For almost two decades, Creative Alternatives has been pioneering arts-based approaches to mental health and wellbeing in Merseyside. What began in Sefton in 2006, has grown into a long-standing programme in St Helens, where it has now reached the milestone of a decade of delivery. Rooted in the principle of Arts on Prescription, the service offers creative and community-based alternatives to more traditional clinical interventions; supporting individuals who are experiencing anxiety, depression, and stress.
In this interview, Charles Daniel McDonald speaks with Helen Holden, the programme manager who has managed and led this service in St Helens since its initial inception in 2015. Here, she speaks about the evolution of the service, its core strengths, and its future direction.
Creative Alternatives has been supporting communities for many years; beginning in Sefton, before moving into St Helens and later adapting to online delivery during the Covid pandemic. Could you talk us through how the programme has evolved over time, and how lessons from Sefton shaped the St Helens service?
Creative Alternatives first started in 2006, which means it has now been running for nearly twenty years! The St Helens programme began in 2015, which is also when I joined the organisation – so we are celebrating our tenth year here. The fact that we are still going after a decade is wonderful, particularly given the challenges along the way.
The programme has certainly changed since the Sefton days. St Helens is a much smaller borough geographically and more close knit, with a small team of freelance staff working closely together. I think what has helped us sustain the service is the consistency of the programme. Some things have shifted; for example, our venues, originally from their Central Library, had to change when it closed. The structure of the programme has also become more flexible: people can now join for seven or twelve weeks. That way, they feel supported rather than pressured to complete a fixed course.
During the Covid pandemic we adapted and moved everything online. That was a challenge, as we had always worked face to face, but we still felt such a strong duty of care. Many of our participants were already vulnerable, and lockdown only increased their isolation. Keeping the programme going virtually was essential.
The Arts on Prescription model is at the heart of Creative Alternatives. How does it function in practice, and what makes it different from more traditional interventions?
Arts on Prescription offers people a social model of care. It is about seeing the individual first, with their illness or diagnosis being secondary. People with anxiety or depression often feel labelled or judged, we simply want them to feel understood and accepted.
We are not replacing clinical support, medication or therapy that may still be needed; but what we offer complements that. By listening, giving people time, and involving them in creativity, we create a safe and creative space where they feel genuinely cared for and seen as an individual.
How do the creative facilitators design activities, and what role do mindfulness and self-care play within in the sessions?
The creative projects are usually inspired by everyday themes – often from nature: seasons, colour, the elements, animals and other links to the natural world. The artistic mediums change regularly, so depending on when people join, they experience something new. Writing and mindfulness are often woven in naturally.
Every session begins with a short mindfulness exercise, such as breathwork. This grounds people and helps them feel present before they begin the creative activities. The facilitators also offer practical self-care tools that participants can take away and use at home to help them to stay well.
Who can take part in Creative Alternatives, and how does the referral process work?
Adults over 18 are welcome, and there is no upper age limit. People can be referred by professionals such as GPs or counsellors, but they can also self-refer, which gives them autonomy. Once someone is referred, I phone them personally to introduce the service. They are then invited to a taster session, so they know what to expect before they decide if they want to commit to a seven- or twelve-week programme.
Our groups meet weekly at St Helens Town Hall and people remain with the same group throughout the initial block of the weekly sessions. That consistency allows friendships to form and trust to develop, which is one of the most powerful aspects of this programme. We have six intake points throughout the year so there is never a long waiting list for new people to be able to join one of the groups. And we run two groups concurrently on different days and times so there’s a choice depending on what works best for the individual.
How do you measure the impact of the programme on the participants’ wellbeing?
To achieve this, we use both quantitative and qualitative evaluation. Participants complete wellbeing scales, such as the Short Warwick Edinburgh Mental Wellbeing Scale at the start, middle, and end of the programme. On average, scores improve by about five points, which is above our target of a 3.5 increase. We also measure lifestyle factors, such as diet, GP visits, and antidepressant use, and we consistently see positive improvements.
But the most meaningful evaluation comes from what people tell us. Many describe the service as a lifeline, or the best support they have had for their mental health. Those kinds of comments are both moving and affirming for everyone that works here.
Creative Alternatives has received awards such as the North West Public Health Award and Team of the Year. How important has this recognition been?
Awards are not why we do this work, but they certainly help with our credibility. They show that the quality of the programme is recognised, and this can make a real difference when it comes to securing funding. We are fortunate to receive strong support from St Helens Borough Council’s Public Health Service, and their Arts In Libraries Programme, but recognition helps demonstrate value on a regional level.
Do participants help shape the future of the service?
Yes, and it is something we would like to expand further. We already take on their feedback during our Moving Forward sessions and evaluations, but we would love to develop a structured volunteer and peer support programme. People with lived experience bring insights that are invaluable to everyone inside and outside of the community.
Looking ahead, what ambitions do you have for the future of Creative Alternatives?
We would love to broaden our range of creative activities. Not everyone wants to do visual arts or writing, so offering new forms of creative expression would be fantastic. We would also like to establish a volunteer programme and create opportunities for participants to stay engaged beyond the initial twelve weeks. Many people tell us they wish they could continue, so creating peer groups or spin off sessions would be a brilliant next step.
Finally, how does it feel to have delivered this service for a decade?
I feel both proud and humbled. I truly love what I do. Having experienced anxiety myself, I know how difficult and debilitating it can be. That helps me to connect with the participants, and to show them that there are ways to rebuild. I feel privileged to have grown alongside the service, and to be part of a wider team effort with Alef Trust and St Helens Borough Council.
Creative Alternatives demonstrates the profound impact that small, dedicated teams can have when creativity and compassion are placed at the centre of mental health support. Ten years on, the St Helens programme remains a testament to resilience, adaptability, and the power of the arts to heal and connect. As the service looks towards its next decade, its ethos endures: to offer people a space where they feel valued, supported, and inspired to move forward in their lives and to feel better about themselves. And long may it continue.
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