Mindfulness in Education Case Studies

After Covid, we need effective ways to support the mental health a significant proportion of people in Wales. We also need to support the wellbeing of NHS staff who are reeling from a year of intense, traumatic work, on top of already demanding conditions

Mindfulness is a viable, proven practice that lets patients become active participants in their own health and wellbeing, who actively participate in a compassionate healing process, supplementing what medication can offer. 

A Health mindfulness working group, including senior people in NHS Wales and grassroots service providers, has been meeting to review current provision and consider ways forward. Here are our thoughts on the contribution of Mindfulness Based Programmes (MBPs) as:

  • A clinical intervention for individuals facing physical and psychological challenges
  • A group or individually delivered training to support staff wellbeing
  • A methodology to enhance organisational effectiveness

Clinical Delivery

Matrics Cymru recognises MBPs in Welsh Mental Health strategy, recommending clinical delivery of Mindfulness Based Cognitive Therapy for depression prevention, health anxiety, and antenatal anxiety and depression; MBP for psychosis; and Mindfulness-informed interventions such as Acceptance and Commitment Therapy (for anxiety disorders) and Dialectical Behaviour Therapy (for borderline personality disorder). 

MBPs are being used to support cancer care and managing chronic pain and other longterm conditions and in wellbeing programmes ranging from light touch tasters to in-depth interventions. 

Clinical Delivery

The Matrics Cymru framework, which guides the delivery of psychological therapies in Wales, already embeds MBPs in the Welsh Mental Health strategy. It recommends the clinical delivery of

  • Mindfulness Based Cognitive Therapy (MBCT) for depression prevention, health anxiety, and antenatal anxiety and depression
  • Tailored MBP for psychosis
  • Mindfulness-informed interventions such as Acceptance and Commitment Therapy (ACT – for anxiety disorders) and Dialectical Behaviour Therapy (DBT – for borderline personality disorder)

Matrics Cymru informs a well-developed structure of Psychological Therapy Management Committees (PTMCs) at national and Health Board (HB) level that support and oversee the delivery and implementation of psychological therapies. The Welsh Government and PTMCs recognise that there are differences across Wales in availability, quality and access to psychological therapies including MBPs. Furthermore, service leads, must balance local needs and priorities with national strategy which leads to variability in services across Wales. 

The group agreed that MBCT has an important contribution to make as part of the range of psychological therapies being delivered: it is an evidence-based cost-effective alternative to long-term antidepressants and there is demand for it from patients. However, a review found that services in Wales are patchy. Across the seven Health Board’s two have a thriving MBCT service; three have small scale implementation; and two have yet not begun to develop MBCT services. Currently only one HB has mindfulness practice guidance available in Welsh. 

Innovative clinical work employing MBPs in other ways is also taking place in some Health Boards including: 

  • MBPs for other conditions such as cancer care, pain management and long term physical health conditions
  • Implementing different models of MBP delivery from light-touch tasters to more in-depth programmes

Staff Wellbeing

Evidence shows that mindfulness for healthcare staff is cost-effective, reduces absenteeism, burnout and stress, and increases life-satisfaction and compassion. Some Health Boards already offer staff access to MBPs to cultivate wellbeing, improve working habits, and stay in contact with the values that underpin their work.

Staff Wellbeing

Innovative work is taking place in some Health Boards offering staff access to MBPs tailored to cultivate:

  • Wellbeing
  • Effective working habits
  • Values-informed engagement with life and work 
  • Compassion for self and others. 

Evidence shows that this training is a cost-effective return on investment, reduces absenteeism, burnout and stress, and increases life-satisfaction and compassion. 

Some areas include introductory mindfulness training in healthcare professional training, building capacities for self-care, compassion and wellbeing early in professional development. These implementers believe that mindfulness can help address Health Service’s challenges in recruiting and retaining staff, especially doctors.

    Organisational Culture

    We believe that Wales needs a Health Service in which mindful and compassionate values are integrated into all aspects of the NHS, from senior leadership down.

    Recommendations

    We recommend:

    • Mindfulness Based Programmes become a core part of Approaches to Mental Health and psychological wellbeing in Wales.
    • A vision and delivery strategy for how MBPs can support whole population approaches to healthy habits.
    • An accessible national program of socially prescribed mindfulness courses and classes as a Foundation Tier, public health initiative available across Wales following the model being developed by Aneuren Bevan UHB and Valleys Steps.
    • Effective models of mindfulness for people with ongoing health challenges.
    • Collaboration across the NHS in Wales including sharing good practice for implementation, delivery and evaluation, and sharing resources.
    • Funding for mindfulness training pathways for Welsh Healthcare professionals.
    • Support for Healthcare staff through mindfulness interventions.
    Steps to Strengthen Implementation

    The Mindfulness in Health Working Group recommends:
    1. Strengthening communities of mindfulness practice across Wales. The clinicians we spoke to felt that establishing a Welsh network of mindfulness practitioners would support:
    Sharing best practice, including evidence-informed implementation strategies, models of delivery and ways of evaluating course outcomes
    Disseminating what clinicians have learned about barriers and supports to implementation
    Developing personal and clinical mindfulness skills
    Sharing resources such as translated materials and clinicians experienced in delivering MBPs, enabling economies of scale in group supervision and training
    Reducing the isolation of lone implementers
    2. Raising the profile of MBPs
    Bringing MBP implementation to the agenda of the PTMCs at HB and national level to strengthen the impetus behind existing MBP implementation efforts; and to link grassroots implementation experience with national initiatives.
    3. Developing a vision and implementation strategy for the contribution that MBPs can make to people living with long term physical health conditions
    MBPs are particularly effective in empowering people with ongoing health challenges (a population who also have a heightened risk of depression) to discover their inner capacities for living well and self-managing their condition.
    4. Widening access to MBP courses for public sector staff and workplace wellbeing
    Develop a vision and delivery strategy within Wales for the ways that MBPs can contribute to the range of strategies that support whole population approaches to healthy habits.
    Include mindfulness in training pathways for healthcare professionals in Wales.

    “Mindfulness practice enables us to orient towards our inherent wholeness and capacities for health and wellbeing in the midst of whatever challenges we are living with. Through a kindly and rigorous training to bring awareness to experience, we draw out our innate capacities for learning, growing, healing and transformation, and become active participants in investing in our health and wellbeing as a complement to whatever medicine can offer. 

    The practice of mindfulness reconnects us to our common humanity and is relevant to both those offering and receiving services. It helps us shift from a ‘fixing’ paradigm in which getting healthcare is like taking the car to the garage, to recognising that both care giver and receiver are active participants in the healing process ”

    Rebecca Crane, Director, Centre for Mindfulness Research & Practice, Bangor University

    “ It isn’t easy to find calm and focus in the average frantic day, but investing just a few minutes every morning in mindful contemplation helps brings order to my day. I’ve found this brief discipline of mindfulness repays the time many-fold and makes my days more positive and productive. I’d say to anyone: give it a try! ”

    Heather Payne, Senior Medical Officer, Wales NHS