Sometimes things just come together. They click into place, everyone is on message and the team pulls together. Well my worlds of health care and yoga just clicked into place pulled together. The result was an Outstanding rating from the Care Quality Commission when they inspected our GP surgery at the Docs in Central Manchester. The inspection looks at quality indicators such as are we safe, effective, caring, responsive and well-led?  It also considers different patient groups and how we care for them. Well despite the challenges facing the NHS we have put the work in and we continue to do our best for the folk of Manchester city centre. You can read the report here Obviously this inspection was more about health care than yoga but nevertheless, my personal practice of yoga and sharing it with my patients drew the interest of the CQC inspectors. Yoga was one of the examples that they found demonstrated, that as a practice, we are able to tailor the services that we offer to the needs of our patient population. Some of you may remember that at the beginning of the year I cheekily wrote all over a GP’s prescription to encourage people to make yoga part of their life in 2016. This image linked to an open letter to the NHS about the benefits of yoga for psychological and physical wellbeing was shared widely over social media and even got the attention of local and national press. This snowballed yet further and to celebrate International Yoga day I was invited to speak at the Houses of Parliament for an All Party Parliamentary Group to support an Early Days Motion, “… yoga to be included as part of mindfulness and well-being initiatives for NHS staff and for yoga to be integrated within treatment for patients; and urges the Department for Education to introduce yoga in the school physical education curriculum.” Whilst waiting for National Bodies to mull over the potential of yoga as a health care intervention, Yoga Manchester and the Docs put their heads together to reinforce this message locally. So now patients often leave my consulting room without a prescription for antidepressants, rather they have had a more wide-ranging discussion about what lifestyle interventions could help them get through difficult times. If they are up for it they may take up the challenge of trying yoga for the first time and skip away with a first class free voucher. Now the gods roll their dice and the date of a Care Quality Commission inspection is beyond my control. It turns out that they chose to come during the week that I was undergoing David Swenson’s week long teacher training intensive workshop. My work colleagues were a bit put out that I had dodged the bullet of the inspection, so in the spirit of team work I legged it over from the Northern Quarter back to the surgery in the lunch time break of the workshop.  The Inspectors were a bit nonplussed when I burst into their meeting wearing sweaty yoga kit. “Right, I can give you 60 minutes then I need to leg it back to class.” I said in my most Zen like fashion, as you do when the most important inspection of your professional career is underway. Well what can I say? They like what they heard and the result is an outstanding result for the Docs So my yoga sustains me and gets me through difficult times. Now I am on a journey to share that with others. I have convinced the team at the Docs that this approach has merit for our patients. Now the CQC endorses this view by awarding our practice an Outstanding rating. Happy days!!

the docs surgery

   
After the overwhelmingly positive response to my "Open Letter to the NHS" earlier this year, I have some exciting news. You shared my message far and wide and it got both local and national attention in the press. After the Guardian article  I was invited to speak at an All Party Parliamentary Group in the Houses of Parliament on Monday 27th June for an "Early Day Motion". The motion is "That this House celebrates the 2nd International Day of Yoga, on 21 June 2016, adopted by the UN General Assembly in 2015; ... recommends yoga to be included as part of mindfulness and well-being initiatives for NHS staff and for yoga to be integrated within treatment for patients; and urges the Department for Education to introduce yoga in the school physical education curriculum." Quite rightly there is growing interest in the benefits of yoga as a healthcare intervention. Many of us have personally experienced the physical and psychological benefits of our yoga practice. Now there is an opportunity to spread this message yet more widely and bring this idea to mainstream debate. Where better to do this than the mothership of debate, the Houses of Parliament. So on Monday afternoon, I fought my way through the frenzy of tourists, protesters and journalists in Parliament Square. My resolve did waiver from time to time but thankfully I brought the well informed and tenacious Charlie Taylor-Rugman, one of the UK’s leading Ashtanga teachers, with me for support. As we crossed the Central Lobby, Lords to to the right and Commons to the left, the frenetic activity of Parliamentarians responding to a Labour leadership crisis and the fall out of the EU referendum made me wonder whether anyone would be interested in hearing about yoga.   Dr Matt Joslin Yoga Houses of ParliamentOur allocated space for debate was to be the oak panelled, green-leather cushioned Committee Room 10, upstairs overlooking the Thames. It holds about 100 people and to my surprise it was packed. The mood was celebratory. After all this was a coming together of individuals and teams across the world who are passionate about yoga and health care. The event took the opportunity to mark the second International day of Yoga. MPs sat shoulder to shoulder with yoga researchers, practitioners and therapists. Presiding was High Commissioner of India Shri Sarna. After introductions and an opening mediation, we had presentations about yoga in healthcare systems in India and Sweden. Data on pilot studies and some health economics was shared. One energetic and articulate young man emotively shared his story of cancer survival and passion for yoga practice.   Matt Joslin Yoga Houses of ParliamentMy time in the spotlight was brief, but hopefully memorable. I had been asked to talk about prescribing yoga as a GP. So proudly representing our great city of Manchester I stood up, cracked a joke or two and realised that my allocated five minutes was nearly up! My key message was simply that an endorsement of yoga by a health care professional under the banner of the NHS is a powerful message to patients. Patients trust their GPs, practice nurses and physiotherapists and the more of us healthcare providers there are who  can confidently signpost to quality yoga classes, the more effectively we can roll out the benefits of yoga in the NHS. This meeting is a first but very significant step on a path towards closer integration of yoga into NHS healthcare. Let us see where this network takes us.It has been such an honour to represent Yoga Manchester and the wider UK yoga community at this event. I will continue to do my best for you. Dr.Matt Joslin   Save Save Save Save Save Save Save Save Save Save Save
Popularised by Winston Churchill, the Black Dog metaphor for depression is a powerful image for this most disabling of mental health conditions. With spring nearly sprung, the sun is coming out and there is lightness of step again after the long grey of the Manchester winter. So let’s lengthen the leash a little on the Black Dog of depression and run him around the metaphorical park through the metaphorical daffodils. This blog has been harder to write than my previous one on anxiety. Anxiety is full of energy, albeit misplaced energy with an inappropriate direction. There is a certain dynamism to anxiety, which when redirected can turn around quite quickly. Depression is more like an oil tanker (I know I am mixing my metaphors but indulge me…). It is much slower to react and to readjust. Sitting heavy and low in the water the captain knows to change direction; the steering wheel is on full lock but it is aeons later that the most imperceptible shifts start to happen. So how to make those changes when feeling overwhelmed, sapped of energy and crushed by the weight of depression? Well as a GP I have discussions about depression all the time, perhaps even on a daily basis. People use a variety of strategies to cope. Increasingly they choose to get on their yoga mats. One of my patients suffering with depression, let’s call him Winston, has given the gift of sharing his experiences and talks about how yoga has helped him. Winston’s Black Dog is a heavy, shaggy, energy-sapping mutt. He never noticed him creeping into the room but once the Dog is there he resides resolutely on the mat immovable and stubborn. He is brooding, resentful and passive. His negativity wafts around and is tangible not just to Winston but also to all those around him. So without going into all the gruesome details, Winston has had his fair share of the usual interventions for depression. Medication, talking therapies, self-help materials, boundary setting and hiding under the duvet for weeks on end… They all have their place and sometimes a combination thereof was required. But for Winston, getting on his yoga mat has become his therapeutic intervention of choice. When depression bites the world closes in. He couldn’t imagine coping with all the responsibilities of daily life. But after trial and error with a variety of depression busting methods, he came to understand that what works for him, is to get himself onto a yoga mat. Even the simplest of tasks in this mind state can be daunting. The thought of doing a full session of practice seemed overwhelming. So Winston didn’t approach it with such goals in mind. He just used the yoga as a framework to stand, to breathe then to move through one posture at a time. Soon he’s linking postures together and things start to flow. He gets just as far as he gets, with no self-recriminations.  But as time goes by his motivation to do a deeper practice starts to grow and the sessions get longer. While he is on the mat moving and breathing, his Black Dog depression is temporarily banished. So Winston explains “I feel good when actually doing my yoga practice, but initially my mood slides away and it feels like I am back to square one by the next morning”. But experience tells him that he is not back to square one. As he does his practice day by day, his dark mood lifts little by little, confidence grows and the changes move off the yoga mat into his day to day. For Winston, the act of bashing out a few sun salutations gets him on his way. The discipline of yoga pays dividends over time.  It is by no means a quick fix. Just like the slow-to-turn oil tanker, the practice of yoga can steer you back to a healthy balanced mind and perspective. It might take weeks or months but trust that it always will. The Black Dog can be turned into a down-dog and maybe even an up-dog.      
Balancing upside down gives a novel perspective. I like to do this frequently even though my family finds it odd and even embarrassing. For example I have been known to tip up into a headstand whilst out and about on holiday. My daughter then disowns me and extorts heavy financial compensation before she will again admit that we are related. Wall space at home gets commandeered for elbow balance and handstands; there is a tide-mark where sweaty heels have left an impression. Once the tussle with the physical unusualness of the situation settles down I do get moments of reflection. The other day whilst head standing and contemplating the fluff that had accumulated under the sofa that otherwise I would not have seen, I was thinking about how to balance. This refined itself to an awareness of balance in general. Lots of yoga is about balance. There is the obvious headstand, handstand, elbow balance thing. Initially it’s a struggle to get up and stay up. After time, when the body seems to know what it is doing some stillness may come. But you don’t have to be upside down for balance to come into play. Just standing in Samastitihi requires equanimity. Left side has to equal right side, weight evenly distributed across the toes and the heels with evenness of breathing. Apply this concept to some more challenging one-legged standing postures and awareness has to be balanced between the grounding of the standing leg and the work of the lifted leg. After spying a bit of Lego and one child’s sock under the sofa from my new vantage point, I thought some more. There is a balance required in any posture, seated, supine, standing or inverted, between the intensity of the muscle work required and the softening and release that allows you to deepen a little. In twists the attention is drawn to the side to which you turn, but this has to be balanced with the release on the other side. These subtleties are particularly important injury prevention. Overworking and overstretching can cause grumbling tendon inflammation, muscle tears or joint pains. The art is to challenge yourself beyond what is cosy and comfortable to the full capabilities of the body yet balancing this with a softening in the intensity. Taking a look at the practice of yoga as a whole there is balance to be considered here too. I notice there are times when I do more practice and other times when I do less. Life can get in the way of yoga! If I practiced every day for as many hours as I would like to, the impact of yoga on my life could swing in the wrong direction. I have a wife, children, friends, a job, colleagues and many other facets of my life to consider. If I over commit and try to squeeze in as much practice as I can, or I push and try too hard, then friction builds. My coping mechanisms for stress and worry management go out he window and trying to do yoga can become a problem in itself. I notice if I get the balance of practice right then other areas of my life jog along quite nicely. From a professional point of view, my yoga practice helps me to help my patients. The physcial health benefits aside, it is the mental composure that is one of the benefits that can have the biggest impact. Of all the hundreds of thousands of GP appointments that take place very day in the UK, more than 25% of them have a significant mental health component. Using the balance of yoga and its inherent mindful approach is one tool available to help manage the stresses, anxieties and worries that assault us all. So I’m nearly ready to come down now from my inverted perspective, but what occurs to me is that I need to turn this balance idea on its head. I am not doing yoga to learn to balance in postures that I practice in class. The lesson of balance that I achieve in my yoga practice is actually something I need to apply more widely in my life. Yoga helps me bring balance to relationships, to the intensity which I do any activity. It teaches equanimity from moment to moment.