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GOVERNMENT REPORT ON MINDFULNESS OCTOBER 2015
MINDFUL NATION UK
The Mindfulness All-
• review the scientific evidence and current best practice in mindfulness training
• develop policy recommendations for government, based on these findings
• provide a forum for discussion in Parliament for the role of mindfulness and its implementation in public policy.
The Mindfulness Initiative provides the secretariat to the group (www.themindfulnessinitiative.org.uk)
1. What is mindfulness?
2. The role of mindfulness in health
3. The role of mindfulness in education
4. The role of mindfulness in the workplace
5. The role of mindfulness in the criminal justice system
6. The implementation challenge
Appendix 1: List of expert witnesses
Appendix 2: References
Officers of the Mindfulness APPG
This report is the culmination of over a year of research and inquiry including eight hearings in Parliament when members of the Mindfulness All-
take notice and we urge serious consideration of our report. This work originated with an initiative led by Lord Richard Layard and Chris Ruane, the former Labour MP who lost his seat in 2015. They established a programme of mindfulness classes in Parliament attended to date by 115 Parliamentarians and 80 of their staff. We want to pay particular tribute to Chris’s energetic advocacy of mindfulness and warmth of heart which won him friends across Parliament and beyond. His enthusiasm and commitment were vital to the work of this inquiry along with the leadership of his co-
We are also deeply appreciative of the work of the Mindfulness Initiative which provides the secretariat to the Mindfulness All-
for Worthing East and Shoreham
for Newport East
In recent years, there has been an explosion of interest in mindfulness with widespread media coverage, bestselling books and a remarkable uptake of online resources1. Mindfulness means paying attention to what’s happening in the present moment in the mind, body and external environment, with an attitude of curiosity and
kindness. There has been a huge increase in academic research on the subject with more than 500 peer-
There is still much research to be done on how mindfulness training can be offered at scale in different settings and with different population groups, but what is already clear is that it is an important innovation in mental health which warrants serious attention from politicians, policymakers, public services in health, education and criminal justice as well as employers, professional bodies, and the researchers, universities and donor foundations who can develop the evidence base further. We particularly urge research into its potential to be cost effective, with savings in key areas of government expenditure. We are aware that the current popularity of mindfulness is running ahead of the research evidence in some areas, and have tried to steer a balanced course midst the claims and counterclaims reported in the media. While it is not a panacea, it does appear to offer benefit in a wide range of contexts. Mindfulness has a role to play in tackling our mental health crisis in which roughly one in three families include someone who is mentally ill3. Up to 10% of the UK adult population will experience symptoms of depression in any given week4. This crisis is largely going untreated with only one in three of those with mental illness receiving treatment. Physical ill health conditions absorb the bulk of the health budget; parity of esteem between mental and physical health is an urgent priority. As the Chief Medical Officer noted in her 2013 annual report, citing the World Health Organisation’s 2010 Global Burden of Disease Study, there is a “striking and growing challenge that [mental] disorders pose for the health systems”. This burden of mental ill health is distressing not only to those directly affected but to all those who care for them. It is also immensely costly to the nation as it particularly affects people of working age: nearly half of all absenteeism and claims for incapacity benefits are due to mental illness. No single therapy works for everyone: we need availability of a wide range of evidence-
Equally importantly, we need to take prevention strategies seriously if we are to reduce the burden of mental ill health, and encourage the flourishing and wellbeing of a healthy nation. Mindfulness is one of the most promising prevention strategies and is regarded as popular and non-
exercise used by millions across the world with great benefits to personal health. There is a widespread consensus around the benefits of active physical exercise, but as yet no comparable understanding of how to maintain one’s mental health. Mindfulness could play that role as a popular, effective way for people to keep their mind healthy. Kabat-
The government’s Foresight6 report developed the concept of mental capital, by which it meant the cognitive and emotional resources that ensured resilience in the face of stress, and the flexibility of mind and learning skills to adapt to a fast-
We have considered four distinct areas where mindfulness could play a major role, and have reviewed the existing research and heard evidence at inquiry hearings in Westminster from pioneering and inspiring projects. The testimony of individuals describing the transformational impact of mindfulness has been powerful (as illustrated in the report’s case studies). At present, the work is fragmented, with small mindfulness projects scattered across the country, driven by enthusiastic and dedicated grassroots advocates, but the funding has been scarce in the public sector for provision that reaches groups and communities at the highest risk of mental health problems. We make recommendations on how to further develop this exciting new field. Our intention is that this inquiry report will widen interest in this innovation, deepen understanding of its relevance and potential, and stimulate developments for better access. Our long-
We Therefore Make the Following Key Recommendations
We redommend that:
1. MBCT (Mindfulness-
2. Funding should be made available through the Improving Access to Psychological Therapies training programme (IAPT) to train 100 MBCT teachers a year for the next five years to supply a total of 1,20010 MBCT
teachers in the NHS by 2020 in order to fulfil recommendation one.
3 . Those living with both a long-
4. NICE should review the evidence for Mindfulness-
We recommend that:
1. The Department for Education (DfE) should designate, as a first step, three teaching schools11 to pioneer mindfulness teaching, co-
2. Given the DfE’s interest in character and resilience (Character Education Grant programme), we propose a comparable Challenge Fund of £1 million a year to which schools can bid for the costs of training teachers in mindfulness.
We recommend that:
1. The Department for Business, Innovation and Skills (BIS) should demonstrate leadership in working with employers to promote the use of mindfulness and develop an understanding of good practice.
2. We welcome the government’s What Works Centre for Wellbeing, and urge it to commission, as a priority, pilot research studies on the role of mindfulness in the workplace, and to work with employers and university research centres to collaborate on high-
3. Government departments should encourage the development of mindfulness programmes for staff in the public sector – in particular in health, education and criminal justice -
4. The National Institute of Health Research should invite bids to research the use of mindfulness as an occupational health intervention and its effectiveness in addressing occupational mental health issues such as stress, work-
I am deeply honoured to have been invited to contribute to this All-
Mindfulness is a way of being in wise and purposeful relationship with one’s experience, both inwardly and outwardly. It is cultivated by systematically exercising one’s capacity for paying attention, on purpose, in the present moment, and non-
Basically, when we are talking about mindfulness, we are talking about awareness – pure awareness. It is an innate human capacity that is different from thinking but wholly complementary to it. It is also “bigger” than thinking, because any thought, no matter how momentous or profound, illuminating or destructive, can be held in awareness, and thus looked at, known, and understood in a multiplicity of ways which may provide new degrees of insight and fresh perspectives for dealing with old problems and emergent challenges, whether individual, societal, or global. Awareness in its purest form, or mindfulness, thus has the potential to add value and new degrees of freedom to living life fully and wisely and, thus, to making wiser and healthier, more compassionate and altruistic choices – in the only moment that any of us ever has for tapping our deep interior resources for imagination and creativity, for learning, growing, and healing, and in the end, for transformation, going beyond the limitations of our presently understood models of who we are as human beings and individual citizens, as communities and societies, as nations, and as a species.
In the past 40 years, mindfulness in various forms has found its way into the mainstream of medicine, health care and psychology, where it has been broadly applied and continues to be evermore extensively studied through clinical research and neuroscience. More recently, it has also entered the mainstream of education, business, the legal profession, government (witness this very report and the mindfulness programme in
Parliament that gave rise to it), military training (in the USA), the criminal justice system, etc. Interest in mindfulness within the mainstream of society and its institutions is rapidly becoming a global phenomenon, supported by increasingly rigorous scientific research, and driven in part by a longing for new models and practices that might help us individually and collectively to apprehend and solve the challenges threatening our health as societies and as a species, optimizing the preconditions for happiness and wellbeing, and minimizing the causes and preconditions for unhappiness and suffering.
As a consequence of these varied and complex developments over the past 40 years, this report may be a singular and defining document, suggesting as it does that mindfulness has the capacity to address some of the larger challenges and opportunities to be found in the domains of health, education, the workplace, and the criminal justice system by tapping into interior resources we all possess but that are mostly undeveloped or underdeveloped in our education system and in our society more broadly, at least up to this point in time. If the unique genesis of this document as a collaborative effort across all parties in Parliament is recognized and its forward-
I look forward to following with great interest the outcomes of this unique undertaking. Once again, I extend a deep expression of gratitude to all those whose hard work and engagement with mindfulness in their own lives and in their communities has brought us to this point.
Professor Emeritus of Medicine at the University of Massachusetts Medical School
What Is Mindfulness?
Mindfulness means paying attention to what’s happening in the present moment in the mind, body and external environment, with an attitude of curiosity and kindness. It is typically cultivated by a range of simple meditation practices, which aim to bring a greater awareness of thinking, feeling and behaviour patterns, and to develop the capacity to manage these with greater skill and compassion. This is found to lead to an expansion of choice and capacity in how to meet and respond to life’s challenges, and therefore live with greater wellbeing, mental clarity and care for yourself and others.
Typically mindfulness practice involves sitting with your feet planted on the floor and the spine upright. The eyes can be closed or rest a few feet in front while the hands are in the lap or on the knees. The attention is gently brought to rest on the sensations of the body -
Where Does Mindfulness Come From?
Methods for training mindfulness have long been central to the contemplative traditions of Asia, especially Buddhism. Using these methods, but freeing them from any religious or dogmatic content, Jon Kabat-
practice using audio guides at home. The class-
Most significant of these adaptations has been the Mindfulness-
to depression by building resilience. MBCT includes basic education about depression and a number of exercises derived from cognitive therapy that demonstrate the links between thinking and feeling, and how best participants can care for themselves when they notice their mood changing or a crisis threatening to overwhelm them.
How Does It Work?
Both MBSR and MBCT are based on the premise that participants can train themselves, through the meditation practices and supporting psychoeducational training, to be more aware of, and less reactive and judgmental towards their thoughts, emotions and body sensations. Key elements of this include seeing thoughts as mental events rather than facts, learning how to work skilfully with automatic patterns of reacting to stress, developing capacity to notice and enjoy pleasant events in life, and cultivating a more unconditional kindness towards yourself and others.
This allows people to develop healthier, more compassionate responses to their own experience, as well as to events in their lives and the people around them. Regular meditation practice is considered helpful as a way of cultivating mindfulness. Mindfulness is thus presented through such courses as a skill to be trained in, rather like learning a new language.
Practitioners may be less drawn into unhelpful habitual reactions and more able to make good choices about how to relate to their circumstances. Neuroscientific studies into the effects of mindfulness indicate that it is associated with brain changes that seem to reflect improvements in attention and emotion regulation skills21. The benefits of mindfulness appear to extend to relationships so that practitioners are more likely to respond compassionately to someone in need22, and enjoy more satisfying personal relationships23. There is also some evidence that they take more environmentally responsible decisions24. As with any new field of enquiry, there is much more research to be done to understand its effects.
Comments from Parliamentarians that Atteneded Mindfulness Classes
''Although initially sceptical…having completed the course, and attended every session, I am a convert. It’s just logical that we could all do with simple techniques to help us remember to live in and appreciate the present moment. I’ll be recommending it to all those who work with young people in my constituency.”
“ I found the ethos, thinking and practice totally compelling and,additionally, free of ‘psycho-
“ The mindfulness course has been of great benefit to me both personally and professionally. The mindfulness breathing techniques and practical exercises have helped me to cope much better with the stresses and strains of a highly demanding job and gain a better work-
“ I found the course extremely helpful in focusing my mind, reducing stress and improving concentration.”
“ For anyone looking to find a way of balancing the often competing demands of home, work, and not least, ourselves, it’s worth their checking out an introduction to mindfulness. Too often we overlook the basics in our lives and need to find a way of connecting with what really matters.”
“ In today’s mad whirl, a few well-
“ Mindfulness need not be thought of only as a ‘cure’ for those in need, it also helps one to know how to…enjoy living a life of service. I have found the mindfulness course amazingly helpful.”
The Role of Mindfulness in Healthcare
experience symptoms of depression in any given week25 and the rate of recurrence is high -
It has been estimated that in the next decade the cost of depression will rise to £9.19 billion a year in lost earnings alone, with an additional £2.96 billion in annual service costs27.
Depression is two to three times more common in people with a long-
For people with both physical and mental health problems, recovery from each is delayed and the effect of poor mental health on physical illnesses is estimated to cost the NHS at least £8 billion a year30. Through its mandated Parity of Esteem programme, NHS England has recognised that mental health and physical health need to be equally valued and innovative models of care integrating physical and mental health approaches have been called for as a priority. Mindfulness offers a particular opportunity here given its integrated mind-
The effect of poor mental health on physical illnesses is estimated to cost the NHS at least £8 billion a year30.
MBIs are inherently participative, inviting an interest in the experience of the body and mind, and promoting a different relationship to them. This engaged participation is in keeping with self-
One of the most important areas of research has been MBIs and the treatment of longterm physical health conditions38. A recent review of 114 studies39 found consistent improvements in mental health and wellbeing, notably reduced stress, anxiety and depression, in the context of poor physical health. In terms of specific physical health conditions, the strongest evidence presented is for the psychological impact of living with cancer, where 43 studies including nine randomised controlled trials are described; evidence is also presented from randomised controlled trials for the benefits of MBSR for lower back pain, fibromyalgia, arthritis, HIV and irritable bowel syndrome. There is also promising evidence which suggests the potential benefits of MBIs in a broader range of other physical health conditions (see list40) including conditions which are of pressing concern to policymakers, such as diabetes and obesity. Whilst most research in this area is with adults, there is also interest in the potential of MBIs for children and young people living with long-
While most research has been on MBCT and MBSR face-
The Challenges of Implemention in the NHS
There is great interest in mindfulness among health care stakeholders with 72% of GPs wanting to refer patients to mindfulness courses on the NHS46. Yet only one in five GPs report having access to mindfulness courses in their area47. Only one in five GPs report having access to mindfulness courses in their area47.
Some pioneering NHS trusts have developed small-
One such programme has been developed by the Sussex Mindfulness Centre, a collaboration between Sussex Partnership NHS Foundation Trust (a mental health trust) and the University of Sussex. The centre conducts mindfulness research, offers MBCT courses to patients and staff, as well as an MBCT teacher training programme. In their adult primary care service in East Sussex (Health in Mind) they offer nine MBCT courses, catering for around 100 patients each year, with a dedicated MBCT teacher in post to support this provision and ensure its integrity. They are also extending provision into their secondary care adult mental health services and into their children and young people’s services.
Another model is Breathworks, a social enterprise founded in 2001 that is based in the north-
There are also some excellent examples of courses in NHS physical health services. Three MBCT for cancer (MBCT-
However, despite such programmes, access to MBCT as recommended by NICE is still extremely limited38. One barrier to implementation is that MBCT is recommended as a prevention intervention for recurrent depression rather than as a treatment for current depression. That requires an NHS which prioritises prevention; the importance of this is well understood in the debate about future health care.
Another barrier to implementation of MBCT is that mental health and physical health are almost always treated by separate NHS trusts leaving patients and their care teams to negotiate separate systems. Despite the Parity of Esteem principle, availability of psychological interventions within physical health settings is still very limited and this is true for MBIs, despite the wealth of evidence that they can alleviate symptoms of depression, anxiety and stress across a broad range of physical health conditions.
The lack of provision within the NHS contrasts with the flourishing and rapidly expanding private provision of mindfulness courses. This restricts access to those who can afford an eight-
In addition, there are another set of challenges around implementation which go to the heart of the effectiveness of those teaching mindfulness. Questions of teacher training integrity and quality are considered in chapter six (please see page 61).
How Much Would It Cost?
Using figures on the cost of depression from The Kings Fund report, “Paying the Price: the cost of mental health care in England to 2026”50, this could mean savings of £15 for every £1 spent51, with further savings in related health care costs such as antidepressant prescriptions. In line with other mental health treatments, the savings in lost earnings far outweigh the costs. How much would it cost? Health 22 References 38,
1. MBCT (Mindfulness-
2. Funding should be made available through the Improving Access to Psychological Therapies (IAPT) training programme to train 100 MBCT teachers a year for the next five years, to supply a total of 1,20054 MBCT teachers in the NHS by 2020 in order to fulfil recommendation one.
3. Those living with both a long-
4. NICE should review the evidence for MBIs in the treatment of irritable bowel syndrome, cancer and chronic pain when revising their treatment guidelines.
1. The National Institute of Health Research (NIHR) should invite research bids to evaluate the effectiveness (including maintenance of effects) of MBIs in the following areas:
• A definitive randomised controlled trial of adapted MBCT as a relapse prevention intervention for young people with a history of depression to see if the relapse prevention findings from studies with adults generalise to younger people.
• A definitive randomised controlled trial with full health economic evaluation of MBSR for people living with a range of long-
• A programme of research exploring the effectiveness of lower intensity MBIs as a public health preventative intervention for groups and communities at higher risk of mental ill health or indicating preclinical levels of mental health problems. This should include measuring wellbeing and physical health outcomes, as well as costing health care use.
This is an exciting opportunity to develop an innovative treatment to reduce the burden of mental ill health and the added suffering it brings to those facing physical pain and disease. The rate of commissioning within the NHS appears to be slow since the NICE guidelines came out in 2004. Also disappointing has been the inadequate investment in the highquality research needed to strengthen the evidence. We urge health care commissioners and the national research-
The Role Of Mindfulness in Education
There are three key policy challenges in education on which the research evidence for mindfulness has a bearing. The first is the concern with academic attainment and improving results; the second is the deepening anxiety around the mental health of children; the third is the growing interest in concepts (which have been identified as a policy priority by all the major parties) of character-
As schools continue to respond to these challenges, a growing number are turning to mindfulness training for children in the classroom and report both a range of benefits and its popularity with children and staff. The research is emergent but with increasingly promising evidence57 of its potential for the three policy challenges outlined. (There are now 50 published research studies.) However, as is inevitable in a new field, many of the studies to date have been relatively small and most without long-
In the meantime, the level of mental ill health in this age group is alarming60: around 10%61 of children experience mental health issues between the ages of five and 16, around three children in every class62. The number of 15-
Many argue that the most important prerequisites for child development are executive control (the management of cognitive processes such as memory, problem solving, reasoning and planning) and emotion regulation (the ability to understand and manage the emotions, including and especially impulse control). These main contributors to self-
There is promising evidence that mindfulness training has been shown to enhance executive control in children71 and adolescents72 in line with adult evidence. What is of particular interest is that those with the lowest levels of executive control73 and emotional stability74 are likely to benefit most from mindfulness training. Recent meta-
What is of particular interest is that those with the lowest levels of executive control73 and emotional stability74 are likely to benefit most from mindfulness training.
Since chronic stress can negatively impact on maturation of the brain areas involved in learning77, interventions to improve executive function which also support stress reduction, such as mindfulness, are more likely to result in academic improvements78. Indeed, studies on mindfulness with children and adolescents have demonstrated benefits in cognitive (e.g. attention) and academic outcomes79. There is now also good evidence of the link between achievement and emotional and social learning; a recent global survey found that the academic achievement of children taking programmes promoting social and emotional skills (including mindfulness) rose by about 10 percentile points80. More specifically, one evaluation of a small study of children with learning difficulties showed significantly improved academic achievement as well as social skills81.
Emotional buoyancy, coping skills, the capacity to manage difficulties and the ability to form constructive social relationships are all important aspects of children’s flourishing and there is evidence that mindfulness contributes to each82. These positive effects are often apparent three years after taking a course and relatively short inputs produce discernible results83.
In addition to studies of targeted interventions, there is evidence of the benefits of universal programmes designed to support the flourishing of all children. One pilot trial84 of a year group of 137 students aged 17-
What could prove of particular interest to schools is the impact of mindfulness on difficult behaviour, with improvements for those with Attention Deficit Hyperactivity Disorder, as well as decreases in impulsiveness, aggression and oppositional behaviour90. This is consistent with the beneficial impact of mindfulness on self-
There is an emerging body of evidence that suggests that extending the influence of mindfulness into families can support both parents and children. Mindful parenting programmes aimed at parents in socio-
The US has led innovation on how to introduce mindfulness into schools with over 4596 variations of mindfulness programmes for schools at the most recent count. They range from short practices taught by any teacher (e.g. the Inner Explorer programme97) to lesson-
We estimate that around 2,000 people have been trained to teach mindfulness programmes to young people in the UK under the ages of the main UK training organisations. These include Mind with Heart101, Youth Mindfulness102 and Mindfulness in Schools Project (MiSP)103.
MiSP is advised by staff from three universities and the curricula it has developed have been adopted by a number of countries and translated into 10 languages. MiSP is now delivering 46 teacher training courses a year in response to rising demand104, and since 2011 has trained 1,670 teachers in its secondary school curriculum and 391 in its primary curriculum. All prospective mindfulness-
The consensus is that the success of the programme in a school depends to a considerable extent on the quality and experience of the teacher’s106 own mindfulness practice, and this can take several years of sustained personal commitment well beyond the formal training. Quality is also affected by how it is implemented; an isolated instance of a teacher working with one class is less effective than a whole school approach in which everyone in the school community including parents and all the staff participate in the programme. There are ongoing research programmes evaluating these claims and the best way to train teachers.
The “.b” mindfulness programme developed by MiSP107 is taught in ten 40-
MiSP’s “Paws b” mindfulness programme for primary school pupils is delivered in 12 half-
One of the most developed projects is Bright Futures Educational Trust110, a multiacademy trust of 10 schools based in the north-
In another research programme at Bangor University over 40 school teachers were first trained on the “.b Foundations” course (designed to teach teachers and other staff for their own wellbeing), and then six months later, trained to teach a mindfulness curriculum appropriate for the age of their pupils. Through this research project more than 300 primary school pupils and 180 sixth-
One of the longest running programmes has been the introduction of ‘daily stillness’ by Dr. Anthony Seldon115 during his headship at Wellington School. He has also been an enthusiastic advocate in the national media for contemplative practices (such as mindfulness) in education.
1. The Department for Education (DfE) should designate, as a first step, three teaching schools116 to pioneer mindfulness teaching, co-
2. Given the DfE’s interest in character and resilience (as demonstrated through the Character Education Grant programme and its Character Awards), we propose a comparable Challenge Fund of £1 million a year to which schools can bid for the costs of training teachers in mindfulness.
3. The DfE and the Department of Health (DOH) should recommend that each school identifies a lead in schools and in local services to co-
4. The DfE should work with voluntary organisations and private providers to fund a freely accessible, online programme aimed at supporting young people and those who work with them in developing basic mindfulness skills118.
The Role Of Mindfulness in the Workplace
This is the sector where there has been the most intense interest, widespread experimentation and enthusiastic media coverage of the subject of mindfulness. High-
It is important to emphasise that this proliferation of programmes has outstripped the research evidence which, while promising, remains patchy. Workplace mindfulness interventions to improve wellbeing have not been researched with high-
The most pressing issue is the rising toll of work-
The leading cause of sickness absence in the UK is mental ill health, accounting for 70 million sick days, more than half of the 130 million total every year. Each year between 2010 and 2014, a million people took sick leave for longer than four weeks120. Many public sector workforces are particularly affected including the NHS (one of the five biggest employers in the world) which has higher sickness absence rates than any other large public sector organisation, with 3.4% of worker hours lost to sickness in 2013121. The leading cause of sickness absence in the UK is mental ill health.
Further examples include police forces which have reported rises in stress-
There is also a need to address occupational mental health in Small and Medium Enterprises (SMEs) which form an important part of the UK economy, but have limited access to occupational health. SME owners/ managers face particular challenges in recognising, acknowledging and seeking help in this area. There is a need to develop accessible, appropriate mental health interventions for those working in SMEs, which reflect their specific working conditions and their support needs.
Given that the mental ill health prevalence in the population has not significantly increased in the last twenty years126, there is a growing body of literature on what is driving this rise in mental ill health in the workplace. Key factors have been identified such as work intensification with multiple demands on attention and the need to multi-
Mental ill health is an issue of huge significance to the long-
A number of randomised controlled trials of MBIs have found positive effects on burnout, wellbeing and stress130. Mindfulness can assist with focus and a range of cognitive skills. Studies have shown that those using mindfulness report lower levels of stress during multi-
Even brief periods of mindfulness practice can lead to objectively measured higher cognitive skills such as improved reaction times, comprehension scores, working memory functioning and decision-
Other research suggests that employees of leaders in a range of other settings who practise mindfulness have less emotional exhaustion, better work-
Research Findings in Specific Workplace Contexts
1. Improved emotional skills after mindfulness training have emerged in studies of school teachers137. Participants were more able to manage their thoughts and behaviour and were more skilled in coping, sustaining motivation, planning and problem solving. There was greater emotional positivity (with empathy, tolerance, forgiveness and patience, and less anger). New teachers in Canada who followed a University of Toronto programme that combined mindfulness with other wellness strategies, showed better teaching ability and physical health and experienced less stress when they started teaching.
2. First responders in the USA, such as their police and fire services, have used the mindfulness programme developed for the US military, Mindfulnessbased Mind Fitness Training (MMFT)138. High-
3. Mindfulness practised throughout an organisation can help generate highreliability organizations (HROs), through paying close attention to day-
4. Studies in the US found that after mindfulness training, there were improvements in emotional intelligence metrics which included decisionmaking skills and resistance to bias, including racial bias and age-
5. Some preliminary evidence shows that mindfulness training might enhance quality of care from health care staff, for example by improving empathy with patients144. More research is needed but there is interest, enhanced by the recognition of the need to train NHS staff to be compassionate following the failure of care in Mid-
There is enormous variety in the way mindfulness training is delivered in the workplace. It may be in teacher-
A wide range of major UK organisations across the public, private and voluntary sectors147 have introduced mindfulness projects within the past few years including a number of NHS trusts148, the Department of Health149, civil service departments150, BT, Unilever, Barclays, Capital One, Starcom MediaVest Group and Goldman Sachs. Sally Boyle, HR Director at Goldman Sachs maintains that, “In years to come we’ll be talking about mindfulness as we talk about exercise now”151.
Some Examples of Mindfulness in the Workplace
Google offers classes and online resources for all staff. There are daily practice sessions in more than 35 offices around the world and day-
Transport for London has offered mindfulness combined with other interventions like cognitive behavioural therapy (CBT) to staff and it has led to 71% reduction in days off for stress, anxiety and depression153, while absences for all conditions dropped by 50% according to internal assessments154.
Bosch and Beiersdorf, two major German companies, have been developing a programme to embed collaborative mindfulness ways of working such as mindful feedback, emailing and meetings155. They have also participated in a three-
Tees, Esk and Wear Valleys NHS Foundation Trust launched the Staff Mindfulness Project in 2012. Since then, 12 MBCT eight-
The Finance Innovation Lab (an incubator for systems change in finance) has run mindfulness classes for its staff and participants on its programmes, and found considerable benefit at a team level. “The training gave us a structured pathway of development that we all went through at the same time. It feels like a safe way of amplifying the emotional connection with others. The quality of dialogue after group meditation is amazing,” said Charlotte Millar, co-
The Challenges of Implementation in the Workplace
The popularity of mindfulness in the workplace has provoked concerns about motivation. A large number of companies and consultancies have sprung up to offer mindfulness training, some with little experience or qualification to do so (see chapter six); at the same time, without a recognised system of professional listing, companies are unsure how to assess potential providers158. There has been criticism that mindfulness is being used to prop up dysfunctional organisations and unsustainable workloads. One widely-
Despite these valid concerns, it seems that mindfulness has considerable potential across a very wide range of capacities needed in employment ranging from emotional resilience and empathy to cognitive skills and creativity. While it seems that mindfulness can offer real benefits for reducing stress and absenteeism, it is important to emphasise that as an isolated intervention it cannot fix dysfunctional organisations. Mindfulness will only realise its full potential when it is part of a well-
While it seems that mindfulness can offer real benefits for reducing stress and absenteeism, it is important to emphasise that as an isolated intervention it cannot fix dysfunctional organisations.
1. The Department for Business, Innovation and Skills (BIS) should demonstrate leadership in working with employers to promote the use of mindfulness and develop an understanding of good practice.
2. We welcome the government’s What Works Centre for Wellbeing, and urge it to commission, as a priority, pilot research studies on the role of mindfulness in the workplace, and to work with employers and university research centres to collaborate on high-
3. Government departments should encourage the development of mindfulness programmes for staff in the public sector – in particular in health, education and criminal justice – to combat stress and improve organisational effectiveness. One initiative could be seed-
4. The National Institute of Health Research should invite bids to research:
• the use of mindfulness as an occupational health intervention, using both face-
• the effectiveness of mindfulness, including its different components, in addressing occupational mental health issues such as stress, work related rumination, fatigue and disrupted sleep.
Mindfulness and Unemployment
A combination of mindfulness training and coaching has proved successful in a number of small projects to help self-
In 2009, JobCentrePlus (JCP) in County Durham commissioned a mindfulness programme for people who had been unemployed for one to five years. This programme involved 300 participants over three years, many of whom had been unemployed for up to five years. (This programme had no control group, but 47% had moved into work or full-
A combined mindfulness training and coaching programme with the unemployed in East London over three years found that using the WHO Index on Wellbeing, scores increased by an average of 75.58%163.
In 2011/12 a Department of Health (DOH) pilot supported participants in the north-
The Role of Mindfulness in The Criminal Justice System
Nearly half the prison population have depression or anxiety, 25% have both166 and suicide rates are considerably higher than in the general population167. In the year after release from custody, prisoners who have anxiety and depression are more likely to be reconvicted than those who do not168. Given the impact of Mindfulness-
Wider research into mindfulness also points towards its potential to address a number of psychological processes and states that are relevant to risk of recidivism169. Wider research into mindfulness also points towards its potential to address a number of psychological processes and states that are relevant to risk of recidivism169. MBCT has been shown to be most effective amongst individuals who have suffered childhood abuse, a group who also tend to have more depressive relapses and suicide attempts170. Given that 41% of prisoners interviewed for the Surveying Prisoner Crime Reduction study reported having observed violence in the home and 29% reported experiencing emotional, sexual, or physical abuse as a child,
MBCT could have a significant impact and affect the higher one-
In the absence of definitive evidence, the findings from small studies conducted on offenders in the US are only indicative. They have found:
• Improved self-
• Reductions in negative affectivity175 -
• Reductions in drug use and associated attitudes and behaviours compared to normal relapse prevention treatment176.
• Improved regulation of sexual arousal177 and control of aggression178 in offenders with intellectual disabilities.
One feasibility study assessed a mindfulness programme provided by the Mind Body Awareness (MBA) Project, a California-
Negative affectivity has been identified as relevant to many forms of offending183. One of the largest studies in the forensic field to look at the impact of mindfulness on negative affectivity assessed a Mindfulness-
Substance addiction such as drug and alcohol dependency is well known to be associated with offending, and recovery from addiction is often a key part of desisting from crime186. Mindfulness-
Learning Disabilities: mindfulness programmes have been adapted to help those with learning disabilities control the urge to be physically or verbally aggressive. Between 20% and 30% of offenders have learning disabilities or difficulties192 and they are three times more likely to have clinically significant depression or anxiety and five times more likely to have been subject to control and restraint techniques193. In a trial, participants with a history of violence were taught a simple technique called “Meditation on the Soles of the Feet”, shifting attention away from aggression to the soles of their feet. Results showed that physical and verbal aggression decreased substantially, no medication or physical restraint was required, and there were no staff or peer injuries. Benefit-
Other programmes195 in the USA have gathered significant qualitative evidence. For example, the Prison Mindfulness Institute (PMI), based in Rhode Island, is running classes across four local prisons and has helped establish courses elsewhere in North America, Sweden and Australia, supporting more than 185 groups that teach meditation in prisons. They developed a programme over a five-
Following the successes in the US over the last 20 years, innovative mindfulness programmes are starting to emerge in the UK. The National Offender Management Service (NOMS) in Wales is developing a mindfulness programme of four MBCT-
Mark Campion, Wellbeing Strategy Manager of the High Security Prisons Group, is leading a small teaching programme for staff and offenders and adapting an eightweek MBSR course to be delivered to prisoners more widely across the High Security Prisons Estate. In another small project, MBSR-
Accredited Offending Behaviour Programmes (OBPs) and Substance Misuse Programmes198, such as the Sex Offender Treatment Programme (SOTP) and Resolve (for anger management), have also begun featuring mindfulness components. However, the vast majority of facilitators delivering these programmes do not practise mindfulness and receive only minimal training and supervision199.
There is interest within the National Offender Management Service (England and Wales) to conduct high-
Criminal Justice System Recommendations
1. The NHS and NOMS should work together to ensure the urgent implementation of National Institute for Health and Care Excellence’s (NICE) recommended Mindfulness-
2. The MOJ and NOMS should fund a definitive randomised controlled trial of MBIs amongst the UK’s offender populations.
The Implementation Challenge
As is clear from the preceding chapters, there is growing interest in mindfulness in a wide range of contexts. We have identified five urgent questions for those working in this field, all of which need to be addressed if the recommendations of this report are to be successfully implemented and to ensure full public confidence in the effectiveness of Mindfulness-
Where will the Mindfulness Teachers come from?
The training of teachers is critical. Mindfulness is a subtle practice and can only be taught well by people with considerable personal experience. It is not something that can be learnt quickly. It is deceptively simple, and people can easily think that they know what it is when they are actually only using a small aspect of mindfulness (e.g. taking a mindful pause). Presented simplistically, or with misinterpretations, the radical perspective-
It is estimated that there are currently around 2,200 teachers who have been trained to a minimum standard over the last 10 years201. However, we estimate that only 700 of these teachers are likely to be active and have a professional clinical training that qualifies them to teach MBCT to people with depression, and many are not able to teach regularly within their professional context due to lack of their organisation’s support202. These 700 teachers working within the NHS are likely to have an annual teaching capacity of about 25,000203 participants which is just 4.3% of the 580,000 adults at risk of recurrent depression each year.
Training a Mindfulness-
Increasingly, people’s first contact with mindfulness is through books or online resources; these are inexpensive, flexible and private and can appeal to those with tight budgets, unpredictable schedules, or concerns about stigma. Digital platforms can adapt to user needs and preferences, integrate features like social interaction, psychometric tracking and “gamification” to motivate individuals to establish and maintain a meditation practice, and deliver progressively more advanced content over a period of time.
Further innovation is needed to develop the face-
Programmes need to be adapted to accommodate different levels of literacy, communication, comprehension ability and access to technology (such as listening to mindfulness audio recordings). Individuals who develop teaching content must have a great deal of mindfulness and teaching experience, and a very deep understanding of how a mindfulness practice develops over time. For example, an MBSR/MBCT teacher is trained to cultivate compassion but without ever explicitly instructing participants to bring this into their practice. Within a workplace context, the concern is that these important qualities can be set aside in favour of the language of focus, calm and performance.
Individuals who develop teaching content must have a great deal of mindfulness and teaching experience, and a very deep understanding of how a mindfulness practice develops over time.
How can the quality of mindfulness based interventions (MBI’s) be maintained?
It is important to emphasise that most of the academic research and evidence on mindfulness programmes has been conducted on the eight-
A distinction should be drawn between MBSR-
Untested models of delivery need systematic research both on their efficacy for participants, and on what is required to ensure that practitioners have the appropriate training to deliver. We need to discover what is potentially lost and gained when targeting greater reach versus less depth. It seems sensible that different levels of skill – and therefore training – are required to deliver highversus low-
In order for shorter courses, books and digital resources to be called “mindfulness-
How can the integrity which is critical to mindfulness be upheld?
There are strong ethical values underpinning effective delivery. The skilled teacher conveys this implicitly through embodying and inviting a certain way of relating to experience. The general public accessing courses need to be reassured that the class they are attending has appropriate governance around it, is held with skill, appropriate ethics and boundaries, and offers an authentic experience of mindfulness training.
There are a number of concerns within the mindfulness community about the risks of rapid growth. There is some mindfulness teaching which gives cause for concern: for example some practitioners are delivering mindfulness courses without adequate personal or professional preparation, training in workplace settings has erred towards goal-
Some practitioners report significant challenges when teaching mindfulness in mainstream settings such as health or education. The imperatives of these institutions can often overtake attention to skilful processes. Significant numbers of highly-
We have concerns that the current commissioning environment within the public sector supports entrepreneurial and ambitious expansion by mindfulness training providers and that there can be poor scrutiny of qualifications and training in a field where other forms of regulation may also be lacking (i.e. many freelance mindfulness teachers do not benefit from the usual governance structures of a professional body). Guidance needs to be developed by the main training centres to support commissioners of public services in selecting high-
It is also important that teachers need to uphold strong ethical boundaries, by teaching in ways that are universally accessible to people of all faiths and none. There have been isolated reports of religious organisations offering compassion training within the NHS, and through this, inappropriately sharing their ideologies and personal spiritual ideas with participants
How can the mindfulness teaching profession develop effective regulation
The UK is recognised internationally as an example of good practice for its governance structures in this field. The UK Network represents 16 teacher training institutions212 and it has developed and disseminated a consensus on minimum training standards and good practice guidance for both teachers and teacher trainers. However governance and regulation structures are at an early stage. Training organisations have a particular responsibility for offering leadership on integrity and capacity-
This work is currently being built on through the following ways:
• UK academic leaders are collaborating with leaders internationally to publish a position statement defining what a Mindfulness-
• The UK Network in collaboration with the Mental Health Foundation is developing a central listing of mindfulness teachers who meet minimum training standards and are adhering to recognised Good Practice Guidance217. This may be the first step towards a professional register of mindfulness teachers.
• Training organisations are working on building a community which supports teachers and eight-
• An international association of teacher training organisations is in the process of being set up.
• Administrative hubs are needed and are in development which offer administrative infrastructure to trained mindfulness teachers with credentials and a point of access to quality teachers for the general public and commissioners.
• Guidance for commissioners is being developed by the UK Network to enable them to make informed choices regarding appropriately qualified teachers. It is clear that just as the research is emergent, there is still some way to go to establish mindfulness teaching as a profession with the appropriate governance structures and organisations to disseminate best practice and respond to growing need.
1. Funding should be made available through the Improving Access to Psychological Therapies (IAPT) training programme to train 100 MBCT teachers a year for the next five years and aim to reach a total of 1,200218 MBCT teachers in the NHS by 2020 in order to cover 15% of the 580,000 adults at risk of recurrent depression each year.
2. Current university-
Appendix 1. List of expert witnesses
May 20th: Mindfulness in the Workplace Chaired by Madeleine Bunting Speakers included: Roland Lamb, entrepreneur and founder of roli.com; Gary Heads, Durham-
Appendix 2. References Executive summary 1
One prominent online provider, Headspace, currently has in excess of 700,000 users registered in the UK. 2 By June 2015, 115 Parliamentarians and 80 of their staff had attended eight-
38 Evidence for the effects of MBIs on physical health was presented at the Parliamentary hearing of the MAPPG on 5th November 2014, in the following order, by Vidyamala Burch, Dr. Christina Surawy, Dr. Catherine Cameron, Dr. Trish Luck, Dr. Stirling Moorey, Dr. Lana Jackson and Dr. Angela Busuttil. 39 Carlson L. Mindfulness-
86 Kuyken W, Weare K, Ukoumunne OC, Vicary R, Motton N, Burnett R, et al. Effectiveness of the Mindfulness in Schools Programme: non-
136 Reb J, Narayanan J, Ho ZW. Mindfulness at work: Antecedents and consequences of employee awareness and absent-
177 Singh NN, Lancioni GE, Winton ASW, Singh AN, Adkins AD, Singh J. Can adult offenders with intellectual disabilities use mindfulness-
Acknowledgments We are grateful to the Mindfulness Initiative for the clerking of the Mindfulness APPG (MAPPG) and for the research and writing of this report. Many of the Initiative’s Associates donated considerable amounts of time to assist this inquiry. The Initiative is an advocacy project set up in 2013 as a collaboration of three universities (Bangor, Exeter, Oxford) and the Sussex Mindfulness Centre (for a full list of Associates and advisors see http://www.themindfulnessinitiative.org.uk). We are also grateful to many members of the MAPPG who have given their support to assist this inquiry but we would particularly like to mention Lord Richard Layard, Lord Alan Howarth, Lord Andrew Stone, Baroness Ruth Lister, Baroness Anna Healy and Lisa Cameron MP. The founding chairs of the MAPPG, Tracey Crouch MP (Conservative), Lorely Burt (former Liberal Democrat MP) and Chris Ruane (former Labour MP) provided inspirational leadership in the setting up of this inquiry. In particular Chris Ruane’s tireless advocacy of mindfulness won cross-