This is such an important topic! Thanks for starting the conversation @SeanB
We often hear people are told that meditation is a cure-all for everything from anxiety, depression, trauma, intrusive thoughts, schizophrenia etc etc but I truly despair at people with complex mental health issues being blithely encouraged to practice meditation.
Without proper care, rather than helping, it’s likely that meditation will actually exacerbate the existing mental health condition.
People with active mental health conditions need access to qualified and informed meditation teachers, which in this case means someone who is both experienced in meditation and also who has a good knowledge about various mental health conditions. It is especially very dangerous for an uninformed meditation teacher to give advice to people struggling with an acute episode, and in many cases would be considered a breach of their duty of care, with potential legal consequences. Always get professional help.
Most people will go through a mental health issue at some stage in their life. There are many conditions all with very different symptoms. We can’t just have a one size fits all approach to mental health and meditation. Also, sometimes meditation will be fine for some folks, but at other times it will be problematic for them, though they might be fine to practice meditation later, depending on what is going on with their condition.
Some mental health issues are generally not suited to prolonged periods of seated meditation, where they are left sitting with their thoughts - such as anxiety, intrusive or obsessive thoughts, or acute episodes of PTSD, suicidal thoughts or self harm. So, for example, someone who is experiencing severe anxiety should avoid long periods of silent seated meditation, but might be okay doing some calming walking meditation, or some chanting, or controlled breathing practices. It’s important to recognise that there are often bodily symptoms to thing such as PTSD and anxiety and that these also need to be acknowledged and managed.
Other people’s symptoms will be triggered by silence, social isolation and solitude of a retreat or monastery environment, especially those with some types of schizophrenia, including paranoia, persecution, or delusional patterns. For these folks, sometimes silence and solitude means they lose touch with our shared experience of reality and deluded views take over, and they may start to have paranoid thought patterns, hear voices or experience visual disturbances. These folks might not be suited to long intensive retreats but might be able to do short stays where they are more involved in community.
Some general advice for people with mental health issues:
- Be upfront about your condition if going to a retreat centre or monastery
- Indicate on your application form if it is an active condition or was historic, and list your current medications and your specialist’s contact details
- Have a chat with your specialist before undertaking meditation practices or retreats and ask what particular practices might adversely affect your condition
- Have a mental health care plan in place to make sure your treatment wishes are followed in case of an episode
- Don’t go off medication on retreat
- Have regular chats with the teacher
- Practice for shorter periods and less intensively
- Watch for breakthrough symptoms / pro-drome symptoms
- Be prepared to stop meditating if it is not going well
- Have some alternative practices to do if meditation does not work out for you
- Remember that meditation might not be the answer for you right now but might be ok in the future.
Some suggestions for Teachers and organisations:
- Undertake mental health first aid training for teachers and staff to better understand conditions and to watch for warning signs of acute episodes and how to handle them
- Do a suicide prevention or intervention course.
- Develop connections with mental health emergency services and professionals in your local area
- Keep contact details and mental health first aid resources in the retreat centre office
- De-stigmatise mental health issues by having conversations in your community and in Dhamma talks
- Be welcoming of people with mental health issues (don’t reject folks just because they have mental health issues, that would be discrimination and illegal)
- When you ask about people’s mental health issues in application forms ensure that applicants are informed that the information will be treated confidentially and will not adversely affect their application.
- Have a dedicated mental health contact person at the retreat centre and let participants know they can contact them at any time
- Be prepared to make accommodations for people with mental health issues just as we make allowances for people with differently abled bodies. Allow people to move postures when they want, or leave the hall whenever they need, to do less intensive practice, to do walking meditation instead, come at any time for an interview or chat etc
- If someone has a mental health care plan, make sure you follow it
- Don’t call the police if there is an acute situation, call the emergency mental health team. Learn how to de-escalate difficult situations skillfully. Only involve police as a very last resort
- Remember that meditation is not a cure-all. Don’t encourage people who are experiencing symptoms to “just observe l” it “just sit with it”.
- Never treat people going through a crisis with condescension, or disempower them or treat them as any less of a human. Always centre their needs and make sure they have agency and dignity.
Anyway these are just some ideas that popped into my head, largely informed by my research using the resources below, as well as training and personal experiences in monasteries and leading retreats. I'm sure there's many more useful ideas that folks might contribute.
I have done mental health first aid training and suicide prevention and intervention training and these experiences were extremely valuable. Importantly I learnt that many of the usual approaches one might take to things are actually the WRONG approach. So it’s worth doing such training.
Lastly these days, folks who have a diagnosis are usually pretty keyed in to their condition and good at self care. But it’s the undiagnosed folks or unrecognised underlying conditions triggered by meditation that are likely to create the biggest challenges in retreat environments, both for the individual and the organisers.
There are several good resources out there, check them out!
Meditating in safety
Set up by a Buddhist and a psychologist. User friendly and simple.
You might want to check out two figures leading this field:
Dr Willoughby Britton - the academic behind the Meditation Safety Toolbox above and involved with Cheetah House
Dr David Treleaven, also involved with Cheetah House and who wrote a book called Trauma Sensitive Mindfulness.
Hope this helps!