Atlas›Domain VIII · Creative & expressive arts therapies›Guide 196
Guide VIII-196

Museums on prescription

2014London and Kent, UK
A 39 · L 45 · M 1619 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: the UCL Museums on Prescription (MoP) programme (AHRC-funded, 2014–2017, older adults, central London and Kent) as set out in its practice guide (Veall et al., 2017) and its outcome paper (Thomson, Lockyer, Camic & Chatterjee). Two other published models are described alongside it: the Montreal Museum of Fine Arts (MMFA) and Médecins francophones du Canada (MFdC) physician museum prescriptions (pilot from 1 November 2018), and the UCL and UCLH Heritage in Hospitals object-handling sessions on hospital wards (pilot sessions May to July 2008). The general social prescribing pathway (link workers, referral, follow-up) is covered in 195 Arts on prescription. This tab covers only what is specific to museums.

What it is. Museums on prescription is a community and arts-in-health programme, not psychotherapy. It is a social prescribing route: health, social care or third-sector workers refer people (in the UCL model, lonely or socially isolated older adults) to a series of facilitated group sessions in a museum or gallery. The sessions are run by museum staff and volunteers, not by therapists. The museum guide is explicit that facilitators focus on creative, cultural and social engagement rather than psychological support, redirect requests for therapy and avoid creating dependency [source: Veall et al., 2017]. Your role as a psychotherapist is to judge fit, refer, liaise and hand over risk information, and to keep any therapeutic work in your own sessions.

How change is thought to happen. In the programme's own account, change comes from regular, structured contact with museum objects and collections in a supportive small group with an engaging facilitator. This contact offers new learning, mental stimulation, creative activity and social connection. For the most isolated people, the reported gains were in social confidence and feeling valued [source: Camic et al., 2017, abstract; Thomson et al., accepted manuscript]. Object handling is described as working along two lines. One is impersonal and educational: tactile learning, imaginative connection and aesthetic appreciation. The other is personal and reminiscence-based: it helps people face illness, loss and questions of identity, especially older patients [source: Chatterjee, Vreeland & Noble, 2009, abstract].

Professional frame. Museum-on-prescription facilitation is not a regulated profession. Facilitators in the UCL programme were museum staff and volunteers [source: Thomson et al.]. The programme is not art therapy. In the UK, art therapy is a separate, HCPC-registered profession (the professional body is BAAT). Where a museum employs an art therapist, as the MMFA does with a full-time art therapist [source: MMFA, 2018], that therapist's work is a separate service and should not be confused with the prescription visit. Psychotherapists who join or adapt a programme work within their own registration and should not present the museum sessions as therapy [synthesis].

2. Framework

The programme is a structured group course in its UCL form and a single prescribed visit in its Montreal form. These are two different formats, so pick the one that matches what is available locally.

A. UCL group programme (version followed) [source: Veall et al., 2017; Thomson et al.]

  • Who: lonely or socially isolated adults aged 65–94, referred by health, social care or third-sector partners. Research inclusion criteria were: socially isolated at home or in a care home; not in paid or voluntary work; not regularly attending social or cultural activities; able to give informed consent, read and write English and travel to the museum, with help if needed; likely to attend all sessions; able to function in a group; and with enough sight, hearing and hand and arm use to take part. People with moderate to severe dementia were excluded; people with mild, early-stage dementia could take part. These were research criteria, and a service may set its own [synthesis].
  • Format: groups of 8–10 participants, plus carers or befrienders and museum facilitators. In the research, 12 programmes of 10 weekly sessions of about two hours ran across seven museums (four in central London, three in Kent) from 2015 to 2017. The guide recommends 6–10 weekly sessions of 90 minutes to 2 hours, no more than a fortnight between sessions, and the same day, time and place throughout. It suggests two facilitators per session, one leading on pastoral support and one on content.
  • Phases:
    1. Set-up: partnerships with referrers, an access audit of the building, a safeguarding policy, and taster sessions in day centres or clubs.
    2. Referral and first contact: one named contact person, the participant's preferred way of being contacted, and a rough schedule.
    3. Opening session: introductions, practical arrangements, access needs and discussion of the programme.
    4. Core sessions: a balance of new knowledge, creative activity and social time, with creative and expressive tasks placed later once the group is comfortable.
    5. Closing session: reflecting on and celebrating what the group achieved, with participants helping to plan it.
    6. Legacy: signposting to ongoing talks and events.
  • Moving between phases: the sources set no formal criteria. In practice the programme follows a fixed calendar. The guide's one pacing rule is to bring in creative activities once the group is comfortable [synthesis based on Veall et al.].

B. Montreal physician prescription [source: MMFA, 2018; Culture for Health mapping]

  • Starting 1 November 2018, MFdC member physicians who registered with the association could prescribe a free visit to the MMFA collections and exhibitions. The pilot was listed as running 2018–2019.
  • Each prescription admits the patient plus up to 2 adults and 2 children aged 17 or under.
  • Physicians could issue up to 50 prescriptions. The museum page leaves unclear whether this was per physician; the Culture for Health page says per doctor per year [uncertain].
  • The museum describes the visit as an adjunct to conventional treatment.
  • The sources do not describe how a prescription is redeemed, any eligibility criteria, or any extension to other professions [uncertain].

C. Ward object handling (Heritage in Hospitals) [source: UCL Museums blog, 2012; Chatterjee et al., 2009, abstract]

  • These were facilitated sessions of about 40 minutes with adult patients on chronic and acute wards, handling and discussing museum objects. Over the three-year project, about 250 patients took part. The 2008 pilot ran 32 sessions.
  • Programme planning, safeguarding of participants and objects, staff support and training, and evaluation are covered in the UCL guide Heritage in Health (2012). That guide's details are [uncertain].

3. Guiding principles

  • It is an arts-in-health activity, not therapy. Do not refer someone here in place of treatment they need. A museum programme can sit alongside therapy but cannot replace it [source: Veall et al., 2017; MMFA, 2018].
  • Facilitators do not do psychological work. Hand over only the information they need to keep the person safe and included, and keep clinical work in your own sessions [source: Veall et al., 2017].
  • Do not overpromise health outcomes. Describe the programme to clients as learning, creativity and company, not as a cure [source: Veall et al., 2017].
  • Consistency. Same day, time, place and contact person, with short gaps between sessions. This matters most for anxious or isolated clients [source: Veall et al., 2017].
  • Access first. Barriers include stairs, distance to the session room, seating, toilets, lighting, noise, glass reflections, transport, the cost of refreshments and caring duties. Check them before you refer [source: Veall et al., 2017].
  • Choice and co-production. Older people are not one group. Offer variety and build on participants' own interests and objects [source: Veall et al., 2017].
  • Less is more. Too many activities cause fatigue, so pace sessions and build in breaks [source: Veall et al., 2017].
  • Missed sessions are allowed. Make it clear that hospital appointments and illness do not mean dropping out [source: Veall et al., 2017].
  • Safeguarding of adults at risk is built in from the start. Staff roles, a code of conduct, incident reporting and external contacts such as the local Safeguarding Adults Board are set up before the first session [source: Veall et al., 2017].
  • Plan the ending from the start. Set out exit routes into ongoing museum events, volunteering or self-organised groups so the ending is not another loss [source: Veall et al., 2017; NASP prompts].
  • Two-way feedback with the referrer. Agree how attendance and outcomes are reported back [source: NASP prompts].

4. Intervention inventory

Part A covers what you, the therapist, do. Part B covers the programme components the museum delivers, described so you can prepare clients and liaise well. The sources describe the museum components; almost all of Part A is your role around the programme, and steps the sources do not give are marked [synthesis].

Part A. The therapist's role

A1. Judging fit

  • Purpose: to decide whether a museum programme would help this client now, alongside or after therapy.
  • Steps:
    1. Look for the needs the programme is built for: loneliness, social isolation, few cultural or social activities, low stimulation, and wanting new learning or company [source: Thomson et al.; Veall et al., 2017].
    2. Check the practical requirements of the version on offer. In the UCL model these are travel (with help if needed), sitting in a group for 90–120 minutes, enough sight, hearing and hand use, and committing to most sessions. The research also required English literacy and excluded moderate to severe dementia [source: Thomson et al.]. Ask the provider what its own criteria are [synthesis].
    3. Check the client's current state [synthesis]. Hold off, or refer with support in place, if the client is in acute crisis, at high current suicide risk, newly bereaved and overwhelmed, or so socially anxious that a group would not yet be tolerable. Consider a graded first step, such as a single Montreal-style visit with a companion.
    4. Weigh up likely triggers [synthesis]. Collections on war, medicine, pathology, death, colonial violence or a client's own trauma history can evoke strong responses. Ask the museum about the themes planned.
    5. Agree the purpose with the client in plain words: company, interest, getting out of the house. Avoid framing it as treatment [source: Veall et al., 2017, on not overpromising].
  • Example language (illustrative): "This isn't therapy. It's a small group at the museum, once a week for a couple of months, looking at objects and chatting over tea. Does that sound like something you'd want, or would it feel like too much right now?"
  • Watch for: the client agreeing in order to please you; a referral that is really a way to end therapy; a client who sees it as a test they might fail.

A2. Choosing and making the referral

  • Purpose: to get the client into the right programme by a working route.
  • Steps:
    1. Find out which route exists locally. In the UCL programme, referrers included GPs, practice nurses, psychological services, adult social care, third-sector groups, housing associations, befrienders, carers and social workers, and people could also self-refer through posters or flyers [source: Veall et al., 2017]. The original project referred through local NHS and Local Authority Adult Social Care services [source: MoP project overview].
    2. Where a social prescribing link worker exists, refer through them, using the pathway described in 195 Arts on prescription. The guide notes that where social prescribing is not embedded, the museum may liaise directly with referrers [source: Veall et al., 2017].
    3. In a physician-prescription model like Montreal's, only registered prescribers can issue the prescription (in Montreal, MFdC member physicians). A psychotherapist's part is to suggest it to the client's doctor and help the client plan the visit [source: MMFA, 2018; synthesis for the therapist step].
    4. Get the client's consent to share information, and agree with them what is shared [synthesis].
  • Example language (illustrative), to a link worker: "I'm referring Mrs A, 78, who lives alone and has said she'd like a regular reason to go out. She uses a stick and needs step-free access and a seat near the toilet. She's happy for me to share that she's having therapy with me."
  • Watch for: waiting lists, programmes for older adults only, and programmes that have ended. The guide reports that many museums lacked the capacity to keep programmes running [source: Veall et al., 2017].

A3. Preparing the client

  • Purpose: to lower the anxiety and practical barriers that stop people turning up for the first session.
  • Steps:
    1. Go through the logistics: day, time, how the client will travel, who the named contact is, and whether a friend, carer or buddy can come. The guide welcomes companions [source: Veall et al., 2017].
    2. Check access needs against the venue: a step-free room, toilets on the same floor, seating, lighting and hearing [source: Veall et al., 2017]. Pass on any needs with consent.
    3. Rehearse the first few minutes if the client is socially anxious: arriving, giving their name, the tea break [synthesis].
    4. Make it clear that missing a session is fine [source: Veall et al., 2017].
  • Example language (illustrative): "What's the bit you're dreading most about the first week? Let's plan just that bit."
  • Watch for: avoidance that builds up the night before; transport that is unreliable.

A4. Liaison and risk handover

  • Purpose: to make sure the people running the sessions know what they need to know to keep the client safe, without turning them into therapists.
  • Steps [synthesis, built on the guide's safeguarding and pastoral-facilitator structure]:
    1. With consent, share only functional information: access needs, health issues relevant on the day (falls risk, continence, diabetes, epilepsy), communication needs, and a named emergency contact.
    2. If there is any current risk, agree a plan: who the facilitator contacts if the client becomes distressed or talks about self-harm, and how to reach you or the duty service. Do not hand over clinical risk management to museum staff. If the risk is too high to manage in a community setting, do not refer yet.
    3. Confirm the museum has a safeguarding lead and procedures for adults at risk [source: Veall et al., 2017].
    4. Agree how the museum lets you or the referrer know about non-attendance or concerns, and what outcome feedback, if any, will come back [source: NASP prompts].
  • Example language (illustrative), to the facilitator: "If she gets upset, a quiet break usually helps. If she mentions not wanting to be alive, please call me on this number, or the duty line if I'm not available, the same day."
  • Watch for: sharing more than the client agreed to; museum staff starting to act as counsellors; feedback that never arrives.

A5. Working with the experience in therapy

  • Purpose: to link what happens at the museum with the client's own therapy goals, without making the museum part of the therapy [synthesis].
  • Steps [synthesis]:
    1. Ask briefly about each week: what they noticed, who they spoke to, what they enjoyed.
    2. Treat attendance and contact as behavioural steps, if your model uses them (for example, activity scheduling).
    3. Explore reminiscence material that comes up in your own sessions, not by asking facilitators to probe it.
    4. Watch for the programme ending as a possible loss, and plan for it (see A6).
  • Example language (illustrative): "You said holding that old coin brought your father back to mind. Would you like to talk about him here?"
  • Watch for: the client feeling you are "marking" their attendance; therapy time being filled with museum chat to avoid harder material.

A6. Ending and follow-on

  • Purpose: to stop the end of the programme becoming another withdrawal of contact.
  • Steps:
    1. Before the end, find out the exit routes the museum offers: ongoing talks and events, event lists and volunteering. The NASP prompts suggest volunteering as a sustainable next step [source: Veall et al., 2017; NASP prompts].
    2. Encourage self-organised continuation. In the research, some participants kept in touch, planned more museum visits, joined adult education, or started a sketching meet-up [source: Thomson et al.].
    3. Review with the client and the referrer what changed and what comes next [synthesis].
  • Example language (illustrative): "There are two weeks left. Which of the people in the group would you like to keep seeing, and how could that happen?"
  • Watch for: low mood or renewed isolation after the programme ends [synthesis].

Part B. Programme components (delivered by museum staff)

Unless stated otherwise, the activity list, pacing and facilitation advice below come from Veall et al. (2017). The step-by-step detail is a synthesis for clinicians who co-deliver or adapt a programme and is marked as such.

B1. Opening session

  • Purpose: to orient the group and settle access and logistics.
  • Steps: introduce the facilitator, the museum, the programme and the other participants; ask about tea preferences and access needs; go over the practical arrangements; invite discussion of what the group would like to do [source: Veall et al., 2017]. Agreeing group ground rules together at the start is also recommended [source: Veall et al., 2017].
  • Example language (illustrative): "Before we look at anything, let's go round: your name, how you take your tea, and anything that would make the room easier for you."
  • Watch for: people who say nothing. The guide advises checking privately, because reluctance may come from low confidence or simply missed instructions.

B2. Curator talk

  • Purpose: new knowledge and mental stimulation.
  • Steps: a curator or expert speaks for no more than 20 minutes about a theme drawn from the collection, followed by discussion [source: Veall et al., 2017].
  • Example language (illustrative) [synthesis], curator: "I'll talk for about fifteen minutes, then I'd love to hear what you think. Tell me if you can't hear me."
  • Watch for: fatigue and hearing difficulties. Speakers should face the group, especially for people with hearing loss [source: Veall et al., 2017].

B3. Group object handling

  • Purpose: to spark conversation through touch, curiosity and memory [source: Veall et al., 2017]. Handling also supports tactile learning, imaginative connection and reminiscence [source: Chatterjee et al., 2009, abstract].
  • Steps [synthesis, apart from the mystery-object task, which is in the guide]:
    1. Set out a small number of objects that conservation staff have cleared for handling.
    2. Give the handling and hygiene instructions (see the hygiene box below).
    3. Pass one object at a time, or give each small group one object. As a shared task, small groups can try to identify a mystery object [source: Veall et al., 2017].
    4. Use open prompts about weight, texture, what the object might be, who used it and what it brings to mind.
    5. Share what is known about the object, then invite personal associations.
  • Example language (illustrative): "Take your time with it. What does it feel like? What do you think it was for?"
  • Watch for: reminiscence that turns painful (offer a break, as in B10); people who cannot grip or see well, who can be offered a cushion, a supported hold or a description.

Object-handling hygiene and safety box. None of the sources sets out hygiene procedures. The MoP guide does not cover them, and the Heritage in Health guide, which covers safeguarding of objects, is not drawn on here [uncertain]. The following is [synthesis]; follow your local infection prevention and control (IPC) team and the museum's conservator, whose rules take precedence.

  • Everyone cleans their hands before and after handling. Clean hands also protect the objects.
  • Use only objects from a handling collection that conservators have cleared, never display objects without their approval. Exclude anything with sharp edges, loose fragments, powders, pesticide-treated or other hazardous historical materials (some natural history and older objects may have been treated), or parts small enough to swallow if dementia is present.
  • Ask the museum which objects can be wiped or cleaned between users, and how. Do not apply disinfectant to an object yourself without conservator guidance.
  • Gloves: follow the museum's policy for the specific material, because gloves can reduce grip and make dropping more likely. In hospitals, follow ward IPC rules.
  • Hold objects over a table or a padded surface, and support them with both hands.
  • On wards, check with the nurse in charge before each session. Do not take objects into isolation or barrier-nursed areas unless IPC have agreed it, and leave out people with open wounds on their hands or those who are acutely unwell.
  • Consider the person's allergies (for example to latex or animal materials).

B4. Ward and bedside object handling (Heritage in Hospitals model)

  • Purpose: to bring museum objects to patients who cannot visit, for stimulation, enrichment and reminiscence.
  • What the sources give: facilitated sessions of about 40 minutes with adult patients on chronic and acute wards, in which patients handled and discussed museum objects. Self-reported life satisfaction and health status rose on average after handling. Analysis found impersonal and educational themes alongside personal and reminiscence themes [source: UCL Museums blog, 2012; Chatterjee et al., 2009, abstract]. The session procedure, facilitator background and session format (one-to-one or group) are not described in the sources [uncertain].
  • Steps [synthesis]: agree each session with ward staff; ask the patient for consent at the bedside; follow the hygiene box; keep sessions short and stop if the patient tires; tell staff about any distress afterwards.
  • Example language (illustrative) [synthesis], at the bedside: "I've brought a few objects from the museum. Would you like to hold one for a few minutes? It's fine to say no."
  • Watch for: medical instability, delirium, and patients who feel obliged to say yes.

B5. Behind-the-scenes store tour

  • Purpose: a sense of privileged access and of being valued, plus new learning [source: Veall et al., 2017; Camic et al., 2017, on feeling more valued].
  • Steps: a guided visit to the stores or other non-public areas [source: Veall et al., 2017]. In practice, check the route, lifts, standing time, temperature and dust in advance [synthesis].
  • Example language (illustrative) [synthesis]: "Most visitors never see these rooms. There's a chair at each stop, and we can turn back at any point."
  • Watch for: falls risk in cramped stores; people who are claustrophobic.

B6. Directed gallery visit

  • Purpose: focused looking and discussion in the public galleries.
  • Steps: visit a small number of selected works or cases with prompts, keeping walking distances short and seating available [source: Veall et al., 2017 for the activity and the access audit points; synthesis for the detail].
  • Example language (illustrative) [synthesis]: "We'll look at just three paintings today, with seats at each one. What catches your eye first?"
  • Watch for: crowding, noise, glass reflections and lighting, all flagged in the guide's access audit.

B7. Collection-inspired creative activity

  • Purpose: creativity, achievement and new skills.
  • Steps: writing or art-making inspired by the collection, led by a skilled facilitator. Place it later in the programme, once the group is comfortable [source: Veall et al., 2017].
  • Example language (illustrative) [synthesis]: "Pick anything from today that stayed with you and make something from it. There's no right way and nothing will be judged."
  • Watch for: fear of "not being artistic". Keep the emphasis on the process, not the product [synthesis]. This is an arts activity, not art therapy: do not interpret the images people make [synthesis].

B8. Film screening and discussion

  • Purpose: a low-demand way to share an experience and talk about it.
  • Steps: screen a short film linked to the collection, then hold a discussion [source: Veall et al., 2017]. Use subtitles and check the volume [synthesis].
  • Example language (illustrative) [synthesis]: "The film is ten minutes long. Afterwards, tell us one thing you noticed, or just listen."
  • Watch for [synthesis]: hearing and sight difficulties, drowsiness in a darkened room, and film content that touches on loss. Working when people join the discussion afterwards.

B9. Show-and-tell with participants' own objects

  • Purpose: an early way to build identity and connection in the group.
  • Steps: participants bring a personal object and talk about it. The guide places this early in the programme [source: Veall et al., 2017].
  • Example language (illustrative) [synthesis]: "Bring something small that matters to you, if you like. You choose how much you say about it."
  • Watch for: personal objects tied to grief. Let people choose what they share [synthesis].

B10. Social time and group facilitation

  • Purpose: to build the social connection the programme aims for.
  • Steps [source: Veall et al., 2017]:
    • Hold a tea break at the start or partway through, and allow extra breaks when needed.
    • Arrange seats in a U-shape, use comfortable chairs, and provide quiet space away from noise.
    • Learn names and how people take their tea.
    • Introduce isolated people to others with shared interests, more than once.
    • Rotate seats and partners to stop cliques forming.
    • Manage dominant members with agreed conversation rules or a private word.
    • Address offensive remarks calmly and privately.
    • If someone is upset, offer a break and time to recover.
    • Staff share delivery and debrief after each session.
  • Example language (illustrative) [synthesis], facilitator: "Joan, you mentioned you used to sew. Maureen was telling me about her quilting. You two should compare notes over tea."
  • Watch for: facilitators being drawn into a counselling role. The guide says to redirect requests for therapy and avoid creating dependency.

B11. Closing session

  • Purpose: to recognise achievement and connect participants to what comes next.
  • Steps: reflect on and celebrate what the group has done, let participants help plan the session (for example by inviting back a favourite speaker), signpost to ongoing events, and serve cake [source: Veall et al., 2017].
  • Example language (illustrative) [synthesis]: "For our last week, what would you like to do, and who would you like to invite back?"
  • Watch for [synthesis]: sadness or anxiety about the ending, and participants with no follow-on plan. Working when each person leaves knowing one next step.

B12. Single prescribed visit (Montreal model)

  • Purpose: free access to a museum visit with family or carers, as an adjunct to treatment [source: MMFA, 2018].
  • Steps: a participating physician issues the prescription, which admits the patient plus up to 2 adults and 2 children aged 17 or under [source: MMFA, 2018]. The redemption process is not described in the sources [uncertain]. For therapists [synthesis]: help the client choose a quiet time and a short route, and plan what they will look at.
  • Example language (illustrative) [synthesis], therapist: "Your doctor can prescribe a free museum visit. Who would you like to take with you, and what time of day is quietest?"
  • Watch for: a single unstructured visit offers less social contact than a group. It suits clients who already have companions.

B13. Evaluation tools

  • Purpose: to track change in wellbeing across sessions.
  • What the sources give: the UCL Museum Wellbeing Measure (the older-adult version has six emotion items, each rated 1–5 before and after sessions at the start, middle and end of the programme); a museum diary or passport for participants' reflections; and, in the research, WEMWBS and the Revised UCLA Loneliness Scale [source: Thomson et al.; Veall et al., 2017]. The items of these instruments are not reproduced here; obtain them from their owners.
  • Steps [synthesis]: use the official versions of the measures, obtained from their owners; give them at the points the programme specifies; keep completion short and optional; and share results back with participants and referrers as agreed.
  • Example language (illustrative) [synthesis]: "Before and after today's session, would you mind ticking a few boxes about how you feel? It's optional and takes a minute."
  • Watch for: questionnaires add to participants' workload, so keep the data collection light [synthesis]. Diary wording may echo the measure's own words [source: Thomson et al., limitations].

5. Handling problems

For general social-prescribing problems (no link worker, a referral that is not taken up, follow-up), see 195 Arts on prescription.

  • Client won't go to the first session (stuck or avoidant). Go back to A3: plan the journey, arrange a companion or buddy (the guide welcomes companions), and have the named contact phone before the first session [source: Veall et al., 2017 for companions and a single contact; synthesis for the rest]. If the client still cannot face it, offer a single prescribed visit with family first (B12-style) as a graded step [synthesis].
  • Client sits on the edge of the group or stays silent. The facilitator checks privately whether the cause is confidence or missed instructions, introduces the client to people with shared interests, and uses small-group shared tasks such as a mystery object [source: Veall et al., 2017]. In therapy, explore what got in the way [synthesis].
  • Dropping out or missing sessions (non-adherence). Make clear that a missed session is fine, keep the day and time the same, and keep gaps to no more than a fortnight [source: Veall et al., 2017]. Agree in advance that the museum will tell the referrer when someone stops attending [source: NASP prompts on feedback; synthesis on the trigger]. Then ask the client without blame [synthesis].
  • Overwhelm or distress in a session. The facilitator offers a break and time to recover [source: Veall et al., 2017]. Have the contact plan from A4 ready for anything beyond ordinary sadness [synthesis]. Afterwards, work with what came up in your own sessions, not at the museum [synthesis].
  • Painful reminiscence or trauma triggers from objects. Personal and reminiscence responses to handling are expected, including around illness and loss [source: Chatterjee et al., 2009, abstract]. Before referring, ask about planned themes and leave out collections that are likely to trigger the client (war, medical or pathology collections, human remains, objects from colonial violence). Let people pass on any object, and never press for a personal story [synthesis].
  • Client wants the facilitator to be their therapist, or becomes dependent. Facilitators redirect requests for therapy and avoid creating dependency [source: Veall et al., 2017]. Make sure the client knows where therapy happens, and talk with them about the attachment [synthesis].
  • Dominant, offensive or cliquey group members. Use agreed conversation rules or a private word, rotate seats and partners, and set ground rules together [source: Veall et al., 2017].
  • Rupture with you over the referral ("you're getting rid of me"). Name it directly and confirm what continues and what is changing. If the museum programme is not a step towards ending therapy, say so [synthesis].
  • Access barriers turn up on the day. Raise them with the named contact. Use the guide's audit points (steps, lifts, rest seating, toilets on the same floor, temperature, lighting, signage, reflections, noise, transport and refreshment costs, caring duties) to set up a fix [source: Veall et al., 2017]. Provide large print, face people with hearing loss when speaking, and leave space for wheelchairs and scooters [source: Veall et al., 2017]. For people with cognitive impairment, the UCL research included mild dementia only, so check what support the programme has before referring someone with more advanced dementia [source: Thomson et al.; synthesis].
  • Safeguarding concern (signs of abuse, neglect or exploitation of an adult at risk, or a child brought on a family prescription). The museum follows its adults-at-risk policy, incident reporting and the local Safeguarding Adults Board route [source: Veall et al., 2017]. Your own statutory and professional duties are unchanged whatever setting the concern comes from: act on them and record what you did [synthesis]. For children, apply local child-protection procedures [synthesis].
  • Suicide risk raised at the museum. Museum staff do not assess risk. They contact you or the agreed crisis route the same day, and you assess risk following standard practice [synthesis].
  • Physical incidents (falls, fatigue, a medical event). Pace the activities, provide seating and breaks, and make sure the museum has first-aid cover and the emergency details you handed over (A4) [source: Veall et al., 2017 on fatigue and seating; synthesis for the rest].
  • Programme ends or isn't funded again. The guide reports that programmes are resource-intensive and that many museums lacked the capacity to continue them. Its recommendations are drop-in or fortnightly rolling provision, mainly run by trained volunteers and linked to link workers [source: Veall et al., 2017; Thomson et al.]. Plan follow-on with the client before the end (A6).
  • Client expects a cure. Reset expectations: the programme offers learning, company and enjoyment [source: Veall et al., 2017, on not overpromising].

Evidence status, as the sources report it

  • UCL MoP: a within-participants design with no control group. Scores on the Museum Wellbeing Measure for Older Adults rose from before to after sessions at the start, middle and end of the programme, with the largest increases in feeling "enlightened" and "absorbed". The authors list as limitations: no control group, short-term programmes, and follow-up not reported [source: Thomson et al.]. The conference abstract reports a significant rise on the UCL-WM, but no significant change in WEMWBS or Revised UCLA Loneliness scores [source: Camic et al., 2017]. The MoP guide also reports no significant change on WEMWBS or the UCLA scale [source: Veall et al., 2017]. The sample is reported as 115 people aged 65–94 in the paper and 110 aged 65–86 in the abstract, so the samples or analyses may differ [uncertain].
  • Heritage in Hospitals: a pilot of 32 sessions in which self-reported life satisfaction and health status rose on average after handling [source: Chatterjee et al., 2009, abstract].
  • MMFA prescriptions: the Culture for Health mapping lists increased wellbeing and reduced stress as results but gives no data. No formal evaluation of the pilot was found [source: Culture for Health mapping] [uncertain].

Sources

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