Research Article, J Fashion Technol Textile Eng Vol: 6 Issue: 3
Impacts of Co-design Process on Ex-Mentally Ill Persons Practicing Expressive Textile Arts in Hong Kong
Jin Lam CH* and Pinky HY Tsao
Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hunghom, Kowloon, Hong Kong
*Corresponding Author : Jin Lam CH
Assistant Professor, Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hunghom, Kowloon, Hong Kong
Tel: +(852) 2766-6487
Fax: (852) 2773-1432
Received: November 21, 2018 Accepted: December 03, 2018 Published: December 08, 2018
Citation: Lam JCH, Tsao PHY (2018) Impacts of Co-design Process on Ex-Mentally Ill Persons Practicing Expressive Textile Arts in Hong Kong. J Fashion Technol Textile Eng 6:3. doi: 10.4172/2329-9568.1000176
This study aims to investigate the impact of co-design process on ex-mentally ill persons practicing expressive textile arts after taking a series of co-design textile arts and fashion creativity workshops from service learning subject, “Community Engagement through Expressive Textile Arts and Fashion” offered by the Hong Kong Polytechnic University from 2017 to 2018. A total of 38 prototypes had been jointly created by exmentally ill persons, subject lecturers and undergraduate students during attending the co-design workshops in these two years. Through the co-design process, expressive textile arts and fashion creativity was adopted as the caring medium to improve ex-mentally ill persons’ mental well-being, socialhealth, empowerment, self-esteem, self-understanding and self-confidence, and also rebuild their personal identity. Concepts of ex-mentally ill persons in the community, expressive arts therapy, textile arts, expressive textile arts and service-learning subject are introduced. In this study, quantitative research method was used to explore the impacts of co-design process on ex-mentally ill persons practicing expressive textile arts. For the results, positive impacts are found on ex-mentally ill persons of feelings and thoughts before and during attending the expressive textile arts workshops in 2017 and 2018. And the most important impact is raising public awareness, it helps to eliminate misconception of ex-mentally ill persons in the society, reduce alienation and discrimination, and also promote social cohesion and acceptance.
Keywords: Expressive textile arts; Creativity; Fashion; Exmentally ill persons; Service learning
Over recent years, numerous studies have found that the therapeutic value of art therapy is as effective as other forms of psychotherapies . Davies et al.  stated that arts engagement improves mental well-being, social and physical health. Also, art projects for people with mental illness lead to increased self-esteem, self-understanding, self-confidence and empowerment [3-5]. Lith et al.  added that artbased practices act as a significant role in mental health recovery especially on psychological recovery in the areas of self-discovery and self-expression. Also, recipients’ communication skill and connections with others are also enhanced through group participation . Thus, it is assumed that expressive textile arts would be an effective rehabilitation therapy to ex-mentally ill persons to enhance their mental well-being, social health, empowerment, self-esteem, self-understanding and self-confidence, and also help them to reintegrate into the community.
In this study, it aims to explore the impact of expressive textile arts with co-design process on people with special needs namely, ex-mentally ill persons after participating in a series of interactive textile arts and fashion creativity workshops from a service learning subject offered by the Hong Kong Polytechnic University from May to July in 2017 and 2018. Cumulatively, 38 prototypes were co-created by subject lecturers, undergraduate students and ex-mentally ill persons to enhance their self-confidence and rebuild a satisfactory identity through practising expressive textile arts. Continuous 2-year data were collected by quantitative research method, the findings suggested that it could carry out positive changes in their lives and improve their well-being. Besides, the static exhibition and fashion show effectively disseminated the expressive textile artworks jointly created by the subject lecturers, students and ex-mentally ill persons were able to draw the social issue of the people with special needs to the attention of the public.
Expressive Arts, Textile Arts and Expressive Textile Arts
Expressive arts therapy
Expressive arts therapy refers to creative arts therapy, intermodal expressive therapy, or interdisciplinary arts therapy, it is the practice of using storytelling, imagery, dance, drama, music, poetry, dream work, movement, and visual arts in an integrated way, to support human growth, development, and healing . Lopez et al.  suggested that expressive arts therapy is a form of nonverbal communication; it keeps the principle of art recipient-centered to avoid any interpretations other than recipients. Atkins et al.  and Appalachian Expressive Arts Collective (2003) brought out that each human being possess inborn creativity and imagination. And expressive arts therapy is about experiencing creative expression and creative community for mental illness recovering. Through the creative process of expressive arts, recipients are able to release their stress and ease emotional problems which lead to mental healing . Regarding Hanevik et al.  artistic expression contributes to recipients’ cognitive understanding to themselves and their illness, and it helps to control their psychosis. Thus, it increases their self-understanding and mental health wellbeing. Moreover, artistic expression encourages self-expression, provides new perspective to recipients’ lives and enables them to reconstruct their self-esteem and self-confidence through interactions with other people and artworks . Rankanen et al.  and Rankanen et al.  adopted expressive arts therapy approach and reviewed recipients’ experience in their viewpoint. They pointed out that expressive arts therapy facilitates personal achievement and empowerment, also recipients can experience pleasure and relaxation in arts making process. Additionally, it enables distraction from sad emotions which promotes healing of mental illness.
According to National Institute for Clinical Excellence , group therapy is the most effective treatment context to people with mental problems. Through expressive arts engagement in group, recipients enhance their experience of catharsis and interpersonal relationships from an empathic stance . Comstock et al.  emphasized that group participation encourages and supports participants to reveal their authentic parts into the groups and into the relationships with others. It further facilitates recipients to express themselves and get involved in connections with others. Similarly, Snow et al. , supported that expressive arts therapy improve participants' communication, interpersonal skills and socialization. And they added that self-image, self-confidence and freedom of expression can be improved through group interaction. Also, a sense of accomplishment and more positive sense of self are experienced in group engagement. A report showed participants in group engagement of expressive arts therapy had demonstrated mutual respect, they learnt to receive others’ opinions and displayed confidence in their work with positive sense of self-regard .
Expressive arts therapy promotes self-discovery and self-expression, and also enhances recipients’ self-esteem, self-confidence and empowerment. They can experience pleasure and relaxation, improve their interpersonal skills and connections with others in the therapy. The impacts of expressive arts therapy can stop stigma of mental illness and also facilitate social integration for ex-mentally ill persons.
Orbán et al.  defined that textile arts are the linkage between handicrafts and arts as a metamorphosis of materials enriched with motifs, colours, meanings and concepts, it leads to unique personal experience. Griffiths et al.  suggested that creative textile arts can be used as a therapeutic medium as they facilitate engagement, empowerment and control of illness. Collier et al.  claimed that textile making as an intervention in the therapy stimulates recipients’ self-expression, personal growth and communication through creating metaphoric handicrafts. Also, flow theory was examined in textiles making process to prove engaging in textile activities helps participants to experience a sense of control, a highly focus state, and creativity [21,22]. In textile arts making process, recipients can strengthen their sense of personal identity which promotes self-discovery . In the same vein, Johnson et al.  indicated that textile handcrafting brings both tangible and intangible benefits which connect to recipients’ personal experience. And Collier et al.  denoted that textile making allows handcrafters to be calmness, to feel focused and to enjoy sheer pleasure during the creative process. Reynolds et al. [24,25] revealed textile arts allow recipients to feel that they could resist their illness and positively promote their own health.
Reynolds had explored the role of textile arts in women with depression  and long-term health problems [26,27]. Qualitative interview data were analyzed and found out that textile arts enable recipients to handle grief and depression, and allow them to enjoy happiness and confidence at the same time . Therefore, involvement in textile arts improved recipients’ quality of life through social connections with others, since recipients experience relaxation during creative pursuits, this can help them to combat emotions of depression and anxiety .
Expressive textile arts
Expressive textile arts were the medium used in the service-learning subject. Ex-mentally ill persons practiced textile arts in the form of expressive arts, the benefits of these two art forms appeared simultaneously. Self-discovery, self-expression and reflection of recipients involved in the making process. Inborn creativity and imagination allow everyone to express themselves and create unique personal experience through creative expression . The ex-mentally ill persons can increase their self-understanding, self-esteem and self-confidence in the creative process of expressive textile arts. And personal identity can be strengthened through the making process. Also, recipients can experience sheer pleasure from the expressive textile arts making process and communication. Additionally, expressive textile arts can be a tool of empowerment for recipients and connect them with others. The personal experience of the recipients in the making process of expressive textile arts can be treated as a healing process to control their psychosis. Expressive textile arts are classified as an art-based intervention which promotes personal growth, development and healing, it is predicted to have positive impact on people with mental illness and facilitate ex-mentally ill persons to reintegrate into the community.
Principle of co-design process and its benefits
Co-design is defined as the “creativity of designers and people not trained in design working together in the design development process” . The design process of co-design enables a wide range of disciplines and stakeholders to collaborate together . While the role of designers in this service learning referring to subject lecturers and undergraduate students. Lee et al.  proposed a new role for designers in co-design service. It suggested that designers are not designing for the service recipients but with them, simultaneously they can control the process and achieve aesthetic quality. As mentioned by Steen et al. , the principle of co-design process is creative cooperation in design process during the service delivery and usage, for instance, the interactions between service provider and recipients in service touch point. And Sleeswijk Visser et al.  stated that various experts such as designers, researchers or developers, and recipients cooperate creatively in co-design process, where recipients are also “experts of their experiences”. Co-design is distinguished as a process for recipients jointly explore and vocalize their latent needs, it is an approach to organize joint creativity [35,36]. Apart from recipients, co-design also affects service providers’ mindset; it helps to make them to realize the value of co-creation and the significance of empowering service recipients . Both service providers and service recipients are crucial roles in co-design process, their perspectives are essential leading to successful service design.
Muller et al.  mentioned a range of benefits of co-design practice such as enhancing mutual learning and understanding, accepting others’ ideas, facilitating communication and cooperation between various people, and jointly generating new ideas. Steen et al.  also stated the benefits of co-design process are in the areas of service design project, the service recipients and the organization. For service design project, the co-design process improves idea generation through better understanding of service recipients and knowing what their needs are, and it improves the project management with better decision making and less time-wasting. For the service recipients, the co-design process generates service which is better fit for recipients’ needs, and the service recipients would have higher satisfaction towards the service. For the organization, the co-design process enables better cooperation between different people and across disciplines within the organization.
Similarly, the co-design practice of expressive textile arts is classified as an art-based intervention and is predicted to have positive impact on people with mental illness.
The service-learning subject was conducted with a combination of lectures and workshops about interactive textile arts and fashion creativity in 2017 and 2018. And a seminar was delivered by the collaborative local community partner to introduce their background and the skills required for communication and cooperation with the service recipients before students meeting recipients in each year. Eventually, mini fashion show and exhibition were held in the Hong Kong Polytechnic University to present the final expressive textile artworks. From 2017 to 2018, the service site focused on Yaumatei, Tsimshatsui and Mongkok Districts in Hong Kong. The collaborative agency was “The New Life Psychiatric Rehabilitation Association” under the “Integrated Community Centre for Mental Wellness”. The objectives of the service-learning subject are as follows:
To introduce the concept, theories, and practice of expressive arts, textiles arts, and expressive textile arts;
To develop students’ practical skills of developing expressive textile artworks, and its application for contemporary fashion;
To enable students to use expressive textile arts making process as a healing medium to help needy people in a wider community;
To enhance students’ skills of problem solving, communication and teamwork in the context of art and design;
To introduce the concept and practice of service-learning for needy people locally and overseas; and
To nurture students’ sense of social awareness, responsibility and engagement.
The final expressive textile artworks were showcased in a styling presentation, a static exhibition, and a mini fashion show within the university. “Laugh and Walk Together for a Better Future 2017” was also offered from May to July. The service recipients were 20 exmentally ill persons. Lectures and workshops were held in May. Mini fashion show was showcased on 30 June and static exhibition was held from 4 to 21 July. “I’mPerfection ? I’mPerfashion 2018” was offered from May to July. The service recipients were 18 ex-mentally ill persons. Lectures and workshops were held in May. Mini fashion show and static exhibition was conducted from 4 to 13 July.
In the expressive textile arts making workshops, 3 to 5 students were paired up with a recipient to discuss and co-design expressive textile artworks, the whole artworks making process was under subject lecturer’s supervision. The application of colours, textures and patterns on textile artworks were emphasized, they helped to interpret recipients’ past experience and personal stories which leaded to self-discovery, self-expression and mental recovery. Mini fashion show was held in the university to demonstrate the final expressive textile artworks jointly created by students and service recipients. For the preparation of the mini fashion show, a professional make-up and hair sponsor was sourced and a professional show production house was appointed. During the mini fashion show, recipients demonstrated their expressive textile artworks by modelling their designs by themselves. The self-expression and self-confidence of recipients were further accelerated through the mini fashion show. The university as the venue for the mini fashion show and static exhibition acted as a social platform to propagate the results of the service-learning project to the public effectively.
In this study, a quantitative research method was adopted to collect data. A self-administered questionnaire survey was conducted before and during the expressive textile arts making workshops in each year. The questionnaire was designed on the basis of the ‘Art-based Intervention (ABI) Questionnaire’ . A 24-question questionnaire was used in 2017 and 2018. Variables in the two questionnaires were ‘feeling and thoughts before attending the workshops’ and ‘feeling and thoughts during attending the workshops’. Subjects were 20 and 18 ex-mentally ill persons from the collaborative agency “The New Life Psychiatric Rehabilitation Association” in 2017 and 2018 respectively. A 7-point Likert scaling was adopted in the questionnaires for the questions regarding feelings and thoughts in the workshops. The ranking scales were set as 1 for ‘entirely disagree’, 2 for ‘mostly disagree’, 3 for ‘some-what disagree’, 4 for ‘neither agree or disagree’, 5 for ‘some-what agree’, 6 for ‘mostly agree’, and 7 for ‘entirely agree’, where scales 1 to 3, 4 and 5 to 7 are later divided as ‘little’, ‘a fair amount’ and ‘much’ respectively. Respondents took an average time of 45 minutes to accomplish the questionnaire. Software IBM SPSS Statistics 25 was applied to analyze the data collected.
Results and Discussion
The results of the questionnaire survey conducted in 2017 and 2018 are presented in Table 1 and show the impacts of co-design process on ex-mentally ill service recipients practicing expressive textile arts. Service recipients’ perceptions of ‘feelings and thoughts before attending the workshops’ and ‘feelings and thoughts during attending the workshops’ are revealed below.
|Items||N||Mean||SD||Percentage Distribution (%)|
|Little||A Fair Amount||Much|
|Before attending the workshops|
|5||I am excited to participate in the expressive textile arts workshops||38||5.89||1.181||3%||3%||94%|
|6||I am curious about the expressive textile arts workshops||38||5.97||1.127||3%||3%||94%|
|7||I have ideas about what I want to make for the expressive textile arts workshops||38||5.16||1.498||10%||16%||74%|
|8||I feel confident in my ability to perform well in the expressive textile arts||38||5.29||1.412||8%||16%||76%|
|9||I am upset to get involved in the expressive textile arts workshops||36||2.42||1.556||75%||17%||8%|
|10||I am a verse to participating in the expressive textile arts workshops||38||1.53||0.951||92%||8%||0%|
|During attending the workshops|
|11||I feel pleased to create an expressive textile artwork||38||6.34||1.279||5%||3%||92%|
|12||I feel relaxed in my creative process||38||5.97||1.461||11%||0%||89%|
|13||I can concentrate on creating an expressive textile artwork||38||6.24||0.943||0%||5%||95%|
|14||I enjoy working on my expressive textile artwork||38||6.32||0.989||0%||5%||95%|
|15||I feel frustrated to execute my creative ideas||37||3.27||1.82||51%||14%||35%|
|16||I feel limited in my creative process||38||4.08||1.937||37%||8%||55%|
|17||I encountered the technical difficulties in creating an expressive textile artwork||38||3.71||1.784||42%||5%||53%|
|18||I can overcome my failure on my creative process||38||5.55||1.427||5%||21%||74%|
|19||I am worried about the appearance of my expressive textile artwork||38||2.5||1.782||68%||11%||21%|
|20||I feel satisfied with my textile artwork||37||5.81||1.351||8%||5%||87%|
|21||I feel scared to handle the textile arts materials||38||2.29||1.523||76%||11%||13%|
|22||It takes me a while to understand how to work with the textile arts materials||38||3.84||1.838||39%||11%||50%|
|23||I feel I am playing with the textile arts materials||37||6.57||0.835||0%||5%||95%|
|24||I am interested in working with the textile arts materials||38||6.47||0.797||0%||3%||97%|
Table 1: Findings of Art-Based intervention (ABI) Questionnaire of Ex-Mentally Ill Persons in 2017-2018.
Before attending the workshops in 2017 and 2018, 94% of respondents claimed that they were “much excited” to participate in and “much curious” about the workshops. 76% of them felt “much confident” in their abilities to perform well in the expressive textile arts. Only 8% of them were “much reluctant” to get involved in the workshops.
During attending the workshops, 92% of respondents felt “much pleased” to create expressive textile artworks. And 89% of them felt “much relaxed” in the creative process. 95% of them stated that they were “much concentrated” on creating expressive textile artworks. Also, 95% of respondents “enjoyed” working on expressive textile artworks. Only 5% of respondents asserted that they could not “overcome the failure” in their expressive textile arts creating process. There are 35%, 21% and 13% of respondents said they felt “much frustrated” to execute their creative ideas, “much worried” about the appearance of their expressive textile artworks, and “much scared” to handle the expressive textile arts materials respectively. Nevertheless, 87% of respondents expressed that they felt “much satisfied” with their expressive textile artworks and 97% of them were “much interested” in working with the expressive textile arts materials. Also, 95% of them felt they were “playing” with the expressive textile arts materials.
Overall, the service recipients’ perceptions of feelings and thoughts before and during attending the workshops in 2017 and 2018 showed positive outcomes. The research findings indicated that service-learning subject with expressive textile arts and fashion creativity in co-design process as the caring medium brings positive impacts to exmentally ill persons.
In this study, positive impacts were found on ex-mentally ill persons’ perceptions of feelings and thoughts before and during attending the co-design expressive textile arts workshops in 2017 and 2018. Sheer pleasure was created in the expressive textile arts workshops, interactions between service recipients themselves, with subject lecturers and students were promoted. Also, the workshops encouraged empowerment, self-discovery and self-understanding in expressive textile arts creative process. These allowed ex-mentally ill service recipients to improve their mental well-being through understanding themselves and concentrating in their participation. Moreover, self-expression was encouraged in the workshops and mini fashion shows, which enabled service recipients to reconstruct their self-esteem and self-confidence. Through participating in this servicelearning subject, ex-mentally ill persons were allowed to express their feelings and thoughts in expressive textile arts making and fashion styling, it stimulated re-establishment of their personal identity, expansion of their social networks, mental recovery, and further helped them to reintegrate into the community. Lastly, the greatest impact of the service-learning subject is raising public awareness, it helps to reduce misconception of ex-mentally ill persons in the society, eliminate discrimination and alienation, and also promote social acceptance and cohesion to the people in need.
- Wampold B (2013) The good, the bad, and the ugly: A 50-year perspective on the outcome problem. Psychotherapy 50: 16-24.
- Davies C, Knuiman M, Rosenberg M (2016) The art of being mentally healthy: A study to quantify the relationship between recreational arts engagement and mental well-being in the general population. BMC Public Health 16: 15.
- Parr H (2006) Arts and social capital. Ment Health Today 23: 5.
- Kagan C, Sixsmith J, Siddiquee A, Bol S, Lawthom R, et al. (2005) Community psychology meets participatory arts: Well-being and creativity.
- Rankanen M (2016) Clients’ experiences of the impacts of an experiential art therapy group. The Arts in Psychotherapy 50: 101-110.
- Lith TV, Schofield M, Fenner P (2013) Identifying the evidence-base for art-based practices and their potential benefit for mental health recovery: A critical review. Disabil Rehabil 35: 1309-1323.
- Comstock D, Duffey T, George H (2002) The relational-cultural model: A framework for group process. The Journal for Specialists in Group Work 27: 254-272.
- Atkins SS, Adams M, McKinney C, McKinney H, Rose L, et al. (2003) Expressive arts therapy : Creative process in art and life.
- Lopez M (2011) Expressive arts therapy as a treatment approach for adults suffering from severe and persistent mental illness. Masters Abstracts International 49: 186.
- Hung BL, Chen FN (2010) Expressive art and emotion management – the learners’ feedbacks and reflections. Journal of Taiwan Art Therapy 2: 107-121.
- Hanevik H, Hestad KA, Lien L, Teglbjaerg HS, Danbolt LJ (2013) Expressive art therapy for psychosis: A multiple case study. The Arts in Psychotherapy 40: 312-321.
- Teglbjaerg HS (2011) Creating art therapy.
- Rankanen M (2014) Clients’ positive and negative experiences of experiential art therapy group process. The Arts in Psychotherapy 41: 193-204.
- National Institute for Clinical Excellence (2009) Schizophrenia: Core interventions in the treatment and management of schizophrenia in adults in primary and secondary care.
- Lenz AS, Holman RL, Dominguez DL (2010) Encouraging connections: Integrating expressive art and drama into therapeutic social skills training with adolescents. Journal of Creativity in Mental Health 5: 142-157.
- Snow S, D’amico M, Tanguay D (2003) Therapeutic theatre and well-being. The Arts in Psychotherapy 30: 73-82.
- Argue J, Bennett J, Gussak D (2009) Transformation through negotiation: Initiating the Inmate Mural Arts Program. The Arts in Psychotherapy 36: 313-319.
- Orban AM (2013) From legendary textiles to fibre art, cultural fingerprints in textile art. Diversitate Si Identitate Culturala in Europa 10: 109-118.
- Griffiths S (2008) The experience of creative activity as a treatment medium. J Ment Health 17: 49–63.
- Collier A (2011) The well-being of women who create with textiles: Implications for art therapy. Art Therapy 28: 104-112.
- Blood J (2007) Non-industrial textile production as optimal experience: Applicability of the flow theory to clothing and textiles subject matter.
- Riley J (2008) Weaving an enhanced sense of self and a collective sense of self through creative textile-making. Journal of Occupational Sciences 15: 63–73.
- Johnson JS, Wilson JE (2005) “It says you really care”: Motivational factors of contemporary female handcrafters. Cloth Tex Res J 23: 115-130.
- Reynolds F (2000) Managing depression through needlecraft creative activities: A qualitative study. The Arts in Psychotherapy 27: 107–114.
- Reynolds F (2004a) Conversations about creativity and chronic illness II: Textile artists coping with long-term health problems reflect on the creative process. Creativity Res J 16: 79–89.
- Reynolds F (2004b) Textile art promoting well-being in long-term illness: Some general and specific influences. Journal of Occupational Sciences 11: 58–67.
- Reynolds F (2002) Symbolic aspects of coping with chronic illness through textile arts. The Arts in Psychotherapy 29: 99–106.
- Reynolds F (1997) Coping with chronic illness and disability through creative needlecraft. Br J Occup Ther 60: 352–356.
- Meadow ML, Rutherford EB (1999) Becoming whole: A pastoral story. Health Care Women Int 20: 427-432.
- Sanders EN, Stappers PJ (2008) Co-creation and the new landscapes of design. CoDesign 4: 5-18.
- Burns C, Cottam H, Vanstone C, Winhall J (2006) Transformation design.
- Lee Y (2008) Design participation tactics: The challenges and new roles for designers in the co-design process. Co-Design 4: 31-50.
- Steen M, Manschot M, Koning N (2011) Benefits of co-design in service design projects. International Journal of Design 5: 53-60.
- Sleeswijk Visser F, Stappers PJ, Van der Lugt R, Sanders EBN (2005) Contextmapping: Experiences from practice. CoDesign 1: 119-149.
- Sanders EBN (2002) From user-centred to participatory design approaches.
- Sir S, Regev D (2013) ABI – art-based intervention questionnaire. The Arts in Psychotherapy 40: 338-346.
- Parker S, Heapy J (2006) The journey to the interface: How public service design can connect users to reform.
- Muller MJ (2002) Participatory design: The third space in HCI.