Teaching patients with mental health disabilities

For the past year, I have been teaching yoga to patients with reasonably severe mental health disabilities who live in a supported housing association. Given the respect for patients' confidentiality, I was never given full details of what affects them, and therefore I cannot be more specific on the conditions that I work with.

However, I thought to share some of my findings in case this post might help other teachers starting in this field. I'd like to clarify that my experience makes me NO expert on the subject, and this post is solely the fruit of my reflections about working with specific students in a specific setting. Here is what I learned.

It's all about the relationship
For students with mental health disabilities turning up to a class can be a challenge. Especially at the beginning, when they do not know you and the prospect of moving and being in touch with their bodies might not be their idea of fun. Coming to class is an indication that they wish to change something in their life and they are putting their trust and energy in you. Honour this and be incredibly encouraging and kind.

Make them feel welcome. Your class must be a safe space for them and they need to feel that there is no benchmark they need to be aspiring to. Remind them that whatever they are doing is good and acceptable and totally ok.

Tell them that you are happy that they showed up and you hope to see them again soon. If appropriate, why not get to know them a little more by chatting at the beginning and at the end of the class? Some of my students love watching films so we often talk about that, or how their job or volunteering experience is going, etc. This will work towards creating a friendly and trusted environment.

Every person is different
You don't know who you have in front of you. Quite rightly, for data protection purposes, you will not have full details of what affects your students. In the same class, you may teach people who have severe learning difficulties, or patients with debilitating depression, or who suffer from schizophrenia, etc. This could mean that they might respond in different ways to your teachings, your descriptions or your touch. Be aware of this and adjust your class accordingly.

Give & ask for permission
In order to build trust and create a safe relationship, promote a supportive environment where patients feel free to express themselves. Always offer them the option to stop, take time out of the room if they need to and re-join when and if they can. Or to leave if this is what they feel they should do.

As you progress during the class, especially in case you notice that they are really enjoying or struggling with something, ask them permission to explore it more. It can simply be a question such as "shall we do this one more time?": this will empower them and they will feel in control and comfortable.

Keep it super simple
Just as in a beginners' class, drop the idea of teaching a super creative sequence, talking through huge amounts of alignment cues and offering in-depth anatomical descriptions. Keep your sequence simple and repeat it, repeat it, repeat it.

Demonstrate everything. Visual aid is invaluable in a setting such as this where sometimes body awareness is limited, and it is important that students copy you for the whole time. My experience is that patients will do everything you do and therefore mirroring might not be the best option. Do your best to see how they are getting on behind your back.

Physical adjustments
Touch could be problematic, at least in the beginning when you don't know your students very well and are not aware of their history and medical condition. Patients might respond in very different ways to the human touch. I personally err on the side of caution and avoid physical adjustments; however, if you feel you'd like to adjust students, ask them permission and this will remove uncertainty.

Pranayama, breathing practices
This has been the area were I experimented the most and with the greatest results. At the beginning I was not comfortable in teaching breathing exercises given the strong connection of the breath to emotional states as I worried that I might trigger unwanted or upsetting feelings.
However, by asking students permission to work on the breath and giving them permission not to follow my instructions during the exercise, I noticed that they really enjoyed breath work and asked for more.

Initially I offered a simple mindfulness exercise of counting the breaths from 1 to 10, a technique I learnt at the London Buddhist Centre. After the success of this breathing practice, I introduced counted inhales and exhales, with the aim to gradually lengthen the exhales. This has also been very well received. The counting keeps the mind focussed and promotes a sense of calm.

I avoid breath retention or high energy pranayama (kapalabhati or bhastrika) in order not to trigger possible anxiety episodes. I feel that all gentle techniques which help students focussing their mind on something and being more in their bodies are welcome.

My students tend to arrive late to class and this has implications on the amount of time I have available to teach. Their lack of punctuality also brings other considerations: staff at the housing association tell me that those students who arrive late are also late for their doctor's appointment, job interview,etc.

Kindly, but firmly, remind them to be punctual. Be gentle and avoid patronising them, but still make a point of it. I tend to lift my hand up, spread the fingers, smile, and say "see you next Tuesday at 5, not a quarter past five, at 5!". Punctuality improved dramatically after these gentle reminders, and my hope is that they can take this new skill into other areas of their life.

I also noticed that some students were very regular in their attendance for months, followed by weeks of not seeing them at all. Be aware that they go through peaks and throughs in their physical and mental health and therefore their attendance might be affected by this.

Finally, I'd like to reiterate that I can only account for my experience with my students during a limited amount of time - therefore this pointers might not apply to your group.