Inpatient adolescent mental health care: art therapy, acute distress, and restrictive practices

Background: Child and adolescent mental health challenges are increasing globally, thereby driving greater demand for inpatient child and adolescent mental health services (CAMHS), where restrictive practices persist despite WHO ambitions to eliminate them. Art therapy is a valuable clinical intervention associated with a significant reduction in these practices. However, there is a gap in knowledge as to why. Aims: This research aimed to hear directly from young people in inpatient CAMHS settings about their experiences of art therapy, and to identify how those findings might help explain the association between art therapy and a reduction in restrictive practices. Methods: Semi-structured, arts-informed interviews using the principles of sensitive enquiry were conducted with twelve young people within two Australian acute inpatient CAMHS units. Transcripts were analysed using reflexive thematic analysis. Results: The inpatient setting gave rise to several challenges, including difficulties communicating with staff, the constraining inpatient environment, and mental health escalations. Art therapy helped reduce acute distress through providing opportunities for freedom, choice and agency, externalising internal states, and generating positive physiological and emotional effects. Conclusions: Art therapy supports young people to navigate acute mental distress by providing an immersive, non-verbal avenue of creative expression within an inpatient CAMHS setting, where there are challenges engaging with verbal therapies. Lowering acute distress through art therapy also helps to circumvent mental health escalations, thereby reducing the likelihood of restrictive practices being used. Implications for practice/policy: The accessibility of art therapy programmes run by qualified art therapists should be a priority in all CAMHS settings.