NOAH members Alex Rodriguez, Jennifer Kuo, Jill Sonke, and others authored and published this new article on May 4th, 2025. You can read the full article via Frontiers in Public Health.
The mental health crisis in the United States has been exacerbated with the emergence of the loneliness epidemic and resurgence of mental health inequities. To address the scope of this crisis comprehensively and equitably, a socioecological, cross-sectoral approach is necessary. While arts in mental health strategies have been employed internationally and nationally for preventative and rehabilitative mental health support, there remains limited knowledge of policy in the US to sustain and expand arts in mental health practices. Subsequently, this review sought to understand what priorities and strategies are employed in public health policies that seek to engage the arts to address mental health in the United States. Fourteen databases — inclusive of Embase, PsycINFO, PubMed, Scopus, and PolicyFile — were searched alongside a comprehensive grey literature search. Included documents were originated by a US organization or agency, included a mode and form of arts participation, had a focus on mental health, maintained a public health purview, pertain to the United States, and can be considered a policy document. Of 4,958 identified documents, 29 met inclusion criteria and were included. Following extraction, the evidence revealed several salient results: (a) the relative nascency of arts in mental health policy documents in the United States; (b) that policy recommendations primarily center on creating sustained, collective action and leveraging funding; and (c) that the arts sector alongside the arts and health sector are primarily leading policy work. Current momentum in the United States offers a “policy window” as there is alignment, as evidenced in this review, amongst national policy makers, the prevailing mental health crisis, and opportunities for arts in mental health policies as a viable solution. As such, this work can be mobilized to strategize how to best engage or promote the engagement of local artists, mental health practitioners, arts in mental health researchers, and policy makers in the development of arts in mental health policies moving forward. Future work should seek to intentionally build on areas of sustained effort to effectively catalyze future work towards developing legislative, regulative, or even litigative cross-sectoral, arts in mental health policies.
According to the National Institute of Mental Health (NIMH), greater than one in five adults in the United States (US) — about 57.8 million people — currently experience mental illness (1). Further, not only has this prevalence increased since the COVID-19 pandemic, but it has also disproportionately impacted minoritized communities (2). As evidenced by the US Surgeon General’s recent advisory, the expansive scope of this issue can be linked to an epidemic of loneliness and social isolation (3). This national advisory highlights the limitations of combatting this crisis solely through a biomedical model. To address the scope of mental illness comprehensively and equitably within the US, while further bolstering mental health, a socioecological, cross-sectoral approach is necessary.
Arts participation, as defined by Sonke et al. (4), considers culturally inclusive modes and forms of engagement which can be leveraged across all levels of the social ecological model to support mental health (5). As evidenced by the World Health Organization (WHO), participation in the arts offers opportunities to support mental health through a strength-based approach while also acting as a rehabilitative modality for mental illness (6). The WHO also advocates for this intersectional approach by noting that “stronger pathways between the arts, health and social care can provide creative solutions to help to achieve the Health 2020 targets and the Sustainable Development Goals” [(7), p.1]. The evidence at the intersection of the arts and mental health can be considered across a continuum spanning arts engagement in communities, public health practice, and clinical settings. Notably, epidemiological studies have considered cohort data from both the US and United Kingdom and have found that arts engagement was associated with a greater ability to cope with mental health issues in everyday life (8). More specifically, data from 12,055 adults in the US Health and Retirement Study found that group arts participation has been associated with multiple aspects of wellbeing including positive affect, life satisfaction, perceived mastery, and purpose in life (8, 9). Further, evidence has shown that adults who are over the age of 50 who visited cultural venues every few months had a 32% lower risk of developing depression over ten years (8, 10). Further, the arts have even been shown to support mental health in times of crises as evidenced during the COVID-19 pandemic (11). Despite the demonstrated efficacy of the arts in supporting mental health, there remains limited infrastructure in the US to sustain and expand arts in mental health practices.
Efforts in the US to create pathways at scale for cross-sector collaboration between artists and mental health professionals are nascent yet promising. Notably, the National Endowment for the Arts (NEA) and the US Department of Health and Human Services (HHS) have established an Interagency Working Group on Arts, Health, and Civic Infrastructure which seeks to “foster exchanges of insights and information about arts and cultural resources and strategies across federal agencies, with the goal of helping to improve the health and well-being of individuals and communities” (12). Other cross-agency efforts have also acted to promote the advancement and sustainability of this work. Some recent examples include the Federal Interagency Task Force on the Arts and Human Development (13), Sound Health: An NIH-Kennedy Center Partnership (14), and NEA partnerships with the Centers for Disease Control and Prevention (CDC) and the CDC Foundation (15, 16). The NEA also co-hosted a summit alongside the White House Domestic Policy Council — Healing, Bridging, Thriving: A Summit on Arts and Culture in our Communities — which brought together national arts leadership and health leadership on a nationally broadcast stage to discuss how the arts can be leveraged to address our country’s multi-dimensional needs (17). While these notable efforts have progressed arts in mental health work nationally, policy achievements remain limited.
Policy — whether legislation, regulation, litigation, or other forms inclusive of policies which may be organizational or do not have the force of law (18) — offers a mechanism by which to create arts-based mental health solutions at scale. Internationally, countries have already been mobilizing arts in public health policies to employ this practice at scale (19). Notably, a review by Dow et al. (19) which considered arts in public health policies internationally found that the most promising current practices, such as forms of social prescribing, are those developed through collaboration by both health and arts sectors. In the US, policy momentum has been supported by President Biden’s Executive Order on Promoting the Arts, the Humanities, and Museum and Library Services (20, 21). Within his executive order, President Biden asserted that…
Under my Administration, the arts, the humanities, and museum and library services will be integrated into strategies, policies, and programs that advance the economic development, well-being, and resilience of all communities, especially those that have historically been underserved. [They] will be promoted and expanded to strengthen public, physical, and mental health; wellness; and healing, including within military and veteran communities (20, 21).
This degree of support has presented a “policy window” for policy development at this intersection as there is alignment amongst a prevalent need, political momentum, and a viable solution (22). However, it is important to note that despite bipartisan support for arts and health across past administrations, the most recent administration openly threatens this bipartisan commitment to arts, culture, and wellbeing — weakening a once widely open policy window (23, 24).
Despite a high-level review of arts in public health policy internationally (19), there is no current literature delving into such policy within the US, especially as it relates to priorities and strategies employed by US arts in mental health policy. This is of particular importance given the role that policy at this intersection can play in supporting health equity (5). Subsequently, the objective of this scoping review was to assess the extent of the literature which considers current arts and public health policies seeking to address mental health in the US. Given the current gap in the literature, our team sought to utilize a scoping review to address the following research question: What priorities and strategies are employed in public health policies that seek to engage the arts to address mental health in the United States?