MBCT training in the English National Health Service
Even though MBCT has compelling aims and has been shown to work, it remains barely available in the NHS. We anticipate that Health Education England will commission MBCT training for High Intensity CBT therapists working in NHS services at some point in 2017. If this happens, a significant part of the Mindful Nation UK recommendations around health will have been realised.
Mindfulness-based cognitive therapy (Segal, Williams, & Teasdale, 2013; MBCT) has a growing evidence-base both for its effectiveness and its cost-effectiveness (Gotink et al., 2015; Kuyken et al., 2016). MBCT is increasingly cited in treatment guidelines internationally, there is a growing demand from people who wish to participate in MBCT programs and from organizations that wish to offer MBCT. To make MBCT accessible requires training sufficient numbers of MBCT teachers. Effectiveness and sustainability will be determined by the quality of this training.
In England the NHS Improving Access to Psychological Therapies (IAPT) programme provides evidence-based treatments for depression and anxiety. When Rebecca Crane and I undertook a small survey some years ago to see how widely available MBCT was within the NHS we found it was barely available at all (Crane & Kuyken, 2013). The recent larger scale ASPIRE study that I co-led with Jo Rycroft-Malone suggested accessibility was somewhat better, with several pockets of excellence across the UK and understandable barriers to its implementation that innovative centres had found ways to overcome (Rycroft-Malone et al., 2017). However, to date fewer than 50% of NHS IAPT services have trained MBCT teachers in their service.
David Clark chairs the NHS England IAPT Education and Training Expert Reference Group. In 2016 he asked me to advise on MBCT training within the NHS. I was delighted to do so and put together an advisory group of key colleagues, Paul Bernard, Rebecca Crane, Alison Evans Jo Rycroft-Malone, Zindel Segal, Clara Strauss and Tim Sweeney. All were very experienced in MBCT training, the NHS and/or implementation.
Over the best part of a year we drafted a curriculum to train NHS High Intensity CBT therapists so they could also teach MBCT. The work needed to balance the need for rigour and depth with the practical considerations of time and NHS resources. The curriculum was agreed by NHS England on the 30th November 2016 and is downloadable here: MBCT in IAPT curriculum (Final version 16_12_2016).
NHS England then went on to do a scoping exercise to see if there was demand for MBCT training within NHS IAPT services. Nine two per cent of respondents asked “yes” to the question “If mindfulness training was commissioned for your local area, would you be interested for your service?” The report estimated an overall demand for >250 training places. Services identified a bottle neck in supervision. In response we are working with the not-for-profit Mindfulness Network CIC to expand MBCT supervisory capacity across the UK.
We anticipate that Health Education England will commission training at some point in 2017 to make MBCT more accessible within the NHS. If this happens, a significant part of the Mindful Nation UK Report’s recommendations around health will have been realised; namely to build capacity within the NHS to help the millions of people who suffer recurrent depression learn skills to stay well in the long-term.
Professor of Clinical Psychology and Director, University of Oxford Mindfulness Centre
Declaration of interest
Professor Willem Kuyken receives no payment for public engagement or consultancy, and any remuneration is paid in full to the not-for-profit charity Oxford Mindfulness Foundation. He is Director of the Oxford Mindfulness Centre and Principal Investigator of several NIHR and Wellcome Trust grants evaluating MBCT.
Crane, R. S., & Kuyken, W. (2013). The Implementation of Mindfulness-Based Cognitive Therapy: Learning From the UK Health Service Experience. Mindfulness, 4(3), 246-254. doi: 10.1007/s12671-012-0121-6
Gotink, R. A., Chu, P., Busschbach, J. J. V., Benson, H., Fricchione, G. L., & Hunink, M. G. M. (2015). Standardised Mindfulness-Based Interventions in Healthcare: An Overview of Systematic Reviews and Meta-Analyses of RCTs. Plos One, 10(4). doi: 10.1371/journal.pone.0124344
Kuyken, W., Warren, F., Taylor, R. S., Whalley, B., Crane, C., Bondolfi, G., . . . Dalgleish, T. (2016). Efficacy and moderators of mindfulness-based cognitive therapy (MBCT) in prevention of depressive relapse: An individual patient data meta-analysis from randomized trials. Journal of the American Medical Association: Psychiatry. doi: 10.1001/jamapsychiatry.2016.0076
Rycroft-Malone, J., Gradinger, F., Griffiths, H. O., Crane, R. S., Gibson, A., Mercer, S., . . . Kuyken, W. (2017). Accessibility and implementation in UK services of an effective depression relapse prevention programme: Learning from mindfulness-based cognitive therapy through a mixed-methods study. Health Services and Delivery Research, 5(14), 190. doi: 10.3310/hsdr05140
Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2013). Mindfulness-based cognitive therapy for depression. (Second edition ed.). New York: Guilford Press.