Stress-reduction or stress-immersion?

Stress-reduction or stress-immersion?

Mindfulness practice and the full catastrophe of working in the NHS
Autumn 2017
Robert Marx

Consultant clinical psychologist and mindfulness teacher
I have been running mindfulness groups for staff in my NHS trust for more than 10 years and one of my responsibilities at work is to ensure the safety and quality of mindfulness provision to patients and staff. In the time I have been teaching, mindfulness has undergone a huge shift in public awareness and its effectiveness has been charted in an explosion of research. At the same time, the NHS has become an ever more stressful place to work.While mindfulness has been one helpful response to that stress, its provision raises significant questions about both the integrity of the mindfulness approach and the real causes of workplace stress.


Many who work in the NHS are facing unmanageable levels of workload and stress-related problems.
We hear a lot about the use of mindfulness as a psychological therapy, of how it has come to be widespread in the NHS, as well as some concerns about its over-application and the challenges of quality control.This article from a very experienced mindfulness teacher working with NHS staff explores these questions, the realities of NHS staff stress and the limits of applied mindfulness in an overstretched system.

First Paragraph

‘What can we do for you today?’ asks my GP.
‘I’ve been getting headaches’, I venture.
My GP starts to look at the screen in front of her.
Although this GP doesn’t seem to remember me each time I show up in her surgery, I like her: she gives her patients additional time and seems to genuinely want to help. She takes my blood pressure; she asks me about my job and we talk about the stress of working in the NHS as we generally do when I see her. She sympathises with the workload until she hears how many hours a week I work, which is apparently paltry compared to how many she works. She tells me she can’t keep up this pressure much longer.
‘You’re a clinical psychologist aren’t you?’
‘Yes.’ I reply.
Back to the screen.
‘Are you depressed?’ she asks. ‘No, I don’t think so.’
‘But you are anxious’ she returns.
‘Maybe Amitriptyline would help.’ ‘Fill these out.’
She gives me the PHQ-9 and GAD-7 – forms which I give to some of my patients. I know the forms well so scan them and recognise I would fall well below clinical levels on both.
‘I really don’t think…’ I begin.
‘Have you read this?’ she asks triumphantly.
She thumps down a well-turned copy of Don’t sweat the small stuff by Richard Carlson on the space between us.