Picture entering a room that is like a blank canvas: colourless and bare apart from a door, two windows, and a virtual reality headset.
Curiosity compels you to pick up the headset. At first, you see a simulation of the same bare room; the colours, scale, and layout remain unchanged.
As you move about the room, you discover you can interact with elements of both your physical and virtual environments — what is known as a 'mixed reality' experience — and these small interactions transform the space. You open a window and the scene beyond morphs into a lofty mountain landscape; a luscious meadow; a sun-soaked beach.
Edge of the Present is a 10-minute immersive and sensory installation developed by a team of mental health specialists, artists and technologists from Sydney's Felt Experience and Empathy Lab (fEEL).
"We spent a lot of time thinking about 'What would be awesome and how could you feel it?'" says Professor Jill Bennett, director of the Big Anxiety Research Centre (BARC) at the University of New South Wales (UNSW), which incorporates fEEL.
fEEL uses cutting-edge immersive technology to create trauma-informed sensory experiences and tools — ranging from virtual reality installations to live art and performance.
"Art always gives greater freedom [and] that's a significant add-on to what psychotherapy allows. Especially in trauma therapy, because trauma is [an experience that is] hard to express," Professor Bennett says.
The project was developed in consultation with people with lived experiences of suicide survival, and draws on neuropsychological research on the importance of cultivating imagination and future-thinking in preventing suicide.
"This is a new kind of practice, where we're knitting together distinct expertise to create something new that is built on a long tradition of psychotherapy," Professor Bennett says.
In creating Edge of the Present, the fEEL team set out to design a sensory experience that would evoke positive mental imagery and a sense of awe.
"Because people with severe depression don't tend to experience awesomeness. In fact, they often have what's referred to as 'overgeneral memory': when they think about themselves in the past or when they think about their future, which uses the same kind of neural pathways, they don't have a lot of emotion attached to that," Professor Bennett says.
In addition to the eight dynamic landscapes that evolve within the installation, Edge of the Present incorporates sensory stimulants — including a simulated breeze and snow.
"It's hard not to be uplifted by that, and when we test it on people, their mood improves and feelings of hopefulness improve."
Professor Bennett's team at fEEL draws on what is known as psychosocial design to study embodied experiences of mental illness, trauma and aging.
"At the moment, there is great interest in moving beyond just the narrow clinical or medical realm and saying, you know, we need to think of trauma support more broadly," she says.
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What is psychosocial design?
In the context of mental health care, psychosocial interventions are broadly understood as therapeutic strategies that are non-pharmacological (i.e.don't rely on medication) and instead focus on improving social and psychological factors that may be contributing to mental ill health.
Psychosocial interventions encompass a wide range of strategies, including cognitive and behavioural therapies, group therapy, exercise, skills training, community engagement and creative activities.
Through their community consultation and collaborative research, Professor Bennett's team applies a psychosocial lens to designing creative projects that explore trauma and enhance wellbeing.
"[We create] tools and programs that are beneficial to people's mental health — but not just mental health conceived as a chemical imbalance in the brain and an individual thing, but that understands people's interactions, the social determinants of trauma and mental health, and how environments and social relationships can contribute to better mental health," says Professor Bennett.
In developing Edge of the Present, one of the key psychosocial design considerations was embedding agency in the way participants interact with the space.
"We didn't just want to create this 'blissed out' experience, because with suicidality, the really key thing is that you have a sense of your own agency and that you can make things happen.
"It's this sense of, you do a small action, and there's a reward. You can open doors and windows and that triggers something amazing," she says.
The title of the project stems from a conversation with one of fEEL's lived experience collaborators, who described the state of suicidality as "being on the edge of the present" and unable to see into the future.
"What we're saying is, 'Let's just see what can happen, just try this one tiny thing, and see if you can create some change'."
Professor Bennett says people who haven't experienced suicidality may underestimate the significance of being able to take a small forward action.
"As [someone] in our focus group pointed out, you might be able to experience awe in actual nature and, at a certain point, virtual nature doesn't replace real nature. But the point is that you have to plan a trip, you have to drive there … [with this tool], you open a door and it's not one but eight massive experiences in succession.
In testing Edge of the Present, Professor Bennett's team conducted a pilot study to assess how participants felt after interacting with the installation, and found that positive mood and wellbeing increased by 16 and 13 per cent respectively, while feelings of hopelessness decreased by 35 per cent.
"There is a significant improvement in mood, and so what we want to do is to try to scale this and see if it can be sustained," says Professor Bennett.
In Australia, suicide is the leading cause of death among young people. In 2020, deaths by suicide represented just under one in three deaths among people aged 15–17 (31 per cent) and around two in five deaths for people aged 18–24 (39 per cent).
ABS data shows that over 90 per cent of people who died by suicide in 2020 reported at least one risk factor, and two-thirds of people experienced both mental and behavioural disorders and psychosocial risk factors.
Katherine Boydell is a Professor of Mental Health at the Black Dog Institute and collaborated with fEEL on Edge of the Present, and says there is significant need for these kinds of projects to be scaled up and made more readily available.
"We've just applied for a grant to see if we can make this immersive experience more accessible, so that you don't have to have the actual physical structure of the room — you can just put on a headset," she says.
Creative and non-pharmacological approaches to addressing mental ill health are becoming increasingly important in Australia, Professor Boydell says — particularly in overcoming some of the barriers to help-seeking associated with more traditional or clinical approaches.
Research shows that around one in two Australians experiencing mental ill health do not seek help (although hearteningly, the treatment rate is improving).
The need for greater psychosocial support services
In 2020, the Productivity Commission's mental health inquiry identified "significant gaps" in psychosocial support services because of inefficient and short-term funding arrangements, and identified a need to scale up services to make them more accessible.
The report found that of the estimated 290,000 Australians who experience severe mental illness, only a quarter currently access psychosocial support measures through government-funded programs.
Professor Boydell says this emphasises the need for a "whole-of-community approach".
"We have good evidence that engaging in the arts has all of these wonderful positive impacts on overall mental health and wellbeing.
"Especially, when it comes to this 'epidemic of loneliness' … [arts-based] social prescribing programs can really address some of those broader social determinants of health in a more holistic way," she says.
According to the Royal Australian College of General Practitioners (RACGP), mental health is the number one reason Australians visit the GP, and has been for the past five years in a row.
The need for expanded support services has only been accelerated by the pandemic, with ABS data from 2020-21 showing that 15 per cent of Australians aged between 16-85 experienced high or very high levels of psychological distress, up from 13 per cent in 2017-18. Young Australians were more than twice as likely as older Australians to experience high or very high levels of psychological distress, with a rate of 20 per cent for people aged 16-34 years compared with 9 per cent for those aged 65-85 years.
Professor Bennett echoes the need to develop arts-based psychosocial support measures at scale.
"Treatment can't just be pharmacological, it has to be looking at how we can change a situation, how we can bolster someone's sense of agency and control, and how we can enable them to develop what's sometimes called resilience."
She says arts interventions and programs are particularly well-placed as psychosocial support strategies.
Prescribing art for trauma
The benefits of creative practice on mental health and wellbeing are widely documented. From treating anxiety and depression to Alzheimer's Disease and post-traumatic stress disorder, there is an overwhelming body of evidence in favour of integrating arts and creativity into mental health care.
Last October, RACGP called upon the federal government to invest in a national social prescribing scheme to address the worsening mental health crisis fanned by COVID-19.
Professor Boydell says: "[Social prescribing] is about thinking about informal and community resources that can address health and mental health issues that are more aligned with a 'social determinants of health' approach."
"So if you've got somebody who's going to a clinic for depression, but they're depressed because they're marginally housed, or they're in debt over their heads, or they're lonely, then you can begin to imagine that no amount of psychosocial interventions or medication is going to address that issue," she says.
That's where social prescribing can help.
Through her work at the Black Dog Institute, Professor Boydell has spent many years researching and evaluating the benefits of arts-on-prescription programs, which are a subset of social prescribing.
In Space 22, a six-part documentary series premiering on ABC TV on Tuesday night (May 17), seven Australians with lived experiences of mental ill health take part in an arts-on-prescription experiment.
With the support of mental health specialists, including Professor Boydell, participants explore past traumas through a series of creative workshops led by multidisciplinary artist Abdul Abdullah, Archibald-winning visual artist Wendy Sharpe and singer-songwriter Eddie Perfect.
Vivienne, a 55-year-old retired medical researcher, is one of the show's participants.
She heard about the program through a community centre she is involved with in Sydney's inner west, and says that as a scientist she was excited at the prospect of exploring how art impacts the brain.
"There are feelings inside of me that, even when they come up, are really hard to express in words," she says.
"And I thought if I can express them in other ways because, you know, art is a form of expression … maybe that would be really good."
Vivienne has had a long journey with mental health. As a survivor of childhood sexual abuse and post-traumatic stress disorder (PTSD), she describes herself as a fighter.
"I started being abused when I was five. My life has been about recovering from that experience."
In her twenties, Vivienne turned to drugs and alcohol as a way to cope.
"I just needed something to soothe me and to take the pain away really," she says.
"My whole adult life has been about getting therapy and maintaining my sobriety, but there've been times where I've gone back into that and lost faith in the process. And then I've had to come back out of it again.
"I'm lucky because a lot of people don't make it."
She says she reached a turning point about five years ago, when she turned 50, and is now in a place where she feels "less attached to the past".
Embarking on the Space 22 project was a transformational experience for Vivienne. She says working with Wendy Sharpe was particularly affecting.
"Wendy really got to the heart of us, you know. She wanted us to paint our feelings. For me, that was the process where my brain actually felt like it switched. Like, almost my thought pattern changed.
"It's just a different way of seeing things and it's really brought out the colours in everything," she says.
Professor Boydell was recruited to help assess the efficacy of the Space 22 program, and its impact on participants' wellbeing.
"In Space 22, [the participants] are expressing their experiences by using visual and performative and literary means, so it's another way of sharing things that are difficult to put into words and to talk about," she says.
"I also think it creates this sense of not being alone, a sense of community, and [a] decrease in isolation or feelings of loneliness… not to mention the capacity to be creative."
Professor Boydell says these connections can be "transformative".
Having never participated in artistic practice prior to Space 22, Vivienne says that painting is now a part of her life.
"There's such a strong connection between me and the canvas. Like, it's the only thing I can see. It's amazing."
She says putting on music and painting has become a way for her to self-soothe.
"That's why I used to take drugs because I couldn't soothe myself. Post-traumatic stress lives in your central nervous system and it becomes unbearable if left untreated.
"I'm telling you, doing the painting, just watching the colour go on, it's so soothing, which is what we all need.
"And that's the stuff that gets me through the difficult days."
Space 22 premieres Tuesday May 17 at 8pm on ABC TV.
Edge of the Present will be featured in The Big Reach arts and mental health festival, an initiative of BARC, which runs between May 26 — 27 in Brisbane.
