artists and other musical performance groups to add an element of spectacle and are ideally suited to group and audience participation.
Stylophone – the Original Pocket Electronic Organ. About £12 inc P&P from Amazon
And for the cooler dudes on the ward:
Stylophone Beatbox Portable Electornic Beats Machine. About £25 from Amazon. We’re not cool enough to know the details so here’s the blurb:
Stylophone Beatbox has three new exclusive sounds – Beatbox, Percussion and Bass Stylophone and a new record function that allows you to playback loops of your work.
MP3 input means it’s also possible to sync your scratches with your MP3 music. Plug in your device and layer your sounds over the top of your favourite tracks.
And of course there are all the fantastic music programmes on the PC and Wii.
Listening to music, awarely!
From ‘background music’ (eg radio) being appropriate to age and culture of ward patients, to music appreciation sessions where patients, staff and visitors share music they like and people can discuss their own responses to it. Very simple, very lovely.
When music is directly attached to a story (on TV, films, radio dramas), it’s easier to imagine what narrative the music is echoing, creating or reinforcing. For example, a group could listen to the theme from Titanic and describe the emotions being expressed in them as they go along. So, someone might say “It’s mournful.” The pace of music might then pick up and another patient comments: “Sounds quite hopeful now.” This can develop into a discussion about what part of the storyline the music might be accompanying or referring to. (With Titanic, lots of patients will have seen it and know why it’s sad at the end.)
When people feel confident about this (which might be instantly!), they might like to do a similar exercise but with a piece of music unconnected to a particular story. It’s interesting to compare emotional expression in music across different styles, including music from across the globe. Some can be popularly (and accurately or not) thought of as inherently, necessarily having a certain mood – eg country and western is quite twangy.
This sort of activity can branch off in any direction anyone fancies. Could be a discussion on people’s views of classical music, and other music types. Or people’s emotional relationship to music. What moves them? What soothes them? What energises them?
Musicians usually love talking about music! Music groups and mealtime conversations benefit from enthusiastic and knowledgeable patients, staff (including admin staff, senior managers, doctors, catering staff) and visitors. One ward discovered that the guy from the mail-room who brought in the day’s post is a skilled guitarist. He was invited to lead some music groups which were really popular with patients and also gave him a very satisfying new dimension to his work in the hospital.
Local music journalists, producers and musicians might be interested in doing a special session for a ward music group, and, as always, they’re much more likely to agree if they’re asked by someone who knows them.
Youtube, Wikipedia, rock stars’ websites, social media music sharing, Google images…. Endless music related possibilities online.
For patients on longer-term wards, there are some excellent online music appreciation courses covering topics like:
- the basics of music terminology
- the lives of the great composers
- characteristics of each major era of music
- the greatest works from each era
For example, Classic FM offer one at no cost.
And Internet radio apparently exists. Star Wards’ music department hasn’t quite caught up with this but it sounds like a very good idea and something fun to explore, or even create, while in hospital. One of its big advantages is its globalness, which means that patients who come from, or just like, other countries, can listen to music that is particularly meaningful to them. This website has easy to use links with online stations around the world.
Hugely popular, whether performances are by patients, staff, visitors or professional musicians. We’re thrilled to see the growing number of hospital choirs and bands made up of both patients and staff. There are charities which put on concerts in hospitals, eg Music Spaces and Music in Hospitals.
Local music colleges, classes, bands, ensembles are always looking for opportunities for their keen musicians to have an appreciative audience. And for those hospitals which have bands, nice reciprocal arrangements can be made.
An alternative to listening to music is watching movies of popular musicals eg. Porgy and Bess, The Sound of Music, Bombay Nights, Grease. An alternative to settling down with popcorn to experience the whole film is to look at one song or piece of music in some detail, using the remote to pause it for discussion. (See also Idea #23 The Media.)
We strongly recommend, OK we see as pretty essential, individual portable music machines for each patient who would like one, with a choice of music, audio books, soothing/relaxation/nature music/sounds. This could be via a ‘loaded’ MP3 player or CD player + discs. Patients for whom it is safe should be able to have their own radio to listen to, with headphones if necessary.
Some patients bring in their own MP3 players and it’s nice to have one or two docking stations or speakers so that they can share their music with other people if they’d like to.
Bodmin’s Music and Podcast (or should that be BODcast?) studio
Cornwall Partnership Trust have launched a podcast studio, which can be used by members of the public to inform and educate others about their experiences of mental health issues and services. There has been a considerable amount of interest in the studio and it has already been used by many of the hospital’s clients.
The first podcast, launched on 14 January, is entitled “What is depression?” and is aimed at staff, patients and the general public to help inform people about various mental health problems and the services that may be available to them. Podcasts are also available on CD and have involved staff, patients and carers in their creation. In order to make it easier for people to tell their story, Tim Carthew, Paul Tyler (both Social Inclusion Workers with CPT) and Andy Jago (Lead Nurse), have worked together, with funding via Pentreath Ltd, to create a studio on the Bodmin Hospital site. People can use the studio and its equipment via a booking system.
A little note from Marion
And another little note from Marion
“Amazingly, Sandwell’s Hallam Street Hospital has its own recording studio where patients can make their own CDs or demo tapes. Despite complex copyright laws, people can make 1 copy and the hospital is exempt from the Performing Rights’ Society license because the CD is used for therapeutic purposes. For patients who want to do serious practice and composition, the computer room has a keyboard connected to a computer. I was given a demonstration of how relatively straightforward it is to compose multiple tracks, adding layer after layer of simple or complex tunes, with the sounds of different instruments! Because of the equal opportunities’ nature of mental illness, among the backgrounds of patients, the hospital has had professional musicians as patients, including singers and a concert pianist. How fabulous for them to have access to specialized resources, as well as for patients who may never have considered the pleasures they could gain from making music.”
I’m always within arms-reach of my soothing list on my computer or iPhone. My BPD means I regularly go into instant meltdown and I’ve found (8 years on!) that music is definitely the best thing to ease me out of this state. It has to be totally undemanding and low stimulus. Fundamentally slow, thoughtful, mellow. When I’m in a bad state, part of what is going in is that I’ve blown most of the fuses in my brain and am feeling completely over-stimulated. I find classical music the gentlest and least confusing. Music with lyrics tends to pump up my inner frenzy.I’ve also discovered that I need the music I’m listening to feel very close to my mood state and at most just a fraction more upbeat. I feel a bit guilty about sort of wallowing in it when I start with the most mournful of my soothing playlist – Schindlers List. But I’ve tried zillions of other tracks and this is the one that somehow starts to edge me out of my despair. I also respond to the varying tempo in the piece expressing different emotions and creating a sense of narrative; there’s a build up of tension and then a resolution.Similarly, I discovered that the sequence in which the pieces are placed is very important in trying to manage mood plunges. So the first few are highly mournful, the next lot soulful rather than despondent and by the end, they’re pretty cheerful, in a low-key sort of way.However, I have had to stop listening the last few years to one of my favourite artists, Leonard Cohen, because his songs are just too agonising. And I have to be very disciplined about not indulging in any with a self-harm or suicide theme. (It’s a bit of a niche sector, but there are some very beautiful songs which are currently on my traif (unkosher) list.)
- Theme from Schindlers ListLe Onde – Ludovico EinaudiPokearekare Ana – All Angels
- Rossi Psalm 124 – Kings Singers
- Dear Lord and Father of Mankind – Aled Jones
- Silent Night
- Pachelbel – Canon and Gigue for 3
- Let it Be – Beatles
I find repetition very soothing if I’m not in a good state. Repetition within tunes – eg Le Onde by Einaudi. And sticking the Repeat One button on and listening over and over and over to the same song. Again and again.
Less Anxious, More Engaged Through Karaoke
When nurses on an acute care inpatient psychiatric unit started holding a weekly karaoke night, they noticed an immediate change in their patients.
Patients were less anxious, used less pain medication, and were more open in group therapy sessions.
“We were thrilled with the results,” Kelly Southard, RN, BSN, MBA, from Behavioral Health Hospital, Cone Health System, Greensboro, North Carolina, told Medscape Medical News.
The poster, which won first place in the research category, was presented here at the American Psychiatric Nurses Association (APNA) 28th Annual Conference in Indianapolis, Indiana.
Less Anxious, More Engaged
Many studies have demonstrated the benefits of music therapy on physical and emotional well-being, but none have looked at the use of karaoke among psychiatric inpatients, the investigators note.
The researchers studied 61 inpatients (60.7% women) who were participants in karaoke nights. The most common diagnoses were depression (50.8%), bipolar disorder (27.9%), and alcohol abuse (21.3%).
Patients completed the TRAIT Anxiety Inventory Scale and a sleep questionnaire, as well as a survey on relaxation, mood, and stress; the measures were completed both before and after attending karaoke nights. The researchers reviewed the patients’ medical records 24 hours before and after participation in karaoke for changes in pain medication use, and they assessed changes in level of participation in group therapy.
The investigators found that participation in karaoke led to a statistically significant decrease in state anxiety levels. In addition, 30.4% of patients who were known to take medication as needed (PRN) used less medication, and 21.4% used less PRN pain medication.
After karaoke, nearly one quarter of patients (24.2%) increased their level of participation in group therapy.
“The results have been incredible; patients are more relaxed and more engaged in group after karaoke. Normally, patients can’t wait for group to end,” said coinvestigator Joann Glover, RN, BSN.
Average post-karaoke ratings for relaxation, stress, mood, and talking in group were all “very positive,” the investigators report. Karaoke did not appear to have any marked effect on sleep quality.
Southard noted that karaoke has been “really good for our substance abusers because they are used to music usually in bar settings when there is alcohol involved, so to be able to experience this type of fun music being sober is healthy.”
It is “very easy and inexpensive” to conduct karaoke on an inpatient unit, Southard said, “and we have now implemented it on our child and adolescent unit. The patients look forward to it.”
The Use of Music in Dementia Care
For years I have been using music to reach deep into the memories and individuality of my clients with dementia. There are many benefits to using music as a therapeutic modality in OT/PT/ST interventions.
Music therapy in the dementia population can:
- Enhance quality of life and wellness
- Reduce stress
- Enhance memory
- Improve communication
- Express feelings
- Assist with physical rehabilitation
A therapist can use music as a therapeutic modality or a music therapist can partner with us during our interventions.
Mental health ‘helped by birdsong’
Birdsong has a powerful healing effect which can improve mental health and benefit hospital patients, according to a health expert. Dr William Bird, GP, who is a health adviser for the countryside agency, Natural England, said tests had proven the effect. He cites a 2004 report in the prestigious medical journal, Thorax, on the effects of birdsong on patients recovering from a lung operation. “They needed less pain relief and were far more relaxed,” he said.
Dr Bird also recommended birdsong for the elderly and for those who suffer from high levels of stress. “We have lost our connection with nature,” he said, adding: “By having birdsong, it’s away of connecting back, and our mental health improves when that connection has been made.”
Research has found that “ultra waves” increase in the brain when subjects are shown a natural scene, and Dr Bird said the same effect occured with birdsong. Mark Avery, director of Conservation at the Royal Society for the Protection of Birds, said that bird sounds were a “tonic” for people’s general wellbeing.
Music in Hospitals
Music in Hospitals arranges live music for all kinds of healthcare centres throughout the UK. Our concerts are given by small groups of professional musicians who tailor repertoire to suit the individual needs of the audience. Programmes range from classical to jazz, folk, pop, show and old time; often a number of these styles can be included within one concert. In addition to their high standard of musicianship, our musicians possess exceptional communication skills, which enable them to involve audiences beyond a musical level and “bring the person out of the patient.”
On many occasions we receive reports of people singing along to familiar tunes, word perfect, yet they are unable to speak. Music acts on the right hand side of the brain, the opposite side to speech, reading and writing. Live music has the power to open closed doors and help people express emotions they are unable to communicate verbally. This provides the person with a feeling of great achievement and happiness which reflects on their well being.
The Emotional Power of Music
– Psychologies Magazine, June 2012
Nothing beats listening to a song that sends chills down your spine. It’s so powerful you want to hear it again. And again. It can even move us to tears. Research suggests that songs with a soft, repetitive introduction followed by a sudden change in volume, register or voice are to blame.
Try it for yourself. Listen to two recent goosebump-inducing tunes – Adele’s ‘Someone Like You’ and Gotye’s ‘Somebody That I Used To Know’. Two hormones are released when we listen to songs like this,’ says psychologist Dr Martin Guhn. ‘Oxytocin, the bonding hormone, and dopamine, the pleasure hormone. Dopamine rewards the brain, which makes us want to listen to the song over and over again. Essentially, music is a harmless drug.’
Reaching out through radio
From Your Voice
People affected by mental illness in Devon have been sharing their interests and getting support in an unusual place – community radio.
The ‘Padded Wireless’ show on Exmouth community radio is co-presented by locals Jon and Lindsey. Lindsey, who works for Rethink Mental Illness in our Devon community service, says: “My day job is to help people to rediscover their interests and build their confidence and self-esteem, and that’s what we aim to do through ‘Padded Wireless’ too.”
They encourage people affected by mental illness to come and share their interests – especially creative things -and also give information about support available locally. “We’ve had some great feedback from people who have been on the show – including some of the people I support,” says Lindsey.
Visit www.paddedwireless. co.uk for more information and to listen to previous shows.
Resources and references
There is a growing evidence base to support the benefits of using creative activities (for example art, music and reading) to enhance the care provided to those in mental distress. (See: Bittman et al 2001, Koopman et al 2005, Curan2007, Gladding 2008, Billington et al 2010, Caddy et al 2011).
Interesting article about how music impacts on the brain
How music therapy works with Alzheimer’s disease
RiverSpring Health has a very informative resource on how music therapy works with Alzheimer’s disease at http://www.riverspringhealth.org/living-well-blog.aspx?id=48 that can be used.
Music for different moods
Excellent website picking up articles from all over the place, in this case about the benefits of music.
The Use of Music in Dementia Care By Kim Warchol, OTR/L
There’s a fabulous video from the Alzheimer’s Society about the benefits gained by members of a singing group for people with dementia: http://bit.ly/alzsocsing
Music as a Tool to Improve Communications Skills in Alzheimer’s Patients
Musical Quiz CD
Spot the song or tune from this CD selection from the 30’s, 40’s, 50’s, and 60’s £18.99
Affordable, very playable instruments from around the world
Association of Professional Music Therapists
British Society for Music Therapy (BSMT)
Birdsong for patients
Feeling Chirpy, Nursing Standard – January 2008. Birdsong played into hospital wards has proved an innovative success, reports Carol Davis.
And here’s a geeky tip! If you want to find birdsong resources, don’t google birdsong. Unless you want to scroll through dozens of sites about the novel or the film. Here’s what we found via birds singing(!):
- Lots of videos on youtube andsound recordings on websites. We began trying to find particularly nice ones and have to report to you that, frankly, this is a highly subjective exercise! And also, that there are two very distinct types of birdsong recordings. Ones that are basically about identifying birds, for bird-watching enthusiasts. And then the ones that the research is about, which includes a variety of harmonious songs from different birds. A little symphony. But, we will nevertheless intrepidly suggest one. It’s a decent length and has a delightful variety of songs. (Or are they tweeting?)
- If a patient, visitor or passing by ornithologist happens to want to hear the sound of a Cambodian pale legged leaf warbler, you can confidently take them to:
http://www.xeno-canto.org/100463 This website is a bit like an extreme catalogue of bird sounds from around the world. Truly encyclopaedic.
- And for the birding enthusiasts on the ward, the BBC provide recordings which can be downloaded onto an mp3 player to “match the songs you hear in your garden or on a country walk.”
- By far the best option is to buy a birdsong CD and perhaps DVD, eg:
- A selection of British woodland recordings
The Use of Music in Dementia Care. By Kim Warchol
Bodmin podcast studio
Read more at:
See more at:
The Emotional Power of Music – Psychologies Magazine, June 2012
Reaching out through radio. From Your Voice