What price will we pay to reduce our own suffering?
Article by Dr. Jackie Gardner-Nix
Dr. Jackie Gardner-Nix has long been curious about our reluctance to pay for health care which works with our minds to have a long term impact on our complex physical conditions.
In this article, Dr. Gardner-Nix explores what we will and will not spend on our own health care in Canada that is not covered by Ministries of Health or insurance plans. Do we wait until we are sick and become a patient in the health system before considering investing in strategies that could have been preventative?
I arrived in the USA for my first Mindfulness course in 2001, three months before 9/11, one foot still on a plane and one foot at the campus, convinced I would fly home before this course was over. It was just too hokey for me I thought, a Brit living in Canada and steeped in the conventions of clinical medicine. I was there for my clinical practice, I argued, but in truth I was there for me, having just been through a bitter marriage breakup. The other 130 professionals in this vast course were mostly also there for personal life challenges, a covert motivation that hid behind their career aspirations to incorporate mindfulness!
By the end of the seven day course I had changed my view of life and my medical career enormously and have continued to do so for the two decades since. I have watched patients in mindfulness courses I implemented for those living with chronic pain change too; for me, there is no going back. For those who have benefitted, ditto. They were lucky enough to receive the mindfulness teaching covered by the provincial health plan, because I am an MD practicing in Ontario. But as I retired from clinical practice in 2015, there were just too few offering this teaching, especially covered by health insurance. From 2012, my team and I had offered professional trainings to provide these courses more widely through other facilitators, but not many of those trained could be covered by the health budgets. They had to charge course fees and were finding it was hard to enroll enough clients willing to make that investment.
If we are offered a way of relieving our suffering, long term, from a pain disorder or illness which we’d had for years, for a one time cost of $599, would we sell our first born/mortgage our home/sell some jewelry, to raise the funds? You might think so.
But it seems to depend on what we’re paying for—-!
Medication is tangible, so we probably would, even if not covered by our “plan”. We even tend to not grumble about the deductible if it is not fully covered. While the actual medicine is some of the battle toward effectiveness, its method of delivery boosts the outcome too, by as much as 30% in clinical trials on drugs. It depends on where we live in the world in terms of what our culture sees as effective. In the Western world pills would merit the investment we make; in the Far East injections are more credible, and in France, suppositories. But for chronic illnesses few medicines offer long-term relief unless taken continually: a one time cost of $599 is rarely an option.
For sports enthusiasts who have signed up for those joyous experiences that cost money to heal resulting injuries, physiotherapy, chiropractic, osteopathy and massage interventions would likely merit the outlay with little hesitation: the laying on of hands is so believable. Strapping and creams? No problem paying for those either. Like the accepting of vet bill-realities when owning a pet. But still—are these long-term fixes for a one-time payment?
Essential oils – tick. Massage – tick tick. Marihuana – tick tick tick. But $599 is not likely to fund these for chronic conditions for long.
In Canada 70% of health care costs are covered by our publicly funded system and 30% are privately funded by a mix of private insurance and payment by users1. We are no strangers to paying for health care!
So what about registering in a several week course, 2.5 hours per week with meditation practice of 20 minutes per day as a commitment? A group intervention which requires continued practice, and has the power to change our lives permanently as we increase our insight skills, experience more happiness, and reduce not only our own suffering but improve life for friends and family who’d feel happier seeing us suffer less?
We are talking evidence-based, scientifically researched Mindfulness courses led by experienced teachers who are often regulated health care professionals. And just like the parcels we’ve been ordering since COVID changed our way of shopping, we can shop for these courses online, delivered directly to our homes.
Yet even at $599 for an eight week course, it’s a much harder sell than other interventions.
Perhaps because it’s not a quick a fix and we have to be ready to participate and commit to a change to accommodate regular mindfulness practice in our daily lives. Two to 3 hours a week to attend the course plus time for meditation and reading can be hard to carve out of our busy lives, yet the practice itself is helpful precisely because our lives are stressful due to challenges which may be contributing to mental and physical breakdowns.
If we feel there is a stigma in taking a course for our mental and physical health, we can be reassured that such courses are increasingly being regarded as personal development, especially if not paid for by coverage on our provincial health plan. When revealing we are taking a class for our mental health the days of the room going quiet are over. Even more so with the mental challenges brought on by the COVID pandemic, we are likely to be applauded, thanks to the likes of Prince Harry (British royalty), Naomi Osaka (tennis royalty), and Simone Biles (Olympian gymnast) all having talked openly about their own mental health. In fact, when Mindfulness is discussed at dinner parties with friends, many will likely reveal they have taken a course as mindfulness and cognitive-behavioural therapies are increasingly embraced by many people we know. So that stigma has been walked to the door.
And perhaps when offered training in this practice which sounds so simple: Being intentionally more present with what is arising moment to moment without judgment, we do not believe anything physically changes with “just” working with our minds. After all, pain and illness are physical, right? This might fail, right? And we don’t even have the bottle of pills in our hands to show for the money spent.
Yet all pain and disease from which we suffer is a mix of the mind and the body connecting to make sense of the pain/illness message, each unable to function without the other. There is no sensing pain without the mind. There is no pain to sense without the body.
When we work with our minds to change the way we think about, judge and perceive what we encounter, and alter the lens through which we see life using new skills learnt in Mindfulness practice, we change our brains physically and biochemically and, with regular practice, even permanently. The changes affect our physical bodies too, in ways we often hope for from prescribed therapeutic drugs.
Mindfulness practice, often alongside other interventions more conventionally offered, can indeed change suffering, though not in everyone: Just as with medication, there can be adverse effects in a small percentage of those practicing it. In the majority who find it works well for them there is often increasing benefit as the practice continues long after the group work, also therapeutic in its camaraderie, is over. Good science supports it: It is evidence-based as is required in our health systems. It just remains to implement these courses more widely, like big Pharma taking the COVID vaccines and designing production lines to manufacture in bulk.
World-wide, health ministries haven’t caught up yet, except in the UK, where it has taken years to implement mindfulness groups in their National Health Service even after the evidence of efficacy was long reported2. The science was clear enough, according to Chris Ruane, an ex-member of the British Parliament and mindfulness practitioner, speaking at a May 2021 interview conducted online by Michael Apollo of the Mindful Society Global Institute based in Toronto. He and colleagues were able to introduce mindfulness training to the UK parliament from about 2013. He went on to say that “300 politicians, parliamentarians, and 500 members of their staff have had mindfulness training” plus a separate but parallel initiative brought mindfulness training to 3000 senior civil servants across Whitehall, the seat of the British government. He shared that their template for integrating mindfulness into government, now offered through the “Global Network for Mindfulness Initiative”, is sought after by more than 40 countries around the world wanting to establish mindfulness in their legislatures.
In many countries, including Canada, there is not enough progress yet in following the science that Mindfulness practice is cost-effective, potentially cost-saving, and worth implementing widely for many conditions such as pain, depression, stress, and the ubiquitous physical conditions which are birthed and nurtured by stress.
Here in Ontario there is limited access to courses covered by the provincial health budget. If Canadians want to begin Mindfulness practice for their health conditions or for personal development and proactive prevention, currently most must pay.
We have talented trained facilitators and most are in private practice. As we promote these courses from within our organization, $599 buys two facilitators for 20 hours over 8 weeks online and, likely, for many of their participants, a positive change in their lives. No commute to meeting rooms, no parking charges, no missing a class due to not feeling well enough to make a trip to the venue.
Now what is our rationale again for “passing” on this? The investment?
2 Mindful Nation UK, 2015. Report by the Mindfulness All Party Parliamentary Group (MAAPG)