We are pleased to share our latest publication for MELODIC in the International Journal of Geriatric Psychiatry. In this study, we spoke to people with dementia, their families, and staff on mental health dementia wards about their experiences of distress, and the use of music or music therapy to relieve this. Our findings helped to shape the co-design of the MELODIC music therapy intervention for these wards.
In this project, funded by the National Institute for Health and Care Research (NIHR), we will co-design a new music therapy intervention for NHS dementia wards with stakeholders and experts-by-experience, called MELODIC.
We will then pilot MELODIC on two dementia wards to make sure it is possible to deliver and has the potential to be helpful for patients, family members and staff.
Distress is common for people with dementia on hospital mental health wards, but music might help.
There are lots of reasons why people get distressed. Sometimes it is a result of symptoms like hallucinations, and sometimes it is because the care they receive does not meet their needs.
If a person with dementia is so distressed that they behave in a way that puts themselves or others at risk, they may be admitted to a hospital mental health ward. The aim of the hospital stay is to understand and treat their distress, so that they may be discharged with an appropriate support plan. This can take a long time.
There is little research looking at these hospital wards, which can be very different to general hospital wards or care homes. It is hard to care for someone who is very frightened and distressed and both staff and patients can get hurt (staff experience more physical assaults than prison officers).
Calming medications (antipsychotics) are often given to a person with dementia on these wards when distressed. This is a worry because research suggests that these increase the risks of falls and death.
Music therapy has helped lower distress for people with dementia living in care homes, and supported staff to understand why someone might be distressed. But we do not know enough about how music therapy can help people with dementia in mental health wards.
Our own research on mental health wards found that on the days the therapy took place there were fewer assaults and staff could see a positive impact on the ward. But not all mental health wards have music therapy.
People with dementia and their family members that we spoke to also found music helpful and supported the idea of having this therapy on wards.
In this eighteen-month project, we will create a music therapy manual for mental health wards together with people with dementia, their families and staff with the aim of reducing distress and assaults.
ARU will be working with partners at the Cambridgeshire and Peterborough NHS Foundation Trust, the University of Cambridge, the University of Hull, and Humber Teaching NHS Foundation Trust to deliver the project.
Once the manual is finished, we will share it with the public and look to test it on more mental health wards for people with dementia.
Work package 1: Talking to people with dementia, relatives and staff with experience of mental health wards in focus groups and interviews.
This will help us understand how distress is currently managed and the support people need. We will also ask about the ways that music, and music therapy if offered, are currently used on the wards.
Work package 2: Co-creating a music therapy manual with people with dementia, relatives and staff based on findings from work package 1.
This will be done through a co-design workshop, followed by an iterative process of refinement where the co-design group will be sent draft versions of the manual for feedback.
Work package 3: Testing the music therapy manual over four weeks on a mental health ward that already has music therapy.
Following this pilot, we will make changes to the music therapy manual based on our findings and feedback.
Work package 4: Testing the music therapy manual over four weeks on a mental health ward that has never offered this before.
This will help us see how the intervention works in a place that is unfamiliar with music therapy, and make additional changes to improve the manual.
Sharing event: At the end of the project we plan to hold sharing events where we will show the final version of the music therapy manual and our findings with participants and the public.
MELODIC is a co-design research project. This means that academic researchers work equally alongside the intended end users of the research.
This includes stakeholders, such as people who work in a specific setting, and experts-by-experience, such as service users and their family members or loved ones. The end users advise on all aspects of the design, conduct and analysis of the research.
By listening to end users' knowledge of working within, or receiving support from services, we can ensure that our research looks at the most important questions and is delivered in a way that answers the research questions, and that its outputs are manageable for participants and services to engage with.
In MELODIC, we have a co-design team led by an expert-by-experience, together with a member of the research team who has worked as a clinical psychologist on inpatient mental health dementia wards.
Other team members include family members of people with dementia who have stayed on wards, as well as a music therapist, occupational therapist, consultant nurse, and ward manager working on mental health dementia wards across three NHS Trusts.
Team plan
September 2023: co-design meeting
Aim: get to know each other and the project, and finalise questions and adverts, for work package 1.
October 2023 – February 2024: focus groups and interviews
Aim: to understand experiences of distress on wards and identify support needs, for work package 1.
February 2024: co-design workshop
Aim: look at findings from work package 1, and design first version of MELODIC manual, for work package 2.
May 2024: co-design meeting
Aim: finalise first version of MELODIC manual for work package 2, and agree plan for work package 3 pilot.
June – September 2024: pilot of first version of MELODIC manual
Aim: see if contents of manual are possible to deliver, collect data on whether it is helpful, and gather feedback from patients, staff, and families, for work package 3.
September 2024: co-design meeting
Aim: update MELODIC manual based on findings from work package 3, and plan for work package 4.
September – December 2024: pilot of second version of MELODIC manual
Aim: see if contents of manual are possible to deliver, collect data on whether it is helpful, and gather feedback from patients, staff, and families, for work package 4.
December 2024: co-design meeting
Aim: update MELODIC manual based on findings from work package 4, and plan for sharing event.
February 2025: sharing event
Aim: share findings with the public.
Dr Ben Underwood, MELODIC Principal Investigator and Research and Development Director at CPFT:
"I am delighted that we are co-sponsoring this important project with Anglia Ruskin University to bring the benefits of music therapy to our NHS patients. Agitation in the context of dementia can be very distressing for patients, families, and staff, and current interventions are limited.
"All the early evidence, including some from our own research, suggests that music might be a powerful and enjoyable tool to help, so I am very excited to see this work progressing in partnership with the NHS to pilot new approaches on our wards."
Dr Ming-Hung Hsu, MELODIC Chief Investigator and Senior Research Fellow at ARU:
"Calming medications are often given to a person with dementia when distressed, but this is far from ideal as research suggests that sedatives increase the risks of falls and death.
"Therefore, the positive findings of our initial study – fewer reported incidents of distress behaviours and feedback from staff about the joyful and calming effects of music therapy for patients and staff – are really encouraging. These results provide us with a platform to explore ways to use music therapy to better meet patient need on inpatient mental health dementia wards.
"This new funding from the National Institute for Health and Care Research will allow us to develop and trial a music therapy manual which will provide additional music therapy time as well as support staff and family members to incorporate music interventions in everyday care, with the aim of reducing distress for patients and assaults on staff."
Dr Emma Wolverson, MELODIC Principal Investigator and Reader at University of Hull:
"Part of this grant will be co-designing the music therapy intervention to be used on the wards. The intervention will be co-designed with people with dementia, carers, music therapists and health care staff who work in mental health wards. We will be leading the co-design because of our expertise and inpatient and public involvement.
"As a co-investigator I will also be supporting in data analysis and disseminating the results. I am a clinical psychologist and have worked on mental health wards for people with dementia in Hull – so I know how valuable this research will be."
Thompson, N., Hunt, R., Odell-Miller, H., Olewele, A., Pickering, L., Pointon, C., Underwood, B. R., Wilkinson, A., Wise, C., Wolverson, E. and Hsu, M. H. (2025) 'Experiences and Management of Distress and the Use of Music, Including Music Therapy, on NHS Inpatient Mental Health Dementia Wards: A Qualitative Study', International Journal of Geriatric Psychiatry, 40(5), e70091. Available at: https://doi.org/10.1002/gps.70091
Thompson, N. (2025) 'The sound of care: Harnessing music for wellbeing in dementia', Care Talk, May 2025, pp. 18-19.
Thompson, N., Odell-Miller, H., Pointon, C., Underwood, B. R., Wolverson, E. and Hsu, M.-H. (2024) 'Music therapy Embedded in the Life Of Dementia Inpatient Care (MELODIC) to help manage distress: A mixed methods study protocol for co-designing a complex intervention', Nordic Journal of Music Therapy. Available at: https://doi.org/10.1080/08098131.2024.2435869
Thompson, N., Odell-Miller, H., Underwood, B. R., Wolverson, E. and Hsu, M.-H. (2024) 'How and why music therapy reduces distress and improves well-being in advanced dementia care: a realist review', Nature Mental Health, 2, pp. 1532-1542. Available at: https://doi.org/10.1038/s44220-024-00342-x
Thompson, N., Hsu, M.-H., Odell-Miller, H., Underwood, B. R. and Wolverson, E. (2024) 'Characteristics, outcomes, facilitators and barriers for psychosocial interventions on inpatient mental health dementia wards: a systematic review', BMC Geriatrics, 24, pp. 364. Available at: https://doi.org/10.1186/s12877-024-04965-8
Thompson, N., Iyemere, K., Underwood, B. R. and Odell-Miller, H. (2023) 'Investigating the impact of music therapy on two in-patient psychiatric wards for people living with dementia: retrospective observational study', BJPsych Open, 9(2), e42.
Thompson, N. and Odell-Miller, H. (2022) 'An audit of music therapy in acute National Health Service (NHS) settings for people with dementia in the UK and adaptations made due to COVID-19', Approaches: An Interdisciplinary Journal of Music Therapy.
- Using music to reduce distress on dementia wards, University of Hull, 4 July 2023.
- Singing can calm agitation suffered by about 90 per cent of dementia sufferers, new NHS trial has found, Daily Mail, 2 July 2023.
- Study to use music therapy to reduce distress in dementia wards, NIHR, 29 June 2023.
- Using music to reduce distress on dementia wards, ARU, 28 June 2023.
- Researchers using music to reduce distress on dementia wards, CPFT, 28 June 2023.
Project team
- Dr Ming-Hung Hsu, ARU (Chief Investigator)
- Professor Helen Odell-Miller, ARU (Co-chief Investigator)
- Dr Ben Underwood, Cambridgeshire and Peterborough NHS Foundation Trust and University of Cambridge (Principal Investigator)
- Dr Emma Wolverson, University of Hull and Dementia UK (Principal Investigator)
- Chris Pointon (Public team member)
- Naomi Thompson, ARU (PhD Scholar)