Stage struck – occupational health in the performing arts

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Often called “the original gig economy” because of its casual, self-employed and flexible working practices, the performing arts are an area where occupational health and wellbeing can often get overlooked, if support exists at all. A recent conference looked at the challenges of supporting workers in this often precarious industry, as Ann Caluori reports.

Earlier this year, the occupational medicine section of the Royal Society of Medicine (RSM) held a joint conference with the British Association of Performing Arts Medicine (BAPAM).

The aim was to consider the health and work needs of performers in a range of contexts, as a vehicle to understand how the self-employed might avoid ill health and injury, and its consequences.

About the author

Ann Caluori is communications and events manager at the Society of Occupational Medicine

The discussion encompassed the economics of arguments for provision of support – both for the self-employed and those in the performing arts in a variety of performance types, from music, to dance and to broadcasting. The value of access to occupational health services was highlighted.

It quickly became clear that health in the world of performance raises interesting and unique issues. For example: the blurring of career and identity; the belief that the creation of art and culture is an “organic” process that should not be medicalised; and the prevalence of freelancers in the industry.

Unique working conditions, unique problems

If we look at the career arc of musicians, it is characterised by gigs, often with little or no income, exposure to drink and drugs, and living a lifestyle perceived to be “fun” (perhaps a dangerous idea!). If success comes, there is little information, support or assistance with the escalation of workload; then, after success, comes even less assistance.

The career arc of roadies/crew also has its own unique challenges. Often with no professional or health and safety training, and a lack of any supportive network, they move from one tour to the next, which can damage home life and relationships.

Later life can bring physical problems with a lack of pension or health insurance, and a difficulty finding equivalent non-touring jobs. For both crew and musicians, confusion can arise around the distinction between fun and work, with anti-social working hours often causing isolation.

Health concerns include mental health issues, and the impact on voice, hearing, sight and musculoskeletal issues. Further challenges may include poor diet and a lack of sleep.

Thankfully, some support for musicians is now available (through organisations such as BAPAM, Help Musicians, and Music Support) but this does not include occupational health services for those who are self-employed. This is because the model for occupational health is employer provision or funding through contracts.

This does not only apply to musicians. Radio 4 broadcaster Zeb Soanes gave a performer’s perspective – relating his experience of losing his voice on air and the journey back to health. He noted the “umbilical” link between career and identity, with the psychological impact of facing a potential loss of career.

Performers often “plough on” and can fear that disclosing illness will result in losing future jobs. In Zeb’s case, assistance was provided by BAPAM, which arranged private medical care at a reduced cost and treatments including speech therapy.

Although assistance like this is available, a structured, coherent occupational health pathway is not in place for those self-employed – and performers are often left to direct their own recovery.

The world of broadcasting carries particular threats to health. For example, cameramen and journalists can work in dangerous environments with a risk of conflict, imprisonment and kidnap.

There is also the potential for post-traumatic symptoms as a result of their experiences, and burnout. Added to that are the problems that affect many professions: ergonomics, bad working practices, and night shifts. In the land of television, an emerging area is the treatment of reality TV stars, with high-profile cases of suicide recently making headlines.

Building resilience

Considering the above challenges, promoting an understanding of health and wellbeing during a performer’s formative years in education is a good first step. The network Conservatoires UK (http://www.conservatoiresuk.ac.uk/) has started to play an integral role in this by working to create learning environments that embed health and wellbeing in all aspects of a college or conservatoire’s culture and community, so providing a more positive, holistic approach to health and wellbeing. Health and wellbeing is also increasingly recognised as being essential to sustaining a stable career. For example, Musical Impact (http://musicalimpact.org/network/), a Conservatoires UK-project funded by the Arts and Humanities Research Council, has looked at two questions:

  1. How do the physical and mental demands of making music interact with and determine musicians’ health and wellbeing?
  2. What can we learn from existing international educational and professional approaches to promoting musicians’ health?

In terms of predicting positive health, health-promoting behaviours (such as cooling down after practising) and coping strategies can all link to higher scores of health (plus less fatigue and more sleep), it concluded.

Trinity Laban Conservatoire of Music and Dance has looked at what works and doesn’t work when promoting health in performance education, considering the dancer as an artist/athlete. Among dancers, the main causes of injuries are fatigue, overwork, environment, poor fitness, and psychological problems. Health initiatives at Trinity Laban therefore now include:

  • An onsite health clinic offering for example physiotherapy, acupuncture, massage
  • Treatment “cash for health” plan, triage/remedial care charged at low rate
  • Conditioning studio – yoga, strength and conditioning, Pilates, self-practice
  • Student services – counselling, disability support
  • Educational workshops – mindfulness, coping with stress/anxiety, flexibility training, nutrition for performers
  • Screening and profiling – to assess potential risk of injury, to observe health factors related to dance training, observe the effect of dance training, and to inform and empower students. This is interdisciplinary, encompassing biomechanics, physiology and wellbeing

Trinity Laban found that, when promoting health in performance education, the following did not work:

  • Modules/set of sessions that were stand-alone, elective or not integrated
  • Information that was too theory-based, too general and/or not applied
  • Sessions that took place at the end of the day or with large groups
  • Sessions that were not genre/instrument-specific, and were taught by non-specialists or teachers who did not have an understanding of the performing arts

By contrast, it found that the following did generally work:

  • A whole system approach whereby everyone who teaches the performing artist is, in part, responsible for their health and wellbeing
  • Addressing topics from different angles, at different times and in different ways
  • Making assessment of health and wellbeing part of the larger performance assessment
  • Encouraging health-promoting behaviours (good coping strategies, health literacy, health responsibility and so on), not just sign-posting to where to “get fixed”
  • Robust professional development for all faculty members (including hourly paid) – first aid, new methods of teaching, applying concepts from sports science; effective evaluation of existing support

Why it pays to invest in health

Similar schemes are now being implemented elsewhere. For example, the Royal Liverpool Philharmonic’s musicians’ performance and wellbeing programme examines the technical, artistic, physical and psychological attributes required to enhance and optimise performance. The goal is to create happier and healthier musicians who feel valued, listened to and empowered. Its strategy includes:

  • Health and wellbeing (for example, physiotherapy, injury prevention screening, with musicians deemed high risk helped and then becoming low risk)
  • Optimising performance (for example curating their own programmes)
  • Performance planning, for example looking at performance environments
  • Performance coaching, sponsored by the Jerwood Foundation
  • Individual one-to-ones
  • The development of a greater sense of autonomy
  • Building trust so that individuals come earlier for help

Performance is a competitive market, so it makes economic sense to attract, retain and sustain the talent you are employing. Moreover, investing in health and wellbeing reduces injury and time off means a reduction in costs, as replacement costs for sick performers can be astronomical.

What’s more, a relatively low investment is required. For example, £18,000 for physiotherapy for a whole orchestra, with the total cost of the Liverpool Philharmonic’s wellbeing programme only 1.5% of its total salary bill.

Conclusion

In terms of occupational health provision for this sector, in common with the self-employed more generally, this is currently limited. Initiatives are in place in some areas to enhance provision of work and health advice for the self-employed through training for general practitioners with further training in workplace health.

For this to change, the economic case for investing in occupational health must be emphasised. Is one barrier because organisations engaging freelancers are fearful they are acting like an employer, with tax implications? Perhaps another fear is that occupational health interest might lead to restrictions that could dilute creativity?

Thankfully, attitudes towards investment may well be changing – with the clear financial and other benefits of getting performers back into work they have passion for.

Schemes such as those employed by the conservatoires, demonstrate the way forward – so that budding performers understand the value of health and wellbeing, and can be provided with the occupational health advice and intervention when needed to have a full and fulfilling career.

  •  The meeting was co-chaired by Claire Cordeaux, chief executive of BAPAM, and Dr Robin Cordell, president of the occupational medicine section of the RSM. Further information on BAPAM may be found at: https://www.bapam.org.uk and on this meeting at: https://www.rsm.ac.uk/events/occupational-medicine/2018-19/omm02/

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