Healing sounds: Note-Able Music Therapy Services, treating health issues for a decade-plus, now also serves inmates 

The healing power of music is often spoken of metaphorically. Going to see our favorite band, listening to the album we’ve been waiting months for, or jamming with some friends in the garage are all simply “good for the soul,” and not necessarily a prescription for any specific ill. 

But at Reno’s Note-Able Music Therapy Services, music is used in a clinical, scientific setting to help treat neurological conditions, behavioral health issues and physical disabilities. 

“We are using music very intentionally to address social, physical and mental health needs in our community,” said NMTS founder and executive director Manal Toppozada. 

Toppozada came to Reno with a master’s degree in music therapy in 1999, when music therapy services in the city were virtually nonexistent. Her first initiative took place outside of a formal health care setting: She started a band. 

“I started a music class for people with disabilities,” she said. “I put up a few fliers, and on the very first day of the class, I had about two dozen people show up … hauling amplifiers and guitars. Over the next couple of months, they named themselves the Note-Ables.” 

The Note-Ables became a musical-education initiative and performing group for musicians with disabilities, scheduling public performances throughout the year. As interest in the group grew, Toppozada recognized the need it filled in a traditionally underserved community, and in 2003, she filed for the Note-Ables to become an official nonprofit. 

“I hired my first music therapist, and we just realized that this community had this really deep need for creative expression, and this need to be heard and seen,” she said. “They have so much to say and so much to offer, and music is the perfect vehicle for us to offer that through.” 

In 2012, the Note-Ables changed its name to Note-Able Music Therapy Services to reflect the shifting goals of the organization and its broader mission. While the Note-Ables band still exists and performs, NMTS incorporates adaptive musical therapy services via in-house classes and also contracts with local health care facilities. 

NMTS now employs 11 full-time staff and is on track to treat more than 3,000 people this year—but treating that many people doesn’t just involve teaching them to play an instrument. Instead, NMTS’ approach to music therapy exploits the still-mysterious cognitive link between music and the human brain for medical purposes. 

“We take all of the science that we’ve learned about how our brains process music, and we apply it to working with people who have Parkinson’s, Alzheimer’s, strokes, to help with motor function, cognition and speech,” Toppozada said. “For people with Parkinson’s, you can actually share and work with somebody for 12 weeks, and you can help them improve the cadence of their gait, their speed, the fluidity, and all of those things can help reduce the shuffling and some of those issues that lead to falling. I can help people be independent for longer in their lives.” 

The inherent qualities of music like repetition and rhythm are uniquely suited to help people with physical disabilities, because music is interpreted differently in the brain than speech or movement. Toppozada even mentioned working with stroke victims who cannot speak but, through treatment, are eventually able to sing—a powerful revelation to patients and their families. 

But the power of music isn’t just limited to physical challenges. Sharon Hickox, a musical therapist at NMTS, often works with patients struggling with mental ailments like addiction, schizophrenia and bipolar disorder. In treating these populations, music’s social and emotional components are especially useful. 

“With addiction, we do some song sharing where people have songs that have meant something to them, and we talk about the lyrics,” Hickox said. “A lot of times, there are songs that people listen to when they were high and stuff—so how do we reconcile? How do I listen to that song in a different way in my new life?” 

For the past four years, Hickox and other therapists have spent time treating a community disproportionately affected by addiction, mental-health disorders and behavioral problems, in a setting that’s far from conducive to healing—the Washoe County Detention Facility. In 2019, as part of Washoe County Sheriff Darin Balaam’s request to bring more educational and therapeutic resources into the jail, NMTS was contracted to provide music therapy to inmates struggling with mental health problems. These patients are housed in a different unit from the general population and often exhibit antisocial proclivities as a result of their conditions. 

“We do twice-a-week music-therapy sessions there, regardless of any holidays,” Hickox said. “They like to do song-sharing a lot. We can’t connect to the internet, but they get to choose songs. … We start with a song, and they have to talk about why they chose that song, what it means to them.” 

In addition to NMTS’ twice weekly appointments with both the men’s and women’s units, the inmates also have the option to take part in what’s become a tradition—an annual Christmas performance.

“It’s neat to see the mental health population communicate and participate in something and not just (stay) locked behind doors. They’re engaged. They’re not fighting. They’re not yelling. They’re not kicking doors. They’re listening.”

Lt. John Stewart, Washoe County Sheriff’s Office

Hickox leads groups of nearly a dozen inmates in practicing Christmas songs they’ve chosen to perform, complete with instruments like drums, bells and guitars. This year’s performance will happen on Dec. 19. Other inmates at the jail usually attend, and so do members of the Sheriff’s Office staff—many on their days off. 

The point of the performance is not musical aptitude. To Hickox and NMTS, the value of the sessions is in helping inmates with real-world skills that provide structure and levity to their time behind bars—like socialization, cooperation, goal-setting and habit-forming. 

“It’s just a little example of trying to (help) 12 people who have not necessarily been the most cooperative with others in their life’s journey,” Hickox said. “We’re going to be respectful with everybody’s ideas. It’s a democracy. They get to use their brains; they get to feel valued and get to do something that’s a little bit hard, but they can do it.” 

Lt. John Stewart, a 10-year veteran of the Washoe County Sheriff’s Office, said that ever since the implementation of music therapy, the inmates are more likely to wash and clean their cells more regularly, and avoid fighting; they’re generally more compliant, so that they may retain access to music therapy.  

“It’s neat to see the mental health population communicate and participate in something and not just (stay) locked behind doors,” said Stewart. “They’re engaged. They’re not fighting. They’re not yelling. They’re not kicking doors. They’re listening. Some of them have written lyrics to music. And it’s really just neat to see them have something to be happy about. It’s difficult to be in this environment. It is a very negative environment.” 

Stewart is quick to note that the jail often lacks the infrastructure and resources to adequately help inmates with mental health and behavioral conditions. The NMTS program creates a motivating factor to help diminish dangerous behavior, which leads to better outcomes for the safety of inmates and jail staff alike. But it also provides a rare positive experience to help inmates recognize destructive patterns and adjust their behavior, hopefully leading to better decisions outside of the penal system as well. 

“We have to understand that they’re a vulnerable population, and most likely this isn’t the best place for them,” Stewart said. “But a lot of times, there’s no other place for them to go, and so what happens is they get stuck in that system where something happens in the community, and they get arrested, and they come here as a pretrial detainee. Those deputies who work day in and day out with them, they’ve seen the change in how they act. … What I can tell you is that everybody that’s involved with the program or actually works in those units thinks it’s a success.” 

Working with the Sheriff’s Office is one example of NMTS’ grander goals to serve Northern Nevada. With the recent purchase of a new 70,000-square-foot facility, Toppozada, Hickox and the rest of the staff plan to offer an expanded range of in-patient care they hope can become a national model for how music can heal a community. 

“Really, our ultimate goal is to have no barriers so that anyone can access music therapy,” Toppozada said. “You can be deaf. You can be unhoused. You can be incarcerated. It doesn’t matter. If you’re a human being, you respond physiologically to music on some level.”