Transcript Workshop - Bangor University

Mindfulness-Based Cognitive Therapy:
Implementation in the UK Health
Service
Rebecca Crane & Willem Kuyken
Mindfulness Conference, Bangor University
9th 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
Oxford
Mindfulness
Centre
MBCT
Manual &
RCTs
Bangor
Centre for
Mindfulness
Research
& Practice
2004 &
2009
NICE
Guideline
Mental
Health
Foundation
Report
Early
NHS
projects
National Institutes for Clinical Excellence
(NICE) Recommendation
for Relapse Prevention (2009)
© WK
5
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!
Small Group Work
(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?
Four Exemplars
Key Ingredients in Implementation
• Grassroots
enthusiasm
• Access to
training and
supervision
• National or
regional initiatives
• Management
buy-in
MBCT Implementation
The North Wales Experience
Summary
Grassroots enthusiasm
Access to training and
supervision
X management buy in
X national or regional initiatives
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)
Key challenges and achievements
• 2 classes per year
• Relies on the
delivered in local
enthusiasm and time
CMHTs
availability of
individual
• Ongoing MBCT service
practitioners
within local oncology
unit
• Stop/start
• Pilot research on MBCT • Practitioners feel
within primary care
unsupported by
management
• Strong relationship
built with local GPs
through current MBCT
research
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 enthusiasm
Access to training and
supervision
Management buy in
National 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
Barriers
• 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
• 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 enthusiasm
Access 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 MBCT
sessions
Ongoing contact through follow-up reunions
Pre-Post Average Depression Outcomes:
Beck Depression Inventory
N>150
severe
moderate
mild
well
© MDC 2008
MBCT Implementation
The Oxleas Experience
Summary!
Grassroots enthusiasm
Access to training and
supervision
Management buy in
National 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