Yoga is increasingly popular with all sectors of society, and mindfulness (a core aspect of yoga) is an accepted mental health intervention; the potential for yoga to be offered within prevention-focused health and social care initiatives such as social prescribing is enormous and requires commissioners and GPs see it as a palatable approach. This article written by Kate Binnie, HCPC registered music psychotherapist, yoga and mindfulness teacher (CPCAB) with an Msc in Palliative Care, and Yogacampus Yoga Therapy diploma course tutor, sheds light on the matter. On days like International Day of Yoga, it's crucial for yogis to continue working together across different yoga communities, getting involved in research, and offering our best work (sometimes it just has to be for free) in some capacity to help generate more awareness.

The NHS Long Term Plan (published January 2019) sets out a model of health and social care delivery that aims to “take more action on prevention”. Investment across the country in social prescribing has begun, with Clinical Commissioning Groups (CCGs) and local authorities working together to develop community-based networks of arts and movement-based activities. The idea is to offer people with long-term conditions structured community support that will encourage socialisation, exercise, creativity and the development of new skills (sounds like yoga to me!) The hope is that this will reduce both health inequality and the burden of cost and time on primary and secondary healthcare services. However, evidencing this has proved difficult due to lack of generalisibility across interventions and contexts, and methodological issues in determining effectiveness.

My mother – who is 87 with advanced heart failure and very breathless – was the recipient of a social prescribing leaflet last week. It sat on her table for a few days and then went into the recycling bin. The leaflet promised her chair-based exercise, art and singing classes with which to improve her wellbeing. I asked her why the leaflet was in the bin. Well she said I asked the social worker about it and she said I’d be picked up in a minibus and taken over to the other side of town to do the class but I haven’t got the energy for that! We went on to discuss the lunacy and expense of bussing old people (which – having to stop frequently to collect each person – would take hours) to a class out of their immediate community. The idea – surely – must be to not only enable access to the social prescribing intervention itself (singing, exercise, art etc) but to encourage and stimulate interconnectedness and relationship that can continue and grow between classes, increasing social support and reducing isolation. For old people such as my mother - often suffering from a combination of frailty, fatigue, incontinence, breathlessness and pain – convenience, continuity and locality are key. So I just teach her at home.

I believe that social prescribing and changes in the way money is allocated (responding to individual communities to target primarily social issues) presents a fantastic opportunity for yoga - this flexible, responsive and holistic practice designed to meet the whole-person needs of people across the life-span. Yoga teachers are everywhere and Yoga therapists are coming through UK trainings such as the Yogacampus Yoga Therapy Training in increasing numbers. There is a resource here, but sadly this resource is often treated with suspicion.

Yoga is increasingly popular with all sectors of society, and mindfulness (a core aspect of yoga) is an accepted mental health intervention. And yet – in my area at least – yoga is not offered by social prescribing programmes. I run courses for people living with chronic and life-limiting illness but these people are not officially referred and pay to attend. Although several local GPs, secondary care specialists, psychologists and psychiatrists are regulars at my classes, and even though many of them have said how “helpful” it would be to offer such classes to their patients…… there still seems to be no mechanism for their patients (or their burned-out colleagues) to attend, on referral. A particular area of interest (and frustration) for me has been the potential for yoga for patients experiencing chronic breathlessness. The Life of Breath project on which I am a researcher shows that pulmonary rehabilitation is not being accessed by a large proportion of people who need it. In short, people with lung disease (such as chronic obstructive lung disease, a common illness caused by smoking or exposure to air pollutants) need to move – exercise is indicated even in advanced disease. Yet for many patients (who are often isolated, socially disadvantaged, and suffering from multiple comorbidities) going to a community gym and taking part in a functionally-focused, prescribed set of repetitive movements is neither desirable nor possible. My experience of using Mindful Yoga with patients with severe lung disease is that the gentle, exploratory, creative, self-compassionate and whole-person approach embedded within the practice of yoga is transformative. Patients begin to learn new ways of relating to their breathing and their tight bodies. They gain skills of self-awareness and self-regulation that are simply not currently part of the thinking behind pulmonary rehab programmes. This is not to denigrate PR which currently had the best evidence-base for the rehabilitation of patients with non-malignant lung disease, but to suggest that yoga practices, yoga teachers and therapists might offer something to broaden the reach of existing programmes and physiotherapy trainings. Indeed, I recently taught a COPD support group which was attended by a physiotherapy student on placement. She immediately recognised that the psycho-spiritual elements of yoga were helpful to the people in the group, and the need for her training course to teach students an awareness of these elements which so deeply affect our experience of adjusting to and living well with difficulties such as breathlessness and frailty.

Yoga has enormous potential within prevention-focused health and social care initiatives such as social prescribing. Whether commissioners and GPs see it as a palatable approach (I still receive a significant amount of prejudice against yoga as something mystical, hippy, unevidenced and “foreign”) is a different matter. However, where there’s life there’s hope! As yogis we must continue working together across our different yoga communities, getting involved in research and offering our best work (sometimes it just has to be for free) on days like International Day of Yoga on Friday 21st June in some capacity whether it be in a school, hospital, care home or shopping centre.

I finish with a direct quote from my boss, Professor Havi Carel who lives with a rare lung disease (LAM).

“Yoga is the perfect body-mind exercise for people with respiratory impairment….. It helps with all aspects of embodied being: strength, flexibility, balance, posture, bodily awareness, relaxation, and challenge. It involves the whole person engaging both body and mind. It teaches important skills of calmness, bodily control and of attention to your breath and your state of being.

I'm surprised no health professional has ever recommended yoga to me and I am certain that my years of practice have helped me stay more supple, stronger and calmer than I would be. Being able to experience progress and success despite having severe lung damage has meant so much to me.”