Arts on Prescription: Evidence from the Baltic Sea Region Pilot Highlights Mental Health Benefits and Policy Relevance

The pilot implementation of the Arts on Prescription (AoP) programme in the Baltic Sea Region has been accompanied by a comprehensive quantitative* and qualitative** evaluation, conducted by the National Institute of Public Health, University of Southern Denmark and the Turku University of Applied Science. Together, these evaluations provide empirically grounded insights into the potential of arts-based, non-clinical interventions to support mental wellbeing, while also highlighting key considerations for policy design, cost structures and future implementation.

Quantitative findings: Positive trends in mental wellbeing, with clear methodological limits

The quantitative evaluation draws on before-and-after survey data regarding mental health outcomes, costs, and implementations lessons drawn from participants of 24 AoP pilot programmes implemented in Denmark, Sweden, Germany, Latvia and Poland. Complete pre- and post-programme responses were available for 79 participants.

The findings indicate consistent positive trends across several mental health indicators:

• The proportion of participants reporting low mental wellbeing decreased from 61% at baseline to 42% at programme end.

• The prevalence of symptoms of depression, anxiety and loneliness was lower after participation than before the programme.

• Among participants who reported low mental wellbeing at baseline, approximately 71% showed improved scores by the end of the programme.

In addition to these health-related indicators, participant satisfaction with AoP was notably high:

• Participants rated the programme 8.3 out of 10 on average.

• 92% stated that they would recommend the programme to others.

However, these results must be interpreted with caution. Response rates were relatively low and no control group was included. As a result, the observed improvements cannot be attributed causally to AoP participation. Rather, the findings should be understood as indications of potential benefit, warranting further investigation through more robust study designs.

Qualitative findings: Understanding how and why Arts on Prescription works

The qualitative evaluation covered 24 pilot programmes across the region and included data from 255 participants, collected through session-based feedback and creative focus group interviews. Its aim was to explore perceived changes in mental and social wellbeing, potential mechanisms of change, and any adverse experiences related to participation.

Participants consistently reported a range of positive outcomes, including:

• Improved mood, emotional relief and enjoyment

• Relaxation and reduced stress

• Positive distraction from worries, rumination and difficult life circumstances

• Strengthened self-esteem and self-confidence

• Development of emotional skills and self-awareness

• Reduced performance pressure within a non-clinical, non-diagnostic setting

• Decreased loneliness and a stronger sense of social connection

• Renewed hope and future orientation

The qualitative findings underline that AoP operates as a complex, multi-component intervention rather than through a single mechanism. Reported benefits were shaped by several interacting factors, including:

• The group-based format and the experience of belonging

• Active, multisensory engagement with different art forms

• Opportunities for non-verbal and metaphorical self-expression

• The role of skilled arts facilitators and a supportive, judgement-free environment

Importantly, the evaluation also documents that AoP is not uniformly experienced as positive. Some participants reported feelings of discomfort, emotional strain or overload. The systematic identification of such adverse experiences is highlighted as essential for programme refinement, ethical delivery and long-term sustainability.

Costs and implementation: Insights for policy and decision-making

The economic evaluation reveals substantial variation in costs across pilot sites:

• Total expenditure per pilot round ranged from €8,400 to €57,800.

• Cost per completed participant ranged between €684 and €5,349.

These differences are largely explained by national price levels, programme design choices, staffing models, group sizes and organisational arrangements. A formal cost-effectiveness analysis could not be conducted due to the absence of a comparator, such as usual care.

Nevertheless, several pilot sites anticipate that costs could decrease if AoP programmes are continued or scaled up, as partnership structures are already in place, referral pathways have been established and start-up costs would not recur. The evaluation further identifies key implementation factors, including awareness-raising, competence development, cross-sector collaboration and the establishment of feedback and evaluation systems.

Conclusion and outlook

Taken together, the quantitative and qualitative evaluations suggest that Arts on Prescription represents a promising approach at the intersection of public health, culture and social policy. While evaluation result do not allow clear conclusions to be drawn on causal evidence on effectiveness, the findings provide a robust empirical basis for further research and informed policy deliberation.

For researchers, the results point to the need for controlled studies (e.g., a control group or standard practice) that can more precisely assess outcomes and mechanisms of change. For policy-makers, they offer evidence-informed insights into the potential value, costs and implementation conditions of arts-based interventions as part of broader strategies to promote mental wellbeing.

*Carsten Hinrichsen, Stine Arp, Isabelle Pascale Mairey (2025): Piloting Arts on Prescription in the Baltic Sea Region. Evaluating health outcomes, costs and implementation strategies. National Institute of Public Health, University of Southern Denmark.

**Liisa Laitinen, Outi Linnossuo (2025): Arts on Prescription (AoP) in the Baltic Sea Region. Qualitative evaluation of the 24 pilot AoP programmes. Turku University of Applied Science. ISBN:978-952-216-898-6

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