Historical Context and Evolution

Music has always held a special place in human culture, forming an integral part of our lives for centuries[ 1 ] . Throughout history, it has served not only as a source of entertainment but also as a medium for emotional expression and social connec- tion[ 1 ] . The omnipresence of music across all cultures and its profound influence on our physiological and mental well-being underscore its importance[ 2 ] . However, the historical narrative around music has often glamorized its association with a hedonistic lifestyle, encapsulated by the phrase “sex, drugs, and rock & roll”[ 3 ] .

In recent years, the discourse surrounding mental health in the music industry has evolved significantly. Traditionally, the industry’s culture, characterized by irregular work conditions and lifestyle factors, has contributed to a unique vulnerability among musicians[ 4 ] . Research has highlighted that musicians are more prone to mental health problems, with those in the industry being up to three times more likely to suffer from clinical depression compared to the general population[ 5 ] . This is further

exacerbated by long hours, irregular sleep patterns, and the constant pressure to succeed, which contribute to heightened stress and anxiety[ 6 ] .

The aftermath of global events like the COVID-19 pandemic and socio-political changes such as Brexit have added to the stressors faced by the general population, including those within the music industry[ 5 ] . The increased dialogue around the mental health challenges faced by musicians has shed light on systemic issues within the industry[ 7 ] . For example, a 2019 study by the Swedish platform Record Union found that 73% of independent musicians struggle with mental illness, a figure that rises to 80% among those aged 18-25[ 5 ] .

Recognizing the growing mental health crisis, various stakeholders in the music industry, including corporate giants, grassroots organizations, and individual artists, have begun to take action[ 3 ] . New initiatives and non-profit organizations have emerged to provide mental health support to musicians and touring crew members[- 8 ] . For instance, Music Minds Matter, a sister charity of Help Musicians, has reported a 200% increase in those seeking support over the past two years[ 5 ] .

Despite these efforts, many in the industry argue that systemic change is needed to address the root causes of mental health issues among musicians. Proposals include treating musicians as employees, providing in-house therapy, and establishing a standardized code of conduct across record labels to ensure consistent support[ 9 ] . These measures aim not only to improve individual well-being but also to foster a sustainable and productive career for artists[ 9 ] .

The Mental Health Crisis in the Music Industry

Before the disruption of the touring industry due to COVID-19, most musicians were relying on tours and live performances as a primary means of financial support.

With many musicians out of work during the pandemic, organizations like Backline witnessed their case management submissions quadruple. Over the course of the pandemic, discourse surrounding the mental state of musicians and how the industry plays a giant role has increased significantly[ 7 ] . According to Gleason, “We’re un- derstanding that so much of it is systemic. That goes beyond just the artists, which, the mental health challenges for the artists themselves can be a little bit easier to understand. But really, we serve the music industry in its entirety. So crew people, agents, and managers … some of the reasons we’re seeing more and more mental health struggles is because there is no governing body. There is no HR in most of these organizations”[ 7 ] .

Backline is an organization that connects participants of the music industry and their families to mental health and wellness support and resources, streamlining access to a network of trusted organizations and care providers. These include case management, support groups, and other resources such as free subscriptions and articles[ 7 ] . As album sales continue to fall and record labels and digital distributors gobble up the majority of streaming revenue, artists essentially have no choice but to tour more and more. According to Kevin Lyman, founder of Warped Tour and a longtime mental health advocate, “We’ve hit a tipping point where the people who work in our industry — artists as well as crew — are commodities”[ 3 ] .

There are new initiatives popping up from both corporate giants and grassroots orga- nizations to address the growing mental health crisis. For example, on October 10th

— World Mental Health Day — Live Nation announced it was backing a new nonprofit called Tour Support, which gives artists, crew members, and vendors on a given tour 24/7 access to a therapist via phone or online. In December, the American Society

of Composers, Authors and Publishers (ASCAP) debuted a wellness program called TuneUp in response to a survey that found musicians are 31 percent more likely than the general population to say their health and wellness majorly impact their careers[ 3 ] . This initiative will include recovery-support groups in several cities and online, and discounts to its 725,000 members on fitness, nutrition, and mindfulness services[ 3 ] .

Compounding factors that increase the risk of mental health challenges to those working in the music industry include work overload, work underload, pressure to gain and maintain success, racism, sexism, homophobia, discrimination, perfor- mance anxiety, band dynamics, pressure from labels, lack of autonomy, social media toxicity, and job insecurity[ 5 ] . Joe Hastings, head of Music Minds Matter, reports a 200% increase in those seeking support over the past two years. Financial stress

is a significant factor underpinning these psychological difficulties. According to Anneliese Harmon, General Manager of the Music Managers Forum (MMF), “The real problem, when it comes down to it, is financial pressure. When you don’t have money and you’re worried about how you’re going to keep your electricity on, or you’re working at Tesco during the day and in the studio at night, getting three hours of sleep; that causes mental health issues”[ 5 ] .

The mental health challenges faced by those in the music industry have been exacerbated by the pandemic, Brexit regulations, and

Navigating Mental Health: Challenges and Sup- port Systems

Navigating mental health within the music industry involves addressing a variety of unique challenges faced by artists and industry professionals. The unpredictable and sometimes isolating nature of the work, long periods on the road, financial difficulties, and lack of routine all exacerbate mental health issues[ 4 ] . This sector-specific envi- ronment can significantly impact mental health outcomes, making access to targeted support systems crucial.

Industry-Specific Challenges

Mental health in the music industry is a multifaceted issue impacted by various sector-specific stressors. Musicians and industry professionals often experience poor working conditions, lack of recognition, and unstable working patterns, which make it difficult to manage their mental health and well-being[ 5 ] . Additionally, external pressures such as the pandemic, Brexit regulations, and the cost-of-living crisis have compounded these issues, placing the music industry under significant strain[ 5 ] .

Research indicates that those working in the music industry are up to three times more likely to suffer from clinical depression compared to the general population[ 5 ] .

Support Organizations and Resources

A variety of organizations have emerged to address the growing mental health crisis in the music industry. Backline, for instance, connects music industry participants and their families to mental health and wellness support, providing access to case management, support groups, and other resources[ 7 ] . Backline’s services have become increasingly vital, especially as the pandemic disrupted touring schedules,

causing financial instability for many musicians[ 7 ] .

Another notable organization is Music Minds Matter, which operates a 24-hour helpline staffed by BACP-accredited counselors. This service offers emotional sup- port, debt and legal advice, and access to therapeutic help through BAPAM (British Association for Performing Arts Medicine)[ 4 ] . The charity also runs free online ses- sions that provide coping strategies for mental health issues[ 4 ] .

Behind the Scenes offers counseling grants and mental health first-aid training, along with an anonymous online self-assessment tool and suicide prevention resources[- 10 ] . Their partnership with HelpPRO has resulted in a Therapist Finder search tool specifically for the entertainment industry, allowing professionals to find therapists who understand their unique challenges[ 10 ] .

MusiCares, the Recording Academy’s charitable arm, has introduced virtual support groups such as the Cyber Emotional Support Group, Women’s Support Group, and Black Community Support Group in partnership with ASCAP[ 10 ] . These initiatives aim to create a more supportive environment for music professionals by providing tailored mental health resources.

Systemic Solutions and Advocacy

Addressing mental health in the music industry requires systemic changes. Propos- als have been made to consider musicians as employees, provide in-house therapy, and create a standardized code of conduct for industry practices[ 9 ] . Such measures would help ensure that mental health is prioritized before tours are canceled or albums put on hold, thus safeguarding the long-term well-being of artists[ 9 ] .

Efforts by record labels and artists to destigmatize mental illness, along with initia- tives by both corporate giants and grassroots organizations, are essential steps in addressing the mental health crisis in the music industry[ 3 ] . Festivals and benefits are being planned to raise awareness, and the increased dialogue around mental health is gradually helping to break down long-standing stigmas[ 3 ] .

The Role of Industry Stakeholders

In the music industry, various stakeholders, including artists, managers, record labels, and event organizers, play a critical role in fostering an environment that prioritizes mental health and well-being. It is essential for these stakeholders to pro- mote work-life balance, provide access to mental health resources, and encourage open dialogue about mental health challenges[ 6 ] . By addressing these challenges head-on, the industry can create a safer and healthier environment for all involved, thereby destigmatizing mental health and supporting musicians holistically[ 6 ] .

Before the COVID-19 pandemic, touring and live performances were primary means of financial support for many musicians. The pandemic-induced disruption highlighted systemic issues in the industry, revealing that mental health challenges extend bey- ond artists to crew members, agents, and managers[ 7 ] . The absence of a governing body or HR in most organizations exacerbates these struggles, demonstrating the need for systemic change[ 7 ] . Initiatives like the Check Your Head Podcast, which provides resources and facilitates open discussions about mental health, are crucial in this context[ 7 ] .

To address these issues, some have proposed that musicians be considered em- ployees, with access to in-house therapy and a standardized code of conduct for record labels to ensure fair treatment[ 9 ] . These measures would help protect both the

economic investment in artists and their long-term careers. For example, after taking a break and relocating, musician Doyle advocated for record labels to offer mental health coverage akin to what is provided for office employees, emphasizing the high risk of poor mental health among musicians compared to average office workers[ 9 ] . There has been a growing awareness and proactive efforts within the industry to tackle the mental health crisis. New initiatives from corporate giants and grass- roots organizations, as well as festivals and benefits, aim to raise awareness and destigmatize mental illness[ 3 ] . Prominent musicians like Bruce Springsteen, Justin Bieber, Lizzo, and Demi Lovato have openly discussed their mental health struggles, furthering these efforts[ 3 ] . Specific examples include Sully Erna’s Scars Foundation, Widespread Panic’s fundraising for Nuci’s Space, and Billie Eilish’s public service announcement on depression[ 3 ] . Moreover, record labels such as Royal Mountain Records have begun to provide mental health stipends for their artists, demonstrating a shift towards supporting artist well-being[ 3 ] .

Organizations like MusiCares offer essential mental health care and resources to

musicians, although there is a call for major labels to take a more active role in providing health care and subsequent access to therapy and rehab[ 11 ] . Despite some support from artist unions like SAG-AFTRA, many artists are unaware of available resources, indicating a need for better communication and outreach[ 11 ] .

Furthermore, research teams are encouraged to employ study designs that yield robust evidence for complex interventions in mental health, ensuring transparent reporting and documentation of their findings[ 12 ] . Organizations like Backline and Nuçi’s Space offer tailored mental health plans and community support aimed at reducing the stigma around brain illnesses and preventing suicide among musicians, reinforcing the importance of a supportive community and appropriate treatment[ 13 ] .

Strategies for Improvement

Comprehensive Literature Searches and Systematic Re- views

Great effort was taken by multiple research team members to access all missing tex- ts, using InterLibrary Loan (ILL) requests at multiple research institutions and exten- sive hand-searches online. Although dozens of texts were located using this strategy, 88 studies remained inaccessible and were ultimately excluded. Comprehensive literature searches were conducted by an experienced health sciences librarian in databases such as PubMed, the Cochrane Library, PsychINFO, CINAHL, Embase, SCOPUS, RILM, and The Music Periodicals Database[ 12 ] . The search strategy was peer-reviewed by external experts, following modifications recommended by the PRESS Checklist (McGowan et al., 2016). Once the searches were completed, the results were exported to EndNote, de-duplicated, and uploaded into the Covidence platform for further screening by the research team[ 12 ] .

In December 2019, the research team conducted searches in PROSPERO, Cochrane Database of Systematic Reviews, BioMed Central Systematic Reviews, and the JBI Database of Systematic Reviews and Implementation Reports to identify similar reviews or protocols[ 12 ] . The aim was to advance understanding of music’s effects on mental health, particularly in addressing serious mental illnesses (SMIs)- [ 12 ] .

Interventions and Support Services

The music industry has seen an increase in non-profit and research-based initia- tives aimed at addressing mental health issues among musicians and touring crew members since 2019[ 8 ] . Organizations such as Music Minds Matter, Music Support, and the Actors Fund offer helplines, crisis support, and training on mental health, resilience, and addiction[ 4 ] [ 10 ] . Music Support, for instance, provides a helpline on weekdays, as well as crisis support for urgent psychiatric or addiction issues[ 4 ] .

The Actors Fund retains licensed social workers who offer short-term mental health treatment, crisis intervention, and referrals to outside mental health providers who understand the specific demands of the music industry[ 10 ] .

Backline is another organization that connects music industry professionals and their families to mental health and wellness support and resources, including case management and support groups[ 7 ] . They provide resources like free meditation and yoga subscriptions tailored for the music industry, helping to create custom care plans based on individual needs[ 13 ] .

Raising Awareness and Systemic Changes

Artists and industry leaders are increasingly coming together to share their mental health struggles and raise awareness, which is crucial for destigmatizing mental illness[ 3 ] . Musicians from Bruce Springsteen and Justin Bieber to Lizzo and Demi Lovato have opened up about their mental health challenges, encouraging a broader conversation about the issue[ 3 ] .

There is also a call for systemic changes within the industry, including the introduction of universal healthcare and better support structures for artists and crew members[ 8 ] . Proposals have been made to consider musicians as employees, provide in-house therapy, and establish a standardized code of conduct between labels to ensure artists’ wellbeing before financial considerations such as tours and album releases are impacted[ 9 ] .

Special Considerations for Study Designs

Research teams working with music and SMIs should consider employing study designs capable of yielding better evidence for complex interventions, such as cluster-randomized trials, N-of-1 designs, and step-wedge designs[ 12 ] .

Case Studies and Personal Narratives

Personal stories and case studies shed light on the mental health struggles faced by individuals in the music industry, offering both a humanizing perspective and potential pathways to support and recovery.

One notable initiative is Silence the Shame, founded by music industry veteran Shanti Das. Das, who experienced her father’s suicide at an early age, aims to dismantle the stigma surrounding mental health through storytelling and advocacy[ 13 ] . Similarly, the Check Your Head Podcast invites artists, musicians, and mental health experts to share their experiences and provide resources for seeking help, emphasizing that mental health is not a one-size-fits-all issue[ 7 ] .

The recent suicides of high-profile artists such as Chester Bennington of Linkin Park

and Chris Cornell of Soundgarden have sparked a broader conversation about the pressures faced by musicians. These tragedies highlight the romanticized trope of the suffering artist, prompting a reevaluation of how mental illness and emotional distress are perceived in the music world[ 9 ] . William Doyle, a musician and mental health advocate, underscores the need for cultural shifts that recognize the legitimacy of seeking psychological support, much like seeking help for physical ailments[ 14 ] . The economic impact of the COVID-19 pandemic has further exacerbated mental health challenges within the industry. With live performances and tours—the primary sources of income for many artists—brought to a halt, organizations like Backline have seen a significant increase in case management submissions. The pandemic has intensified discussions about the systemic issues contributing to mental health struggles among musicians, extending beyond artists to include crew members, agents, and managers[ 7 ] .

Kevin Lyman, founder of the Warped Tour, points out that the commodification of individuals in the industry contributes to mental health challenges. The decline in al- bum sales and the necessity for frequent touring add to the pressure, making mental health support crucial for sustainable careers[ 3 ] . Similarly, Kevin Liles advocates for a more holistic approach to health and wellness in the industry, urging record labels to take a more active role in supporting their artists[ 11 ] .

Furthermore, musicians often face the pressure to succeed in a highly competitive environment, leading to stress and anxiety. This pressure is compounded by the unpredictable nature of the industry and the financial insecurity that many artists experience[ 15 ] . Mental health experts recommend integrating mental health support into the fabric of the music industry to foster a nurturing environment that allows artists to thrive both creatively and personally[ 6 ] .

By sharing these personal narratives and case studies, the music industry can move toward a more empathetic and supportive culture that prioritizes mental health and well-being.

Summary

The music industry, celebrated for its cultural and emotional contributions, has long been entwined with a narrative of hedonism epitomized by the “sex, drugs, and rock & roll” ethos[ 1 ] . However, behind the glamour and artistic expression lies a profound mental health crisis that affects musicians and industry professionals at alarmingly high rates. Studies indicate that individuals in the music industry are up to three times more likely to experience clinical depression than the general population[ 2 ] .

This statistic underscores a pressing need for targeted mental health support within this community.

Recent years have seen a paradigm shift in how mental health is perceived and addressed within the music industry. The COVID-19 pandemic, coupled with so- cio-political upheavals like Brexit, has exacerbated existing stressors, leading to

heightened mental health challenges[ 3 ] . For instance, the Swedish platform Record Union’s 2019 study revealed that 73% of independent musicians grapple with mental illness, a figure that escalates to 80% among those aged 18-25[ 4 ] . These alarming statistics have catalyzed a growing movement to tackle mental health issues head-on, involving various stakeholders from grassroots organizations to corporate giants.

Several initiatives and organizations have emerged to provide crucial support. Orga- nizations like Backline and Music Minds Matter offer mental health resources, case

management, and support groups specifically tailored for those in the music indus- try[ 5 ] . Furthermore, the pandemic’s disruption of live performances and touring—a primary income source for many artists—has amplified the need for mental health services, with organizations like Backline reporting a significant increase in support requests[ 6 ] .

Despite these efforts, systemic changes are imperative for long-term improvement. Proposals include recognizing musicians as employees, offering in-house therapy, and establishing a standardized code of conduct across record labels to ensure con- sistent support[ 7 ] . High-profile artists like Bruce Springsteen, Justin Bieber, and Demi Lovato have publicly discussed their mental health struggles, helping to destigmatize these issues and fostering a more open dialogue within the industry[ 8 ] . These efforts are crucial in creating a more supportive environment that prioritizes the well-being of all music industry professionals.