Ruth Passman Senior Health Policy Adviser Department of Health North West Health, Work and Mindfulness in the North West

Definitions of Mindfulness Mindfulness is a way of directing attention that originates in Eastern meditation traditions but is increasingly discussed and practiced in Western culture Jon Kabat-Zinn (1987) Jon Kabat-Zinn (1987)

Mindfulness: A Naturally Arising Phenomenon? Arguably evident in all cultures and societies and often traditionally codified in religious or spiritual practices -Naturally arising but can be cultivated by regular mindfulness meditation practice Facets of Mindfulness (Baer R.A 2004) Observing Describing Acting with Awareness Non judging of inner experience Non reacting

Improving Mental Wellbeing By 2020 depression estimated to be the 2 nd biggest determinant of burden of disease (mental illness 22%) Growing high costs- economic and societal Key Impact worklessness Treatment alone will not reduce prevalence Our collective contribution to the burden is STIGMA

The withering of the Big Machine State and the growth of Big Society? A new Chapter for Welfare and Public Service

Public Sector Austerity

Recovery and the Policy Context Liberating the NHS : Referenced the importance of work in recovery NHS Outcomes Framework both have specific outcome measures for increasing the number of people with mental health conditions in work Healthy Lives, Healthy People is the first Public Health strategy to give equal weight to mental and physical health. There is also a clear statement that employment needs to be addressed in order to tackle health inequalities A Vision for Adult Social Care: Capable Communities and Active Citizens similarly includes many references to the value of employment and the need for services to integrate employment support. New Drugs Strategy : Shift of emphasis from treatment to re-integration and recovery.Reintegration,and Re-ablement

No Health No Health Without Mental Health ‘A cross-Government mental health outcomes strategy for people of all ages’ based on six objectives: More people will have good mental health More people with mental health problems will recover – This is where employment fits because it is a recovery model definition: more people will have a good quality of life – a greater ability to manage their own lives, stronger social relationships, a greater sense of purpose, improved chances in education and employment and a decent place to live More people with mental health problems will have good physical health More people will have a positive experience of care and support Employment link here as definition of good care and support is given as timely, evidence-based interventions and approaches that give people choice and control over their own lives Fewer people will suffer avoidable harm Fewer people will experience stigma and discrimination A companion document describes in greater detail how we can improve mental health outcomes, what ‘good’ looks like, and gives the underpinning evidence base

The Future of Public Health in England: The Public Health White Paper Giving life to our values: – preventing harm and reducing poor health – strengthening responsibility – acting on evidence and with evaluation Working across Government Working through the system The approach - rebalancing responsibility - behaviour change and enabling choice The solution - cross-government initiatives - Public Health Service The Marmot Review : Creating Fair Employment and Work For All

The Public Health Service A new Public Health Service (PHS)- it will not be a separate legal entity from the Department of Health; Many functions that are currently in ALBs, including the Health Protection Agency and the National Treatment Agency, will be brought into the Department; Directors of Public Health will be jointly appointed by the PHS and Local Authorities (LAs). They will be employed by the LA; DsPH will lead on health improvement for their area and will have use of a ring fenced budget; There will be elements of the ring-fenced budget that will recognise differences in need and elements that will recognise good performance; The Secretary of State will establish an outcomes framework for public health; There is a Cabinet sub-committee on Public Health, chaired by the Secretary of Sate; and A Health Bill introduced, which is the route by which any necessary changes to primary legislation will be made to establish the new system.

Our New Approach to Public Health Grounded in localism with a strong focus on assets and need Planning and decision making that takes account of public priorities, community assets and a range of social / environmental outcomes e.g. green space, support into work Different way to deliver services - responsive to public choice – Health protection, Community Orientated Primary Care; Social Value NHS - A prevention, treatment and care service

LIVING WELL IN THE NORTH WEST LIVING WELL ACROSS LOCAL COMMUNITIES Prioritising wellbeing to reduce inequalities Building on the strengths, assets and resilience of individuals, families and communities to bring about change. Create a social movement. Resources: Investment for health’ - where public investment becomes a force for the creation of health and wellbeing for all communities ‘Social Value’ – doing the right thing. An accreditation scheme for NHS organisations: – Sustainability – Worklessness – Community outreach/engagement – Procurement & Commissioning

“Communities have never been built upon their deficiencies. Building communities has always depended upon mobilising the capacities and assets of people and place” (Kretzman and McKnight 1993) Wot? Assets??

Five ways to well-being Connect..with family, friends, colleagues, neighbours Be active..walk, run, cycle, garden, dance Take notice..be curious, reflect on experiences Keep learning..try something new Give..doing something for others

Mindful Employment Increasing recognition that good work is good for health But bad work makes people ill Department of Work and Pensions is now aware that getting people into work is only PART of the job Keeping people in work is a shared responsibility: employer, individual and GP/clinical staff. Retention is good for businesses and individuals

Good Work or Not? Uncertainty, job insecurity, fixed term contracts, temporary working, high demand/low reward; low autonomy/low control effects employees’ health Depression, absenteeism, difficulty sleeping, unexplained physical pain, suicides have been flagged up as major telltale signs Bullying related to poor job dissatisfaction, increased symptoms of stress, anxiety and depressive symptoms compared to those not exposed to bullying

Poor Work. Health Impact The combination of high job demands and low job control leads to poor mental and physical health Increasing job demands/perceived low level of reward predicts higher levels of burnout and poor self rated mental health. Lack of job control related to increased morbidity, sickness absence and poor mental health. Poor work is associated with higher levels of spill over from work to family life and vice versa. The effects on middle managers own health and wellbeing include sleep disturbances physical health problems and depressive symptoms

Workplace Wellbeing Charter. Leadership 2. Attendance Management 3. Health and Safety Requirements 4. Mental Health and Wellbeing 5. Smoking and Tobacco control 6. Physical Activity 7. Healthy Eating 8. Alcohol and Substance Misuse

Mindfulness in the Workplace Using Mindfulness to decrease reactivity at work Dealing more effectively with workplace stressors Mindfulness to support employees facing employment uncertainty Increased creativity Increased productivity Wellbeing building mental and emotional resilience in our workforce

North West NHS North West DH Measuring Wellbeing: Beyond GDP? The Social Value Movement

Government (Public) Sector Market (Private) Sector Two Sector Orthodoxy

North West Actions Awards-“we already do this!” Manifesto Commitments Foundation -Support to social innovation based on Foundation Trusts and NHS Trusts Commissioning -Falling out of PCT/SHA/3 rd sector by and through Scenario Planning event and now 3 rd sectorsupporting WCC Community -Using Community Cohesion to Cohesion Auditenable the NHS to play its role in the North West

‘Mindful’ Interventions Those that strengthen social relationships and opportunities for community connection, especially those most in need Those that build and enable social support, social networks and social capital within and between communities –growing evidence that social networks are a determinant of mental health and other social outcomes Those that improve the quality of the social relationships of care between individuals and professionals e.g practice that avoids social disparagement Growing policy interest that the ‘core economy’ matters; Need to avoid economic growth at the cost of social recession

Cohesive, Resilient Communities and Mindfulness-based approaches Social Value- eg Social Value project in Northwest Resilient communities and localities do better than expected in the face of adversity The capacity of the public sector to respond to social problems and engage with communities Tension and value conflicts –strengthening community cohesion and acceptance-promoting access and inclusion in Places. Working with communities of difference Tackling wellbeing and health disparities and inequalities

Mental wellbeing as a resource The social and economic prosperity of Europe will depend on improving mental health and wellbeing (EU MH Green Paper 05 ad pact 06) Foresight ‘analysis suggests that action to improve mental capital and wellbeing could have very high economic and social returns (GOS 08) mental capital conditions how well an individual is able to contribute effectively to society, and also to experience a high personal quality of life. Mental capacity and mental wellbeing fundamentally affect behaviour, social cohesion, social inclusion and our prosperity (Foresight Report 09) Understanding the importance of mental health has the potential to contribute significantly to new thinking about sustainable economic growth and social cohesion (Freidli/WHO 09) ‘the mental health of the European population is a resource….to put Europe back on the path to long-term prosperity (European Commission Social Agenda )

Mindfulness Provision: Related Values and Principles Quality Social Prescribing Social Value Efficiencies Person-centred provision Self management Empowerment Dignity Skilled for Health/ Health trainer provision Mindful Employers Prevention and Support: Creating Healthy Working environments and practices

Mindful Assets Addressing mental health as a determinant of physical health – eg the contribution of poor wellbeing to muscular skeletal disorder and heart disease Commissioning and evaluating interventions that improve wellbeing Building community assets and using strengths-based approaches eg Multiple Index of Assets Enabling social networks Encouraging individuals to improve their own mental health

Dignity Evaluation –early markers Breathworks Mindfulness Courses in Wigan and Leigh Real time action research: anticipating opportunities and barriers adaptation of written course material mapping referral routes customising provision to specific groups cultural contexts sensitivities around benefit insecurity: Voluntarism and security/ Respect and trust Negotiating public sector bureaucracy procedure and culture, Gaining credence with GPs and health practitioners:Establishing relationship and communication flows

Quality, Dignity and Self-Care Service Experience is an emotional experience not A CLINICAL EXPERIENCE Quality of life Choice and control Inclusion and contribution Health and wellbeing Dignity and Safety How can we commission for Dignity, Quality and Person-centred provision? Paying for better quality outcomes and supporting quality providers Linking patient experience to broader social values Delivering the re-ablement model to achieve measured improvements in independent living Measuring patient experience: Patient recorded outcomes, Empathy Measures,Patient Diaries Personalised budgets and Solutions Self Directed Care and Support in NHS and social care

The Mindfulness Pilot Meets the Dignity Challenge? The Mindfulness Pilot Meets the Dignity Challenge? High quality services that respect people's dignity Respect, Building on and acknowledging strengths, Empathy and ‘’Psychologically minded ‘relationships, Looking after you, Looking After Me 1. Support people with the same respect you would want for yourself or a member of your family. 2. Treat each person as an individual by offering a personalised service. 3. Enable people to maintain the maximum possible level of independence, choice and control. 4 Listen and support people to express their needs and wants. 5. Ensure people feel able to complain without fear of retribution. 8. Engage with family members and carers as care partners. 9. Assist people to maintain confidence and a positive self-esteem. 10. Act to alleviate people’s loneliness and isolation.

Worklessness Exemplar Raising understanding of health and work Promoting innovative provision and mindfulness approaches in the recovery agenda Creating a business case with benefits to clients, economy and health service

Innovative Provision in the North West Mindfulness programmes- in hospitals, prisons and community settings. For chronic pain, health conditions and stress/ anxiety Alexander Technique and Voice work in educational and community settings- for chronic respiratory and muscular skeletal conditions ‘Embodied’ Mindfulness, Alexander Technique (A.T.)& voice work Aims to release habitual psychophysical tensions interfering with the breath and voice and the expression of the Self. Lessons in A.T. provide a practical and physiological basis for applying mindfulness in daily life No current NHS funded provision however there is significant evidence of a demand for Alexander Technique work ‘on prescription’ in the region Contact: Trish Baillie Sue Fleming

People first Structures second

...is it really so difficult? Pigs CAN fly when properly equipped!