By Cherry Hense
Young people recovering from mental illness may benefit from ongoing musical opportunities in the community following music therapy engagement in mental health services. In this paper I describe the second cycle of a Participatory research project investigating young people’s musical identities in their recovery from mental illness. This cycle explored the types of services needed for young people’s ongoing recovery and compared these against the reality of service provision in the local area. Findings revealed the need for a unique advocacy body to facilitate partnerships between institutions and community-based services and lead to the forming of a Youth Music Action Group to address this unmet need.
Keywords: Young people, musical identity, recovery, mental illness, community music therapy
This paper presents the second of two research cycles in a Participatory study with young people accessing a youth metal health service in Melbourne Australia. This project has investigated how and why supporting young people’s musical identities may facilitate their recovery from mental illness. Cycle one was an exploration of how young people’s musical identities change with experiences of mental illness and recovery. The finding from this cycle was a constructivist grounded theory detailing how young people came to music therapy to engage in a process of recovery of their musical identity (Hense, McFerran & McGorry, 2014). An outstanding finding from this theory was young people’s expressed need for community-based opportunities to play out their musical identity in late recovery. This paper details how and why I instigated a second cycle of research to investigate how community-based music engagement may support this process of playing out musical identity. I describe the process of investigating what resources were available to young people in the local community, and the actions taken towards establishing accessible musical pathways for recovery.
Youth mental health services in Australia follow a recovery model where staff aim to collaborate with young service users in decisions about their care (Orygen Youth Health Research Centre, 2013). Music therapists are increasingly attuning to recovery philosophy in their work within mental health services both nationally and internationally. In particular, Norwegian music therapist Solli (Solli, 2014; Solli, Rolvsjord, & Borg, 2013) has been significant in highlighting the congruence between Resource-Oriented music therapy and the recovery approach. The recovery approach stems from adult user survivor movements in mental illness that advocate for the rights of service users to a say in their care as equals (Frese & Davis, 1997). The contribution of recovery philosophy to contemporary mental health care has been a shift away from a focus purely on symptom remission, towards a holistic approach encompassing each person’s capacity for meaningful engagement in the community (Davidson, Rowe, Tondora, O'Connell, & Lawless, 2008).
While recovery philosophy informs mental health policy throughout Australia (Commonwealth of Australia, 2009), youth mental health services increasingly incorporate early-intervention strategies (McGorry, 2007; Rickwood, Telford, Parker, Tanti, & McGorry, 2014). These strategies focus on early identification and intervention to minimise duration of untreated illness, whilst maintaining the philosophy and political agenda of recovery (Yung, 2012). The result is progressive youth services that prioritise community-based recovery and offer resources that include, but also exceed, pharmacological symptom management through inclusion of social and function recovery agendas (McGorry, Killackey, & Yung, 2007; Repper & Perkins, 2003).
Facilitating recovery involves fostering health-based identities that incorporate illness as one facet rather than as the defining factor (Davidson et al., 2008). From a social constructionist perspective, fostering healthy identities does not occur in isolation, but relies upon interaction with social conditions that afford health-based identity roles (Wetherall, 2010; Yanos, Roe, & Lysaker, 2010). Therefore, an essential part of recovery services is supporting people to engage in social opportunities that draw upon strengths rather than limitations. This process involves not only working with the individuals receiving care, but addressing the surrounding communities to ensure adequate social opportunities are available (Slade, 2009).
Historically, pervasive social exclusion of those with mental illness has meant working towards community engagement has not been a simple task (Burdekin, 1993). Experiences of social isolation remain common among young people with mental illness (Corrigan, Watson, & Barr, 2006), both as a result of changes in behaviour resulting from their experiences, as well as enduring social prejudices against those who are sick (Link, Struening, Neese-Todd, Asmussen, & Phelan, 2001). Thus, a major focus of the recovery movement has been advocating for the social rights of those with mental illness. This political emphasis stresses the right to equal opportunities of such minority groups and recognises the central role of positive social engagement to every person’s wellbeing.
Music therapy discourse abounds with discussions of musical engagement in the construction and expression of identity. McFerran (2010, p. 61) highlights the importance of identity to humanistic music therapy work with young people. She articulates how music therapists can draw on the affordances of music with young people for performing and identifying with particular self images in the ongoing process of identity construction (McFerran, 2004, 2010). Amir (1999) and Cheong-Clinch (2009) describe the way young people use existing songs for expressing aspects of the self to others in the performance of social identity. Derrington (2005) details how even individual therapeutic song writing offers young people opportunities for negotiating the self-other process of identity construction. She proposes that songs created with the listener in mind act as a presentation of the self to "other. This process aligns with Ruud’s (2010) proposition that musical experience can act as a “virtual performative space” (p. 50) for engaging with identity formation processes.
Other music therapists position the use of music for exploring identities beyond their existing constructions. Burland and Magee (2014) articulate the way music offers young people access to alternative identities such as the performer or creator, that connect to social contexts outside of institutions. From a psychoanalytic orientation Tervo (2001) theorises how young people draw upon musical identities in therapy for exploring fantasies of sexual identity and power. Tervo further suggests that music provides a mode for the projection of identity in processes of personal insight and growth. From a music centred perspective, Aigen (2005, p. 277) details how improvised melodies can be the agent in musical explorations and extensions of the self. He proposes that melodies provide a useful mechanism for identity growth because they afford development and variation without the loss of essential identity. From a mental health perspective, Aigen’s description aligns with recovery processes that suggest a complex acculturation of identity in growing beyond illness without essential loss of the illness experience from the identity construct.
Music therapists working in recovery-based mental health care have described the affordances of musical participation for constructing identities that extend beyond illness to include resources and positive social roles. Reflecting on his work with a young man recovering from mental illness, Solli (2014) describes how music afforded opportunities for agency, and the recognition and building of strengths. Solli argues these potentials of music support the growth of positive identity in “battling against” the limitations experienced in mental illness. Solli aligns his perspective with the Resource-Oriented Music Therapy articulated by Rolvsjord (2010) who has also been instrumental in arguing the potential of music as an inherent resource for those in mental health care. Rolsjord’s work forms part of a larger Nordic music therapy discourse that posits music as a health resource in both working towards and maintaining wellbeing (Ruud, 2010; Stige & Aarø , 2012).
While these insights make powerful arguments for music therapy work with young people recovering from mental illness, there is little research investigating how musical identities fostered through these processes actually play out beyond the therapeutic context. When community engagement and social identity are central to recovery processes, such considerations deserve further exploration and discourse.
Some music therapists have addressed the need for greater community integration for those accessing mental health services, although this discourse has so far been from perspectives of adults experiencing more enduring forms of illness. Odell-Miller (1995) presents some of the early music therapy initiatives for adults receiving community-based mental health support in the United Kingdom. Whilst her descriptions (Odell, 1988) offer a psychodynamic approach congruent with psychotherapy approaches in mental health at the time, her focus on self-directed assessment and therapy by the group members presents the beginnings of service user empowerment that has since been further articulated by other music therapists pursuing recovery approaches. In later discourse, Baines (2003) asserts that consumer driven groups (groups driven by those with experiences of mental illness) offer greatest potential in supporting recovery for those with mental illness. In her study of a consumer-driven music group, Baines found that the community context offered opportunities for people to collect around the common interest of music and draw upon strengths in their capacity to attend and engage – thus strengthening resources and promoting health-based social identities.
Music therapy discourse represents an increasing willingness to step away from traditional institution-based therapy in the search for approaches that best align with the ethos of recovery. Procter (2001) has described how non-medical mental health community services offer music therapists freedom from the dogma of hierarchical institutions in order to foster equitable collaboration with service users. In these facilities music therapy can take on diverse forms offering opportunities for community building in and around music rather than curing illness. In the findings from their study investigating the quality of life benefits for those with mental illness who attend a weekly music therapy group, Grocke, Bloch and Castle (2009) detail how group participants used song writing to unite around everyday social concerns. They allude to the recovery benefits associated with people’s experiences of connecting upon everyday human concerns, promoting engagement in broader society for those typically isolated by illness. Ansdell’s (2010) reflections upon a community music group for adults with mental health problems in East London details how musical communities create opportunities for greater social participation through collective identities and broader societal roles. These opportunities act against traditional sick roles and stigmatising identities often assigned to those with illness.
Community Music Therapy theory is oriented towards social justice through the promotion of inclusive musical communities (Stige & Aarø , 2012). A once highly contested topic (Erkkila, 2003), Community Music Therapy approaches are now well established and accepted among many music therapists worldwide (Ansdell, 2002; O'Grady & McFerran, 2007; Pavlicevic & Ansdell, 2004; Stige, Ansdell, Elefant, & Pavlicevic, 2010). From a mental health perspective, Community Music Therapy appears highly relevant because many of these principles align with recovery philosophy.
Both recovery and Community Music Therapy have roots in Critical Theory, challenging hierarchical ideologies that oppress minority groups and privilege those with power (Lincoln, Lynham, & Guba, 2011). Early recovery activists fought against pervasive oppression of those with mental illness, challenging the dominant paradigm (positivism) in rejecting traditional expert psychiatrist roles, and demanding a culture of plurality and equality in the ways people with mental illness are constructed (Fossey, Harvey, McDermott, & Davidson, 2002). Music therapists orientating towards Community Music Therapy have also critiqued the ways positivism perpetuates disempowerment in everyday therapeutic encounters (Procter, 2011; Rolvsjord, 2004). Whilst not all music therapists who practice outside of a Community Music Therapy orientation necessarily align with positivism, Community Music Therapy presents the discipline’s greatest engagement with challenging the political and social ramifications of positivist practice both in and beyond music therapy. Stige and Aarø (2012, p. 3) open their Community Music Therapy text with the call to attend to unheard voices of subordinate groups, highlighting the potential of music therapists to contribute to broader discourse on social change.
Recovery philosophy and Community Music Therapy are based upon a social critique of illness. Prominent recovery advocate Anthony (1993) asserts that the social impacts of mental illness can often be more difficult to recover from than the biological. Anthony describes how social stigma attached to mental illness, social isolation, and interruption to vocation can present major challenges. From this perspective, the experience of illness can be made greatest by surrounding social deficiencies that fail to support those in need. This critical perspective is mirrored by music therapist Ruud (2010, p. 120) who posits that although health is an individual construction based upon personal values and meaning, these subjective ideas are inherently shaped by the societal forces of macro systems. An early advocate of Community Music Therapy, Ansdell (2002), proposes it is not possible to locate problems entirely within the individual but rather, that issues stem from complex system of interactions between different societal forces. These claims represent the ecological theory in recovery and Community Music Therapy in working to address structural conditions that inhibit full participation in society (Ruud, 2010; Slade, 2009).
A fundamental belief implicit in these theories is the benefit of focusing upon the strengths and resources of individuals and communities. Contemporary recovery philosophy draws upon the strengths-based orientation of positive psychology and focuses on working with the health-based goals and capacities of individuals (Commonwealth of Australia, 2010). Within music therapy, resource-orientation not only stands alone (Rolvsjord, 2010) but is also identified as an essential part of Community Music Therapy. Resources are conceptualised not only from the perspective of the individual, but from a social equity stance – addressing equal rights to community resources (Stige & Aarø , 2012).
At a practical level, recovery-informed clinical care and Community Music Therapy offer fruitful synergy. In both approaches there is an emphasis on equal partnerships between institutions and lay community members. Individual goals are considered in context of the community and usually with a sense of the ripple effect to broader and reciprocal social benefits (Pavlicevic & Ansdell, 2004). In considering how to approach the musical needs of young people recovering from mental illness in this study, a Community Music Therapy orientation was adopted to critically explore the possibilities available in the community and determine what action might need to be taken to support young people’s ongoing recovery of musical identity.
This Participatory project began when young people attending the music therapy program at a youth mental health service entreated ongoing musical opportunities in the community. As the clinical music therapist at the time, I was unable to identify appropriate resources, leading to questions about what services were needed to best support young people’s ongoing recovery of musical identity beyond the service.
I chose a Participatory research approach (based upon Community-Based Participatory Research as detailed by Minkler & Wallerstein, 2008) to align with the agenda of recovery philosophy in refuting positivism and promoting social equity. In her paper addressing emancipatory research practices, Lather (1986) calls for researchers to “practice in their inquiry what they preach in their theoretical formulation” (p. 258). Thus, Participatory research provided a way of engaging with these recovery-based principles both as practical research procedures as well as generating the emancipatory knowledge I sought.
In the first cycle of this project I developed an understanding of the change in 11 young people’s musical identities as a process of recovery of musical identity in mental illness (Hense, McFerran, & McGorry, 2014). In this interpretation, recovery of musical identity involves a final stage of playing out through: presenting musical identity, tolerating musical identity, and sharing musical identity. These findings demanded community-based musical opportunities and the aim of this second cycle became to address the presented need for playing out musical identity in the community. In this cycle, I sought to answer the research question: What community-based music resources are needed to support young people’s recovery? This also contributed to answering the larger research question framing the study, which was: How and why does supporting musical identity facilitate young people’s recovery from mental illness?
This cycle of the research involved iterations of reflecting, planning and acting. Whilst I describe successive methodological processes in this paper, these processes often overlapped and cycled backwards and forwards around each other. This approach is consistent with many Participatory research projects that follow an emergent rather than prescribed design (Herr & Anderson, 2005; Minkler & Wallerstein, 2008).
Praxis, most famously described by Critical Theorist Freire (2014) is a form of increasing critical awareness and action in which people are empowered through coming to know their own oppressive realities. Praxis is said to involve cycles of “critical analysis and enlightened action” (Comstock, 1982, p. 387). These cycles are central to Participatory research approaches. In this project, data collection and analysis was a form of praxis involving collaboration and interaction with participating young people in the music therapy group, community service providers, and the academic researchers. This process was also emergent and based upon negotiations between young people’s needs and the perceived capacity of the community to respond to that.
Data collection and analysis was iterative in that it involved constant movement between gathering information on community-based services and insights from partners; and analysing this information by critically comparing it to the needs identified by young people. Srivastava and Hopwood (2009) describe the qualitative iteration “not as a repetitive mechanical task, but as a reflexive process” (p. 76), and similarly, these iterations were driven by critical insights and questions raised in response to each piece of data. Data was gathered purposively: first collecting insights from young people involved in the study, then targeting all known youth music resources in the area, and later identifying individuals or services who were seen to provide resources related to the needs I was trying to fill. Young people provided insights in person, either individually or as small groups. Community service providers were contacted via phone or email and offered additional in-person meetings, of which five services took up the invitation. Information collected on services was either already publically available on a website or provided freely in consultation with the service. This information included what each service provided, their location, as well as any costs or limitations.
Insights from young people about the types of services needed were drawn up in a table (see Table 1). All data about services was categorised in an excel spreadsheet for analysis purposes, under the headings Organisation, key contact, location, accessibility (transport), what they offer, relevance to young people’s needs (which included rationale for perceived relevance or irrelevance), level of involvement, partnerships, and interactions. Reflexive notes were also kept, detailing my responses to each interaction with community members including thoughts, physical responses and interpretations of the way the community member responded, such as the perceived degree of interest. These reflexive notes were used for critical analysis purposes.
|Forms of Playing Out Musical Identity||Musical Opportunity Needed in Community||Additional Considerations Raised by Young People|
|-Presenting Musical Identity||-Opportunities for playing in public
|-Need to build instrumental skills through lessons
-Lack of funds for lessons
-Fear of judgement from teachers
-The need for instruments
-Desire for public performance rather than intimate musical relationships
|-Tolerating Musical Identity||-Group music experiences
-Regular members for building relationships
|-Wanting support of a music therapist in group environments
-Working with "real" musicians
-Desire for committed members
|-Sharing Musical Identity||-Access to social music scenes
-Going to music events such as gigs
|-Lack of peer networks
-Lack of instruments
-Varying degrees of social confidence
-Need enough instrumental skill to be able to jam with others
-Need for flexibility in attendance if busy
Analysis involved approaching each piece of data with a critical and inquisitive lens. This ongoing process involved asking questions of each piece of data including: What does this information tell me? As well as integrating these new insights into the larger emerging finding – What does it contribute to the constructed findings? And then determining what was needed next: What is it I need to know next? (see Figure 1). Thinking critically involved not taking data at face value but also exploring each contributing person’s context, underlying assumptions, influences, and motives. At times visual mapping was used to explore relationships between emerging ideas and to compare insights about services with young people’s demonstrated needs. At other times I engaged in critical dialogue (Fay, 1977) with the supervising researcher of the project.
Data collection and analysis continued through stages of planning and acting and ceased once I deemed saturation to be achieved. I decided saturation was met once the identified gaps in available resources had been filled or adequately addressed.
Participatory researchers aim to include community members as equal co-researchers to rebut oppressive hierarchies embedded in the traditional research-participant relationship (Israel, Schulz, Parker, Becker, Allen, & Guzman, 2008). Locally, music therapists (Bolger, 2013; McFerran & Rickson, 2014) have chosen the term players to capture the agency of those involved in collaborative processes. Early in this project, three young people reported preferring the term young people and so I have used this term throughout.
Whilst I maintained a philosophy of equality in approaching all young people in this study, involving them in all research processes was challenging. Five young people remained involved at this stage of the project and expressed interest in the outcomes, yet limited time and interest for the processes of data collection and analysis. Other music therapists (Bolger, 2013; McFerran & Hunt, 2008) have noted similar challenges in trying to engage young people in Participatory research processes. In the context of young people’s added mental health challenges my supervisors and I have proposed that the concept of participation needs to be considered creatively (Hense, McFerran, Killackey, & McGorry, under review). These young people chose to participate as an advisory panel, providing feedback and ideas at various stages rather than constant involvement in the practical research processes and attendance at larger board meetings. Five young people each participated in an individual meeting to provide feedback on this project. As their social confidence increased we also met as a group on two occasions. For transparency, research descriptions were written in a way that reflects how I personally guided decisions through critical analysis of all available data. However, these decisions were informed by young people’s feedback which I held with deep respect at all times.
Where young people’s participation was a focus from the inception of the research project, community-based services’ participation evolved as the emergent design progressed. This difference meant that young people had a greater influence in directing the nature of community-based investigations. Given my focus on attending to the voices of young people with mental illness, I felt this emphasis was appropriate. Where service providers were initially contacted for information about the nature of their service, they were offered opportunities for more collaborative participation in the later stage of acting (described below), once this emerged through analysis as an appropriate step to take.
Planning involved mapping the existing landscape. I entered this stage of the research with an assumption that existing services were inadequate and new services would need to be initiated. This assumption was informed by my own experiences as a music therapist in struggling to locate services for young people, as well as anecdotal reports from my colleagues. However, Freire (2014) describes needing to know the reality in order to transform it. In line with this principle, it was critical to thoroughly explore both the existing services and knowledge before working towards any kind of change I perceived as necessary. In line with Community Music Therapy principles, I intended to draw upon existing community resources (Stige & Aarø, 2012, p. 21) and therefore developing awareness of what was available was a critical step.
Mapping took place by gathering information into the spreadsheet (described above) and critiquing all known existing music services for young people in the area. At this stage of the research it was essential to remain open to the possibility that the limitation was in my own awareness of existing services. Information available on these known services was limited, and obtaining further information was not straight forward. In some cases it involved multiple emails, phone calls, and even meetings. This revealed a limitation in accessibility of relevant information and was ultimately important in determining the direction of action.
My interpretation of the data was that although many services existed, they did not meet the needs identified by these young people and appeared better suited to those already thriving in the community rather than those seeking a way to engage. Many services relied upon a high degree of social confidence or musical skill of young people or focused upon those wanting to engage in music as a vocation. However, my interpretation of discussions with these service providers also indicated that many were interested in adapting to better meet the needs of young people recovering from mental illness. This finding represented great potential for taking action through community-based partnerships. The mismatch between the unmet needs of young people, with the enthusiasm of many community service providers suggested a gap in communication and awareness of these young people’s needs. What was most needed was a body that could advocate to such services about the needs of young people recovering from mental illness and facilitate communication and partnerships between these services and institutional settings.
The Youth Music Action Group (YMAG) was initiated to advocate for the musical needs and rights of young people recovering from mental illness. The idea for YMAG was also influenced by other postgraduate research projects in the National Music Therapy Research Unit in Melbourne at the time. Bolger (2013) had identified a need for sustainable music opportunities for young people in the local area, and Murphy (personal communication April 6, 2014) was venturing into a project addressing the gap in music services for young people with disabilities. To add to my colleagues’ thinking, my own interpretation of the data in this study suggested a need for partnerships between institutions and community-based resources rather than the instigation of entirely new and discreet services. The purpose of YMAG was, therefore, to foster a network of accessible musical pathways for young people in the community. It was also about critical awareness building – making community organisations aware of the needs of young people recovering from mental illness. Building critical awareness (Freire, 2014) in the local community was seen as a central step in instigating this social action.
The Youth Music Action Group (YMAG) was created with the following mission:
YMAG was created as a self-sustaining entity that, if needed, will continue after this research project is completed. This information is therefore discussed not in the past but as an ongoing agenda of the present.
The structure of YMAG (see Figure 2) is integral to enabling and enacting the principles of Community Music Therapy and recovery philosophy. YMAG is about networks and thus involves a board of people who are committed to creating social change for young people, or have an interest in young people’s musical engagement. I formed the board by engaging specific members of the community, institutions and service users (young people from the study) and inviting them to contribute ideas and opinions. YMAG began with those working in academia and mental health services, and I have worked to include young people who are recovering from mental illness, music therapists working outside of mental health, mental health workers working outside of music, community-based service co-ordinators, community musicians, and industry professionals.
In line with recovery philosophy the board purposefully aims to demonstrate equality in action by including members and partners from different fields and disciplines. Each board member’s contribution is valued as unique, yet equal.
During the research process it was at times challenging to remain critical, yet collaborative. The intention was to actively work against oppressive traditions of researcher control, to engage community members and young people in collaborative decision making or make my own decisions based decisions upon their input. Yet, there was a need to oversee all the contributions and direction of the project to ensure it best met the YMAG agenda. I grappled with this challenge by mapping each YMAG board member’s (including my own) context and potential agendas; what they stood to benefit from their involvement. Drawing upon literature from ethical leadership (Brown & Treviño, 2006) I acknowledge that my perspective as a researcher afforded a more comprehensive picture of each board member and community partner’s input, and aimed to use this position to benefit the entire project.
The outcomes from this cycle of research are both the formation of YMAG itself and a number of partnerships between the mental health service, music stores, and community-based organisations that have been established for community-based music resources for young people (see Figure 3). These resources cover six different purposes of instrumental lessons, access to instruments, jam groups, song writing and closed groups, hip hop participation, and social music scenes. Whilst the outcomes described here are targeted to meet the needs identified by young people involved in this research project, it is the hope that YMAG will continue to grow after this research project has concluded.
Some young people described a need to continue building their instrumental skills through individual lessons. For some, this was essential in supporting them to engage in more socially oriented groups, and for others it was about engaging with a healthy and normal musician’s social role. Access to funding for lessons was an issue for some young people, while others indicated a need for teachers who were sensitive to their needs. I felt it was not ethically appropriate to ask teachers to contribute their time for free, yet the alternative of drop-in style lessons offered by free youth services nearby was not appropriate for some due to the anxiety associated with unpredictable social encounters and the loss of normal lesson styles. One of these services The Artful Dodgers expressed capacity to book in free private lessons with young people, information they had not previously offered until I explicitly revealed the need for this service. For young people with capacity for funded lessons, I also worked to up-skill two community-based instrumental teachers on basic knowledge of some of these needs of young people recovering from mental illness. The aim is to continue building a network of listed teachers who are sensitive to the needs of young people recovering from mental illness, and where needed, have access to the mental health service for advice.
Nine out of the 11 young people who participated in the study did not have regular access to the instrument of their choice outside of the mental health service. This was seen as a major barrier for many of these young people in continuing their musical engagement in the community. The financial capacity of these young people varied, however, it was common for incomes to be low due to limited employment and the costs of other living expenses such as rent and food. Offering each young person a free instrument was not a sustainable solution. Furthermore, findings from Bolger’s Doctoral research (2013) indicated that young people were more inclined to remain engaged in music projects when they bought in by committing a degree of their own resources and obtained a sense of self-efficacy in the process. We involved the CEO of a major instrument distributer and store, Allans Billy Hyde, and established a Young Musicians program, where young people can access good quality instruments at a significantly reduced cost. The emphasis on musician aims to promote constructions of young people around their personal interests and resources rather than objectifying them by as service users in a mental health system (Minkler & Wallerstein, 2008, p. 30). The Young Musicians program also acts as an entry to a network of musicians for ongoing advice and support.
Young people’s desire for a supportive, yet open jam group in the community has been the hardest to meet, given that group demand often fluctuates and the nature of the group requires trained professionals to dedicate ongoing time. Some of these young people wanted to work with real musicians yet described needing supported experiences that required knowledge of their mental health recovery needs. I met with the community-based service, The Artful Dodgers, to help shape their ideas for new groups. Suggestions involved groups that would accommodate those early in developing social confidence, varying musical skills, or varying interest in performance. I emphasised the social benefits of these groups and meaning of engaging with social music scenes rather than necessarily pursuing music as a vocation. I also connected with the head of an adult community initiative, Weekend Warriors, and we shared ideas to expand the program to include a Young Warriors. I offered suggestions about young people’s needs for flexible and supported performance opportunities, sessions in accessible locations, as well as young people’s limited access to funds to pay for these programs. This program will offer young people supported band mentoring opportunities with a focus on shared music experiences.
Where the above jam groups focus on non-mental health specific groups, facilitated by musicians, some young people described needing closed groups with a higher level of support – the type of group usually run by music therapists or specialist clinicians. This need presented an opportunity to link-in with an existing community-based music therapy group, Aardvark. Previously for those with chronic illness, this group had recently expanded to include those with experiences of illness – such as those recovering from mental illness. This connection facilitates better pathways of referral between the mental health service and this community-based group.
A number of young people described desires to attend gigs and workshops, and get to know other musicians. I conceptualised these activities as engaging with social music scenes in which young people become part of a larger social identity and build their own networks over time (Bennett, 2004). However, it became clear that some of these young people lacked existing social networks through which to engage in these socially-based musical events. We made contact with a local organisation, Freeza, that hosts a network of youth-based free gigs. However, these gigs also require a high degree of social confidence and existing peer networks.
In discussing alternatives, the music store, Allans Billy Hyde, involved in the Young Musicians program offered support through their company’s activities such as meet the artist events, small in-store performances, workshops, and access to gigs and music-based movies. These activities are on a smaller scale than Freeza events and present opportunities for overlap with existing music groups at the mental health service for graded building of peer networks. The Young Musicians program has expanded to incorporate these activities as well as offer ongoing support and advice to young people about instruments and music in general. This music store functions as a music hub in a central part of Melbourne and may be a useful networking site for young people.
The desire to join hip hop-based groups was the only genre-based idea that emerged from young people. I attempted to link YMAG in with a local youth hip hop choir. However, due to high degree of success, this choir had recently closed to new members and there was no possibility for collaboration at that time. A second hip hop mentoring program and studio did not respond to my invitations.
Despite these challenges, I felt it was important to tap in to existing hip hop groups to facilitate a link with the scene (Bennett, 2004) rather than incorporating rap activities into other groups. We contacted the local Phoenix Youth Centre offering a hip-hop drop-in group. This service initially offered limited support for young people with mental health needs and expected a high degree of social confidence and independence to engage. Tapping in to the service’s need for referrals, we suggested a referral system and optional support linkages with mental health services should young people need this. At this time, a female only hip hop workshop series also spontaneously started in another service, and this was added to the YMAG list of potential networks although a formal link has not been established.
Procter (2011) states “music therapy reconceptualised as cultural engagement, is itself empowerment to work not only with individuals, group and community, but with society as a whole” (p. 257). Where the first cycle in this research focused on personal change in musical identity, this second cycle has attempted to contextualise these understandings within larger societal issues surrounding mental health, recovery, and community music opportunities. This shift was not a predetermined focus, but emerged through the cycles of action and reflection that demonstrated young people’s natural outward trajectory with experiences of recovery.
The expansion from a private to social focus with experiences of recovery is not unique to these findings. In a study of music therapists working in Victoria, Australia, O’Grady and McFerran (2007) theorised both the music therapist’s and individual’s focus depends upon the individual’s location along a health care continuum spanning acute illness, through crisis, rehabilitation, community, and wellbeing. They suggest that during acute illness, the focus of the individual remains on the internal experience, but with progression towards wellbeing, the focus becomes increasingly external. According to O’Grady and McFerran, music therapists orientate from private safe individual sessions, through to closed groups, to community-based open musical engagement to match the individual’s experience along the continuum. In this study playing out could be positioned at the community-based stage on O’Grady and McFerran’s continuum. This context both aligns with young people’s external focus on moving their musical identity into the broader social sphere, and supports my response as a music therapist and researcher in considering increasingly open social musical engagement.
While the emergent research design necessitated a shift in focus to broader social issues, the capacity to afford this shift was facilitated by consistent values of the recovery philosophy and Participatory research. The congruence of these principles with Community Music Therapy emerged gradually throughout the project. For myself as both the researcher and clinical music therapist in the mental health service, these realisations expanded my own understanding of the potential of music therapy not only in progression to community engagement, but also within the service itself. Stige and Aarø (2012, p. 90) refer to both geographical and relational domains in conceptualising community. They highlight how distinctions of Community Music Therapy from other music therapy approaches relate to philosophies and guiding values more than clinical practices or settings. Ansdell (2003, p. 3) uses the term “anti-model” in positioning Community Music Therapy not as a particular model of practice but an orientation guided by values of equality and social justice. This perspective illustrates the way Community Music Therapy practices are not dependant upon a community context and are relevant to institutions such as mental health services.
Ecological theory is embedded within Community Music Therapist’s orientations and is also relevant to this investigation. Within the local Australian context few music therapists working in youth mental health describe ecological orientations. However, the systemic thinking is represented in other neighbouring areas. Thompson (Thompson, McFerran, & Gold, 2013) advocates for a family centred approach in working with children with Autism Spectrum Disorder in which the parent-child (and often sibling) relationship is paramount. This approach contrasts traditional forms of therapy in which the therapist’s engagement with the child would be seen as the primary therapeutic agent (Edgerton, 1994; Wigram & Gold, 2006). In reference to their work within school systems McFerran and Rickson (2014) describe “the potential of Community Music Therapy in schools as a shift away from individualised pathologies to fostering flourishing musical cultures within the whole school system” (p. 2). Their work emphasises how individual benefits can be conceptualised as stemming from cultural musical influences, and how music therapists can work with entire communities to foster musical possibilities. In her Doctoral investigation of collaborative music processes with young people, Bolger (2013) suggests ecological assumptions. Bolger takes careful consideration of the role of music within the different contexts of these groups and advocates for greater networks of music within youth community systems. These authors represent different, yet complementary foci of ecological practice and illustrate the different levels at which music and music therapy can be relevant. YMAG contributes another perspective, primarily of peer systems and broad societal participation.
In the context of recovery-oriented work, the construct of social capital (Putnam, 2000) has also been central to the discourse. Procter (2004) has been influential in articulating the relevance of social capital (Procter draws on the definition by Putnam, 2001) to music therapy and his work is frequently drawn upon in discourse of social justice and Community Music Therapy (Baines, 2013; Stige & Aarø , 2012). Procter (2011) has also developed the concept of a proto-social musical capital in which music affords opportunities for generating musical capital through cycles of risk and reciprocity. Procter details how musical capital in micro contexts forms a building block for social capital at meso and macro levels. From this broader ecological perspective, community forms of musical engagement afford the generation of various types of social networks, from intimate homogenous music groups, right through to heterogeneous and loose social music scenes.
The potential health benefits from building social and musical capital stem from research indicating the link between social connection and wellbeing (see Cohen, 2004; Ichiro & Berkman, 2001). As a social critique, if the focus is more broadly on the health of a community or society rather than individuals alone, then social factors must be addressed as central issues (Ichiro & Berkman, 2001). A cohesive society in which there is reciprocity and solidarity between groups is seen to support health through buffering against social stressors (Cohen & Wills, 1985). A cohesive society implies a degree of social capital – through bonding of homogenous groups and bridging between heterogeneous groups that increase access to resources and supports (Stige & Aarø , 2012). Thus, working to build social capital through musical initiatives is one way of conceptualising the intended benefits of initiatives such as YMAG.
YMAG aims to foster opportunities for building different types of social ties. These include close bonding through song writing groups or jam groups; through to opportunities for loose social connections in social music scenes. YMAG also offers opportunities for building and expressing social musical roles. The guitar over the shoulder on the way to a lesson, or building instrumental skills in order to busk in the street, represent opportunities for playing out musical roles. These roles draw upon the culturally defined parameters of musical identities and what they represent in society - a capacity rather than limitation, regardless of where the skill was first developed. YMAG also aims to generate bridging capital through reciprocal partnerships between different areas of communities from institutions, to academics, through to young people, community musicians, and even music industry. Building the musical resources and musical communities may contribute to buffering against the detrimental effects of other forms of oppression, and promote inclusion, reciprocity, and capacity for participation.
Despite researcher’s focus on the benefits of social connection for individual and societal health, Kawachi and Berkman’s (2001) review of existing literature in the area of social connection and health found that some forms of social ties can have mixed outcomes. When close knit groups form around unique traits of difference, the benefits of connectedness and belonging within the group can be accompanied by poor overall social integration when the group identifies as other. In these situations, group members may lack the benefits of reciprocal interactions between social groups and often limit their connections to one type of relationship. Kawachi and Berkman highlight the need for a variety of social ties with a key factor being reciprocity and inclusivity of a range of groups and interactions at the broader societal level.
From the perspective of services seeking to support recovery through social connection, it is important to consider how resources are designed for subordinate groups. Mental health specific groups may support feelings of intimate belonging and connection; however, if these groups are not adequately integrated within a larger network of heterogeneity then the experience may not contribute to a cohesive society. There is perhaps greater need for groups founded on the lowest common denominator rather than the forming of intimate niche groups connected by highly unique features. Music, being common to all humanity, offers an ideal common denominator through which to foster groups that can traverse other social divisions.
At the time of forming YMAG, the Australian Government withdrew large amounts of funding for group-based community services for those with mental illness (Victorian Government, 2012). This decision affected the primary mental health service of the project as well as another partnering community-based service. In the face of diminishing mental health-specific services, one board member noted that all community-based organisations should be held accountable for being accessible to those with mental illness (Cognotto, 2014, personal communication). Barnes & Shardlow (1997) note how too often, in striving to provide rights for service users we simultaneously remove people’s rights as equal everyday, citizens. Perhaps this is another argument for the broadening of services away from mental-health specific, to socially inclusive? In an Australian political climate that is reducing funding for mental health specific community groups, the need for equal citizenship of those also accessing mental health services needs to be emphasised.
The formation of YMAG and its partnerships is a small but important step towards addressing social justice for young people with health disparities in the local community. However, there are remaining issues to be addressed and possibilities for further growth - should YMAG’s momentum continue.
Firstly, the separation between young people and adult board members seems against the ethos of YMAG. Addressing this separation was a challenge in this project when young people expressed hesitations about social situations. Self-directed and graded social engagement was important to each young person’s recovery plan, however pushing this issue for the sake of quality participatory research felt unethical. I hope that in the future YMAG members will find new ways of engaging young people.
Secondly, YMAG could continue to build a network of teachers who are sensitive to young people’s mental health needs and supportive of young people’s own reasons for engaging with music. Suitable teachers are needed across a range of instruments and geographical areas. Offering information sessions and support for teachers would be one way of going about this task and approaching the music teachers industry body could be a useful means of accessing teachers and co-ordinating these sessions.
Thirdly, access to information about services was a key issue throughout this cycle of research. Working to get a YMAG webpage housed on an appropriate website remains in progress. This webpage will include relevant information about existing music services for young people in the community and specific initiatives of YMAG partners such as the Young Musicians program. The website will be for young people independently as well as in conjunction with service workers seeking music resources for young people. YMAG is not funded and cannot commit to ongoing website hosting costs or promotions. Therefore, it is important to find an existing website as the home for this page, ideally within a relevant partnership with another service. Finding ways to promote YMAG will also be increasingly important in order to ensure the website is accessed and the information is shared.
Finally, YMAG needs to find ways to connect institutions with community organisations for greater integration and partnerships. These connections need to stem beyond mental health specifically and consider other minority groups of youth in the community. My Doctoral colleague investigating the gap in services for young people with disabilities has already expressed an interest in taking the reigns of YMAG and seeing what her network can do to continue this YMAG agenda. This transition seems both necessary and timely.
My own Doctoral contribution to YMAG will culminate in a YMAG First Birthday Party to which young people, board members, academics, service providers and community members are all invited. This event is to celebrate the contributions of those involved so far and to welcome in the next wave of partnerships for YMAG’s continued growth. It is hoped that this event will harness the positive energy of many community members committed to music and young people, and inspire plans for future developments in the ongoing work towards social justice.
Although this paper is written in the singular form to accurately portray the level of agency I held as the Doctoral researcher of the project, I also wish to acknowledge that all thinking was deeply influenced by the young people involved in the project, community service members, and members of the National Music Therapy Research Unit. I wish to particularly thank Lucy Bolger, Carmen Cheong-Clinch, and my Doctoral supervisors Katrina Skewes McFerran, Eoin Killackey, Raymond MacDonald and Patrick McGorry.
Aigen, K. (2005). Music-centered music therapy. Gilsum, NH: Barcelona Publishers.
Amir, D. (1999). "My music is me": Musical presentation as a way of forming and sharing identity in music therapy group. Nordic Journal of Music Therapy, 21, 176-193. doi: 10.1080/08098131.2011.571279
Ansdell, G. (2002). Community music therapy & the winds of change. Voices: A World Forum For Music Therapy, 2(2). doi: 10.15845/voices.v2i2.83
Ansdell, G. (2003). Community Music Therapy: Big British balloon or future international trend? In British Society of Music Therapy (Ed.), Community, relationship and spirit: Continuing the dialoge and debate London: British Society of Music Therapy Publications.
Ansdell, G. (2010). Musicing on the edge: Musical Minds in East London, England. In B. Stige, G. Ansdell, C. Elefant, & M. Pavlicevic (Eds.), Where music helps: Community music therapy in action and reflection. Surrey: Gower Publishing, Ltd.
Anthony, W. A. (1993). Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychiatric Rehabilitation Journal, 16(4), 11-23. doi: 10.1037/h0095655
Commonwealth of Australia. (2009). National Mental Health Policy 2008. ISBN: 1-74186-835-1. Retrieved April 12, 2012, from http://www.ag.gov.au/cca
Commonwealth of Australia. (2010). National Standards for Mental Health Services: Principles of recovery oriented mental health practice. Retrieved from http://www.health.gov.au/internet/main/publishing.nsf/Content/CFA833CB8C1AA178CA257BF0001E7520/$File/servpri.pdf.
Baines, S. (2003). A consumer-directed and partnered community mental health music therapy program: Program development and evaluation. Voices: A World Forum For Music Therapy, 3(3). doi:10.15845/voices.v3i3.137
Baines, S. (2013). Music therapy as an anti-oppressive practice. The Arts in Psychotherapy, 40, 1-5. doi: 10.1016/j.aip.2012.09.003
Barnes, M., & Shardlow, P. (1997). From passive recipient to active citizen: participation in mental health user groups. Journal of Mental Health, 6, 289-300. doi: 10.1080/09638239718824
Bennett, A. (2004). Consolidating the music scenes perspective. Poetics, 32, 223-234. doi: 10.1016/j.poetic.2004.05.004
Bolger, L. (2013). Understanding and articulating the processa and meaning of collaboration in participatory music projects with marginalised young people and their supporting communities. (Doctoral Thesis), University of Melbourne, Melbourne, Australia.
Brown, M. E., & Treviño, L. K. (2006). Ethical leadership: A review and future directions. The Leadership Quarterly, 17, 595-616. doi: 10.1016/j.leaqua.2006.10.004
Burdekin, B. (1993). National inquiry into the human rights of people with mental illness. Sydney, Australia.
Burland, K., & Magee, W. (2014). Developing identities using music technology in therapeutic settings. Psychology of Music, 42, 177-189. 10.1177/0305735612463773
Centre, O. Y. H. R. (2013). The OYH model. Retrieved January 10, 2014, from http://oyh.org.au/oyh-model
Cheong-Clinch, C. (2009). Music for engaging young people in education. Youth Studies Australia, 28(2), 50.
Cohen, S. (2004). Social relationships and health. American psychologist, 59, 676. doi: 10.1037/0003-066X.59.8.676
Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98, 310. doi: 10.1037/0033-2909.98.2.310
Comstock, D. (1982). A method for critical research. In E. Bredo & W. Feinberg (Eds.), Knowledge and values in social and educational research (pp. 370-390). Philadelphia: Temple University Press.
Corrigan, P. W., Watson, A. C., & Barr, L. (2006). The self-stigma of mental illness: Implications for self-esteem and self-efficacy. Journal of Social and Clinical Psychology, 25, 875-884. doi: 10.1521/jscp.2006.25.8.875
Davidson, L., Rowe, M., Tondora, J., O'Connell, M. J., & Lawless, M. S. (2008). A practical guide to recovery-oriented practice: Tools for transforming mental health care. New York: Oxford University Press.
Derrington, P. (2005). Teenagers and songwriting: Supporting students in a mainstream secondary school. In F. Baker & T. Wigram (Eds.), Songwriting: Methods, techniques and clinical applications for music therapy clinicians, educators and students (pp. 68-81). London: Jessica Kingsley Publishers.
Edgerton, C. L. (1994). The effect of improvisational music therapy on the communicative behaviors of autistic children. Journal of Music Therapy, 31, 31-62. doi: 10.1093/jmt/31.1.31
Erkkilä, J. (2003). Contemporary voices in music therapy (Book review). Nordic Journal of Music Therapy. Retrieved from: http://njmt.b.uib.no/2003/02/25/contemporary-voices-in-music-therapy/
Fay, B. (1977). How people change themselves: The relationship between critical theory and its audience. In T. Ball (Ed.), Political theory and practice (pp. 200-233). Minneapolis: University of Minnesota Press.
Fossey, E., Harvey, C., McDermott, F., & Davidson, L. (2002). Understanding and evaluating qualitative research. Australian and New Zealand Journal of Psychiatry, 36, 717-732. doi: 10.1046/j.1440-1614.2002.01100.x
Freire, P. (2014). Pedagogy of the oppressed (30th Anniversity edition ed.). London: Bloomsbury.
Frese, F., & Davis, W. (1997). The consumer-survivor movement, recovery, and consumer professionals. Professional Psychology Research and Practice, 28, 243-245. doi: 10.1037/0735-7028.28.3.243
Grocke, D., Bloch, S., & Castle, D. (2009). The effect of group music therapy on quality of life for participants living with a severe and enduring mental illness. Journal of Music Therapy, 46, 90-104. doi: 10.1093/jmt/46.2.90
Hense, C., Mcferran, K., & McGorry, P. (2014). Constructing a grounded theory of young people’s recovery of musical identity in mental illness. The Arts in Psychotherapy, 41 594-603. doi: 10.1016/j.aip.2014.10.010
Herr, K., & Anderson, G. (2005). The action research dissertation. Thousand Oaks, CA: SAGE.
Israel, B., Schulz, A., Parker, E., Becker, A., Allen, A., & Guzman, R. (2008). Critical issues in developing and following BCPR principles. In M. Minkler & N. Wallerstein (Eds.), Community-based participatory research for health: From process to outcomes (pp. 47-62). San Fransisco, CA: Wiley & Sons.
Kawachi, I., & Berkman, L. F. (2001). Social ties and mental health. Journal of Urban health, 78, 458-467. doi: 10.1093/jurban/78.3.458
Lather, P. (1986). Research as praxis. Harvard educational review, 56, 257-278.
Lincoln, Y., Lynham, S., & Guba, E. (2011). Paradigmatic controversies, contradictions, and emerging confluences, revisited. In N. Denzin & Y. Lincoln (Eds.), The SAGE handbook of qualitative research (4th ed.). (pp. 97-128). Thousand Oaks, CA: SAGE.
Link, B. G., Struening, E. L., Neese-Todd, S., Asmussen, S., & Phelan, J. C. (2001). Stigma as a barrier to recovery: The consequences of stigma for the self-esteem of people with mental illnesses. Psychiatric Services, 52, 1621-1626. doi: 10.1176/appi.ps.52.12.1621
McFerran, K. (2004). Using songs with groups of teenagers: How does it work? Social work with Groups, 27, 143-157. doi: 10.1300/J009v27n02_10
McFerran, K. (2010). Adolescents, music and music therapy. London: Jessica Kingsley Publishers.
McFerran, K., & Hunt, M. (2008). Learning from experiences in action: music in schools to promote healthy coping with grief and loss. Educational Action Research, 16, 43-54. doi: 10.1080/09650790701833097
McFerran, K., & Rickson, D. (2014). Community music therapy in schools: Realigning with the needs of contemporary students, staff and systems. International Journal of Community Music, 7(1), 75-92. doi: 10.1386/ijcm.7.1.75_1
McGorry, P. (2007). Welcome to early intervention in psychiatry. Early intervention in psychiatry, 1(1), 1-2.
McGorry, P., Killackey, E., & Yung, A. R. (2007). Early intervention in psychotic disorders: Detection and treatment of the first episode and the critical early stages. Medical Journal of Australia, 187, 8-10. doi: 10.1111/j.1751-7893.2007.00019.x
Minkler, M., & Wallerstein, N. (2008). Introduction to CBPR: New issue and emphases. In M. Minkler & N. Wallerstein (Eds.), Community-based participatory research for health: From process to outcomes (pp. 5-19). San Fransisco; CA: Jossey-Bass.
Odell, H. (1988). A music therapy approach in mental health. Psychology of Music, 16, 52-61. doi: 10.1177/0305735688161005
Odell-Miller, H. (1995). Approaches to music therapy in psychiatry with specific emphasis upon a research project with the elderly mentally ill. In T. Wigram, B. Saperston, & R. West (Eds.), The art and science of music therapy: A handbook (pp. 83-111).
O'Grady, L., & McFerran, K. (2007). Uniting the work of community musicians and music therapists through the health-care continuum: A grounded theory analysis. Australian Journal of Music Therapy, 18, 62-86.
Pavlicevic, M., & Ansdell, G. (2004). Community music therapy. London: Jessica Kingsley Publishers.
Procter, S. (2001). Empowering and enabling. Voices: A World Forum For Music Therapy, 1(2). doi:10.15845/voices.v1i2.58
Procter, S. (2004). Playing politics: Community music therapy and the therapeutic redistribution of musical capital for mental health. In M. Pavlicevic & G. Ansdell (Eds.), Community music therapy (pp. 214-230). London: Jessica Kingsley Publishers.
Procter, S. (2011). Reparative musicking: Thinking on the usefulness of social capital theory within music therapy. Nordic Journal of Music Therapy, 20, 242-262. doi:10.1080/08098131.2010.489998
Putnam, R. (2001). Social capital: Measurement and consequences. Canadian Journal of Policy Research, 2(1), 41-51.
Repper, J., & Perkins, R. (2003). Social inclusion and recovery: A model for mental health practice. London: Baillière Tindall.
Rickwood, D. J., Telford, N. R., Parker, A. G., Tanti, C. J., & McGorry, P. D. (2014). Headspace—Australia’s innovation in youth mental health: Who are the clients and why are they presenting. Medical Journal of Australia, 2000, 1-4.
Rolvsjord, R. (2004). Therapy as empowerment: Clinical and political implications of empowerment philosophy in mental health practises of music therapy. Nordic Journal of Music Therapy, 13, 99-111. doi: 10.1080/08098130409478107
Rolvsjord, R. (2010). Resource-oriented music therapy in mental health care. Gilsum, NH: Parcelona Publishers.
Ruud, E. (2010). Music Therapy: A perspective from the humanities. Gilsum, NH: Barcelona Publishers.
Slade, M. (2009). 100 ways to support recovery: A guide for mental health professionals. Rethink recovery series, 1. London: Rethink.
Solli, H.-P. (2014). Battling illness with wellness: A qualitative case study of a young rapper's experiences with music therapy. Nordic Journal of Music Therapy. 24, 1-8. doi: 10.1080/08098131.2014.907334
Solli, H.-P., Rolvsjord, R., & Borg, M. (2013). Toward understanding music therapy as a recovery-oriented practice within mental health care: A meta-synthesis of service users' experiences. Journal of Music Therapy, 50, 244-273. doi: 10.1093/jmt/50.4.244
Srivastava, P., & Hopwood, N. (2009). A practical iterative framework for qualitative data analysis. International Journal of Qualitative Methods, 8(1), 76-84.
Stige, B. (2002). Culture-centered music therapy. Gilsum, NH: Barcelona.
Stige, B., & Aarø , L. (2012). Invitation to community music therapy. New York: Routledge.
Stige, B., Ansdell, G., Elefant, C., & Pavlicevic, M. (2010). Where music helps: Community music therapy in action and reflection. Surrey: Gower Publishing, Ltd.
Tervo, J. (2001). Music therapy for adolescents. Clinical Child Psychology and Psychiatry, 6, 79-91. doi: 10.1177/1359104501006001007
Thompson, G., McFerran, K., & Gold, C. (2013). Family‐centred music therapy to promote social engagement in young children with severe autism spectrum disorder: A randomized controlled study. Child: Care, Health and Development. 40, 840-852. doi: 10.1111/cch.12121
Victorian Government. (2012). Psychiatric disability rehabilitation and support services reform framework. Melbourne, Australia.
Wetherall, M. (2010). The field of identity studies. In M. Wetherall & C. Mohanty (Eds.), The SAGE handbook of identities. London, UK: SAGE. doi: 10.4135/9781446200889.n2
Wigram, T., & Gold, C. (2006). Music therapy in the assessment and treatment of autistic spectrum disorder: Clinical application and research evidence. Child: Care, Health and Development, 32, 535-542. doi: 10.1111/j.1365-2214.2006.00615.x
Yanos, P., Roe, D., & Lysaker, P. (2010). The impact of illness identity on recovery from severe mental illlness. American Journal of Psychiatric Rehabilitation, 13, 73-93. doi: 10.1080/15487761003756860
Yung, A. R. (2012). Early intervention in psychosis: Evidence, evidence gaps, criticism, and confusion. Australian and New Zealand Journal of Psychiatry, 46, 7-9. doi: 10.1177/0004867411432205