Music therapy intervention shows promise for NHS dementia wards
A pioneering music therapy programme embedded within NHS mental health dementia wards has demonstrated feasibility and acceptability in a groundbreaking study that could transform care for some of the most vulnerable patients in the health system. The MELODIC intervention achieved high treatment adherence rates while showing no increase in distress symptoms or safety incidents.
The MELODIC (Music therapy Embedded in the Life Of Dementia Inpatient Care) feasibility study, published in Frontiers in Psychiatry on 16 July 2025, represents the first standardised music therapy protocol specifically designed for NHS mental health dementia wards. These specialist units care for people with dementia experiencing acute levels of distress that put their safety or that of others at risk.
Complex intervention addresses critical care gap
Mental health dementia wards provide care for individuals with advanced disease progression, extreme distress behaviours, and multiple comorbidities. The average length of stay is 100 days, contributing to high care costs. Despite evidence-based recommendations favouring psychosocial interventions as first-line treatment, pharmacological approaches – particularly psychotropic medications with limited benefit and severe adverse effects – remain prevalent.
“Research into psychosocial interventions to reduce distress was rated as the top priority for mental health dementia wards by healthcare professionals and experts-by-experience,” the authors noted. The MELODIC intervention addresses this critical gap through a comprehensive four-component approach.
Four-pillar intervention design
The co-designed MELODIC protocol integrates a registered music therapist into the multidisciplinary team for 15 hours weekly, delivering specialist individual and group music therapy sessions. The intervention includes developing personalised musical care plans for all patients and providing training and support for staff and families to implement these plans.
The research team, led by investigators from the Cambridge Institute for Music Therapy Research at Anglia Ruskin University, tested the intervention sequentially across two NHS mental health dementia wards with differing music therapy experience. The iterative design allowed protocol refinement between sites, creating three progressive versions of the intervention.
Robust feasibility outcomes achieved
The study recruited 28 patients, 13 family members, and 48 staff members across both sites, exceeding recruitment targets. Data completeness was exceptionally high at 98.2% for patients, 95.8% for families, and 89% for staff. Music therapists successfully adhered to protocol requirements, delivering minimum session numbers while engaging in daily staff interactions.
“The MELODIC intervention was acceptable with high levels of treatment adherence,” the authors reported. “The research methods were feasible with recruitment targets met and all requested data collected with high levels of data completeness.”
Treatment costs proved reasonable, with interventionist time totalling £2,025 per month including training, plus £400 for equipment as a one-off cost. Most music therapy interactions occurred spontaneously rather than through scheduled sessions, highlighting the importance of flexible, responsive intervention delivery.
Safety profile and preliminary outcomes
Crucially, the study found no increase in routinely reported incidents during intervention periods, with no adverse events related to music therapy interactions. Quantitative data showed promising trends, including non-significant decreases in symptom severity and disruptiveness, alongside improvements in quality of life measures.
“While conclusions on safety or efficacy of the intervention cannot be drawn, there were no increases in routinely reported incidents or distress symptoms from pre to post intervention,” the researchers emphasised. The confidence intervals for outcomes were wide, reflecting the exploratory nature of this feasibility work.
Co-design approach drives intervention refinement
The study employed a collaborative co-design methodology involving academics, clinicians, and experts-by-experience throughout research design, data collection, analysis, and interpretation phases. This approach enabled real-time intervention refinement based on participant feedback.
Key modifications between pilot sites included simplifying musical care plans, transitioning from mandatory to voluntary staff training workshops, and appointing multiple MELODIC Champions to enhance communication between therapists and ward teams. These adaptations improved intervention acceptability and feasibility.
Implementation insights and future directions
The research revealed important contextual factors influencing intervention delivery. Site differences in ward occupancy, patient acuity levels, and family visiting policies affected implementation patterns. Music therapists required flexibility to adapt interventions to fluctuating ward environments and individual patient needs.
“This highlights the skill needed by the interventionists to tailor the intervention to the needs of the patients and the ward atmosphere in the moment,” the authors observed. The study identified visiting policy restrictions as a significant barrier to family engagement, particularly at sites with limited access arrangements.
Clinical trial pathway established
The feasibility study provides a robust foundation for future effectiveness research. The authors concluded: “A multi-site cluster randomised controlled trial is required to determine clinical and cost effectiveness.” They recommend collecting patient data more regularly to track changes over time and ensuring greater demographic diversity in future studies.
The research addresses a critical evidence gap in dementia care, potentially offering an alternative to medication-heavy approaches. As the authors noted: “In an area where presentations of distress are complex and healthcare professionals are often reliant on psychotropic medication, this psychosocial intervention has the potential to improve the quality and experience of care on these wards.”
The MELODIC intervention represents a significant advancement in standardised psychosocial care for mental health dementia wards, with implications extending beyond the NHS to international dementia care settings.
Reference
Thompson, N., Odell-Miller, H., Pointon, C., et. al. (2025). Music therapy embedded in the life of dementia inpatient care to help prevent and manage distress: a feasibility study to inform a future trial. Frontiers in Psychiatry, 16, 1618324. https://doi.org/10.3389/fpsyt.2025.1618324
