Scottish NHS Mindfulness Network

The Scottish NHS Mindfulness Network supports and co-ordinates the delivery of Mindfulness-Based Cognitive Therapy (MBCT) and Mindfulness-Based Stress Reduction (MBSR) for patients and staff throughout mainland Scottish NHS Health Boards. It is supported by NHS Education For Scotland. It has a developed pathway for therapist training and supervision.  Mindfulness courses are delivered to patients (with depression, anxiety, chronic pain, other mental and physical health conditions) and to staff (for managing stress and fostering wellbeing). The Scottish NHS Mindfulness Network is a member of the British Association for Mindfulness-Based Approaches (BAMBA). BAMBA upholds standards across the UK through their Good Practice Guidelines and listing of mindfulness therapists.  The Scottish NHS Mindfulness Network consist of 2 National Co-ordinators, and up to 2 Mindfulness Leads for each of the 11 mainland Health Boards.

https://learn.nes.nhs.scot/40297/scottish-nhs-mindfulness-network

The provision of Mindfulness-Based interventions varies across Health Boards. The areas with strongest provision, have good managerial support, an active mindfulness lead with allocated time within the job role, localised training of mindfulness therapists including a forward plan to enhance sustainability of teams who are delivering mindfulness in localities across the Health Board.  Some Health Boards have limited or no provision. Factors which have contributed to this include loss of managerial support or changing priorities; loss of a mindfulness lead, or a lead who has limited support / time in their job plan; the retirement of key mindfulness therapists / influencers; lack of investment in the sustainability of a service including the training of suitable staff.

If a Health Board no longer has a mindfulness service operating, it can be a challenge to get it re-started again.  This guide is intended to support areas to offer mindfulness-based interventions who will need to re-build capacity.  It can be used alongside the decision-making process outlined in the Matrix using the hexagram tool.

Go to www.matrix.nhs.scot and search for Mindfulness.

The hexagon tool has been introduced to assist services in deciding if a particular therapy intervention is suitable and fitting for a health board area - see below.  It comprises six domains. The domains of evidence, supports and usability are summarised for each intervention and rated in terms of strength (from 1-5).  The other three domains of fit, capacity and need offer guided questions to enable a team to facilitate discussion to support implementation decision making.

Mindfulness-based interventions (MBSR / MBCT) have strong ratings for EVIDENCE, USABILITY and SUPPORTS (using the strength of the network).  The hexagon tool can support the decision-making process in terms of NEED and FIT.

• What population does your organisation serve? What physical or psychological conditions will it prioritise?

• Does the MBI intervention, with its emphasis on symptom / stress reduction, promotion of adaptive health behaviours and relapse prevention fit with the aims / values of organisation?

• Will this intervention fit alongside existing interventions that treat these conditions? Are there any competing interests?

• Will it offer additional choice, the opportunity to deliver treatment in groups (where 3 people may be treated for the same staff resource as 1 in individual therapy)?

• To whom do you hope to deliver the intervention (patient groups; staff)? Is this a comparable population to the research evidence?

• Does your organisation have other treatments in place that effectively and efficiently achieve the same outcomes?

Could mindfulness-based therapies meet a clinical / wellbeing need in your service? Are they a good fit?  Would you like to develop or restart a mindfulness-based service for patients / staff wellbeing? Do you have staff keen to receive training?

This paper will focus particularly upon the domains of CAPACITY and SUPPORT.  The aim is to assist health board and service areas to get mindfulness-based delivery off the ground again in situations where it has become particularly limited or where it has ceased to operate.  It will look at the conditions and supports which are necessary to maintain a service to sustain capacity. It will look at capacity building in terms of the selection and training of staff and the support available through the Scottish NHS Mindfulness Network, following their recommended training pathway for Mindfulness Therapists.

 

Building Capacity: The Training Pathway in Mindfulness-based therapy

Staff selection

• Do staff have a professional health / social care background and experience working with the patient or staff population where the mindfulness-based intervention is intended?

• Does the delivery of the intervention  fit easily into their job description and within the domain of their work? (e.g. if the intervention is to be delivered in adult mental health, the staff member is already delivering in this domain, and it is within their remit to deliver a group intervention).

• Is the staff member willing to train in this modality; do they have an interest in mindfulness, meditation-based practice and are willing to develop or deepen a personal practice?

• Staff members with an existing mindfulness / meditation / mindfulness movement practice (e.g., yoga, T’ai Chi) are particularly suitable and are likely to have a shorter training journey.

• Are you topping up an existing service or developing a new one? How many staff do you need to train to build a sustainable locality based service?

• The local PTTC (Psychological Therapies Training Coordinator) would be able to assist in identifying local interest and the selection of appropriate staff.

Participation in an 8-week mindfulness course

• The first stage of the training journey, giving staff  experience of the course format and its delivery, assisting them in exploring and developing their own personal practice of mindfulness.

• It is preferable if the mindfulness-based course is similar in model to what is to be delivered within the NHS. There are a range of suitable / comparable courses. These include Mindfulness Based Cognitive Therapy (MBCT), Mindfulness Based Stress Reduction (MBSR), MBCT for Life (MBCT-L), MBCT-Finding Peace in a Frantic World, Mindfulness Based Living (Mindfulness Foundation).

• If there is a mindfulness-based service within your health board, it may be possible for staff to attend a patient / staff course as a participant. It might be possible to access a staff 8 week course at another Health Board (in person or online), through the Scottish NHS Mindfulness network.

• The 8-week course can also be accessed privately, delivered in person or on-line (with preference for a live rather than pre-recorded course). Look for an evidence-based model (see above) and to a teacher with suitable experience (e.g. teacher listing on the BAMBA register or NHS Scotland listing).

• 8 week courses cost between £200 and £300 per person and will usually include a practice day in addition to 8 weekly classes. It is possible to employ a trainer to conduct a bespoke training in a local service area or health board. A few suggestions are made in The Appendix.

Consolidation of personal mindfulness practice.

• The trainee will engage in a period of deepening and consolidation of personal practice prior to proceeding with therapist training (on how to deliver the intervention).  This is necessary as the mindfulness therapist will be teaching from their own experience of the domain of practice.  It is what makes the intervention “mindfulness-based” and differ from the delivery of some other models (such as ACT, DBT).  

• They will develop a daily practice with a commitment to mindfulness becoming a valued part of their lives. This will include key components of the curriculum (e.g. sitting meditation, body scan, mindful movement, mindfulness in everyday life) so they are known from the “inside-out”. It can also include, if possible, participation in a more intensive mindfulness experience, such as a 1-5 day residential training.

• The consolidation period is expected to be around 12 months (shorter where the trainee already has an established practice). There are many ways a person can support their own practice and it is particularly beneficial to practice with a group.

• Staff practice groups might be available in your locality (your mindfulness lead will be able to advise, or something might be available within your local Staff Wellbeing service). Community based groups will also support this development (e.g. mindfulness and meditation groups). There are organisations offering on-line practice communities (see Appendix), based around the Mindfulness-Based interventions.

Therapist Training

• Therapist training courses in NHS Scotland, are delivered by experienced mindfulness therapists  who are qualified to train others. They can be delivered locally (in person) if the Health Board has mindfulness trainers or may be delivered (online) across health-boards. Course have been delivered co-jointly between two health boards and  some spaces have been offered to staff from additional health boards.

• Therapist training within NHS Scotland relies on an apprenticeship model and the duration of the training courses is shorter than those you might find in the independent sector. The base-line NHS Scotland mindfulness therapist training is 4-6 taught days (the standard 4-day course has been supplemented with additional training, piloted in Greater Glasgow and now developing into other areas). The trainee is expected to gain apprenticeship experience working alongside established mindfulness therapists and supervisors to build experience of delivery over the course of a year.   

• If no NHS courses are available, training (often called “teacher-training”) can be sought in the private sector. Courses vary in their duration and composition.  Some lead to a university-based qualification. Suitable courses for NHS based mindfulness therapists are accredited by BAMBA and follow the Good Practice Guidelines established by the UK Network.  They are typically delivered over the course of a year with costs around £1,500 to £2,000 per trainee.

• The mindfulness coordinators from NHS Mindfulness network can offer advice on teacher training and let you know if courses are being delivered in an adjacent health board or online.  The appendix offers examples of suitable private courses. This list is not exclusive.  Check the BAMBA website for affiliated training organisations (https://bamba.org.uk).

• Note that there may be a mindfulness lead in a health board area even if a mindfulness service is not supported. A mindfulness lead would be able to assist in any decision making for a service re-build and may be able to deliver training / supervision. 

Moving from Training into Delivery

• If there is an existing mindfulness service within the Health Board, there will be an opportunity for the trainee to engage in an apprenticeship model with other more experienced mindfulness therapists. The encouragement is to “teach” with a more experienced therapist for two 8-week courses.
• The experienced therapist will be able to offer guidance and feedback using the NES Mindfulness Evaluation and Feedback process. This can also be used for self-assessment in a reflective learning process.
• It is expected that the mindfulness therapist engages in supervision (peer-group or individual). A trainee therapist would benefit more from one-to-one supervision (ideally for at least three one-hour sessions per course). More experienced mindfulness therapists will benefit from supervision roughly on a monthly basis. Many Health Board areas have mindfulness supervisors who have attended generic supervision training and a “bolt-on” specific mindfulness supervision course developed by the Network. There may be a shortage of supervisors in some areas but the Network coordinators will organise supervision training as required.  
• If there is no existing mindfulness service, external supervision can be sought. The Network coordinators can advise on accessing supervision, either within the network or privately.
• Ongoing supervision is required for all who are delivering Mindfulness Based Interventions.

 

Using the SUPPORT of the network

• NHS Education for Scotland has supported The Scottish NHS Mindfulness Network since 2009. The Network is a real strength of this therapy modality and is unique in its spread across the NHS in Scotland.

• The Network is supported by two national co-ordinators (Neil Rothwell and Charlotte Procter) and mindfulness leads in each Health Board area, many of whom are experienced in delivering training and supervision.  The leads support the group of mindfulness therapists who are delivering mindfulness-based groups for patients and staff.

• The Network is a member of BAMBA, as a training organisation. This membership supports the development of good practice in delivery, training and supervision and provides a UK national perspective.

• The Scottish Network has an established Training Pathway and Therapist Listing process and has developed a specialist supervision training. 

• The Network has supported the cascading of training into local Health Board areas. Many areas are now able to deliver their own therapist training courses.  Recently, mindfulness leads have worked together to deliver training across 2-3 Health Boards.

• Leads have helped develop / update teaching / training resources. Greater Glasgow and Clyde have developed a Mindfulness app which is soon to be developed into a national resource for mindfulness therapists and practitioners.

• The Network supports the leads to advocate for mindfulness with senior management, and to establish annual plans for the development and sustainability of their local service. Annual visits are arranged between the national co-ordinators and the leads to this end.

• The Network offers annual CPD events for all mindfulness therapists. Recent CPD events have covered themes of Trauma-Sensitive Mindfulness, Equality, Diversity and Inclusion and Embodied Movement. An upcoming CPD event will look at the application of mindfulness-based interventions in 1-1 therapy settings.

• A national audit of therapy outcomes was conducted in 2021 and currently, a national data-base is being developed to support the collection of audit outcome data. There is an aim to standardise the outcome measures collected by Health Boards (with three primary outcome measures decided upon by the network) and a consultation is taking place to advice upon appropriate deprivation indices. 

• The Network has six annual on-line meetings each year, bringing together the mindfulness leads from each Health Board. These are well attended and offer support, consultation and good-practice advice between leads. The Network is involved in strategic discussions to lead the direction of the Network.

https://learn.nes.scot/40297/scottish-nhs-mindfulness-network;                      Network co-ordinators: Neil Rothwell (neilrothwell33@gmail.com),               Charlotte Procter (charlotteprocter2000@gmail.com)

 

APPENDIX

The following lists a few of the recommended courses and practice opportunities which can be accessed outside of the NHS. This list is not exclusive and there may be other opportunities in your locality. The network coordinators or mindfulness leads will be able to advise on their suitability. We would encourage you to speak to your mindfulness lead (there may be a lead even in areas where mindfulness-based provision is limited or absent) and PTTC (Psychological Therapies Training Coordinator) as part of planning how to access training and supervision which might be able to be delivered internally.

8-week courses:

The Mindfulness Project offers regular online 8-week mindfulness courses (MBSR / MBCT) delivered by experienced teachers (include a day of practice). Cost £295 per person trained.

https://www.londonmindfulness.com

The Highland Mindfulness Groups is a registered charity and has supported the delivery of courses to the NHS in Grampian and the Highlands.  It offers 8-week MBSR courses delivered on Zoom.  Courses are free to local people and cost £125 to other participants. They also offer monthly meditation days and residential retreats.

https://highlandmindfulness.co.uk

Mindfulness Sussex delivers 8-week courses on Zoom (MBSR / MBCT-L).  The £260 fee includes an orientation session, the 8 weekly sessions, a 6 hour retreat of intensive practice, audio downloads and a course handbook. The teacher, Ed Halliwell is registered on BAMBA.

https://mindfulnesssussex.co.uk

Clear and Mindful (Claire Hartwell) delivers 8-week MBSR courses online (otherwise based in Argyll). The cost is £195 for the 8 weekly sessions plus an additional £50 for a half day practice session.

https://clearandmindful.co.uk

Mindfully Being are able to offer a bespoke training for a group of participants in a health board or service area. Courses have been offered within NHS Lothian at a cost of £3000 for an 8 week course.

 https://mindfullybeing.co.uk

Other mindfulness trainers may be available to offer bespoke courses and this may be more cost-effective than sending participants onto individual courses.

Contact Charlotte Procter, Neil Rothwell or any mindfulness lead in the Scottish NHS Mindfulness Network.

 

Consolidating personal practice:

Palouse Mindfulness developed by Dave Potter, MBSR teacher from University of Massachusetts Medical School. A free pre-recorded online self-paced MBSR course with guided meditations, teaching materials, resources including TED talks from world renowned teachers.  Optional live Zoom meditations and discussion meetings / Facebook group to accompany you on the course.

https://palousemindfulness.com

Breathworks Community of Practice: Space to Breathe – live meditations every Tuesday evening at 7 pm with Vidyamala on Zoom (past recordings available on YouTube).

https://www.breathworks-mindfulness.org.uk/live-tuesday-meditations-with-vidyamala

Mindfully Being: “Mindful Tuesdays” - online free meditation with Dr. Avinash every Tuesday from 7.30 – 8 am on Zoom.

https://mindfullybeing.co.uk

Oxford Mindfulness Foundation offer two free daily online mindfulness sessions (Monday to Friday), 1.00 – 1.30 pm and 7.00 – 7.30 pm. They offer free monthly guest talks / CPD workshops on the application of mindfulness.

https://www.oxfordmindfulness.org

The Mindfulness Association offer daily live practice sessions on Zoom at 10.20 – 11.00 am and 7.00 – 8.00 pm.

https://mindfulnessassociation.net

The Mindfulness Network, a UK based mindfulness-teacher training organisation offer free online practice sessions (mindfulness and compassion based) under the Community of Friends on Fridays 8.15 to 8.45 am.

https://home.mindfulness-network.org

 

Intensive Mindfulness Workshops:

One day, weekend or week long workshops are opportunities for more intensive practice to deepen your experience of mindfulness.  It is recommended that a mindfulness therapist engages in some deeper mindfulness practice on an annual basis. BAMBA recommends a minimum of 5 days each year.  These could be taken individually if that best suits your personal / family circumstances.  Many workshops / day practice events are available online. Attending a live event with an experienced teacher would be particularly beneficial.

Many of the organisation mentioned in this guide will offer retreat / practice opportunities. Other suggestions include Gaia House (https://gaiahouse.co.uk); Holy Isle (https://www.holyisle.org); The Mindfulness Association (https:www.mindfulnessassociation.net); Mindfully Being (https://mindfullybeing.co.uk); Living Mindfulness (https://www.livingmindfulness.net).

 

Therapist Training courses:

Mindfulness Scotland offers a one-year Mindfulness Teacher Training Course in MBSR / MBCT, delivered in a hybrid format with face to face teaching at the Maggie’s Centre, in Glasgow.  It is accredited by BAMBA and appropriate for Health and Social Care professionals. It includes 7 training days, one of which is a specialist workshop, and an online weekend retreat. Hosted online peer support groups meet between teaching days for skills development and participants can attend regular online practice sessions. Cost £1, 750.

www.mindfulnessscotland.org.uk

Mindfulness UK offers an online teacher training course in MBSR (12 months minimum), which includes teaching days in a virtual classroom (35 hours), a specialist workshop, five days of silent retreat, supervision of two led courses leading to registration as a teacher on the BAMBA website. A portfolio is submitted which logs personal practice and reflections on the learning journey. Cost £1, 465 for initial course; £495 supervision for two taught courses.

https://mindfulnessuk.com