Arts on Prescription: What the Term Means and How a Place Is Arranged

Arts on prescription is a referred place on a time limited creative course, normally arranged through a social prescribing link worker and normally free to the person attending. Nobody writes a prescription, nothing is dispensed, and it is not a regulated therapy. The name is a metaphor that stuck, and a good deal of the confusion around the subject comes from people expecting the formality the word implies.

I found out how the money works by accident. A link worker rang to ask whether I could take two people into a singing group I run, and when I asked who was paying for the places, it took four phone calls and a fortnight to establish that the answer was a grant, in its final year, from a fund that had already announced it was closing. Nobody was hiding anything. It was simply that the person making the referral, the person running the group, and the person paying for it were three different people who had never spoken. That is the shape of this sector far more often than the shape in the policy documents.

Where a claim about effect appears below it carries a tier (Tier 1 supported, Tier 2 promising but limited, Tier 3 practice and anecdote), explained on reading arts in health research.

What arts on prescription actually is

It is a course, not a treatment: usually 8 to 10 weeks, weekly, a couple of hours a session, run by an artist or a facilitator, with a fixed end date.

The 2024 systematic review of the field looked at programmes in Australia, Denmark, Sweden, the United Kingdom and the United States, and found that most ran in that 8 to 10 week range, in community settings, arts venues, GP surgeries, primary healthcare settings and in one case a school, covering a wide range of activities¹. Painting, ceramics, singing, writing, photography, gardening and museum visits all appear under the heading.

The fixed length is a design decision rather than an accident, and it is the thing participants most often find difficult, because the ending tends to arrive at about the point where the group has become the reason to leave the house. What a ten week arts course involves goes through the shape of one week by week. Some schemes are built around a specific venue type, such as museum prescriptions, and some around a specific condition, such as singing for lung health, which is an unusually well defined intervention compared with the rest.

What it is not

It is not arts therapy, and the two are separated by regulation rather than by quality.

Arts on prescription sits on the unregulated side of the field’s central divide. There is no assessment, no clinical goal, no notes, no clinical supervision of the person leading it, and no protected title. Art therapy, music therapy and dramatherapy are clinical interventions delivered by practitioners registered with the Health and Care Professions Council, described on music therapy and art therapy. Community dance and dance movement psychotherapy split the same way, on dance and health.

Both halves help people. What does not follow is the transfer: a result established about a regulated therapy is not evidence about a community course, and vice versa. That transfer is the single most common error in this field’s own literature, and it usually travels from the trial to the class rather than the other way.

It is also not a prescription in any sense that carries entitlement. There is no national standard for what a scheme must offer, no waiting time target, and no guarantee anything exists near you.

How a place is actually arranged

The route is a referral to a social prescribing link worker, and the ask that works is a specific one.

In England the link worker role sits with primary care networks, and the National Academy for Social Prescribing is the body that describes what those workers do and what they can and cannot arrange². The link worker is not a therapist and does not assess you clinically. They have a working knowledge of what is running locally and they make the connection.

The practical difference between getting somewhere and not is almost always the specificity of the request. Asking a busy GP whether there is anything creative available tends to produce sympathy and nothing else. Asking to be put in touch with the social prescribing link worker attached to the practice, by that name, tends to produce a phone call. Many services also accept self referral. How to get referred to an arts scheme sets out the exact wording, and social prescribing explained covers the wider scheme that arts sits inside.

What the evidence actually shows

There is a great deal of description of arts on prescription and very little test of it, and the most useful single fact about the literature is a negative one.

The 2024 systematic review screened 7,805 records and included 25. Of those, 10 were qualitative, 7 were mixed methods, and 8 were quantitative studies using uncontrolled before and after designs. In the review’s own words, no randomised controlled trials were identified in the search. The quantitative studies were all rated medium quality, most commonly for an absence of comparator groups; exactly one included a treatment as usual comparison. The pooled analysis found a statistically significant improvement in wellbeing, and the narrative synthesis described promising but unconfirmed signals on anxiety and depression¹.

That combination puts arts on prescription at Tier 3. Not because nothing was found, but because a pooled result built entirely from uncontrolled before and after studies cannot separate the activity from time passing, from regression to the mean, from who chose to enrol, or from who stopped attending before the second questionnaire. People sign up for these courses at a low point, and low points are usually followed by better ones whatever happens next.

Two things need saying alongside that, and they pull against each other. Tier 3 is not a verdict of “it does not work”: it means the question has not been answered properly, and here the reason is structural rather than suspicious, since these programmes are hard to randomise, run on short grants and are delivered by organisations whose money goes into delivery. And the qualitative half of that literature is not nothing. Social connection, psychological benefit and routes onwards were the consistent themes across the included studies¹, and people describing what a course did for them are reliable witnesses to their own experience even when the design cannot prove causation.

The savings figures, traced to the document they came from

Three numbers dominate the economic case for arts on prescription, and all three come from one uncontrolled evaluation of one scheme.

The source is a cost benefit summary of the Artlift scheme in Gloucestershire, written by a GP in December 2011, covering 2009 to 2012. It analysed 90 patients out of roughly 500 referred over three years, with no control group, and it describes itself in its own conclusion as “a simple observational study” that “does not imply causality”³. Read the document itself and the three figures come apart:

• The 37% reduction in GP consultations is the months 7 to 12 figure: 11.3 consultations a year before, 7.1 in the second half of the year afterwards. The report’s own full year figure, printed in the same section, is 24%.
• The 27% is a reduction in overall NHS spend, from £157,473 to £115,050. It is repeatedly quoted as a reduction in admissions. Admissions do appear in the report, as 54 before and 33 after, with no percentage and no significance test attached, which is the most likely origin of the misquote.
• The per patient saving is built from two figures with different denominators. The report divides £42,423 of observed spend reduction by the 90 patients analysed to get £471 per patient, adds £105 of GP time saved, and sets the total of £576 against a cost of £360, which is £180,000 divided by the 500 patients referred. The difference between those two is the saving figure people quote. Its numerator and its denominator describe different populations.

None of that makes the scheme bad or the author careless; he wrote the caveat himself, in the document, and it has simply been dropped by everyone quoting him since. Combined with the 2024 finding of no randomised trials anywhere in this literature¹, it puts every economic claim about arts on prescription at Tier 3. The full trail, including how the figures travelled into policy documents, is on does arts on prescription save money, and the wider question of what a policy report is for is on creative health policy and reports.

How other countries organise it

Other national schemes are documented in far more detail than the UK ones and are still not tests of whether the thing works.

Sweden. Region Skåne has run “Kultur på recept” in at least four distinct phases, and the numbers quoted for it belong to different ones. The original pilot ran from 1 November 2009 to 31 December 2010 at one health centre in Helsingborg, with 24 participants in three groups⁴. The second phase, from January 2012 to December 2014 in Helsingborg, enrolled 187, with 123 in the published twelve month follow up cohort⁵. A third phase ran in primary care in 2020 to 2021. The fourth, a Malmö research study running from September 2021 to May 2024 across 18 health centres and 9 cultural institutions, referred 198, started 128, completed 112 and lost 16, with a median age of 61⁶. Four different numbers, four different studies, fifteen years apart, and they are routinely quoted with each other’s dates. All of it is programme evaluation and cohort work rather than controlled trial, so Tier 3.

United States. Mass Cultural Council’s CultureRx is the best known American scheme, and the figure attached to it in most coverage belongs to something else. The pilot involved 8 cultural organisations in phase I and 12 in phases II to IV. The “more than 300 cultural organisations” quoted everywhere is real, and it counts organisations signed on with the statewide Art Pharmacy programme for FY24 to FY25⁷, not the pilot cohort. Using it as the pilot’s size overstates it around twenty five times over. The programme also self reports more than 1,940 prescriptions across phases I to IV⁸. The independent peer reviewed evaluation of the same programme reports much smaller numbers for the phase it covered: 12 cultural organisations, 20 healthcare providers, 414 referrals, 363 participants, and participant data on 84⁹. Where the self reported figures and the evaluation disagree, the evaluation is the citation of record. Tier 3.

Arts on prescription around the world compares the UK, Nordic, North American and Australian schemes with what is documented for each.

Who pays, and what happens when the money stops

Arts on prescription is free at the point of use to the participant and funded by somebody else, on grants that end.

That is the sector’s defining practical problem and it is barely mentioned in the material that promotes it. Schemes are typically assembled from health commissioning, local authority money, arts funding and charitable grants, and the grants are short, which is the fact most often left out of the material promoting them. The National Centre for Creative Health is where most of the sector’s own reports and case studies are gathered¹⁰, and reading a few of them in sequence is an education in how many named schemes no longer exist.

For anyone deciding whether to pursue a place, the useful question to ask a scheme is not how good it is but how long it is funded for, and what happens to the group at the end. Who pays for arts on prescription covers commissioning and what happens when the funding ends, and starting an arts programme in a care setting is the practical version for anybody thinking of running one.

Nothing here is a reason to change anything about anyone’s treatment, and a place on a creative course is not a substitute for one.