Breathe Arts Health Research - Breathe Melodies for Mums

Breathe Melodies for Mums is a ground-breaking group singing and music-making programme that has been clinically proven to reduce symptoms of moderate to severe postnatal depression (PND) in new mothers and improve mother and baby bonding.

It was developed in 2017 by the organisation Breathe Arts Health Research (Breathe), founded by Yvonne Farquharson in 2012, with the aim of increasing the evidence base for the arts and health sector, and consequently embedding evidence-based arts and health programmes into mainstream healthcare provision. Breathe design and deliver creative programmes, underpinned by scientific research, to improve health and wellbeing and see an average of 100,000 encounters with their work per year. Breathe’s evidence-based work is co-designed with healthcare staff, patients, artists, and scientists, to meet specific clinical and wellbeing needs and was one of the first not-for-profit arts and health organisations to be awarded recognition from NHS England. Since its founding, Breathe has been commissioned by over 15 NHS Clinical Commissioning Groups (CCGs) and Integrated Care Systems (ICSs) across the UK to deliver programmes within the NHS.

Breathe’s vision is to design, research, and implement sustainable evidence-based arts and health programmes within mainstream NHS healthcare pathways. Breathe Melodies for Mums, is a 10-week group singing programme for new mothers experiencing symptoms or with a diagnosis of PND and is based on a large Randomised Controlled Trial (RCT) research study entitled ‘Music and Motherhood’. The RCT was carried out by the Royal College of Music and Imperial College London during 2016 and looked at the impact of group singing and music-making on new mothers who have, or are at risk of, PND, compared with creative play and care as normal. After 6 weeks, mothers experienced a decrease of nearly 35% in their symptoms of PND, with 67% no longer displaying moderate-severe symptoms. Singing also led to greater decreases in stress hormones and greater mother-infant bonding. This randomised controlled trial also demonstrated a faster improvement in symptoms – one month earlier than other control groups. By 10 weeks, for those with moderate-severe symptoms of PND, the study found a 41% reduction in symptoms and recovery in 73% of participants taking part in the singing sessions.

The Breathe Melodies for Mums Approach

Hour-long, weekly sessions are designed to be a fun way to boost mood, unwind, and de-stress through singing and music-making. The programme allows mothers to connect with each other in a supportive safe space, establish a structure to their week, and have a positive experience to focus on whilst learning new techniques to support bonding with their babies through song. Sessions are led by a specialist arts and health music lead, using a diverse repertoire from across the world in a range of languages to make sessions as inclusive as possible. Leads build engagement in rounds and multiple parts throughout the 10-weeks, challenging participants artistically and rewarding them with a sense of confidence and pride.

Delivery is supported by a Breathe staff member trained in safeguarding. Programmes are fully funded therefore free to attend, aligned with the NCCH Creative Health Review’s key messaging that the benefits of creative health should be available and accessible to all. Participants are further supported to engage through weekly reminders, signposting to other services in the local area and supporting with travel if required.

Breathe use language focussed on symptoms rather than diagnosis in its Breathe Melodies for Mums promotional materials, such as “low mood”, ‘anxiety, ‘stress’ and “social isolation”, breaking down barriers to participation such as stigma or people not identifying as experiencing PND. By promoting the programme through direct channels such as social media, word of mouth, posters/flyers and apps, Breathe can engage people who may not be connected with services such as those experiencing health inequalities.

The programme was co-designed by Breathe staff, music leads (some of whom have lived experience of PND) and mothers and is continually evaluated and iteratively improved through collection of feedback from participants. Breathe elevate the voices of new mothers by producing case studies, podcasts and films sharing their experience of the programme, empowering others to access support.

“(Breathe) Melodies for Mums was one of the best experiences I’ve ever had and strengthened me into the person I am today - to know that there were other people there for us not only as mothers but as human beings who needed support and compassion, I will be forever grateful to you all…Being a participant in Breathe’s programmes have allowed me to see the possibilities and limitless capabilities I have as an individual when I tap into my creative side.” – Breathe Melodies for Mums Participant

Watch a film about the programme here - Breathe Melodies for Mums Overview Film

Partnership working and links to wider systems

Breathe partner with Children & Family Centres (CFCs) who host Breathe Melodies for Mums sessions. These community assets are staffed by knowledgeable, experienced, social care professionals who not only signpost new mothers to the programme, but also support Breathe with signposting to the other services they provide. Since the programme's inception, Breathe have built an extensive network of local mental health nurses, midwives, specialist health visitors, General Practitioners (GPs), Community & Parent Champions and Voluntary and Community Sector Organisations (VCSOs) to refer to and/or promote the programme.

Since 2017, Breathe has reached over 1000 new mothers and babies through delivery of the Breathe Melodies for Mums programme in three broadly different settings: the community, online, and in Mother & Baby Units.

Establishing different streams of Breathe Melodies for Mums has been determined by a combination of factors: identifying need for the intervention in a borough or community; securing support from referrers in healthcare and in the community; sourcing funding to deliver the programme in the immediate term; and finding funding to secure further research supporting the embedding of this intervention in treatment models in the longer-term.

Programmes have been funded through a mixture of trust and foundation funding, research funding and two commissions - South East London NHS Clinical Commissioning Group (CCG) and Cumbria NHS CCG. Although these commissions were relatively short-term, due to the pandemic they required a pivot to online delivery which enabled the programme to continue reaching new mothers at a time when access to support was challenging and social-isolation was high, leading to research with King’s College London being published on the impact of online singing interventions for PND.

Next Steps

Breathe are proud that Breathe Melodies for Mums is one of three arts health interventions participating in a £2million research programme by King’s College London funded by The Wellcome Trust: Scaling-up Health Arts Programmes; Implementation and Effectiveness Research (SHAPER). This research study is exploring how to scale-up and embed effective arts and health interventions in mainstream healthcare pathways, with findings expected in 2024.

Working in collaboration with the World Health Organisation, Breathe were commissioned to train project managers and music leads in Denmark, Romania and Italy, whose teams were part of an implementation study exploring effective and sustainable strategies for integrating and implementing arts and health interventions within different cultural contexts. Breathe hope to continue to scale this work internationally through sharing best practice and training teams in their approach to translating research to practice in the UK.

The biggest challenge to the future of Breathe Melodies for Mums is securing long-term, sustainable funding. Breathe hope that SHAPER will make a strong case – both clinically and economically – for how evidence-based arts interventions like Breathe Melodies for Mums play a vital role in health and social care systems when embedded, enabling new mothers to overcome barriers to accessing support, and improving their mental health and wellbeing.