This article explores the growing international evidence supporting the use of the arts as a complementary approach to mental health care, focusing on cognitive, emotional and societal benefits. Drawing on key studies and international reports, including the World Health Organization's (WHO) landmark 2019 review, this article makes a case for integrating the arts into Malta's mental health strategy. Arts-on-prescription programmes have shown to improve cognitive functioning, promote emotional regulation, support treatment compliance, reduce healthcare costs and strengthen community cohesion. The article proposes the gradual implementation of a national Maltese initiative involving local artists, cultural institutions and the Ministry of Health.

Mental health is a growing concern in Malta, where rising cases of anxiety, depression and social isolation have placed increasing pressure on the national health service. While Malta has made strides in promoting awareness and improving services, the time is ripe to adopt broader, more holistic strategies. The use of the arts as a tool for improving mental health is one such avenue. Globally, the idea of "art on prescription", referring patients to creative activities as part of a therapeutic care plan, is gaining legitimacy as a public health intervention.

On 11 November 2019, the WHO's Regional Office for Europe released a landmark report compiling over 900 studies that examined how the arts affect health and wellbeing (Fancourt & Finn, 2019). The report concluded that artistic engagement can be used in prevention, treatment and management of mental health conditions across the lifespan. This article argues that Malta must follow the lead of countries such as the UK, Sweden and Norway by implementing a national arts and health programme, starting with a structured pilot under the direction of the Medical Council and the Ministry for Health.

The cognitive benefits of the arts

Participation in artistic activities has been shown to enhance brain functioning and cognitive reserve. A 21-year longitudinal study by Verghese et al. (2003), involving 469 participants aged 75 and older, found that engagement in leisure activities such as music, painting and reading significantly reduced the risk of dementia. Cognitive improvements are not limited to older adults; the arts stimulate neural plasticity, support executive functioning and foster memory retention across the lifespan.

For a country like Malta, with an ageing population and a growing prevalence of dementia, these findings offer an opportunity to reframe creative engagement not as leisure but as preventive cognitive medicine.

Arts-on-prescription: Evidence from practice

The UK model: In the United Kingdom, arts-on-prescription (AoP) programmes are being implemented through local health boards and general practice referrals. Bungay and Clift (2010) reviewed several such schemes, concluding that patients referred to creative programmes experienced improved self-esteem, reduced anxiety, and greater motivation to manage their own health. These initiatives are often community-based and involve collaboration between healthcare professionals, artists and cultural institutions.

Scandinavian examples: In Sweden and Norway, cultural prescriptions have been integrated into public health policies. Jensen et al. (2017) reported that these schemes contribute to longer-term mental health outcomes and help reduce reliance on pharmacological treatments. Importantly, these programmes acknowledge the arts not only as therapy, but also as a right to participate in cultural life.

A Maltese perspective: Malta's unique cultural infrastructure: its national museums, local band clubs, theatre houses and community art spaces, offers a fertile ground for adapting the AoP model. Institutions such as Muża, Spazju Kreattiv and the Malta School of Art already run participatory programmes that could be aligned with mental health objectives. By building partnerships between local artists, NGOs and healthcare providers, a Maltese AoP pilot could begin in select clinics and evolve into a national initiative.

Emotional regulation and psychological wellbeing

Art facilitates emotional expression and trauma processing without the need for verbal articulation, which can be particularly valuable in cases of depression, anxiety or PTSD. According to Goodman (2020) from the UK's Mental Health Foundation, "art can be a different and fun way to express and talk about emotion" (para. 2). The creative process encourages mindfulness, helps externalise distress and empowers individuals through acts of making and meaning.

In Malta, where mental health stigma persists in some communities, art could function as a culturally sensitive gateway to support, especially in youth groups and elderly populations who may be hesitant to seek formal psychiatric care.

Societal and economic benefits

The societal impact of arts engagement is significant. Daykin et al. (2008) report that patients involved in arts programmes tend to have shorter hospital stays, fewer medication needs and improved social functioning. These benefits translate into tangible economic savings for healthcare systems.

Moreover, the arts foster community, belonging and resilience, factors that Malta urgently needs to address as it copes with social fragmentation, increased migration and a rise in loneliness. Group-based artistic activities such as community theatre, collective mural-making and intergenerational choir projects not only support mental health but strengthen the social fabric.

Lessons from Chinese art and holistic health

In traditional Chinese culture, health is seen as the harmonious integration of mind, body and spirit. Practices such as calligraphy, brush painting and Tai Chi are used to restore internal balance. Wang et al. (2020) found that participation in traditional Chinese art significantly improved emotional regulation and cognitive stability in older adults.

These approaches resonate with Malta's own history of integrating the arts into daily life, from village festas to religious iconography. Reviving traditional crafts or reimagining them in therapeutic contexts could offer culturally grounded ways to enhance mental wellbeing.

Defining the arts for health: A broad scope

The WHO (2019) defines the arts for health to include visual arts, crafts, digital media, theatre, dance, literature, music, gardening and even culinary arts. The aim is not professional excellence but meaningful engagement.

A future Maltese AoP programme could reflect this breadth by offering culturally specific modules: from folk art revival to modern digital storytelling, delivered by trained facilitators in community or clinical settings.

Recommendations for Malta

Pilot Programme: Begin a six-month AoP pilot in collaboration with Mater Dei Hospital, private hospitals, local councils and cultural NGOs.

Artist Training: Develop an accredited training programme for artists working in health contexts, modelled on Scandinavian and UK examples.

Cross-Ministerial Collaboration: Establish an Arts and Health Task Force between the Ministry for Health and the Ministry for National Heritage, the Arts, and Local Government.

Evaluation and Research: Partner with the University of Malta's Faculties for Health Science and Social Wellbeing to collect data, publish findings and refine the approach.

Conclusion

The case for including the arts in mental health care is no longer anecdotal, it is evidence-based, economically sound and socially necessary. Malta's rich artistic heritage, combined with a close-knit healthcare network, positions it ideally to pioneer a national Arts-on-prescription strategy. This article calls on the Medical Council, policymakers and health professionals to recognise the arts not as a luxury, but as a legitimate, holistic and humane prescription for mental wellbeing.

Prof. Louis Laganà PhD (Lough) lectures on the Arts for Health and Wellbeing at the University of Malta. He is also a curator and practising artist