Helpdesk
Working collaboratively with the third sector
There are a range of organisations offering mindfulness courses outside the NHS. These are a valuable resource for both the wider community and the NHS itself. This paper describes how the Scottish NHS Mindfulness Network can work effectively with these organisations. This provides the opportunity to extend and augment the service offered by the NHS.
Mindfulness is unusual as an intervention, as it has a wide spectrum of application from the general population to major psychiatric conditions such as psychosis. This has sometimes led to the idea that mindfulness is a “lifestyle” intervention that can be provided in the community. While this is true for the general population, for the more severe end of the spectrum, the governance issues are very different, and mindfulness becomes a high intensity intervention which needs to be delivered by specialist clinical staff. This requires the context of the NHS system, including the training pathway and support offered by the NHS Mindfulness Network. This is why we use the term mindfulness “therapists” in the NHS rather than “teachers.”
Distinctive features of NHS courses
The courses delivered in the NHS are mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR). These are the courses with the strongest evidence base for a range of mental health conditions including depression, anxiety, chronic pain, eating problems and addictions. Courses offered in the community may have a different content, which may not have as strong an evidence base for these conditions.
Some form of assessment is required for patients attending an NHS mindfulness course. This allows a clinician to gauge the appropriateness and potential effectiveness of the course for the individual. This is not typically the case for community mindfulness organisations (CMOs).
It is good practice for community organisations or their teachers to be members of the British Association of Mindfulness-based Approaches (BAMBA). The Scottish NHS Mindfulness Network is an affiliated organisation of BAMBA.
How to effectively integrate with community mindfulness organisations
It is good practice for NHS courses to offer ongoing follow-up sessions for participants. CMOs can provide additional follow-up and support. Sometimes, we see a patient who has already been on a community course. In this case, options include offering individual sessions to explore how the practice can help with their symptoms, and attendance on an NHS course.
In some instances, it may be appropriate for NHS therapists and CMO teachers to deliver courses jointly. In this case, there should be clarity about roles, governance, evaluation confidentiality and review, preferably in writing.
Sometimes, NHS clinicians train as mindfulness teachers through a community organisation. In these instances, it is helpful to ascertain whether the training was intended for a similar clinical population and whether the course followed MBCT/MBSR or another curriculum (for example, Mindfulness Based Living or Breathworks). If different, some conversion training is recommended. This could be through attending a MBSR/MBCT 8 week course, having individual mentoring, participating in the NHS therapist training and/or helping to run a course with an established NHS therapist.
Sometimes, an external agency will approach an NHS manager to offer mindfulness for staff, without the knowledge of the NHS mindfulness lead. This is typically because neither the agency or the manager is aware of the NHS activity. Here, it is recommended that the NHS lead has a conversation with both the agency and the manager. It may be that the agency can have a useful input, provided that it is integrated with NHS activity.
Colleagues in the social work service can undergo the same therapist training as NHS staff. Our NHS Mindfulness Training Pathway stipulates that therapists should only work with clients covered by their professional qualification, and this equally applies to social work staff. With two therapists leading a course, only one needs to have the relevant qualification, so this opens the possibility to further joint working.
Supervision should always be provided for mindfulness teachers and therapists. Where there is joint and integrated working, the supervision should be in line with NHS requirements, allowing governance and other issues to be addressed. Supervisors themselves should receive supervision, and this Scottish NHS Mindfulness Network is a resource for addressing general issues.
Resources for staff
The larger mindfulness organisations (e.g. The Mindfulness Network, Oxford Mindfulness Foundation) offer a range of training opportunities for NHS staff. These include residential and non-residential workshops to deepen practice, and CPD events, as well as training in some specialist areas e.g. chronic pain. They also typically offer online and face-to-face practice sessions, which therapists can find beneficial. These are an important component of the CPD of a mindfulness therapist and will hopefully be supported as part of a staff member's training needs.
Examples of Good Practice
In one of the earliest collaborations, a staff member of Action in Mind, a third sector organisation in Stirling, trained on the NHS mindfulness pathway. She then jointly delivered 8-week courses with NHS Forth Valley staff and was able to offer follow-up in the community.
A community mindfulness training agency, the Highland Mindfulness group, was set up by a therapist who was formerly a GP. This now has a number of mindfulness teachers and offers a variety of courses including MBSR and MBCT as well as practice sessions and study days. NHS Highland therapists have a good connection with this group.
The Highland Mindfulness Group also collaborated with NHS Grampian therapists to deliver mindfulness to NHS staff under a project funded by Charities Together. In the year of its operation, 200 staff accessed MBSR groups or tasters.
In Lothian, the NHS is working with Changes, a community health project in East Lothian which has chosen to employ mindfulness teachers who can deliver mindfulness-based groups.
In Fife, teacher training courses have comprised a mix of staff from NHS, social work and the third sector, with follow-up. For example, community staff were supported to deliver mindfulness-based courses within a mental health and employability based charity (Fife Employment Access Trust). Regular consultation and supervision was provided by a clinical psychologist within the NHS.
Neil Rothwell & Charlotte Procter
NES Mindfulness Co-ordinators
And the Scottish NHS Mindfulness Network
April 2024