Health Service Focus

Can mindfulness safeguard staff mental wellbeing?

NHE’s Rosemary Collins reports on the potential benefits mindfulness courses can deliver for NHS staff and patients.

Growing evidence suggests mindfulness practice could revolutionise the health sector, preventing costly long-term problems by providing staff and patients with the mental health tools to cope with stress. 

Based on ancient Asian spiritual traditions, mindfulness uses simple techniques, such as encouraging participants to focus on their breathing and physical bodies for a set length of time every day, to teach them to pay attention to what’s happening in the present moment in the mind, body and external environment with an attitude of curiosity and kindness. 

Although it’s not a universal cure-all – the way practitioners are required to confront their own thoughts means it’s not recommended for those suffering from bereavement or trauma, for example – its far-reaching and exciting possibilities are just beginning to be understood. 

From only being known by a few psychologists and spiritual practitioners, it recently received the Parliamentary seal of approval, with the release of a Mindfulness All-Party Parliamentary Group (APPG) report – the first government report into mindfulness in the world – looking at evidence that it can play a vital role in health, education, the workplace and the criminal justice system.

Mindfulness in action 

Social enterprise Breathworks, which offers mindfulness courses to different workplaces, has long been at the forefront of the mindfulness revolution in the health sector. 

In one recent project, it provided mindfulness courses for 100 members of the home treatment team within Surrey and Borders Partnership NHS FT, including healthcare support workers, nurses, psychiatrists, occupational therapists, team managers and administrators. 

“That’s a very highly stressed segment of the workforce,” said Colin Duff, Breathworks head of business and research. “They’ve got to get round a lot of patients, some of whom have very severe conditions and high needs.”

Evaluations showed reductions in stress and improvements in wellbeing after the course, which was sustained at a six month follow-up. Feedback from individual participants included “feeling less overwhelmed which freed up energy to focus on tasks that need completing” and “feeling less anxious when dealing with stressful situations”. 

Breathworks also carried out a mindfulness pilot project for 48 Department of Health staff. 

“They’ve seen significant changes, reduction in stress, improved satisfaction with life, improved wellbeing scores, reduced isolation and again some quite interesting personal reports,” said Duff. 

“One person reported being able to avoid taking time off with stress as a result of the mindfulness programme. They said the course made them more aware of stress triggers, but also how to reduce the pressures on the team that they were managing. Stress is a team-wide issue.” 

Working with patients 

Breathworks is also looking to work with healthcare patients. For instance, there are talks to launch a Public Health England-funded pilot study of mindfulness programmes, as one of a number of interventions to support older people at risk of loneliness. 

Despite the benefits of mindfulness beginning to be felt in the health sector, wide-scale implementation is proving more challenging. 

“Dissemination and implementation is a big issue at the moment,” said Duff. “There’s a great deal of accumulating evidence that mindfulness can be very, very beneficial in terms of stress levels, absenteeism, wellbeing and so on.  There’s a whole load of well-established benefits coming from it. But implementation is happening slowly. 

“There needs to be a number of things. There needs to be a bit of a culture change, which partly is a matter of education, people just need to get familiar with mindfulness, what it is, how it works, and how can it be applied. There’s some information dissemination and cultural shifts where the kind of understanding of it filters through into the culture and the public sector – the private sector too, but particularly in the public sector.” 

Tackling stress in the NHS 

One recent Health Foundation report revealed the UK tops the table in GP stress, with almost 60% of doctors finding general practice extremely or very stressful and 22% made ill by stress. The latest NHS staff survey also found that 37% of staff reported feeling unwell due to work-related stress and 63% coming into work despite feeling unfit to perform their duties. 

Highly stressed staff are less efficient and are more prone to absenteeism, ultimately costing the NHS more in the long term. So the arguments for implementing techniques such as mindfulness are practical and financial as well as emotional. 

The growing evidence for mindfulness may be there, but convincing healthcare providers of the benefits at a time when the NHS’s £2.3bn deficit means very few new spending initiatives are being authorised is another thing. 

A report by the Social Value Business estimated that every £1 spent on a Breathworks course saves £5.76 for the public purse in terms of reduced use of health services, staff absenteeism and increased productivity at work. 

“My course is quite cheap actually,” Duff noted. “It only tends to cost something like £250 a person for people to go through the programme, which will provide people with a stress prevention system and mental wellbeing kit that is theirs for life, to go home and use for life. So sure, obviously, we’re all concerned about expenditure, but doing nothing about the issue of stress and absenteeism is also an expensive choice.” 

Fragmentation affecting implementation 

Another problem with implementing mindfulness is the increased fragmentation of the health services. As they become more devolved, it becomes harder for mindfulness providers to sell their courses to individual trusts and employers, especially when they’re competing against companies with more resources. 

“It’s certainly true that there’s a whole task to be done to make contact with and build relationships with a whole diverse commissioning sector, which we’re at the early stages of,” said Duff. “It puts a lot of organisations in the mindfulness sphere. None of us are huge organisations at this stage so even though we’ve got a lot to offer it is a challenge to make those links. It’s a two-way thing; the public sector has to come to us as well because otherwise it’s going to be hard for us to find all the places we need to be approaching.” 

However, he says the new Mindfulness APPG report gives him hope. 

“The government report is compelling,” he said. “It’s a very, very strong case being made for benefits being made in a whole range of public sector areas, so there’s enormous potential. It certainly is happening, we just need to make sure there’s strong leadership and decision-making to follow through.”

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