After a wee break out from this blog, I thought I’d start out again with a serious look at how musicians, especially those on tour, go about keeping themselves physically and mentally fit and healthy. To explore this theme, I enlisted the help of Dr Melanie Grundy, trustee of Help Musicians UK, psychiatrist and music aficionado. She talked to me about her background, strategies for staying healthy as a working musician, how to get help if you or a bandmate is struggling from the pressures of touring and the services that Help Musicians UK and others have to offer. Here’s what she had to say:
SP – Could you tell us about a bit about your medical career and how your upbringing and continued love of music have lead to a role with Help Musicians UK?
MG – Looking back on my varied medical career, leading up to my eventually qualifying as a GP in September 2015, it has always been the holistic aspects of medicine which have interested me, but that are often difficult to fulfil, particularly with the unrelenting pace of modern GP. A ten-minute consultation is fine for dealing with acute illness, but it provides insufficient opportunity to look at the whole person in a holistic manner, which in the case of chronic disease is the only way to affect real, long standing change. Working as a GP I found myself consistently fighting time pressure, frustrated that I was unable to do the job to the standard I wanted. Where this applies to patient care it felt morally, ethically, intellectually and emotionally unsatisfying and that I was short changing those in my care, particularly those with Mental Health problems. Because of this I decided to leave GP and move back into Psychiatry, where I can better apply my holistic approach. I am currently working as a Specialty Doctor on a Forensic Adolescent unit in Newcastle upon Tyne.
Music is my main interest outside work. I’ve been marinated in jazz since birth by a piano trio obsessed father and a vocal standards loving mother. As a child, I would sit listening on the stairs as friends of my father’s, who played on the local jazz scene in Nottingham, called in at home late night for post-gig debriefs, so I’ve long been aware of the joys and tribulations of being a musician. I went off on my own musical listening journey as a teenager, but found my way back to jazz in my late 20’s and my career as a dedicated attendee at jazz gigs and festivals has gone from strength to strength over the last 15 years, culminating in my recently taking on the role of Trustee/Secretary of local music promoter Jazz North East. I also sing jazz standards with a local sextet, play flute and write poetry and songs.
I first heard about the charity Help Musicians UK (HMUK) and the Music Minds Matter service project during an interview on Jazz FM with the charity’s then CEO, Richard Robinson, in early November 2017. A couple of weeks later I attended a panel discussion on mental health in musicians, hosted by HMUK at London Jazz Festival; I introduced myself to the HMUK staff and after a meeting at the charity’s headquarters in January 2018, I was invited to become a member of their Musicians Health Advisory Board. Although I have never worked within the music industry, my first undergraduate degree in the visual arts and my previous professional role as a self-employed designer/maker give me a good insight into the nature of working in the creative industries. When you couple this with my varied medical career and my lifelong involvement with live music, I guess I have a completely unique combination of skills and knowledge to bring to my role with HMUK and I am delighted to have the opportunity to share that knowledge with those who can hopefully gain some positive benefit from it.
SP – I understand that there are a number of different elements of your health that you have to look after whilst on tour. One major focus right now is mental health, particularly in relation to a number of high profile suicides, including Frightened Rabbit frontman Scott Hutchison. How can you look after your health as a touring musician, both mentally and physically?
MG – Being on tour represents the fact that you’ve achieved sufficient recognition as an artist to be offered a series of gigs that take you away from home for a period of time. Managers always strive to get the best out of their artists and this requires a level of wellbeing maintenance. There can be an expectation from audiences that you will be on top form to perform the music they’ve bought tickets to see. There’s inevitably also an internal expectation of yourself that you will be able to cope with the pressure and perform the music that you’ve spent so many hours writing and rehearsing at its absolute best; so it’s sometimes hard to cut yourself a little slack and forgive yourself for making small mistakes under those circumstances. Yet being on tour is a really tough call mentally and physically, meaning that being able to perform at the top of your game can be an enormous challenge for a variety of different reasons:
1) The work schedules can be totally unforgiving, with much of the time between gigs spent travelling, which can mean major disruption of sleep patterns at a time when getting enough sleep is absolutely essential so you can physically cope with the demands of touring and because sleep deprivation can have a massive negative effect on mood. It’s therefore really important to try and get as much sleep as you can, whenever you can, preferably as close to your “normal” pattern as circumstances allow. HMUK is looking into how it can support people who work in music with their sleep and the Mental Health Foundation produce a useful leaflet about the importance of sleep which you can download from their website: https://www.mentalhealth.org.uk/publications/sleep-report
2) Being on the road means being away from your usual sources of moral support such as partners, close friends and family; if you are lucky enough to have a supportive relationship with your fellow band-members, then you can keep one another going through difficult times, but the practicalities of being on tour together can put considerable strain on these relationships, so it may be hard to share your personal difficulties with those immediately around you, leaving you feeling isolated and vulnerable, even though there are people around you constantly. If it’s difficult to discuss personal issues with band-mates or those supporting the tour, keep in regular contact via Skype or Face-time with family, friends or loved ones at home. If you are feeling stressed, pressurised or are having problems with performance anxiety (stage fright), then practicing mindfulness can be helpful; this is something you can do anywhere and don’t need any special equipment for, although there are convenient apps available for your phone, such as Headspace and Calm. The Music Minds Matter service can also provide information, a listening ear and emotional support to anyone who calls.
3) When you’re on tour, there’s inevitably more access to alcohol and it’s often included in the rider from a venue. Having one or two drinks at the end of a gig can help you to calm down after the adrenaline high of being on stage (alcohol is a mood depressant after all) and it’s great to socialise with band-mates and audience members, but treat alcohol with respect; it’s all too easy to just “have another” and before you know it you’ve got a serious habit. There’s a common misconception that having a drink can help you sleep, it may help you fall asleep in the short term, but it also prevents you from entering the deeper stages of sleep, where your body (and mind) do most of their healing. Alcohol is a diuretic (makes you pee), so if you do have any alcohol, make sure you also drink plenty of water (you should be aiming for a minimum of 2 litres per day anyway). The drinkaware website has some useful information: https://www.drinkaware.co.uk
4) Irregular hours, being away from home and lack of time can all impact on food choices resulting in eating an unhealthy diet whilst on the road. Work schedules often mean that you end up eating late at night and like alcohol, this can have a negative effect on your sleep pattern, especially if you eat a carb heavy meal (bread, pasta, rice, chips, potatoes). Late night choices may be limited to unhealthy options such as burgers, kebabs, cheap pizza and fish & chips. If possible, try to eat earlier in the evening, and try to make healthy food choices where you can. For more information go to: https://www.nhs.uk/live-well/eat-well/eight-tips-for-healthy-eating/
(This is a good place to start for basic information, although personally I would not endorse eating a diet heavy in the type of starchy carbohydrates described).
5) Sitting for hours whilst travelling and not having time to get any regular exercise is another way in which touring can have a negative impact on both your mental and physical health. Never under estimate the importance of moving for all aspects of your wellbeing! I’m not suggesting that you need to go out for a run everyday, although if you are a runner, pack your shoes and hit the streets for an hour before you sound check; even going for a walk or doing some yoga stretches can be helpful.
SP – There is a lot of media attention being given to mindfulness currently. Is this a strategy you give credence to, and if so, what are the benefits?
MG – Yes, I would absolutely give credence to Mindfulness as a strategy to cope with stress and anxiety. There’s a huge volume of evidence in scientific literature that demonstrates its’ effectiveness, to the point where it is now recommended as a strategy for the prevention of depression in those who have had three or more bouts of depression in the past. Mindfulness is a simple technique, which involves bringing your attention to both internal and external experiences occurring in the present moment; it can be done anywhere, without the need for any special equipment. It can be as simple as sitting still for a few moments and focussing on your breathing and bodily sensations, whilst noticing the thoughts that come into your mind, acknowledging and accepting them without judgement, neither holding onto thoughts or trying to force them away.
The physical benefits of Mindfulness include a slowing of breathing and heart rate and relaxation of muscle tone. The mental benefits include developing the ability to control thoughts and see that they are simply mental events that do not control us; eventually this develops into the ability to bring yourself to a point of inner calm and stillness, where you are better able to put things into perspective and see things as they really are.
Mindfulness isn’t necessarily the answer for every person, every time and if you find that you’re having difficulty with your mental health, which isn’t helped by using these techniques, it’s important to consult a healthcare professional.
SP – What strategies would you recommend for helping a band-mate on tour who is experiencing any form of mental ill health?
MG – It can be really difficult to be in this situation, as this may be a problem that your colleague has not previously shared, but which becomes obvious when you are together for prolonged periods on tour. Talking to them about their difficulties in an open and non-judgemental way can be a really helpful place to start, and simply being heard may be all they need, but you may quickly feel out of your depth, in which case you need to look for other sources of support. Encouraging your band-mate to talk to the band’s tour manager is an option, but if they feel uncomfortable to do this, contacting an anonymous support service such as The Samaritans, SANEline or the music industry specific support service Music Minds Matter, offered by HMUK is another option. If your band-mate is in a really urgent crisis situation, especially if they are threatening to harm themselves, or have already harmed themselves, support them to attend A & E where the team can keep them safe and arrange for review by the Psychiatry Crisis Team.
If your band-mate is already taking medication for a mental illness, the disruptive schedule of touring may mean that they forget to take it, or take it at irregular times, which may decrease the medication’s effectiveness resulting in a deterioration to their mental health. In this situation they should probably be seen by a GP at a local Walk-in or Urgent Care Centre, especially if there has been a gap of several days since they have last taken their medication. If your time schedule makes this impossible, just supporting your band-mate to start taking their medication regularly again can be helpful, but it depends on what medication they are on and how long a gap there has been in taking it; a pharmacist may be able to advise if there isn’t time to arrange to be seen by a GP.
If your band-mate is struggling with performance anxiety, using Mindfulness can be really helpful, and there are some very good apps such as Headspace and Calm, which can help with this.
SP – Additionally, what can you do if you notice yourself struggling?
MG – As a first step try to take the simple measures outlined above: adequate sleep, reducing or avoiding alcohol, trying to eat healthily, staying in contact with friends, family, partners and using Mindfulness techniques. If these strategies are not enough, then be open about your difficulties; those around you can’t offer help and support if they don’t know you need it! Admitting that you are struggling is one of the hardest things you can do, especially if those around you seem to be coping fine. If you don’t feel comfortable talking to band-mates, think about the resources mentioned above, including the Music Minds Matter helpline. If you feel, or the helpline advise that you need to see a GP, then be aware that it is possible to access GP services anywhere in the UK as a temporary resident. Walk-in and Urgent Care Centres provide same day appointments throughout the day and evening. If you are touring abroad then it’s important to ensure that your tour manager has arranged adequate travel insurance to allow you to access medical services if they are required. You may feel afraid of asking for help in case you are told that you are not fit to continue touring, bringing with it a profound sense of guilt and failure if the tour has to be cancelled. However, if you force yourself to continue when you are not mentally well enough to cope with the pressure and stress, you can make the situation far worse, perhaps resulting in harmful use of alcohol or drug misuse as a coping mechanism or even an attempt at self-harm; there will always be another gig, another tour, but you are absolutely unique and completely irreplaceable; nothing is worth the risk of losing that!
SP – Can you tell us a little bit more about Help Musicians UK and what support they offer, including the Music Minds Matter service?
MG – At the moment there are two main targeted health projects, specific to the needs of musicians, run by HMUK: the Music Minds Matter service and the Musicians’ Hearing Health scheme. These focussed schemes run alongside the charity’s general health and welfare program which offers financial support for musicians in crisis, including paying for therapy or medical treatment as well as making payments towards household bills and other living costs, to help cope with not working. This can include financial support to access private healthcare where a specific type of specialist service is not available on the NHS or where the waiting time to access an NHS service is likely to have a significant impact on a musician’s career.
HMUK also offer support services to older musicians including visits from a befriender to prevent social isolation and financial support to provide for their care needs, particularly given that the insecure work pattern means that older musicians often have little or no savings or pension provision; the charity also offers support to music professionals facing terminal illness and bereavement.
My involvement with the charity really began after hearing about their Music Minds Matter service. This service provides 24 hours a day, 7 days a week telephone support service for the whole UK music community. It was launched in December 2017 and provides information, emotional support and a listening ear. Counselling is also available free of charge to anyone who works in the music industry and meets the eligibility criteria and provides access to specialist advice on debt, benefits and legal matters. For more information, or to access the service visit www.musicmindsmatter.org.uk or call 0808 802 8008.
The Musicians Hearing Health Scheme is available to all musicians in the UK; this scheme aims to give all musicians access to a specialist audiology assessment and ear check-up from a specialist in musicians’ hearing and a set of custom made attenuated ear-plugs for a one-off payment of £40 or £30 for Musicians Union members. The scheme also includes a 2 yearly call-back, where appropriate for a subsidised hearing test, expert advice on referral routes and steps to manage any problems found. For more information visit www.hearformusicians.org.uk
SP – There has been a lot of talk about removing the stigma from the discussion of mental health. How can we raise awareness of mental health issues and prepare both our industry and wider society for the challenges of a future generation of musicians?
MG – The more the issue of mental health is discussed, openly and without judgement, the less stigma will be attached to it. It is absolutely essential to maintain a dialogue between those experiencing problems, their families, friends, colleagues and the professionals involved in their care, as everyone can make a contribution to help keep that person well. There is nothing to be ashamed of in experiencing mental health difficulties, according to the Mental Health foundation 1 in 6 adults has a common mental disorder and this number is higher amongst musicians. Research conducted by HMUK in 2016 shows that of 2,211 music professionals surveyed, 71% had experienced panic attacks or high levels of anxiety and 69% had experienced depression. The study suggested that whilst musicians find solace in music making, working in the music industry might indeed be making musicians sick, or at least contributing to their levels of mental ill-health.
In terms of thinking about the future for musicians, we need to change things at multiple levels; in the broadest sense, it is paramount that we maintain an open dialogue about mental health issues to reduce any sense of shame or stigma at all levels of society and across all occupations. We need to educate children and young people about the importance of maintaining their mental wellbeing, how to recognise when their mental health is deteriorating and provide resilience and mindfulness training to ensure that all young people, particularly those entering stressful professions like the music industry (or medicine!) have the skills to cope with stress and the ability to recognise when it’s time to ask for help. Finally, the music industry itself needs to engage in an open dialogue about the high levels of mental health problems in its’ professionals and look at what can be done to address this. It is hoped that over the coming year HMUK can work with those at a high level in the music industry to develop a code of practice, which supports the mental well-being of those working in the business; this might include measures like ensuring minimum performance fees (in the same way other workers have a minimum wage), for venues offer access to healthy food choices, not automatically offering alcohol as a rider, and ensuring musicians have enough time between performances to allow for adequate rest. This is perhaps idealistic, but without an ideal to aim for, how are we going to start changing the music industry for the better?
SP – Thank you for your time and sharing your knowledge with us!
Thanks also to anyone who has given this the time for a read through. This post is a really important one and if you can share far and wide and raise awareness for the issues discussed, please do so. The life of a musician can be an intense and stressful one if not managed and taken care of and we need to promote the strategies and mechanisms to be able to work healthily and happily.
– Sandy (Chief Pict)