Mindfulness-Based Cognitive Therapy : Implementation in the UK Health Service

1. Mindfulness-Based Cognitive Therapy: Implementation in the UK Health Service Rebecca Crane & Willem Kuyken Mindfulness Conference, Bangor University 9th April 2011

2. Goals & Outline • The story so far • Current experience • Four exemplars • Next steps

3. The Story So Far

4. The MBCT Story So Far

5. National Institutes for Clinical Excellence (NICE) Recommendation for Relapse Prevention (2009)

6. Generic Challenge of Implementation • Research-practice gap • Uptake of research – complex and multi-dimensional process - adopting knowledge depends on social processes including: • sensing and interpreting new evidence • integrating it with existing evidence • reinforcement by professional networks • which in turn is mediated by local context (Dopson & Fitzgerald 2005) • Growing interest in the theory and practice of research use/implementation /knowledge mobilisation.

7. Core Challenges of Implementation • Structural • Political • Cultural • Educational • Emotional • Physical and technological (Bate et al. 2008)

8. How Does This Relate to MBCT? • What are the ingredients for successful use of MBCT evidence in practice? • What works / hasn’t worked, with whom and in what contexts? • Can we use collective understanding to develop and disseminate best practice? • This workshop is part of the process!

9. Small Group Work • What is the state of implementation within your organisation (very briefly)? • What has proved most challenging while developing MBCT services in your organisation? • What factors have proved most important in supporting the development of MBCT in your organisation?

10. Four Exemplars

11. Key Ingredients in Implementation

12. MBCT Implementation The North Wales Experience

13. Summary • Grassroots enthusiasm • Access to training and supervision X management buy in X national or regional initiatives

14. MBCT in secondary care – as part of community mental health provision Inclusion criteria broadened: • recurrent depression presently in remission • residual depression • current episode of mild depression • anxiety related disorders including generalised anxiety, recurrent panic attacks and obsessive compulsive disorder Routine evaluation - significant change in symptoms of anxiety and depression, and global distress(Soulsby et al. 2002 - unpublished pilot evaluation of five MBCT classes in CMHT setting)

15. Key challenges and achievements • 2 classes per year delivered in local CMHTs • Ongoing MBCT service within local oncology unit • Pilot research on MBCT within primary care • Strong relationship built with local GPs through current MBCT research • Relies on the enthusiasm and time availability of individual practitioners • Stop/start • Practitioners feel unsupported by management

16. The way forward: - knowledge transfer partnership between university and local health board - developing a strategic vision + up skilling staff at grassroots level - pilot research on MBCT in primary care setting – dissemination and developing interest in further pilot initiatives - Welsh IAPT - on the near horizon - clinical psychology training programme is now ‘mindfulness orientated’ – mindfulness training built in at earlier stage

17. MBCT Implementation The Scottish Experience

18. Summary • Grassroots enthusiasm • Access to training and supervision • Management buy in • National or regional initiatives

19. Development of mindfulness services within NHS in Scotland2nd phase • Underpinned by NHS Education in Scotland (NES) • Because: NICE guidance + SIGN (Scottish Intercollegiate Guidelines Network) guidelines on psychological therapies for depression • NES project developed the Matrix (national strategy for delivering evidenced based psychological therapies)

20. The NES work has entailed: • Delivering teacher training courses • Developing a national forum of mindfulness leads from each locality • Establishing local supervision networks for those trained as teachers • Running supervision courses for experienced mindfulness teachers • Specifying competencies for both teachers and supervisors

21. There are now NHS professionals trained to deliver mindfulness-based courses within each of  the 11 mainland Scottish Health Boards

22. Facilitators Barriers Small funding for training process some managers working outside the process management not always understanding the ‘why’ of the training pathway recent budgetary constraints • small size of Scotland • grassroots mindfulness practitioners had contacts within Scottish Government. • centrally held strategic vision for mindfulness developments, integrated within overarching vision of increasing access to evidenced based psychological therapies

23. MBCT Implementation The Exeter Experience

24. Summary • National or regional initiatives • Grassroots enthusiasm • Access to training and supervision X Management buy in

25. Exeter: Key Elements • Primary care and research context • Treatment integrity • Therapists, therapist training, support and supervision

26. Primary Care Preventing Recurrence Referral to MBCT Service Person attends MBCT sessions MBCT for Recurrent Depression in Primary Care Ongoing contact through follow-up reunions

27. Pre-Post Average Depression Outcomes: Beck Depression Inventory N>150 severe moderate mild well

28. MBCT Implementation The Oxleas Experience

29. Summary! • Grassroots enthusiasm • Access to training and supervision • Management buy in • National or regional initiatives

30. Oxleas: Key Elements • Strategic Trust-wide approach with clear management structures • Clear referral pathways (primary, IAPT & secondary care) • Engagement of Trust managers and staff • Training therapists through Bangor TDR1

31. Oxleas: Key Challenges & Achievements • Resources • Competing demands • Practical issues (time of day, clear run of 8 groups, CDs) • Debates with psychiatry and links with secondary care • Since 2008: • 12 client groups • 105 clients • 8 staff groups

32. Summary and Close