Artists at a conference heard that their work with patients could build self-esteem - seen as 'a powerful determinant of health', writes Mary Leland

It seems like a big boast: "We are not therapists, but allies in the struggle to make people's lives better." Yet when Tony Sheehan, formerly director of community programming for Cork's year as European Capital of Culture 2005 and now arts adviser at the Department of Arts, Sport and Tourism, asserted his belief in the transformative power of culture in the delivery of health care, no one in his audience protested.

Organised as a reflection on that innovative strand of the Cork 2005 calendar, last week's conference on "Culture and Health: Partnership and Opportunities" had drawn an attendance of more than 200 from various health and culture groupings. They were greeted by Ann O'Connor, previously Culture and Health project manager for Cork 2005 and recently appointed arts programme co-ordinator for the HSE Southern Region.

This full-time appointment signals a commitment in Munster at least to what Gretta Crowley, local health office manager for South Lee, describes as "the creative use of available resources". Finding €80,000 for an opportunistic budget (for which there is already an opportunistic queue) she hopes to provide a structure inviting enough to tempt more artists of a high calibre into health services in the region.

Also welcomed at the conference was the news that Charlotte Donovan, the Glasgow artist employed for the Triskel Arts Centre residency at St Finbarr's Hospital during 2005, is to continue in that position for at least another nine months, and has been allocated a house within the complex which she can also use as her personal studio.

The hospital was once "the Union" or workhouse, and covers 25 acres. In her case study presentation, Donovan explained that 13 different artists had come to work there with her, collaborating with staff, patients and visiting groups in a series of events and installations.

Deirdre McCrea of Music Network had directed seven-week modules in mental health centres where she found gratifying levels of support from management and staff with a consistent patient participation rate. There is a hope that this programme will be continued and already the hospitals concerned are building up instrument banks.

If there was a single theme shared by all speakers, it was that this is not art therapy, although its effects are therapeutic. Not all situations were medical: community groups, after-school or homework centres, retirement and youth associations all came under the programme's aegis. Yet revisiting different projects of the past year and offering enthusiastic endorsements of them all may not be the best method of evaluation.

APART FROM AN appeal to justify spending money on the arts when patients are on trolleys, the absence of a critically analytical voice was noticeable. When Forum Theatre presented its play, Better to be Thonged Red than Dead, performed by residents of the Cheshire Home and directed by Peter Kearns, its satirical image of a do-gooder carried an unsettling nuance.

Yet no one was pretending that, as Ann O'Connor said, a box of paints could be as important as a diagnostic machine. As guest speaker Mike White of the University of Durham expressed it, they were building self-esteem - "a powerful determinant of health", through the arts. Crucially, according to White's experience and research, the introduction of art attitudes and practices into the health environment provides both opportunities and mechanisms for the recovery of dignity, autonomy, fellowship and social acceptance.

What has been forgotten, he believes, is the importance of emotional literacy to health; if Anthony Gormley's definition of sculpture as being representative of the collective body were accepted, then the collective body is what distinguishes art in health from art therapy - "health is about the whole person, not just the stricken part".

No one is expected to become an artist out of this kind of interaction, although in fact it can happen, just as forgotten or latent enjoyments can be revived.

By now art in health care is not just one concept but has grown and diversified; spreading, as White says, "almost like a benign virus from community to community". He agrees that there has not been much evaluation to date, and there is some confusion about what evaluation means. Nor is it easy to provide clinical data which might support the social benefits. "Unless we have something like a national research programme in this area there will still be a lot of sceptics," says White, adding that the British Arts Council will publish a national strategy on arts and health shortly, coinciding with a national review of arts and health funding.

The hope is that mainstream thinking on this issue might result in mainstream funding. White says the more this very resourceful sector relies on financing partnerships, the more the Arts Council and health trusts are reluctant to make the funding commitment.

Although Sheila Gorman of the Arts Council of Ireland told the conference that her organisation had designed a new strategy and policy document on the arts and health and disability, there is another problem, the elephant in the room of art and health relationships.

"There is a question mark in the Arts Council in England about the inherent quality of this work," White agrees. "But that question extends into any kind of community work, and the quality issue has to come out of a dialogue between the council itself and the health services. They don't necessarily share the same ideas of what constitutes quality. If arts in healthcare were a system working on the gallery basis then the name of the artist involved would be very important - but that isn't the case. This is not about the cult of celebrity."

But celebrity can help, he makes clear, evoking the entertainers who have talked publicly about their mental illness, or the stand-up comedians whose acts are followed by invitations to a check-up - "if you enjoyed the show". Suddenly the artists become, at best, facilitators.

An undertaking involving 32 projects dealing with 2,500 clients can't be reduced to images of dancing in a hospice or binaural microphones on guide-dogs for the blind, where hope of some kind of magical exchange is like a permit to tip the edge of downright silliness. But can the artist benefit from this?

In a context in which critical evaluation has to focus on the process rather than the product, there were hints that this is a recognisable dilemma. Charlotte Donovan, for example, admitted that she has to take care that, working and now living in an institution, she herself does not become institutionalised.

MOLLY STURGES CAME from America to work with the residents of a sheltered housing scheme - "an inter-generational performance ensemble project" involving clients, staff, relatives, schools and community groups. Her initial approach was exploratory, intent on allowing people to interact creatively with one another and to break down the divisions which often can be typical of health care institutions.

"But this attempt to be creatively representative is not a helping model," she said last week. "Everybody has to take risks, especially if we're hoping to transcend the concepts we carry around with us, hoping to recalibrate the sense of self through creative work."

The challenge of that work, she felt, would last a long time: "We're not singing a song that has already been written."

Launching the booklet and DVD study of the Cork 2005 health and culture strand, Mary Cloake, director of the Arts Council, said the programme had emphasised the powerful influence of the arts in society. As if answering the unasked question of the day, she added that it had also revealed how working in health care settings could enrich the work of the artist in a way which could often be finer than the gallery-led inspiration.

If, as Cork 2005 director John Kennedy had remarked, this conference was the last hurrah for the Capital of Culture programme, the publication would have an influence long after the year itself was forgotten.

• Booklets and DVDs, Culture and Health: a study of 32 projects in diverse healthcare settings, are available from HSE South: 021-4923136