Abstract
BackgroundPatients within psychiatric rehabilitation services have multiple, complex and enduring difficulties, and are frequently described as ‘treatment resistant’. This group have diagnoses of major mental health conditions, most commonly schizophrenia, often alongside a history of complex trauma, co-morbid alcohol/ substance misuse, and cognitive impairment. There is no known effective medical treatment other than Clozapine in this patient group, however, there is preliminary evidence that mindfulness can help individuals with psychosis by improving their ability to cope with stressful internal experiences. This study aimed to determine if mindfulness practice groups are an acceptable therapeutic intervention in an in-patient rehabilitation setting. The study also aimed to monitor the well-being of those who participated.MethodsMindfulness practice groups were offered three times weekly on a 15-bedded rehabilitation ward in a psychiatric hospital over 5 months, and weekly in a second ward over an 18 month period. The sessions were delivered by Clinical Psychologists in accordance with adaptations for a psychosis population. Attendance data were gathered on both wards and additional measures of well-being were collected on one ward. Qualitative interviews were conducted with a sample of patients, group facilitators, and staff, to provide supplementary information about the acceptability of the intervention.ResultsIn both wards around two thirds (65, 67%) of in-patients attended at least one group and smaller proportion (around a third) went on to attend regularly. There was no discernible impact on well-being using the Warwick-Edinburgh well-being scale. Qualitative interviews suggested a number of benefits to individuals attending as well as the potential for groups to enhance the therapeutic culture within wards.ConclusionsClinical guidelines suggest that all patients with a diagnosis of psychosis should have access to psychological therapies, but delivering psychological therapy within an in-patient rehabilitation setting can be challenging. This preliminary feasibility study suggests that mindfulness practice groups are an acceptable intervention, and that further research to look at the effectiveness of mindfulness for symptoms of treatment-resistant psychosis is both possible and merited.
Highlights
Patients within psychiatric rehabilitation services have multiple, complex and enduring difficulties, and are frequently described as ‘treatment resistant’
Ward a Thirty-three group sessions were run in one ward over a 5 month period, at a rate of 3 sessions per week, logistical constraints meant that this schedule could not be followed precisely
Clinical guidelines suggest that all patients with a diagnosis of psychosis should have access to psychological therapies, but the patient group in psychiatric rehabilitation in-patient settings can present a particular challenge in terms of engagement and participation in therapy
Summary
Patients within psychiatric rehabilitation services have multiple, complex and enduring difficulties, and are frequently described as ‘treatment resistant’ This group have diagnoses of major mental health conditions, most commonly schizophrenia, often alongside a history of complex trauma, co-morbid alcohol/ substance misuse, and cognitive impairment. As well as diagnoses of major mental health conditions (most frequently schizophrenia or other psychotic disorders), with ongoing/ residual symptoms; many have a history of complex trauma, co-morbid substance or alcohol misuse, and cognitive impairment. These individuals are often disadvantaged by the difficulties they encounter engaging with mainstream services. At present there is no known effective medical treatment other than Clozapine for TRS
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