Distribution: Mindfulness leads and therapists
In order to enable mindfulness-based therapy (MBT) reach all the people who can benefit from it, it will be helpful to receive more funding. As health boards are the main channels for funding, this is most likely to come from the contacts you have, or develop, with local managers and influential clinicians. This paper gives you 6 tools for doing this:
These tools are designed to be quick and easy to use.
Create Conversations
Making contact with managers is naturally the first step in this process. You may already know the key people, or know of them. You may meet with them in another context. The “Messages” section below shows how mindfulness can be promoted in any conversation. Having as many people in the HB know about mindfulness raises awareness and can create a momentum for further funding.
It is helpful to consider the various possibilities of communication. Face-to-face is ideal or, increasingly, online meetings. Face-to-face can include casual, “corridor” meetings. Email is another key avenue. There may be an opportunity to mention mindfulness in meetings about other topics. If you have a website or an app, these are also useful media, as is mobile phone contact.
Relationships build over time. Therefore it is helpful to make repeated contact. This is unlikely to be seen as an intrusion if you are able to offer help for their problems.
Offer
Managers and others are most likely to be supportive of mindfulness if they see it as useful in some way. They may be under significant stress and it is worth first considering if you can help with this. This can take 2 forms: help with personal stress and offering solutions to the stresses of service provision.
Personal Stress: As you know, mindfulness really comes to life when we experience it ourselves. Is there some way you can offer a mindfulness experience to them? If you or a colleague are running an 8-week staff course, you could invite them to that. You could also point them to apps. For example, John Kabat Zinn has produced a free app, “JKZ”, or there is Headspace, which offers a free trial. Another possibility is offering a short practice at a meeting e.g. 5 minutes. Even the acronym STOP (Stop - Take a breath – Observe/open – Proceed) may be enough to start them on a mindfulness journey. As you know, it can be quite a revelation for someone to see how busy their mind is!
Service Provision: The main service stress managers have is usually related to waiting times and access to services. Staff absence through stress may be aggravating this. Mindfulness can be offered as a solution to these. This is because mindfulness is accessible and applicable to staff as well as patients.
Messages
It is possible to explain the role of MBT quickly and easily with a message like this:
Mindfulness can reduce waiting lists and is effective for a range of patients and for staff .
It’s worth memorising this.
There are a number of key points packed into this:
Reduce waiting times – because MBTs are delivered in a group format, they are cost effective: 3 people can be treated with MBCT with the same amount of resource as 1 person in individual therapy. This assumes 2 therapists run a course for 15 patients [1].
Effective – a recent systematic review [2] of the impact of mindfulness-based interventions for mental illnesses showed:
• The clearest evidence was for mindfulness for depression. The impact of mindfulness-based interventions was similar to current NHS first-line therapies such as cognitive behavioural therapy and antidepressants and better than other therapies.
• For anxiety, mindfulness impact was similar to other evidence-based therapies.
• For smoking, mindfulness outperformed evidence-based therapies.
• For pain and weight/eating, mindfulness performed on par with other active therapies
• Also effective in addictions.
In terms of Scottish NHS audits, MBT patients have shown significant reductions in depression (by 40%) and anxiety (34%) over the 8 week course [3]. These were underpinned by an increase in mindfulness.
There is also evidence for its effective with physical health problems [4]
Wide Range of Patients - As well as the diagnoses listed above, MBTs can be of benefit with a spectrum of issues from public health to psychosis [4].
Repeating the Message
Most people take a while to accept a new idea and it is helpful to repeat the above message (or variants of it) as much as possible, both with the same person and in different settings. This can set up a “wave” of awareness which can build on itself over time.
Asking
Once relationships have been built, you can ask managers for help with mindfulness e.g. in terms of funding and further resources. We can sometimes feel self-conscious about this but it is a necessary step. Even if the funding is not agreed, a seed has been planted in the manager’s mind which may come to fruition with further input in the future. Also, awareness will have been raised about the importance of mindfulness.
Objections
Here are some common objections to developing mindfulness, and some possible responses:
“We don’t have the staffing to do this”
“We don’t have the funding to do this”
“It’s not a priority”
These are all variations on the same theme. The implication that there is already not enough staff to meet current demand. The question you might want to ask is, is reducing waiting times a priority? Managers often initially don’t “get” that MBT can actually reduce waiting times, so it might be helpful to reiterate the cost-effective position (1 individual therapy client = 3 MBT clients). Developing MBT will require some service redesign, which may have a short-term cost. But if managers are convinced that more can be done with the existing resource, they are more likely to make the effort to change things.
“Mindfulness is a lifestyle intervention that can be done in the independent sector”
This arises because mindfulness can be offered across the client spectrum from public health to psychosis. This probably makes it unique as a therapy. However, the governance issues are very different at the two ends of the spectrum. With major mental illness, MBT is a high intensity therapy requiring delivery by clinical specialists. For this reason, MBT with these client groups should generally be run from within the NHS rather than the independent sector.
“We would be able to offer it if the course was shortened”
Most of the studies showing the effectiveness of MBTs are based on an 8-week course, so to try and shorten it for e.g. recurrent depression, would be to go outside the evidence base. For staff, one could perhaps be more flexible and any level of interest could be encouraged (see Offers section above). Even so, it is worth emphasising that an 8-week course is the gold standard.
Good luck!
Neil Rothwell & Charlotte Procter
National Mindfulness Leads
September 2021
References (Neil can provide copies of the NES papers if you don’t have them)
[1] Scottish NHS Mindfulness Network (2019) Proposal to Develop Mindfulness Therapy as a Treatment for Depression in the Scottish NHS
[2] Simon B Goldberg, S.B. et al.. Mindfulness-based interventions for psychiatric disorders: A systematic review and meta-analysis. Clin Psychol Rev. 2018 Feb; 59: 52–60.
[3] Mitchell, C. and Rothwell N. (2020), An audit of mindfulness therapy within NHS Scotland.
[4] Dexing Z et al. (2021) Mindfulness-based interventions: an overall review, Br Med Bull.
Published online 2021 Apr 21. doi: 10.1093/bmb/ldab005