In this section

Wellbeing vs. Mental Health

Where singing fits

Disconnection at the root

The power of the voice

What singing interventions look like

Wellbeing vs. Mental Health

Historically, mental health carried negative connotations. In recent years there has been an active shift in messaging towards focusing on positive factors, such as ‘mental wellness’, which influences the discussion away from solely addressing deficit-based ‘mental health challenges’ towards building positive constructs like resilience and wellbeing. However, the terms ‘wellbeing’ and ‘mental health’ are often used interchangeably, and they are not the same thing.

A useful insight comes from the Dual Continuum Model, developed by psychologist Corey Keyes, which shows that wellbeing and mental health/illness are two separate but related dimensions, not opposite ends of a single spectrum:

• Wellbeing is a positive state encompassing flourishing, life satisfaction, positive emotions, sense of purpose, and feeling that life is going well. It includes both ‘feeling good’ (hedonic wellbeing) and ‘functioning well’ (eudaimonic wellbeing – having purpose, autonomy, positive relationships, personal growth).

• Mental health/illness is a separate dimension – a continuum from no mental health difficulties through to diagnosable mental health conditions (anxiety disorders, depression, PTSD, etc.).

These two dimensions are independent. This means:

• A person can have a diagnosed mental illness AND still experience high wellbeing (flourishing)

• A person can have no mental illness AND still experience low wellbeing (languishing)

• Complete mental health requires both: absence of mental illness AND presence of flourishing

This matters when we consider the impact that singing might have, because it can both support wellbeing (helping people flourish) AND support those experiencing mental health difficulties.

So here’s an interesting challenge for us: in an ideal world, the focus would be preventative – designing environments where young people flourish before difficulties take hold (i.e. sustaining wellbeing). But the current mental health crisis, coupled with the reality that there will always be young people who are struggling, means we need approaches which will work across the whole spectrum, and that means the focus also needs to be reactive.

Can singing nurture wellbeing AND build resilience and preventative factors, AND support those already facing mental health challenges? We think it can. The evidence base is still emerging, particularly around the deeper mechanisms and long-term impact of singing interventions for mental ill-health. Practice is ahead of research in this context, and what we’re consistently hearing is that it’s not just the singing itself that matters, but how it’s led, the environment in which it happens and the relationships that form around it – the old adage rings true, ‘it ain’t what you do, it’s the way that you do it’. The following sections will explore what both practitioners and researchers are discovering about these intricacies of practice.

Where singing fits

Mental health support is often understood through a tiered model:

This framework is useful for thinking about where various kinds of support sit, however the boundaries may be less fixed than they appear:

Singing’s role at Tier 1 is well understood – regular singing builds connection, community, emotional vocabulary. This is valuable and evidenced. And singing’s role at Tier 2 is increasingly recognised, through targeted programmes supporting young people facing challenges.

But what about Tiers 3 and 4? This is where it gets interesting! Practice tells us that singing is already happening with young people in acute mental health settings – secure units, psychiatric hospitals, crisis support. Practitioners (not just therapists) are working in these spaces and seeing impact.

So the question isn’t whether singing CAN operate at Tiers 3 & 4 – it already does. The question is: how do we understand what’s happening, what makes it work, and what it means for how we think about the boundaries?

Tiers 3 & 4 have traditionally been the domain of Music Therapy – a clinical discipline delivered by qualified therapists with specific training, therapeutic intention, and clinical accountability. This is important and valuable work, and this review doesn’t suggest otherwise, but we need to consider in greater depth the relationship between Music Therapy (clinical intervention) and ‘music participation’ (singing/music-making led by practitioners who aren’t therapists). Can there be crossover to achieve a greater good, a therapeutic effect without being therapy? We believe so, but we need to capture more about the conditions, and particularly the practitioner skills, knowledge and attributes that ensure music participation in this context is safe and effective.

The following graphic shows where targeted singing for mental health activity sits within the therapy-education continuum. It is based on a model created by Simon Lock (West of England Music & Arts).

This presents a powerful opportunity. If singing as participation (not just therapy) can have a meaningful impact at Tiers 3 & 4, it expands who can contribute to supporting young people in crisis, offers more access points for those who may not engage with clinical services, and could ease pressure on overstretched provision. Critically, however, it requires skilled practitioners, appropriate training, clear boundaries, proper support, partnerships and a deeper understanding of how and why singing works at this level.

Disconnection as the root

Across the evidence, a pattern emerges: mental health challenges – especially at the more acute end – are often characterised by disconnection, from body, from others, from self, from community/culture, from education & learning, from hope, sometimes even from reality. This isn’t a universal rule – mental health is complex and influenced by many factors, and different people experience and seek connection in diverse ways – but for many young people, disconnection appears to be a significant thread. For some of the most vulnerable young people – such as those in care, displaced, or who have experienced trauma – these disconnections can compound and reinforce each other.

We observe this disconnection as both cause and effect: trauma, adversity and exclusion can create disconnection, but disconnection can then perpetuate and deepen mental health difficulties. For some, it becomes a selfreinforcing cycle. This is why working with mental ill-health problems matters: many of these young people aren’t just experiencing ‘more severe symptoms’ – they’re experiencing deeper, multilayered disconnection that feeds on itself.

The power of the voice

The voice, in this context, goes deep, and we need to be careful. The voice is deeply personal – it is bound up with identity in a way that few other things are. For some vulnerable young people, whose sense of self is fragile, damaged or suppressed, the voice, while being a place of potential, is likely to be a place of profound vulnerability.

Young people in acute circumstances may have – literally or figuratively – had their voice silenced. They’ve learnt not to speak their truth, not to be heard, not to believe that anyone is listening, or to trust those who are.

But the voice can also be transformational. Working with the voice for young people who are struggling can be a pathway back to the voice – to being able to have a voice and to be heard. This requires high levels of skill and safety. It’s almost certainly not, or not just, about ‘singing nicely’, or necessarily even pitching sung notes – it’s about identity, agency and reconnection at the deepest level. And this is why singing at Tiers 3 & 4 is both exciting and demanding.

What singing interventions look like

Singing for mental health and wellbeing for children and young people happens across a broad range of contexts, but might be viewed in the context of tiers as follows:

• Schools (Tier 1/2): Whole-class singing, choirs, curriculum-embedded vocal work, targeted small groups

• Community settings (Tier 1/2): Youth choirs, community music projects, music hubs

• Private/independent practitioners (Tier 1/2/3): One-to-one vocal coaching, singing teaching and creative vocal work, where targeted mental health & wellbeing dimensions are explored

• Specialist settings (Tier 2/3/4): Hospitals, adolescent mental health units, secure units, refugee settings, pupil referral units, youth justice settings, music therapy provision

For music participation, the approaches vary too: choirs and singing groups, songwriting, beatboxing, rap, creative vocal improvisation, one-to-one vocal work. What unites them in this context is intentionality – purposeful work with wellbeing or mental health in mind, and often with a focus on young people’s own creativity, stories, and sense of agency (we explore these themes in depth in the next section). What differentiates these approaches is the level of need, the skills required, and the boundaries in play.

In the context of working with young people navigating the trauma of displacement, an over-emphasis on musical quality could be counter-productive:

This might look like: