Mindfulness-based Therapy

Chris Ruane Excerpts

Tuesday 4th December 2012 Commons Chamber

[Chris Ruane (Vale of Clwyd) (Lab)]

I wish to make a speech about mindfulness and unemployment. I have given up a lot to be here tonight, according to my hon. Friend the Member for Dunfermline and West Fife (Thomas Docherty). I could have gone to the Irish ambassador’s Christmas party. That is how important my speech is. [Interruption.] I think that my hon. Friend is going there now.

The World Health Organisation states that by 2030 mental health will be the biggest cause of burden of all health conditions, including heart conditions and cancer. The term “burden” is not an emotive or pejorative term, but a scientific one that is measured in years of life lost due to early death or severe disability brought on by illness, in this case depression.

We need not wait until 2030 to find out whether that will be the case; the indicators are already there. Some of those indicators have been revealed in the answers to parliamentary questions that I have tabled. For instance, the number of prescriptions issued for antidepressants has gone from 9 million to 46 million over the past 10 years. That is a 500% increase. In a follow-up question, I asked what assessment Ministers had made of the treatment of such people. The answer was that no assessment had been made. Some 10% of children are obese at age five, and by age 10 that figure is 20%. What is happening to those young people over that period?

The response given last week to a parliamentary question stated that 32% of young people between 16 and 24 suffer with a psychiatric disorder that could range from a mild condition such as anxiety or stress through to bipolar disorder and schizophrenia. Evidence from other sources points to how endemic such problems are across the western world: 50% of the population in every US state is overweight or obese, rising to 75% in some states. The total value of illegal drugs worldwide is £400 billion. That is a huge sum, most of which is spent by people escaping their own reality, as Freddie Mercury might have said.

Some 25% of UK citizens will suffer mental illness. What can be causing those shifts in well-being? There are many potential causes and theories. Some trace it back to the 1980s and the release of rampant individualism that led to a rise in consumerism and materialism. Some, such as the psychiatrist and journalist Oliver James, say that the rise of advertising in the post-war period has promoted consumerism, and that our individual wants can never be satiated while advertising continues.

Others such as Robert Putnam, the author of “Bowling Alone”, maintain that mental illness is caused by societal breakdown and people retreating to their home, the television, or spending three hours a day commuting or computing. Professor Richard Wilkinson traces it back to inequality. Food additives, information overload, job insecurity, fear of crime or terrorism, geographical mobility or family breakdown could also contribute to that decrease in well-being.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on bringing this important issue before the House. Youth unemployment is as high as 30% in parts of the United Kingdom, and it is also high in Northern Ireland. In certain parts of the Province, where we have idle hands we have other problems. Does the hon. Gentleman agree that something must be done to reduce youth unemployment, and that the issue he raises might be a way of doing that?

[Chris Ruane]

I agree entirely with the hon. Gentleman. Giving young people antidepressants is not the cure. We need a range of tools and I believe that mindfulness will be key. He is right to say that the devil makes work for idle hands. I have given the statistics and we need young people to be in work and positively contributing to society, rather than being sidetracked into criminality or—dare I say it?—to terrorism in Northern Ireland.

The exact causes of the problem may not be known, but people now feel that they are far from themselves and are on a hedonic treadmill. They are working for consumer durables for themselves and their children, to impress neighbours who perhaps they do not even like. The incidence of mental health problems among the general public is worrying, but among the long-term unemployed it is much higher.

Recent scientific research has measured the impact of long-term unemployment on mental illness, and shows it has physical effects on the brain. Research also shows that those who experience a bout of long-term unemployment never fully recover. It usually takes two or three years to recover from the death of a close one, but long-term unemployment does permanent psychological and physical damage to the individual, their family and community.

The damage that long-term unemployment does to young people just starting their career is particularly harsh. A few minutes ago I gave the percentage of young people who experience mental health problems—the exact figure is 32.3% of 16 to 26-year-olds who tested positive during screening for one or more psychiatric condition. There are 1 million long-term unemployed young people in that age bracket, and their life chances have been diminished from the outset.

For many politicians on both sides of the House, the unemployed are just numbers or percentages with which to bash each other over the head. The true impact on the individual, their family, community and society is not fully appreciated by many Members. The unemployed are portrayed in the media as feckless or wastrels, and the disabled have been particularly marked out. I do not include the Minister or the hon. Member for West Worcestershire (Harriett Baldwin), who are present in the debate, but some Conservative Members have used terminology with which I would not agree, and which has led to an increase in hate crimes against the disabled over the past year. Only one category of the five hate crimes based on gender, race, religion, disability or sexual orientation has increased—that against the disabled.

The language and tone of some politicians, amplified in the media, are responsible for that. It is no wonder that in constituencies such as Merthyr Tydfil and Rhymney, where 85 people are chasing each job, there is a lack of sympathy for the unemployed. There is no modern Yosser Hughes to portray the slow disintegration of an individual within his family, community and finally himself. The negative reinforcements of such labelling and alienating behaviour serve only to make those affected by unemployment and mental illness more difficult to place in work.

The current preferred treatment for depression is antidepressants. As I have said, I was informed in a recent parliamentary answer that the number of prescriptions issued rose from 9 million to 46 million. The increase in the use of antidepressants occurred in the past 10 years, but in 2004 the National Institute for Health and Clinical Excellence said that mindfulness was a better way to treat repeat-episode depression. It is a proven and scientifically accepted way of improving mental illness, but it has not been taken up. When I have tried to find out whether mindfulness has been taken up by general practitioners and hospitals, the answer has always been that the information is not collected centrally. I believe that it needs to be collected centrally.

How can mindfulness help with unemployment? It can prevent people from becoming unemployed, limit the effects of unemployment, and help people to get back to work. What is mindfulness? Mindfulness is an integrative mind-body based approach that helps people to change how they think and feel about their experiences, especially stressful experiences. It involves paying attention to our thoughts and feelings so that we become more aware of them, less enmeshed in them, and better able to manage them. It uses breathing to slow the mind and the body down—it uses breath as an anchor to help us to live in the present moment.

The DUP—

[Jim Shannon]

We are to blame for everything.

[Chris Ruane]

I apologise to the hon. Gentleman. The Democratic Unionist party may have co-funded the pilots in Northern Ireland, but the DWP—the Department for Work and Pensions, which is what I meant to say —has co-funded pilots on the use of mindfulness in helping people to get back to work. A three-year pilot in Durham finished in 2010. The pilot was jointly funded by the DWP and Durham county council, and there was an element of European funding. It dealt with the most difficult cases—people who were unemployed for between one and 15 years. The average length of unemployment was three years. Depression, and loss of self-confidence and self-worth, had already set in. The catchment area was the Derwentside-Consett area, which had experienced mass unemployment in the ’80s and ’90s.

I spoke today to Gary Heads, the organiser of the project. He told me that not only were clients trained in mindfulness, but so were jobcentre staff. A traditional mindfulness course usually lasts eight weeks. This one lasted for four weeks, consisting of a two and a half hour taught course each week, with 45 minutes of homework a day. The cost was minimal—£300 for each person on the course—but the benefits were maximum. Of the 300 clients who attended, 47% found employment within six months. The 53% who did not find work were placed on a traditional full mindfulness course. Ninety per cent. of those who started the course finished it. Pre-screening ensured that the drop-out rate was minimal and efficiencies were maintained. All who attended were, as I have said, from the difficult-to-reach categories.

The report on the pilot will be finished early next year. Will the Minister assess it? If it can be rolled out immediately, I urge him to do so. If it requires further refinement, I urge him to do it. Gary Heads particularly praised the head of the employment team, Bernadette Topham, who gave support to the project and was pleased with the results. The scheme came to an end after three years because—I was informed—the local authority pulled the funding.

Mindfulness-based interventions can and do work. I mentioned steel and coal communities. The new steel and coal communities will have high numbers of public sector workers. In my constituency, 46% of workers work in the public sector. In the neighbouring constituency of Clwyd West, it is 45%. We need to prepare for the mass lay-offs that will occur in such constituencies throughout the country. Mindfulness-based interventions have been used by Google, Apple, the American military since 2009, and American prisons, emergency services, schools and hospitals for the past 40 years. We need to make an assessment of what has worked over there and whether it will work over here.

Mindfulness-based therapy has been rigorously tested in the laboratory, using MRI and electrical scanners. Electrical activities in different parts of the brain have been monitored in the laboratory. Its efficacy in treating a whole range of mental and physical conditions, including bipolar disorder, generalised anxiety disorder, attention deficit hyperactivity disorder and psoriasis, has been tested and proved. It also helps the immune system and the healing process.

Mindfulness has proven to be beneficial in the workplace, with participants more engaged in their work. With a greater ability to concentrate, workers become more compassionate, both to themselves and their co-workers. When it is used in prisons, prisoners become less aggressive and hostile, and have fewer mood disturbances. It has helped those who suffer from long-term pain, lessening the use of painkillers and their damaging side-effects.

Mindfulness is not just for those who suffer with mental health issues, or who work in high stress occupations— its applications go far beyond that. It is being used in education. In primary schools in my constituency, it is used to train five-year-olds to be more mindful, to live in the present moment and to concentrate. Its effect on personal relationships within families and marriages has also been recorded.

Felicia Huppert, the mother of the hon. Member for Cambridge (Dr Huppert), is one of the foremost well-being researchers. She maintains that the bell curve of well-being can be shifted for the whole nation. The biggest gainers will be those below the curve. I pay tribute to the Prime Minister for his work on well-being, which was a bold, innovative and forward-thinking step. This could help to deliver the targets on well-being in the years to come.

It has been estimated that sickness related to mental health costs the economy £12 billion in lost productivity, because of sick leave, and in lost taxes and increased benefits. Surely, if there are successful pilots, such as the two I have outlined, they should be taken up across the country. They would cost a fraction of the £12 billion being lost. The savings to the Exchequer could be massive, public and private sector companies could be more efficient and workers less stressed, more resilient and happier in their workplace.

One of the biggest barriers to the take-up of mindfulness is that GPs do not know about it. Surveys have been conducted by the Mental Health Foundation. More than two-thirds of GPs say that they rarely or never refer their patients with recurrent depression to mindfulness-based practices, and 5% say that they do so very often. GPs do not know about it. Politicians do not know about it. I have asked dozens of questions—perhaps hundreds—on mindfulness and often the response comes back that information is not collected centrally. I urge the Minister to do all he can.

Another reason why mindfulness has not been taken up is that there is no effective political lobby for it. The pharmaceutical industry worldwide spends £19 billion lobbying GPs and politicians to tell them that their latest drug is fantastic—stuff it down children’s throats. That is what happened with GlaxoSmithKline, which received a £2.9 billion fine in America in July. It is a powerful lobby that dismisses any alternative therapies. We need to be open. We need to meet mindfulness practitioners and academics. We should be spreading best practice in our prisons, armed forces, emergency services, the NHS and in the DWP.

In conclusion, I have a number of requests for the Minister. Will he ask the private sector providers of the Work programme if they will engage with the mindfulness experts, practitioners and academics across the UK? In particular, I highlight the work of Mark Williams, at Oxford university, and Rebecca Crane and her team, at Bangor university, north Wales. Will he meet Health Ministers to see whether the Department of Health can play its full and proper role in promoting mindfulness? Will his civil servants in the Department for Work and Pensions assess best practice within the pilots they have sponsored so far, and will they spread this best practice?

Will the Minister visit Durham to see the legacy of the pilot scheme that finished in 2010? Will he visit the real city strategy, in my town, which is using mindfulness and other psychological interventions to help people stay in work, through the fit for work programme, and to reintegrate the unemployed, some of whom are in very difficult circumstances? We have recovering drug addicts and alcoholics working on a local farm. We have disconnected, alienated young people working with animals, including through the coastal hawks project. We have a Jamie Oliver-type restaurant training young people and helping them gain full employment. So there is best practice out there, and I am asking the Minister to go out and visit those projects.

Will the Minister personally meet mindfulness experts and practitioners across the UK? We have many fine academics who have given years, if not a lifetime, of work to the development of mindfulness. They have a strong story to tell, and they have the scientific proof to back up what they are saying. Will he use mindfulness in his own Department? I have put questions to every Department about sickness levels. They have gone up massively. This is a powerful tool that could help Ministers reduce sickness in their Departments. Lastly, will he keep an open mind about, and be mindful of, the issue of mindfulness?

[The Minister of State, Department for Work and Pensions (Mr Mark Hoban)]

I congratulate the hon. Member for Vale of Clwyd (Chris Ruane) on securing this debate. He commented on the effectiveness of the lobbying by pharmaceutical companies, but I think he has done a rather effective job himself in lobbying for mindfulness. He said that he was missing the Irish ambassador’s party tonight. In my research for the debate, I discovered that mindfulness was of growing interest in Ireland, so I expect that the Irish ambassador will be mindful of his explanation for not being there tonight.

The Department recognises the role that a wide range of interventions can play in supporting people to move into work. Mindfulness therapy is a psychological approach to well-being that people report as helpful in the workplace. The principles behind mindfulness therapy are extremely interesting and, by many accounts, can be helpful in alleviating distress. As I understand it, mindfulness encourages people to focus on their present experiences in the here and now, without making judgments about the experiences. It is rooted in Buddhism, but has been westernised through medicine and psychology.

Mindfulness can be delivered in a wide range of ways—the hon. Gentleman referred to the Durham pilot, which I will return to later. People can be taught it through meditation and other techniques, in group sessions delivered every week for eight weeks, with follow-up sessions over the course of the next year. Some advocates believe it has the potential to be used in a range of circumstances, such as for stress at work, for personal problems, and for managing chronic pain, substance abuse and unemployment.

As with all medical and therapeutic interventions, however, the National Institute for Health and Clinical Excellence should be the key deciding body for reviewing the evidence for which interventions should be used and when. Mindfulness is one of several therapy services approved by NICE, which has indicated its benefits in preventing the relapse of depression. In particular, NICE proposes the use of mindfulness for people who are currently well but who have experienced three or more previous episodes of depression. The value of mindfulness as approved by NICE, therefore, is as a useful health intervention to prevent relapse among people who have experienced depression.

As the hon. Gentleman made clear, mindfulness therapy is an emerging and important field. We will watch with interest the outcome of the randomised controlled trials that are under way—not only in preventing relapse, but for treatment of long-term conditions. As he said, a number of organisations are involved in research into mindfulness. Bangor university and the Oxford Mindfulness Centre are examples. In answer to one of his many questions, I can say we will remain open-minded about mindfulness-based therapy; the challenge is to demonstrate how it will work.

The hon. Gentleman referred to the programme in County Durham, in Derwentside. My understanding is that it is a pilot that the Department for Work and Pensions oversaw. He is right that we need to look at the evaluation of it. The point I would make to him—we make this point in connection with all evaluations of pilots that the Department undertakes—is that we tend to benchmark pilots against what would happen in the absence of intervention. We will look at how the rate at which people sign off benefit having gone through the mindfulness pilot compares with the rate of people coming off benefit in other areas, so that we can judge its effectiveness and report back.

Let me respond to the detailed questions that the hon. Gentleman asked. He asked about the Work programme. It is designed so that it is for providers to determine which approaches are best at helping to get people back into sustainable employment, and they clearly need to understand which approaches and therapies are most effective. In order to embed mindfulness, the centres in Bangor or Oxford might want to work with some providers to see how mindfulness could be used more widely.

[Chris Ruane]

That is an excellent suggestion, but all I am asking of the Minister is that he write to those private sector providers to tip them the wink and say, “There are established British centres of excellence; please could you make an assessment of them?” because I do not think they even know about mindfulness therapy.

[Mr Hoban]

The model was set up so that providers have the initiative to make innovations and that it should not be Ministers telling them what to do. There is a role that the centres can play. Perhaps the hon. Gentleman might engage with the two Work programme providers in Wales—Working Links and Rehab JobFit—to see whether they might want to work with Bangor university on this issue.

I know from talking to the Minister of State at the Department of Health just this afternoon that the Department is aware of the issues around mindfulness therapy—the fact that the hon. Gentleman asked about it at Health questions last week has ensured that it is certainly on the ministerial radar.

The hon. Gentleman asked about the evaluation of best practice. Let us see what it says, what lessons should be drawn from it and, if it is successful, how it might be scaled up for use. He suggested that I should visit Durham.

[Chris Ruane]

It’s a long way.

[Mr Hoban]

It is not a long way and it is not difficult to visit. I was in Durham last month and I will be there later this month, as my family happen to live there, so I might visit Jobcentre Plus to understand just how that evaluation worked and what the evidence is.

I am delighted to be invited to Rhyl—it would not be my first visit. I will bear it in mind, because one of the issues we face is ensuring that we find new ways to help and support people with a range of mental health conditions, and there may be some value to be seen in the pilot there.

The hon. Gentleman encouraged me to meet mindfulness therapy practitioners. I have many strengths, but an understanding of psychological therapy is not one of them; but I will ensure that contact is made with either Bangor university or the Oxford centre, and that officials from my Department engage with them in order to understand it.

We take mental health conditions seriously. We need to ensure that support is put in place through Jobcentre Plus to help people to get into work; that, too, is something that we take seriously. Throughout the Jobcentre Plus network, work psychologists and mental health and well-being partnership managers are available to support advisers and to work with their counterparts and providers in the mental health service. That support is there for Jobcentre Plus advisers. All jobcentre staff with a claimant-facing role go through mandatory training modules to help them to support claimants with mental health problems and to refer them to specialist support if appropriate.

Last week, my noble Friend Lord Freud launched the mental well-being and employment toolkit for employment advisers. It has been produced and designed by Work programme and specialist mental health and employment providers. It is a free-to-use product that will help advisers to use employment discussions to identify mental health and well-being needs and to support people to access appropriate therapy services. One of the challenges is to identify those needs and to effect the appropriate referral. Debates such as these are important, because they raise the profile of these issues and ensure that they are on people’s radar screens.

The hon. Gentleman will know from his contacts in the Jobcentre Plus office in his constituency that each Jobcentre Plus has a disability employment adviser. They work with claimants facing complex employment situations resulting from a disability or health condition. Notwithstanding the debate on mindfulness, those resources exist within Jobcentre Plus to support claimants with such conditions. Those advisers can also act as an advocate with prospective employers on behalf of the customer, and they aim to identify work solutions that will minimise or overcome any difficulties related to an individual’s disability in the workplace.

I thank the hon. Gentleman for highlighting this issue. It is something that we need to look at carefully. We need to find every possible way to help people to get back into the labour market and to support them in getting there. I hope that, as people develop their understanding of mindfulness therapy, it might become a tool that could have a wider application.

Question put and agreed to.