Creative interventions in mental health: a critical analysis of the mindfulness agenda in Sussex

Mindfulness-based Cognitive Therapy (MBCT) is a manualised psychosocial, group-based 8 week course specifically designed for people with a history of depression. This study responds to the huge growth in the credibility of MBCT as a therapeutic option in the NHS as well as a rise in the popularity and awareness of mindfulness-based interventions (MBIs). This study is based on semi-structured interviews (N=38) with stakeholders in the field of MBIs in Sussex, and an online survey of Sussex NHS Foundation Trust (SPFT) staff (N=203), as part of a wider collaborative ethnography embedded within the Trust. It contributes to existing literature on the efficacy of MBIs by exploring existing provision and follow-up support, reviewing the perceived benefits and costs of embedding MBCT into the health services. This study has a particular focus on participants of a recent SPFT Randomised Controlled Trial (RCT) ‘Mindfulness for Voices’ that investigated the efficacy of this therapy for people who hear distressing voices. This study brings together both the empirical and theoretical with its focus on mindfulness as a therapeutic technique that epitomises links between the mind, the body and society. This study draws on sociological work on embodiment and emotion in order to understand the experience of innovation as well as of MBIs – starting from the observation that many of those leading this area of research and implementation are also practising mindfulness. Furthermore, this study maps the theoretical shift from a narrow medical model of mental illness to one that characterises emotional health within a holistic and integrated paradigm, and which is influencing and shaping current practice. Key findings from this study are that MBIs, and MBCT in particular, can be beneficial to a diverse range of stakeholders within Sussex, including patient groups that were previously excluded from ‘talking cures’ such as those with a diagnosis of psychosis. Factors that influence the acceptability, visibility and utilisation of an innovation such as MBCT include the role of opinion leaders and champions in garnering support, as well as the degree to which expectations about the future of this intervention are managed. Drawing on sociologies of knowledge and innovation in the health services, the case is used to show the use of experiential knowledge alongside evidence in bringing about innovation. Clinicians also work to develop accounts of the ‘values’ at stake in MBIs; drawing on both evidence and experiential knowledge. The implementation of MBIs into the mainstream health service helps to illuminate some of these practices through being used to address conditions such as chronic pain and severe anxiety disorders which were hitherto seen as untreatable and characterised as ‘complex needs’, or medically unexplained symptoms (MUS) and which can be stigmatising.