Six mental health factors to consider when caring for creative patients

The tortured artist is a common trope, with famous examples throughout history of creators who had psychiatric problems. Should healthcare professionals be on the lookout for symptoms of mental health disorders in artists?There are some differences about this patient population that healthcare professionals should know in order to provide appropriate support throughout an artist’s life. This includes people who are performing artists, such as musicians, dancers or actors; people in visual arts such as graphic designers or painters and also people who are architects, designers or writers.The first thing to realize is that it’s a myth that they have more mental health problems than people in other professions, said Jennifer Robinson, a clinical psychologist and dean of students at the Ontario College of Art and Design (OCAD) University in Toronto.“In general, the profile of mental health in artists is very similar to the general population,” Dr. Rebecca Shalansky, a family physician and psychotherapist at the University Health Network’s Al & Malka Green Artists’ Health Centre in Toronto. For example, like in the general population, anxiety disorder and depression are the most common presentations, she said.Yet there are certain factors or traits that could contribute to poor mental health. Socioeconomic factorsMost people in the creative industries do freelance work, with contracts, gigs, assignments and commissions coming in at various times. This could lead to financial instability, a situation exacerbated by the COVID-19 pandemic. Dr. Shalansky advises healthcare professionals to check in with patients in the creative industries to see how they are doing financially. There may be community resources or programs that can help them, such as groups that help find grants for the arts.Artists may also experience isolation more often, Robinson said. They are frequently alone while creating their work or rehearsing and sometimes have fewer links with the wider community. For all patients, screen for adverse childhood experiences, Dr. Shalansky said. Having one or more adverse childhood experiences is a risk factor for poor mental health.“I’m always surprised to see the amount of trauma people have faced in their lives,” Dr. Shalansky said. “Whether artist or not, screening for trauma or adverse childhood experiences can be very eye-opening in the way that we understand our patients.”Read: After a stroke, this musician found his singing voice again with help from a special choirExternal validationIn general, the way to make a living as a creative is for someone to pay for your work. As such, an artist’s work needs to be accepted by society, or at least by the person paying for it.“Something unique in the artist’s field is the requirement for external validation,” Dr. Shalansky noted. “There’s that stress in needing to please others and receive that external validation.” Artists need to balance the need to please in order to make a living while avoiding having one’s entire self-worth dependent on external validation, “because that can lead to distorted views or striving for only external validation and not having the internal confidence as well.”Emotional intelligence and an openness to talk about mental healthPeople in creative professions need to access their emotions for their work; there is often no separation between work and home life. It also means artists are in tune with their emotions, Robinson said, noting students at OCAD tend to be comfortable talking about mental health.“There’s more openness and ability to articulate mental health experiences,” she said. A higher intensity of emotion or emotional experience that comes with a higher emotional intelligence might be present.It’s also important not to mistakenly pathologize an artist’s emotions. “If someone is coming in and they’re very articulate about their mental health issues, and their emotions are at the surface all the time as a vehicle for their practice, it could be interpreted as mental health issues, as opposed to putting it into context,” Robinson warned. To differentiate between a mental health issue or someone who is attuned to their feelings, use evidence-based, structured assessment tools to diagnose, Robinson advised. Physical injury or creative blockArt is very dependent on being physically able to do that art, especially for performance artists. Many artists are self-employed and a pause from work to heal can take a serious toll on their finances, increasing the stress associated with an injury.The Al & Malka Green Artists’ Health Centre in Toronto is an interdisciplinary family medicine clinic that has a number of healthcare professionals who can treat artists both for physical and mental health. They also provide virtual appointments for residents of Ontario. If an artist is suffering from a creative block, consider referring them to therapy. Read: Updates in the management of behavioural and psychological symptoms of dementiaPerfectionismA trait common in artists is perfectionism, where a person will spend hours and hours honing their work. There’s a link between perfectionism and imagination, and artists want to recreate their vision into real life.“Creators can be prone to obsession to perfect a piece, and obsession is not healthy when it comes to mental health,” Mel Padron-Golding, a U.K. psychotherapist said in an article in It’s Nice That, an online news source for graphic designers. “It can lead to the feeling that it’s never good enough, and in turn ‘I’m not good enough’.” Padron-Golding works at Blue Rhythm, a U.K. clinic that specialises in mental health support for creatives. The British Association for Performing Arts Medicine also provides counselling for artists in the U.K.At times, this quest for the perfect can lead to a creative block. Other times, it means the project takes over the artists’ life and seriously impacts wellbeing and relationships.InterventionDr. Shalansky works with artists using cognitive behavioural therapy.“Often in anxiety and depression, people will have thoughts that are skewed towards the negative or the pessimistic stream,” Dr. Shalansky explained. In an anxiety-provoking situations, “that extreme thought becomes their perception of reality and that’s what causes the stress or uncomfortable emotions.” In working with patients, “we try to look at facts; facts that maybe support that thought but also facts that go against that thought and ask if that’s actually the reality or is there a more balanced truth to what is actually going on to relieve the stress of the more extreme or exaggerated thoughts.”Emotional regulation and normalizing emotions should be promoted, Robinson said. Dialectical behavioural therapy has skills training that includes emotion regulation.Padron-Golding suggested that therapy can help artists set boundaries, so they aren’t consumed by their work. While it's difficult to learn how to ‘call it a day,’ “discipline is a skill that can be learned.” It can also help examine issues, such as low self-esteem, that may be behind the perfectionism.One way to deal with the outside stressors of the creative industry is to promote resiliency training, but a pilot program promoting resilience training was rejected by students at OCAD, Robinson said. The feedback from students was that the program was implying there’s something inherently negative to be combatted in their creative work and lives. Instead, students wanted practical support in managing the unique stressors artists face, such as community resources to support with financial goals and ways of combatting social isolation.In 2023, the Public Health Agency of Canada funded a $4 million initiative at OCAD and other art and design schools to promote mindfulness. In 2024, OCAD used funding from the McCall-McBain foundation to launch a student-led peer support program, that aimed to address “the key root causes of anxiety, depression and poor mental health and provide better support for those with greater needs or lesser access to resources.”Read: New Canadian consensus recommendations for managing chronic insomnia

Six mental health factors to consider when caring for creative patients

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