Benefits of singing

As SYHO does not require participants to be good at singing, or even to sing at all, this has enabled people to enjoy an experience that is otherwise difficult to find. It was noted by interviewees and also by other participants at the workshops that SYHO actually made a very nice sound much of the time.

Organisers and particularly coaches stressed the focus of SYHO as a place to sing; at its most basic they saw it as an ‘opportunity to sing together’. Mental health or illness was not the focus of the workshops. Participants all regarded singing as key to the efficacy of the model and reported a thorough enjoyment of singing. For many this represented a chance to feel good and express happiness with others. The focus on singing rather than therapy allowed participants to use it as a resource and interpret it however they wished. Some saw it as a fun, low-key opportunity to sing, others saw it as a crucial component to the maintenance of their well-being.

There was a SYHO Songbook, with songs chosen for their uplifting or emotional content and harmonies. The songs were mostly musically simple and quite short. Several participants described the repertoire as ‘world music’ as there were quite a number of short foreign-language songs. This variety of songs was welcomed by all participants. The songbooks were kept by the coaches and handed out at each session. The songbooks were regularly edited and updated. The way of teaching meant that reading was not essential. One blind participant found this particularly important, saying, ‘If it was just a book and told to turn to a page, then couldn’t do it. They build up a song line by line and they repeat it.’

All interviewees reported positive effects on their mental health from participation in singing together. For some it represented one component of a wider programme of support. For others it stood out as key to their recovery or the maintenance of health. Participant 1 called it a ‘life saver’ and ‘the key to my recovery … the single most important thing for me’. Participant 2 noted, ‘Without SYHO I wouldn’t be here, I wouldn’t have managed.’ Participant 4 said, ‘SYHO saved my sanity that year.’ The combination of singing and social engagement produced a feeling of belonging and well-being that often lasted for more than a day and, as a weekly engagement, gave ongoing structure, support and contact that kept them at a higher level of functionality and their moods better than they would be without. More specifically, participants explained that singing was, for instance, a form of communication that was safe, that it enabled them to express emotions in a supported environment and communicate in a socially unthreatening way. For many who had a history of social anxiety, this was highly valued and the majority of interviewees reported a significant improvement in social skills and confidence.

A common theme was the change in mood brought about by singing in the group. For example, one participant said, ‘It gives you a real feel good factor and really lifts you.’ Another said, ‘My husband says – you always come home smiling, and probably singing as well when you come back from SYHO …. I feel different … it’s done me some good.’ Another participant said, ‘I always come out on a high … sometimes I don’t want to go, but I make the effort and am always glad I did…. it definitely lifts the mood’. Another said, ‘It builds self-esteem and protects against relapses. It gives people a lift …. I did CBT etc. but didn’t get on with it. But this is actually doing something that’s having an effect.’ The organisers stress there is no serious intent to the singing in SYHO, it is for fun. This was repeated many times in different ways by most participants. They used words like ‘joy’ and ‘happy’, ‘funny’ and ‘silly’. Making mistakes and laughing together about them was part of the experience. For many participants, it was 90 min in the week when they are happy.

Physical benefits to singing were also mentioned by a few participants. One participant reduced her asthma medication after being in SYHO first and then joining other singing groups. Another had found singing helped with rehabilitation after a brain tumour in helping relearn speech. Another mentioned that he had learnt to breathe better at SYHO and that this had been very important to him. One interviewee noted that she had learnt to breathe out and that this had been significant in helping deal with long-term anxiety attacks.

The coaches particularly stressed that SYHO was not a choir. Specifically, the workshops did not rehearse towards performances so there was no expectation or pressure to perform to any particular standard on any given day. Singing was central to the workshops, but the quality of the sound produced by the group was considered only in terms of the best the group could achieve on that day, rather than according to standards of musical excellence. The quality varied from week to week. But as coach 2 said, ‘Their best is always good enough. We wouldn’t want them to feel that they have to be different from that.’

SYHO groups have sung in public on occasion but only with the understanding that the open principles would be maintained up to and on the day of performance and participants were free to engage or not. For example, a public performance in Norwich Cathedral Cloisters was flagged by several as a significant high point of the year or even of their lives. Many interviewees reported thoroughly enjoying these events but also appreciated the low commitment of the SYHO model.

Once participants had taken the step of joining in with SYHO, they were then led by the singing coach. This balance between taking the initiative and being carried by the structure was empowering. Organiser 2 said, ‘You all draw breath together. It’s unlike a conversation where one person goes, and then the other. Producing the same sound together with others and making music, just with the voice, there is a kind of magic in it.’ Coach 1 said, ‘You often see a look of amazement on people’s faces, like we did that. It’s easy to do, but we did this big thing together.’ Several interviewees noted that working together towards a single, achievable goal was a ‘win’ and, as such, empowering. One participant noted that ‘the singing somehow unites you’. For many, this feeling of being together was stronger through singing than it would be in a group that was just social.

Holding a tune in this semipublic way can be a boost to self-confidence. One of the coaches gave an example of an occasion when there was only one man present at a workshop. He was quite shy and was given the option of joining in with a set of ladies, but chose to hold the bass part on his own, with support from the coach. At the end of the session, coach 1 reported that he said, ‘Thank you for that. It was the first time I’ve felt like I really mattered.’

It was reported by several organisers and coaches that singing in the group had helped participants ‘remember’ parts of themselves that are well-functioning. Through engaging, some people had rediscovered lost aspects of themselves. One participant ‘remembered’ that she used to play the violin and started playing again. Her family told the coaches that she had been considerably more like her old and happier self as a result. A coach said: ‘I have witnessed an almost immediate growth in stature when a former singer recovers that part of him/herself which is able to do something well (possibly better than their carer) and own some pride and sense of identity.’

Inclusivity

Organisers saw SYHO as a space that welcomes current and ex-mental health service users as its main target audience, but openness to everyone was the goal. Issues like the accessibility of the venue and the welcoming ethos ensured this outcome was achieved. The aim was to provide a safe environment in which there was understanding of the varieties of mental ill-health and the needs that may arise with such conditions. There was a wide community of occasional attenders, of whom around 120 people each week attended the four different workshops. Two-thirds of participants had had contact with mental health services. With no fee, no pressure to rehearse towards a performance, no questions asked about background and no audition, the workshops were low commitment.

Openness was a key theme in participant interviews, with over half of the respondents noting SYHO’s inclusiveness. One participant said, ‘Lots of things say they are inclusive but aren’t really. SYHO really is. There are no cliques, no animosity, no competition.’ Another said, ‘It all goes back to a feeling of being part of something; to that feeling of inclusion. Some choirs can feel like the opposite. I’ve been in choirs that make people feel they’re not up to scratch – that wasn’t the intention but it was the effect.’ More diverse behaviour was accepted in SYHO workshops than in more mainstream singing groups. For instance, a person who made undifferentiated sounds throughout may be accepted by other participants if it were recognised as a ‘happy’ noise or one that was not intended to be disruptive. It was for this reason that SYHO was described as a workshop, rather than a choir.

For many participants, the low commitment model was very appealing. One said, ‘This was probably somewhere I didn’t have to come every week and no one would ask questions’ as an important advantage. This participant had a fairly high commitment to SYHO and had been attending for some years on and off as part of their programme for managing mental health problems. The safety of SYHO was key for many people. One participant said, ‘I felt OK from the start. I didn’t have to justify taking a break. I didn’t have to say … I could just nip out.’ Another participant, who had joined SYHO during a breakdown when signed off from work but had since returned to work, said, ‘Without SYHO there wouldn’t have been a recovery … I would never have got back to work … it really was that significant … without them I couldn’t have done it … I didn’t realise how bad I was …. If the advert had been worded differently, about mental health problems, I wouldn’t have gone.’ For some, the absence of pressure to give personal information was a significant factor in first coming to the group.

For people who do not have lived experience of mental distress, SYHO acted as public education. Most people ordinarily would not engage with others who behave a bit unusually. But singing together ‘softens the edges round people’ (organiser). Some people found it too strange and had not stayed for that reason. But for others it changed their perception of who is too strange to engage with. They might have been singing with someone happily, and then spoke to them in the break and found out they had been referred by their doctor. According to organiser 3, ‘It opens the door to being with people you might never have been together with before.’ For this reason, some student doctors and nurses had attended SYHO as a small part of their training. At SYHO, no one was identified as a service user, and no one labelled anyone else. This meant that friendships had been formed between professionals and service users that would have been almost unthinkable in other circumstances. For example, the chair of the Mental Health Trust reported sitting next to a service user who helped her. Neither knew who the other was. This kind of contact changed relationships and reduced stigma.

Social capital

All interviewees said the social aspect was a vital component of the SYHO model and a reason why it worked for them. Many cited SYHO as an important turning point in their lives. For instance, one man who had been attending for a few months said that ‘there have definitely been changes since going’ and went on to say that because of gaining confidence going to SYHO he had started going to other social and creative groups. Another noted, ‘I’m left happier so more confident. I know more people and have new friends and contacts.’ And another in a similar vein, ‘It’s given me a lot of confidence. I was scared and anxious and I was only used to unfriendly people. I got welcomed, the people were very nice. The coach gave me eye-contact and wanted to know my name and was considerate to me. She went out of her way, which is what she does for everybody. I really enjoyed it.’

People found there was a camaraderie in singing together, and particularly in singing different parts in smaller groups. There was a physical closeness that people exaggerated in leaning towards each other, listening to the parts and helping others by singing the parts they remembered when others did not. One person remarked, ‘You lean in bodily with your own group. This is bonding and I find this very valuable.’ So although each person was responsible for the sound they made and for joining in, this helping and being willing to receive help increased the sense of being in something together. It also, and perhaps crucially, represented a model of good communication which seemed, in many cases, to rehabilitate the ability to develop relationships which people could then transfer to their lives more broadly.

Organisers in particular, but also a few interviewees, noted that people had formed friendly relationships and sometimes friendships with people they would otherwise never have had social contact with. This had, for some professionals, greatly enhanced their sympathy for service users. For some service users, it had helped support self-esteem as they had found themselves able to engage socially with people, both mental health professionals but also people they thought of as ‘ordinary’ or ‘normal’, on an equal social footing. One participant noted, ‘You talked to everybody, it didn’t matter who they were …. We were all in this together.’ The inclusivity of SYHO enabled several interviewees to feel acceptable whereas they had experienced exclusion and/or alienation in other social groups, ‘When I joined I felt like an outsider because of what was going on inside. With SYHO I felt much more at ease with myself.’ For some it had been the beginning of greater engagement with others, both in SYHO and more widely.

The tea break halfway through the workshop was an important part of the structure. It allowed people to engage socially with low intensity on ordinary matters. There was initially some resistance from the organisers to a refreshment break, due largely to logistics, but the original coach insisted and it was swiftly recognised as an essential aspect of the workshop. She said, ‘When we finally did it and sat down, I said to the organiser, “listen to that”, and there was this amazing sound, “that’s people talking to each other for the first time.”’ Before this, there had just been a 10 min loo break and no one had spoken to each other. Now, coach 1 said, ‘They understood that it wasn’t about the tea, but you need the tea as a prop. It was just ordinary talk about what tea you want? Do you want a biscuit? … but people also start talking about their mental health, things like, “when were you sectioned?”’

The tea break was an element of ordinary pleasure, mentioned regularly by organisers and participants as vital to the model. It allowed them to engage socially, have a break from singing, quench thirst or take a break from the group. A few interviewees reported that they had found the tea break challenging due to social anxiety. But the high acceptance of unsociability within SYHO and the lack of pressure to speak meant that all those interviewed had come to value the break and some to view it as a place to gain social confidence. Some additionally saw it as a chance to have nice tea and chocolate biscuits that they would not otherwise have. A few also noted that being served made them feel valued. It also gave people concrete roles within the group. Everyone could wash up or put the kettle on or pass around the biscuits, and people could grow in these roles.

Coach 1 talked about the role of the annual gathering of the whole network:

One way in which the Big Sing helps further is in offering an extended sense of this immediate family – including all the distant and lesser known ‘relatives’, who, despite not knowing the individual, nonetheless hold this same ‘family’ ethos of acceptance and therefore expand this feeling of safety and a place where you can be the whole of who you are. Of course in time, it’s wonderful if people do recover a sense of their healthy selves and become more recognisable to their family, but in the interim phase, it is essential to feel this sense of another family who are not waiting for you to feel better before they can relate to you.

While a sense of community may often be important in any singing group, in SYHO, the community was especially important because for many participants contact with others was one of the biggest benefits they experienced.

Support and self-help

An important feature of SYHO was to provide support for people who were experiencing distress. Alongside the singing coaches, there were usually others present who were on the lookout for anyone who was distressed or disruptive or otherwise experiencing symptoms of mental ill-health. These were participants of any background, experienced in being with people presenting with mental health problems. Those supporting other participants were knowledgeable and able to contact services and carers where necessary. Participants willing to take on greater responsibility within the group were increasingly encouraged by SYHO to take Mental Health First Aid training (run by MIND), so they had greater awareness of what may have been going on for other participants and knew the basics of how to offer assistance. Support in SYHO was experienced as being welcoming and participants felt emotional behaviour was acceptable. Most of those interviewed experienced this support as coming from the coach and other participants. Those also on the committee were aware of a somewhat more formal arrangement, but in fact, much of the support was gained from the group as a whole.

The aim of SYHO was that the organisational aspects of the workshops would be user-led where possible. Several of the interviewees had been on the organising committee for their group, and others made a point of helping with particular tasks such as making tea, bringing biscuits and putting chairs out. Four participants credited helping, along with the singing, as crucial in regaining their mental health. SYHO offered roles to any participant who wanted to take on any degree of responsibility. For some, this might be as simple as washing up, while others had taken on more substantial positions of responsibility on committees and a few service users had gone on to be key organisers and developed skills in management, public speaking and fundraising. Getting involved in organising provided the benefit of self-efficacy and positive feelings about helping others. One person said, ‘Gradually, as I got more and more drawn in and asked to do things, you feel you need to give more commitment and by giving more commitment you find you’re more satisfied.’