World Autism Awareness Day

Autism affects so many of our lives and families, and yet so many of us know very little about it, make unfair assumptions about people who live with it, or make crass jokes about people, using it as a derogatory term. In this episode of the Black Swan Podcast, I interview, the amazing Deborah Brownson, who recently won an MBE for her incredible work around autism. I am so glad that she is here in Morecambe Bay, though her work has a national and international reach – and rightly so!

 

World Autism Awareness Day is a good time to talk about Autism! The podcast is full of profound wisdom from a woman who has two sons with Autism and is working tirelessly to raise awareness, change perspectives and create practical resources and support networks to help people who live with Autism and the carers who support them. I hope you find it interesting, challenging, comforting and inspiring. Here are the links to the podcast, depending on your preferences!:

 

iTunes

 

Spotify

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Recovery From Addiction – Podcast

Here is the lastest edition of the ‘Black Swan Podcast’ – available on iTunes, Spotify, Alexa and anypod.net

 

This one is with my good friend, Dave Higham, founder and CEO of ‘The Well’ – an incredible community of recovering addicts, here in Morecambe Bay. This one focuses on Dave’s own story through addiction and prison (where he’s spent more than half his life) and his journey of transformation and hope. This podcast is unmissable and (along with the next one, which is a group podcast with other members from ‘The Well’) has some of the best examples I know of how love and kindness practically restores lives and rebuilds communities – a prime example of the new politics and economics we need!

 

https://itunes.apple.com/gb/podcast/black-swan-podcast/id1454670907?mt=2#episodeGuid=Buzzsprout-984751

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Let The Children Play!

In The Guardian today, there is an article in which the Children’s Commissioner, Anne Longfield, is calling for more adventure playgrounds across the country, especially in our ‘poorer’ neighbourhoods. She believes we need more play schemes across the country for the long summer holidays which she argues are having a profoundly negative effect on children’s physical and mental health. Most starkly, she cites a study in which “primary school children lost 80% of the fitness levels gained during term time. The poorest 25% experienced a drop in fitness levels 18 times greater than the richest 25%”. Sadly, this undoes some of the great work of schemes like ‘the daily mile’ in schools and has hugely negative consequences in terms of future health risks.

 

I would personally therefore welcome such a move – it is absolutely the case that increased active play and exercise improves a child’s physical, mental and social health. There is no doubt that more facilities, especially located closer to home would be better than having none at all….but I don’t really think it’s quite that simple (and for the record, I don’t think Anne Longfield thinks it is that simple either, she is a great champion for children across the UK). There is a danger, that by saying children need to play more, that it gets oversimplified by policy makers and could perhaps sound a little too Marie Antoinette! Yes our long summer breaks are becoming like ‘battery hen’ experiences for many children across the UK, but simply building them more parks is not going to change this, and I can give you few reasons why.  To understand why kids are spending more time indoors and on screens, we need to dig a little deeper into some pretty uncomfortable truths and wrestle with the complexity of them.

 

I have a friend, who is one of the kindest and best people I know. On top of his very heavy work schedule, he invests an enormous amount of time into young people, who are often living with really challenging circumstances. Every summer, he runs activities for them, right through the summer break and does extraordinary things. Ten years ago, when he applied for funding through a variety of grants (and let me tell you he is a seasoned wizard at winning bids for such things) he was getting £20k for a packed out summer programme. These days, he struggles to raise £4k. That leaves the situation in which he is having to ask families to contribute more for the care of their kids over the summer. What this leads to is a drop in numbers and more kids stuck in at home.

 

I have another friend, who runs a school in one of our most deprived communities. Throughout the summer break, her school opens up to ensure the kids from the locality do not go hungry and so that families can afford to eat. There have been emergency appeals from many food banks this year. Many working families are seriously struggling to provide both childcare, through the long summer breaks and food….there are some really tough choices to be made. Out of 50 young people on a local holiday scheme, that I know of, 19 of them were relying on daily food parcels, meaning they have no idea from one day to the next what they will be eating and actually no choice about it. When you are working two jobs and struggling to make ends meet, what else can you do with you kids? Just let them roam the streets?

 

I know a police officer who works on some of the toughest estates in the UK. He tells me that the war on drugs has utterly failed and the gangs are absolutely running the show. Cuts to the policing budget and massive stress levels in the force, as a result, are seeing whole neighbourhoods overrun with crime. The play parks in these places are totally unsafe. No parent in their right mind would let their child out to play in such an environment. It’s a bit different in leafy Surrey or middle class suburbiaville. Without police to build relationships with young people and keep the streets safe, simply building new parks or putting on play schemes will not be enough. Without children’s centres, youth centres and health facilities readily available (many of which have been closed or privatised and so less affordable to communities who need them most), there are less places to go.

 

If I’ve learnt anything over the last few years, it is that we have to stop coming up with schemes that we think are good for communities and simply delivering them. We have to really learn to listen to people’s stories and the complexities of their situations and from that place hear what it is that they want and need and then create real partnerships to bring about that change together. Hilary Cottam is all over this in her brilliant book ‘Radical Help’, which is a must read.

 

I love that Anne Longfield, Tanni Grey-Thompson and Sarah Woolaston see this whole issue as being so massively important. Play schemes and parks and cutting sugar (though all excellent) will simply not be enough in and of themselves to get kids out doors and playing in them. We need a a very holistic approach which starts with communities, hearing what their dreams are for their kids and hearing the hopes and desires of the kids themselves. Next we need to understanding what the steps will be to get there. Then we have to build that together. I would suggest a great place to steward this kind of resource would be through health and wellbeing partnerships, like the ones we have in Morecambe Bay. Cross public and voluntary sector partnerships, rooted and working well in their local communities. But I can also guarantee, that this idea will require the right kind of resource – appropriate funding of the required schemes, affordable access to facilities, work that pays a decent wage so families can afford to eat and taking the safety of our streets seriously. That is going to take both a reimagining of youth work/social provision and appropriate help and resource to a diminished and struggling police force. Bring on the parks, but first listen and make sure they can be used!

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Health and Society – Part 3 – Can We Make a Difference?

On the 70th Birthday of the NHS, here is the 3rd and final part of this mini-vlog-series. In this one I look at how we can make some positive steps for our own health and wellbeing and explore the issues of choice and responsibility, whilst we also tackle health inequality and issues of social justice.

 

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Mental Health Help

Here is a series of 5 videos I did for Mental Health Awareness Week this year. Mental health is SO important and struggling with mental health issues, is NOTHING to be ashamed of. These videos cover, depression, anxiety, exam stress, suicide and getting to the roots of stress. There has been really positive response through Facebook, so here they are all in one place through my YouTube Channel.

 

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Creating a Culture of Excellence

This is the 3rd in a 3-part series on how we can create great working cultures. Culture eats strategy for breakfast. The first two vlogs were on joy and kindness; this one focuses on excellence. If we don’t get culture right, we don’t get care right – and in the NHS, that is fundamentally what we are about. This one comes with a health warning! If we try and only build a culture of excellence, without first building a culture of joy and kindness, we will create a very unhappy working environment with low morale and poor quality. Excellence is built on joy and kindness!!

 

 

 

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Facing Our Past, Finding a Better Future – Adverse Childhood Experiences

This week I had the privilege of listening to Prof Warren Larkin, advisor to the Department of Health on Adverse Childhood Experiences. This is something I’ve written about on this blog before and Warren has made me more determined than ever to keep talking about this profoundly important issue. This blog draws on his wisdom and learning.

I believe that Adverse Childhood Experiences are our most important Public Health issue. So I want to be really clear about what they are, how and why they affect us so deeply, where we can find help if we’ve been affected by them and how together we can change the future, by preventing them.

 

What Are Adverse Childhood Experiences?

 

• Physical abuse
• Sexual Abuse
• Emotional Abuse
• Living with someone who abused drugs
• Living with someone who abused alcohol
• Exposure to domestic violence
• Living with someone who was incarcerated
• Living with someone with serious mental illness
• Parental loss through divorce, death or abandonment

 

How Common Are They?

 

The answer is – far too common. There have been some really wide ranging studies across the UK and USA into the numbers of us who have experienced ACEs, and it’s not just in our “most deprived communities” but in predominantly white, middle class areas where we see the stark statistics. Depending on the study you read, between 50 and 65% have experienced at least one ACE. And shockingly 1 in 10 of us have experienced more than 4.

 

How and Why Do They Effect Us?

 

Firstly, they affect us by quantity. The more ACEs we experience, the worse our physical, mental and social health and wellbeing is. If you have experienced one ACE, you have an 86% chance of being subject to several. If you experience more than 4, your health and wellbeing is significantly affected. If you experience more than 6 then you have a 46 times higher chance of becoming an IV drug abuser, a 35 times higher chance of committing suicide and an overall 20 year decrease in life expectancy.

 

Secondly, the toxic stress levels significantly change the way in which our brains grow and function. This has a profound impact on our day to day functioning. ACEs are a massive cause of absenteeism from work, high cost to the health and social care system and highly predictive of time behind bars. That is why so many of us have complex relationships with things like food. Losing weight, for example, is not as straight forward as eating less, exercising more or ending up with a gastric band. Did you know that suicide rates are massively increased after bariatric surgery? By removing the ability to eat, the very thing that takes away or comforts the pain, we expose the underlying issue, but provide no healing into that void.

 

Thirdly, our bodies literally keep the score of the negative experiences. So, we become more likely to develop chronic pain, inflammatory conditions, heart disease, cancer and mental health issues.

 

Fourthly, the toxic stress actually alters the way our DNA works and therefore changes the genetic information that we pass onto future generations. As an example, domestic violence in pregnancy is predictive of child developmental issues and offspring of the survivors of the holocaust or genocide are far more likely to develop chronic anxiety. This highlights just how important our family history really is.

 

Fifthly, there are proven things we can do a) to help our brains learn how to cope in the midst of really difficult circumstances (resilience) and b) therapeutic interventions that can genuinely heal us.

 

Where Can We Find Help?

 

Here’s the thing – this is where the rubber hits the road.

 

Many of us, who have experienced difficult things in childhood/adolescence never talk about them. Sometimes that’s because we can’t remember the experiences – they happen to us before our memories fully form. But perhaps more frequently we bury them because we don’t want to talk about the deeply painful memories, we don’t know how to or we’re worried about what might happen to us, or the people who caused us the pain if we do. And how do you start a conversation like that anyway? What? Are you going to just blurt it out to someone? And what on earth will you do if you just start crying in the middle of a restaurant when you talk to your girlfriend/boyfriend about what happened to you? And what about all those complicated associated feelings of shame, guilt, fear, thoughts of rejection? So…..we keep the lid on….even though it’s to our own detriment because we don’t know how to bring it into the open.

 

And here in lies the starting place. It’s vital that we learn this in the world of health and social care, but actually we all need to hear this incredible truth. Various studies have shown that it takes 9-16 years for people to be able to talk about trauma/abuse they experienced, but most never do. Fraser and Read found that in their patients struggling with mental health issues, only 8% of them volunteered that they had experienced ACEs. However, when they were actually asked about this, 82% then talked about ACEs they had experienced. So? So, we find it almost impossible to talk about, but when someone asks us about what we have lived through, it takes the lid off the box, peels the sticky plaster off the deep wound and allows us to begin talking about our pain. And here’s something really remarkable……Felitti and Andra found in a study of 140000 people that simply by routinely asking all patients about ACEs, they saw a 35% decrease in visits to the GP and an 11% reduction in use of the Emergency Department!

 

What does that mean? It means that giving someone the chance to talk about their journey, what they have been through, breaking the cycle of shame, fear and rejection is, in and of itself, deeply healing! Knowing that you’re not a freak, knowing that it wasn’t your fault, knowing that it doesn’t mean that you yourself will become an abuser/alcoholic/poor parent and many more realisations can make a significant difference to a person’s wellbeing. Maybe it doesn’t have to wait for a GP’s surgery or a counsellor’s chair. Maybe, just maybe if we all care enough to ask each other deeper and more caring questions we can help to heal each other. I know this is true of my own journey and that of many of my friends.

 

But let’s not be naive. For some of us, the experiences we have had are so horrific that we are stuck in a moment and we can’t get out of it. And this is where good therapy really comes in. I wonder if we invested more in therapy and less in drugs to numb our pain, how much more healed we might be – perhaps more expensive in the short term, but overall the cost is far less, both for the individual and society as a whole. There is help available and it can take many forms. EMDR, Trauma Focussed-CBT, Bereavement Counselling and even things like working through a forgiveness process. Unfortunately, many of the waiting lists are very long, and private options are way too expensive for most people to afford.

 

So, Can We Change The Future?

 

You know that I believe together we can! But it’s not going to be easy, especially not in the context of our floundering social services, restrictive school curriculums, reduction in numbers of health visitors and school nurses, eye watering cuts to public health budgets and significantly stretched CAMHS and Adult Mental Health Teams. And I think we have to very real and honest about that, because if this is such a massive issue in our society (and the data and evidence is astounding) then we need, as Warren Larkin so eloquently argues, genuine commitment from leaders and organisations to shift towards a culture of learning and collaboration to bring about change.

 

Here are some things we need to do together:

 

1) Own up to what a massive issue this is.

2) We need to learn how to ask our friends better questions and care enough to listen to each other’s experiences and journeys because it is really hard to know how to start talking about ACEs, but is more possible when someone bothers to ask!

3) We need to recognise that by bottling things up, we do further harm to ourselves. Perhaps some of our complex addictive patterns of behaviour, our mental health issues, our physical pain and symptoms might well be linked to the ACEs we have experienced. So maybe we don’t need a life on painkillers, cigarettes or with a complex addictive behaviour patterns. Maybe we can find a way to deeper healing.

4) In health and social care, we need to adopt REACh (routine enquiry about adversity in childhood) – we need to change the way we take histories from patients and ask better questions. Remember that even by asking, it doesn’t open up scary and messy consultations that we don’t have time for, actually it opens up a therapeutic space which can massively alter how a person goes on to use the health service in the future.

5) We need to ensure schools are more vigilant to thinking that ‘naughty’ or ‘difficult’ children are actually highly likely to be in a state of hyper vigilance due to stressful things they are experiencing at home. Expecting them to ‘focus, behave and get on with it’, is not only unrealistic, it’s actually unkind. Simply recognising that kids might be having a really hard time, giving them space to talk about it with someone skilled, teaching them some resilience and finding a way to work with their parents/carers via the school nurse/social worker could make a lifetime of difference. It is far more important that our kids leave school knowing they are loved, with a real sense of self-esteem and belonging than with good SATS scores or GCSEs. The academic stuff can come later if necessary and we need to get far better at accepting this.

6) Parenting classes should not just be for the well-motivated or struggling. They should be for all of us – a routine part of antenatal care and alongside our children’s education and include help in dealing with previous ACEs, so they are not repeated for the next generation. Prevention is possible. And that means we need to learn to be a whole lot less judgemental and a great deal more open, honest, vulnerable and restorative with each other. One of my best memories of growing up, was going to a “foster home” for families that my mum used to work with and seeing parents being given the chance to learn how to love their kids, rather than have them taken off them. I know sometimes there is no choice, but helping people learn how to be family and to love and cherish their children is a really beautiful thing. When there has been generational abuse, it is is also of the upmost importance. I’m not saying that a child should never be removed, but we can hardly say that our care system is a rip-roaring success story.

7) We need to find a way of working with men and women in our prisons that enables them to find a way to healing and restoration, not retribution for what are often extremely complex stories.

8) We must learn from best practice around the world. For example, did you know that the vast majority of paediphiles begin offending at the age of 14?! Most of them do not go on to become prolific offenders, but the damage caused to the child they abuse is obviously significant. There is some amazing work now going on in Pennsylvania which has shown that you can actually prevent young men from becoming offenders in the first place. Simply by doing some better sex education, explaining to boys about testosterone, the urges they are having and who it is appropriate to perform sexual acts with; alongside creating a really safe space where they can come and talk about feelings they are having (a bit like AA – with no ridicule or judgement) – data shows that you can decrease the incidence of child sexual abuse. We have to learn from this kind of approach and find a better way of talking about difficult issues. Prevention IS possible!

9) We need to find a way to fund more psychological therapies and become much less reliant on drugs to numb the pain with the associated colossal bill paid to Big Pharma.

 

 

This is an area I am really passionate about. I am committing to keep this conversation alive, to ensure that we make a shift in our organisations towards a REACh approach, to find a deeper and more effective partnership with colleagues in education, social services and the police and to create space for more training and awareness for all our staff teams. I know how painful this conversation is, but I also know how utterly damaging it will be if we don’t change the future and prevent this from being a perpetual story through the generations. It is time for the hearts of the elders to turn to the children. Together we can reimagine the future. Together we can.

 

 

Here is a really helpful film:

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A-Z of Health and Wellbeing

Happy New Year!

 

We often start a New Year with resolutions, things which we would like to change for the better. so, I thought I’d start this year of blogging with a vlog about my perspective on the A-Z of what affects your Health and Wellbeing the most.

 

It’s longer than most of the videos on my new YouTube Channel (Dr Andy Knox), at nearly 15 minutes long, but it is pretty tricky to talk through 26 different aspects of health and wellbeing in under 3 minutes!

 

So…..he is a list of the things I talk about……and if you don’t want to watch the whole thing, then you can find the bits in the video that are of interest to you, in helping you think about some changes you might want to make or help you might want to access this year.

 

A is for Alcohol

A is for Adverse Childhood Experiences

B is for Blood Pressure (140/90 – the magic numbers)

C is for Cigarettes

D is for Don’t want to live anymore

E is for Exercise

F is for Fluids

F is for Food

G is for Glucose (Sugar)

H is for Housing

H is for Heating

I is for Irregular Pulse

J is for Joy

K is for Kindness to NHS Staff

L is for Loneliness

M is for Money (Debt)

N is for Narcotics (Drugs)

O is for Obesity/Overweight

P is for Pollution

Q is for Quarrelling

R is for Road Taffic Accidents

S is for Stress

T is for Temper (Anger)

U is for Underweight

V is for Violence (Domestic Violence)

W is for Worry

X is for Xenophobia

Y is for Your Ego

Z is for Zzzzzzzzzzz (Sleep Deprivation)

 

 

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Narcissus and the Narrow Path

Narcissus – The Ego Image of Ourselves

Do you know the story of Narcissus? Such a tragedy of a young man, who looked into a pool of water, seeing his image for the first time and found it so mesmerisingly beautiful that he could never bear to look away and died looking at his own reflection. Needless to say, in the world of selfies, it provides a stark warning to us! Its real meaning though is deeper and profoundly challenging.

I have written on this blog a few times about the enneagram and the power it holds in causing us to confront our root issues. In truth, each of us has an ego that we protect and project to the world around us. It is the image of ourselves that we want others to see, the things we would like others to believe of us. But it is only a narcissistic projection, a fake image that we portray, perhaps the image of ourselves that we are in love with or would, perhaps, like others to love. Our life’s work is to own up to the ego we have created and instead become our true selves, which enables us to become a gift to others. This is our deepest, spiritual healing.
My ego projection is that of a Type 7. I project to those around me that I am an enthusiast, an activator, a visionary, full of fresh and new thinking. I am fun and fun loving, I am an activator, a leader and generous. I so easily love this image of myself and what others think and say about me. But truthfully, I am and do those things because I am, for the most part, avoiding pain. There is, if you like, an inner child or shadow, I am trying to protect. A child who didn’t feel content and did not like pain I encountered early in life. So, in order not to feel that pain, I bury my true emotions and project to the world that “I am ok”. I may not be, but I want you to think that I am. And truthfully, I most likely think that I am ok, because I am a “head type” and so I process things very rationally. In any given moment it is often hard for me to know what I actually feel, because I bury my true emotions so that they do not overwhelm me and I do not have to feel any pain. And if you don’t ask me what I’m feeling I don’t have the language to tell you and even if you do, it will take me an enormous amount of energy and courage to really feel whatever it is that I am feeling. And so, in order to bury that pain further I encounter my root sin, which for a Type 7 is gluttony.

This gluttony does not have to be for food, though in my case it often is – I do love food! But it is also a gluttony for fresh or exciting or stimulating experiences – living life to the max. It can lead to such a rushing and business, so that life is never boring and I do not have to be still too long enough to encounter anything particularly negative. This can easily lead to addictive tendencies e.g. to social media, to creating a fantasy world or to always moving onto the next new thing, leaving those around me feeling caught up in the whirlwind or a bit used, abused and taken for granted, whilst the ‘Andy Show’ rolls on through town.

So, what do I do about my narcissistic ego projection that I want the world to believe of me and that I rather love? Well, I can stay as I am. I can continue to let everyone know that “I’m ok”; or I can fall over The Stumbling Stone and receive the invitation to accept just how overwhelmed I feel sometimes; that there is a deep dissatisfaction within me that drives my gluttonous behaviour to cover over my pain. And as difficult as it may be, there is no other salvation for me, no other way to find the simplicity and contentment I long for and to become the gift I can be. Does it mean if I accept that invitation that all my struggles stop, that my ego will die and that my sin will no longer trouble me? Well….yes and no!

There is a death of the ego, but it keeps rearing it’s ugly head and so needs a daily death and some days it dies more than others. And when I’m running from pain and feeling overwhelmed, gluttony of one sort or another will too easily take hold. But always in my path is The Stumbling Stone, inviting me, instead, to walk the narrow path, the path less trodden, the path less looked for because it means walking through a narrow gate in which the ego, I love too much is stripped off me. What I so easily forget is just how heavy and tiring that old ego is. To have it removed with surgical precision and find a way to walk that is so much lighter and less burdensome is pure joy. No more pretence, no more projection, just me, as I am, loved at the very core of my being.

No matter who you are, you too have an ego that you are projecting to the world. Your life’s work is to recognise that ego and choose which path you will walk. For a Type 2 you project that you are loving and helpful. For a Type 3 you project that you are successful and outstanding. For a Type 4 you project that you are sensitive and special. For a Type 5 you project that you are perceptive. For a Type 6 you project that you are reliable, a loyal skeptic. For a Type 7, like me you project that you are enthusiastic. For a Type 8 you project that you are strong. For a Type 9 you project that you are peaceful. For a Type 1, you project that you are honest, hardworking and orderly. The invitation to each of us to fall out of love with our ego and become our true self. Then we can say, like God, I am who I am.

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Please get your Flu Jab this Year!

We are heading for a massive flu outbreak this winter across the UK and Europe, USA and Canada. Australia have had a seriously nasty outbreak of a strain of flu called H2N3. It held their health care service to ransom over their winter and we need to be ready for it. The best thing you can do is have your flu jab – free on the NHS, here in the UK for those who are most vulnerable. If you get flu this winter, don’t worry, we’re on it! Public Health England are masterful at making sure we are ready and in partnership with the NHS, we will be armed and ready. But the best medicine is preventative. So, PLEASE, get your flu jab as soon as possible and make sure it is the QUADRIVALENT type that covers the strain we are most at risk from! Let’s stay healthy and well this winter.

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