Mindfulness-Based Cognitive Therapy:
Implementation in the UK Health Service
Rebecca Crane & Willem Kuyken
Mindfulness Conference, Bangor University9th April 2011
Goals & Outline
• The story so far• Current experience• Four exemplars• Next steps
The Story So Far
The MBCT Story So Far
MBSR & Stress
Reduction Clinic
Bangor Centre for Mindful-
ness Research & Practice
MBCT Manual &
RCTs
2004 & 2009 NICE
Guideline
Oxford Mindful-
ness Centre
Early NHS
projects
Mental Health
Foundation Report
© WK 5
National Institutes for Clinical Excellence (NICE) Recommendation
for Relapse Prevention (2009)
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.
Core Challenges of Implementation
• Structural• Political• Cultural• Educational• Emotional• Physical and technological
(Bate et al. 2008)
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!
(i) What is the state of implementation within your organisation (very briefly)?
(ii)What has proved most challenging while developing MBCT services in your organisation?
(iii)What factors have proved most important in supporting the development of MBCT in your organisation?
Small Group Work
Four Exemplars
• Grassroots enthusiasm
• National or regional initiatives
• Management buy-in
• Access to training and supervision
Key Ingredients in Implementation
MBCT Implementation The North Wales
Experience
Summary
Grassroots enthusiasmAccess to training and
supervision
X management buy inX national or regional
initiatives
MBCT in secondary care – as part of community mental
health provisionInclusion 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)
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
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
MBCT Implementation The Scottish Experience
Summary
Grassroots enthusiasmAccess to training and
supervisionManagement buy inNational or regional
initiatives
Development of mindfulness services within NHS in Scotland
2nd 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)
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
There are now NHS professionals trained to
deliver mindfulness-based courses within
each of the 11 mainland Scottish Health Boards
Facilitators
• 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
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
MBCT Implementation The Exeter Experience
Summary
National or regional initiatives
Grassroots enthusiasmAccess to training and
supervision
X Management buy in
Exeter: Key Elements
• Primary care and
research context
• Treatment integrity
• Therapists, therapist
training, support and
supervision
MBCT for Recurrent Depression in Primary Care
Primary Care Preventing Recurrence
Referral to MBCT Service
Person attends MBCTsessions
Ongoing contact through follow-up reunions
© MDC 2008
Pre-Post Average Depression Outcomes:
Beck Depression Inventory
severe
moderatemild
well
N>150
MBCT Implementation The Oxleas Experience
Summary!
Grassroots enthusiasmAccess to training and
supervisionManagement buy inNational or regional
initiatives
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
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
Summary and Close
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