Musicians navigating mental health challenges today are frequently asked to focus on managing their stress and anxiety to build resilience. Giulia Ripani and Raluca Matei think a bigger issue isn’t how musicians cope but the culture and structures in which they’re trying to survive, and they’re passionate about transforming how we think about artists’ health and well-being. Rather than seeing mental health as something purely individual, they’re looking at how institutions are run, what norms are enforced, and what kinds of behaviors are rewarded or silenced.
Their project, supported by the Johns Hopkins Bloomberg School of Public Health, brings together voices from across the musical world—students, teachers, freelancers, orchestral players, health professionals, and academics. So far, they have reviewed the existing research and interviewed more than 125 people, gathering insights that go far beyond practice routines and self-care tips.
One important focus of their work is challenging some of the long-held assumptions in Western classical music, especially those that may stifle creativity and autonomy. For example, classical musicians are often expected to perform pieces exactly as written, sticking closely to the score and the presumed intentions of long-dead composers.
Improvisation or reinterpretation is usually discouraged, and they were curious if those expectations are part of the problem.
Research led by David Dolan at the Guildhall School of Music and Drama found that when classical musicians are encouraged to improvise within traditional repertoire, both musicians and audiences benefit. Performers feel less anxious and more engaged, and audiences describe the music as more emotionally compelling and musically convincing.
Building on this finding, Matei—along with UK-based collaborators Keith Phillips and Katharine Liley—surveyed nearly 200 classical musicians around the world to explore how they think about creativity, performance, and tradition. A majority of participants were white and European and their views were anything but uniform.
Responses varied when asked what makes a performance “good”: Some said it’s all about honoring the composer and staying true to historical practices. Others valued audience connection, expressiveness, and letting the performer’s personality shine through. Many advocated for a balance—respecting the score while bringing something personal to the interpretation. And a few supported radical reinventions of the piece, viewing creativity as essential.
Asked about the role of the composer, views ranged from reverence (“we must respect their intentions”) to irreverence (“they’re dead—they won’t mind”), with many offering more nuanced, modern perspectives.
Interestingly, musicians were almost perfectly divided on whether classical performers are even encouraged to be creative: just under half said yes, while slightly more said no.
These findings matter. They tell us something about different perspectives about art, but they reveal also how deeply musicians’ identities and well-being are tied to the structures in which they work. When norms are too rigid, they can limit expression, increase pressure, and even contribute to poor mental health.
That’s why Matei and Ripani advocate for a different kind of music education—one that includes critical thinking as a core skill. They argue that music students shouldn’t only learn how to play well; they should learn how to question. What values shape their training? Whose voices are heard in their institutions? Which rules serve them—and which need rethinking?
“Currently, health education in many music schools still focuses on how to cope with the system rather than how to change it,” Matei says. “But if we want healthier musicians—and a healthier artform—we need to shift the conversation.”
That’s exactly what Matei aims to do in an upcoming position paper on Health Promotion in Tertiary Music Institutions, to be presented at the inaugural Global Summit on Occupational Health in Music. This paper, developed with input from more than 125 international experts across six continents and many disciplines, offers a bold new vision for music education, one that centers student well-being, embraces diversity, and empowers musicians to challenge outdated norms.
Necessary change doesn’t end there, however. Ripani is turning a critical eye to the philosophy behind music education itself. She argues that many institutions still treat health education as a top-down process—where information is delivered from “expert” to “student”—and focus primarily on performance anxiety and coping skills. That’s not enough. Real education should raise awareness of all the factors—social, cultural, structural—that shape musicians’ health, and encourage students to ask hard questions about the very systems they’re in.
“Our message is clear and urgent: caring for musicians’ mental health means going beyond teaching them how to cope,” Ripani says. “It means giving them the tools, the space, and the permission to question the rules they’ve inherited—and imagine new ones.”