The Rhythm and Rhymes Adolescent/Adult Program

The Rhythm and Rhymes Adolescent/Adult Program (RRAP) is a 12-week hip-hop therapy program designed to engage young people with severe mental illness in a way that is enjoyable, creates a sense of purpose in their lives and helps them reconnect to themselves and others.

Aim

To improve the quality of healthcare delivered to marginalised people, by increasing engagement and connection through lived experiences.

Benefits

• Delivers integrated, evidence-based treatment to people with a severe mental illness.
• Improves engagement and attrition in mental health treatment programs.
• Provides positive, meaningful experiences through music in therapy.
• Uses rap music to promote positive behaviour change and build empowerment and self-efficacy in young people.
• Supports the patient experience through music, storytelling and performance, in line with the National Arts and Health Framework.
• Enhances collaboration between mental health staff and patients.
• Offers a person-centred approach to treatment, encouraging teamwork, diversity, collaboration and problem solving.
• Allows participants to share experiences, adversities and needs in a respectful and supported environment.
• Challenges cognitive distortions using cognitive behavioural therapy and narrative therapy.
• Considers the diversity of participants’ backgrounds, trauma and experiences of marginalisation.
• Aligns to strategic directions 1-4 of the Justice Health and Forensic Mental Health Network (JH&FMHN) Strategic Plan.

Background

Rap is one of the most popular genres of music among young people. It was developed as a result of individual and collective marginalisation and is a form of social protest¹. The lyrics often focus on social issues, including drug use, crime, violence, culture, alienation and disenfranchisement, while expressing mental vulnerability in a hyper-masculine culture².

Music can provide a channel for expressing difficult feelings such as anxiety, anger and hostility, with hip-hop therapy showing therapeutic effects in young people who have experienced adversity^3,4. While it is a relatively new and unconventional mode of therapy, rap music programs have been found to increase engagement in at-risk youth, when compared to treatment as usual⁴. It can promote social behaviours, positive coping, resilience, self-identify and connection⁴.

Prior to the project, staff at the Forensic Hospital found it difficult to engage young people in treatment. Motivation to attend treatment sessions was often lacking and attrition rates were low. Young offenders like those at the Forensic Hospital have often experienced chronic marginalisation, early psychosocial adversities and difficulty engaging in treatment⁵. As a result, it was determined that implementing hip-hop therapy in the Forensic Hospital would engage young people and improve treatment outcomes.

Implementation

The RRAP is a 12-week therapeutic group program that provides a way for young people and adults with severe mental illness to redirect their aggression and improve feelings of stability. It is the first hip-hop therapy program of its kind in NSW and was developed by a Clinical and Forensic Psychologist who was a DJ for over 10 years and wanted to establish a creative, engaging and effective program for both young people and adults.

The program uses music in therapy as opposed to music therapy, focusing on a range of areas including substance use, addictive behaviours, interpersonal relationships, antisocial attitudes, values and beliefs, peer influences, identity, grief and loss, anger management, goal setting and coping. Patients are encouraged to write songs and develop rhythms and rhymes in the music room, within the grounds of the Forensic Hospital.

The RRAP is facilitated by allied health and nursing staff, who help patients explore the lyrics of rap songs that relate to the patient’s own experience, then encourage them to compose their own. Sessions are held once a week for 12 weeks and patients can self-refer to the group, however attendance is not compulsory, which empowers patients and gives them a sense of control over their treatment. A group discussion is held during the first session, where confidentiality, collaborative goals and expectations are established.

A manual was also developed as part of the project, so Forensic Hospital staff can replicate the program and use it in other areas of JH&FMHN. It is anticipated that the program will eventually be implemented in prisons, juvenile detention centres and communities across NSW.

Project status

Sustained – The project has been implemented and is sustained in standard business.

Key dates

The RRAP started in August 2015 and has been integrated into the Forensic Hospital as a centralised group program. Ethics approval was granted in 2016 to collect data, with a full evaluation due to be completed in 2019.

Implementation sites

Forensic Hospital, Justice Health and Forensic Mental Health Network

Results

• Six 12-week programs were conducted at the Forensic Hospital between August 2015 and July 2017. Results showed there was a 95 per cent attendance rate, with 43 participants (male and female, adolescent and adult) voluntarily joining the program.
• Surveys conducted prior to and following the first five programs showed evidence of improved coping skills and a sense of hope, as well as reduced levels of depression and anxiety in some patients.
• Patients are invited to take part in a semi-structured interview following the program, to evaluate the group and provide feedback on which aspects of the RRAP are enjoyable, helpful and therapeutic.
• Qualitative data collected from November 2015 showed that patients were interested in doing the program again and used music and song writing as a coping resource, which encouraged self-reflection, insight, connectedness, emotional expression and identity.
• An evaluation conducted in July 2017 found that the program promotes health and wellbeing through creative engagement, social cohesion, a sense of identity and empowerment.
• Some multidisciplinary teams have reported improved engagement and attrition in treatment programs, with a decrease of some symtoms and an increase in self-concept, identity and meaningful experiences during their stay.
• The project will continue to be evaluated over the next five years, with results published in peer-reviewed articles.

Lessons learnt

It was difficult to incorporate multimedia into the program, given the high security of the Forensic Hospital. The program needed to be adjusted to cater to these restrictions. It is important to persevere, think broadly and overcome challenges or obstacles which may otherwise hinder the end goal in mind. However, the obstacles that were faced in the implementation of the program provided a more rewarding experience for facilitators and patients.

References

1. Miller K. It's a rap: hip hop's first ladies. The Charlotte Post 2013;38(27):5B.
2. Reilly T. Hip-hop and psychiatry: A fair rap? The British Journal of Psychiatry: The Journal of Mental Science 2013;203(6):408-11.
3. Levy I. Hip hop and spoken word therapy with urban youth. Journal of Poetry Therapy 2012;25(4):219-24.
4. Elligan D. Rap therapy: A culturally sensitive approach to psychotherapy with young African American men. Journal of African American Men 2000;5(3):27-36.
5. Holdsworth E, Bowen E, Brown SJ et al. Offender engagement in group programs and associations with offender characteristics and treatment factors: a review. Aggression and Violent Behavior 2014;19(2):102-21.

Further reading

• Hadley S, Yancy G. Therapeutic uses of rap and hip hop. New York: Routledge; 2012.
• Heath T, Arroyo P. ‘I gracefully grab a pen and embrace it ’: Hip-hop lyrics as a means for re-authoring and therapeutic change. The International Journal of Narrative Therapy and Community Work 2014;3:31-38.
• Kitwana B. The hip hop generation: young blacks and the crisis in African American culture. New York: Basic Civitas Books; 2002.
• Kubrin C. Gangstas, thugs and hustlers: identity and code of the streets. Social Problems 2005;52(3):360-370.
• Levy I, TaeHyuk-Keum B. Hip-hop emotional exploration in men. Journal of Poetry Therapy 2012;27(4):217-223.
• Mark A. Adolescents discuss themselves and drugs through music. Journal of Substance Abuse Treatment 1986;3:243-249.
• NSW Health. Rhythm and Rhymes Adolescent/Adult Program – hip-hop therapy: NSW Health Awards Fact Sheet. 2016.
• Ogbar J. Hip-hop revolution: The culture and politics of rap. Lawrence: University of Press of Kansas; 2007.
• Rine CM. Therapeutic Uses of Rap and Hip-Hop. Health and Social Work 2013;38(1):59-60.
• Rose T. Black noise: rap music and black culture in contemporary America. Hanover, NH: University Press of New England; 2014.

Contact

Kim Dilati
Clinical and Forensic Psychologist
Forensic Hospital
Justice Health and Forensic Mental Health Network
Phone: 02 9700 3114
kim.dilati@justicehealth.nsw.gov.au