How does participation in clinical mental health services and community arts programmes for mental health influence the expression of Mental Illness Identity (MII) among individuals with chronic and serious mental health difficulties?

Background: Growing evidence points to the benefits of community-based participatory arts for mental health. Such non-clinical interventions differ from traditional interventions for mental illness, which are typically situated within clinical statutory services. Clinical intervention can emphasise a sense of ‘patienthood’ and Mental Illness Identity (MII). MII is said to be dynamic, and further understanding of the factors influencing it is warranted. Aim: This study explored themes of MII and hopes for recovery in people with long-term mental illness, who have accessed both clinical services and a non-clinical arts programme for mental health. Method: A four-week Photovoice methodology was used with nine participants recruited from a community mental health arts group. Three discussion groups and four follow-up semi-structured individual interviews were carried out. Data was analysed using reflexive thematic analysis. Results: Four themes were identified: Navigating identities: the struggle between mental illness and the whole self; Hierarchy, power and positioning; Performing the patient role; and Teetering between hope and hopelessness. This study highlighted the dynamic nature of MII, which was mediated by interpersonal and environmental factors within each intervention setting. Conclusion: The informal, non-hierarchical arts setting offered a safe, consistent space that contrasted with the outcomes-focused and time-limited nature of clinical care. This allowed participants to build trust and reconnect with an identity beyond mental illness. Although MII was less dominant in the art setting, it still persisted, indicating that negative self-belief is deeply held, and that identity reconstruction beyond mental illness is sensitive to changing interpersonal and environmental intervention factors. The findings have key implications for clinical practice, especially regarding power dynamics between clinician and client, shame in repeat help-seeking, and understanding the whole person within brief interventions. Community art spaces for mental health offer a valuable space in which relational safety can grow, which is an important foundation for any future clinical intervention. Therefore, collaboration between creative and health sectors is recommended, such as referring clients to community groups and providing trauma-informed training for arts practitioners. Co-production with service users in developing and maintaining these spaces can promote empowerment through roles beyond ‘patienthood’ and promote sustainability of community arts spaces.