Brizzle

An active weekend in Bristol including a cycle ride to Bath and back (36 miles at full pelt and no injuries except a sore behind), a vertiginous walk over Brunel's bridge, a ferry ride around the harbour (a bargain at under £5), and larging it up at the Old Duke music festival. I also take a rather classy photo of St Mary's Redcliffe, Bristol's best church and much more interesting than the Cathedral (whose nave is a machine-carved Victorian reconstruction - not a great look). St Mary's, built by Bristol's merchants to offset their greedy weekday devotion to Mammon, was described by Elizabeth I as "the fairest, goodliest, and most famous parish church in England" and she knew what she was talking about architecturally unlike the current heir. The church is full of history which I won't try to describe but if you visit don't miss two quirky monuments outside - the grave of Tom (1912-27), the church mouser who used to sit next to the organist during services, and a great piece of twisted tramline stuck at a crazy angle into the graveyard, blown clean over the church by a 1,000 kg bomb (Bristolians famously shouted abuse at Churchill when he visited following the near destruction of their City in 1941).

In the interests of ecumenicalism I should also mention John Wesley's New Room, the first Methodist chapel in the world (including his tiny bedsitter upstairs), an oasis of spiritual calm surrounded by the vast and depressing Broadmead shopping centre indistinguishable from any other city's "retail park" and selling all the usual rubbish. There is a Welsh connection as the chapel was taken over by the Welsh Calvinistic Methodists until it was returned to the Methodist Church a century ago. Looking at the plain, understated but beatifully proportioned building it occurs to me that, whatever the competing religious merits may be between different denominations, in matters of good taste the Nonconformists certainly come out on top...

Maudsley Shame

Shocking news that the Maudsley is puffing the "success" of its scheme to shackle vulnerable mental health patients with electronic tags (see my previous post here and the latest BBC news here). They are now talking about extending use of this demeaning and anti-therapeutic device.

The Maudsley, with whom Hafal has had a long and mutually respectful relationship and which has pioneered so much in terms of progressive treatment, has got this one badly wrong. The Maudsley NHS Trust runs hospitals not prisons; people are there as patients to receive care and treatment.

Hafal's members are well aware of the issues of risk (many have experience of severe restrictions on their freedom and in many instances they understand and support that restriction) but they also understand the overwhelming importance of maintaining the right relationship between services and patients with a serious mental illness. The Maudsley's folly is to jeopardise that whole relationship for a limited (and anyway suspect) reduction of risk. Such is the reputation of this famous hospital that patients' perception of mental health services will be affected for the worse.

Here is the rub. When for the first time (or on a subsequent occasion) a person begins to recognise in themselves the symptoms of psychosis or other serious difficulty they have a choice about whether to seek help and from whom. That choice is obviously informed by what they believe will be the attitude and approach of the people they seek help from. At present there is considerable distrust of services which patients often see as shabby and insensitive (or worse) even if they observe decent and caring practitioners trying to make the best of it. Will they be more likely to seek help from mental health services if they have observed that a leading mental hospital attaches tags to patients as a cheap way of keeping an eye on them?

The tags are a disgrace and will increase the risk of patients choosing not to approach services for fear of humiliation and repression.

It goes without saying that Hafal's advice is always to seek help if you have symptoms of mental illness.

Undeserving

It is my silver wedding anniversary today, an unequal celebration of 25 years honourable vow-keeping by one party and about 23 by me I reckon. At 6am before going to the gym I receive an exquisite silver dragon brooch (should I wear it like a Romano-British chieftain?) and instructions to be back in time for a celebration dinner. It is not exactly that I have forgotten but lunch-time finds me in Neath frantically seeking out a card and a feeble gift (an imitation red rose if you must know). The disparity in effort and thoughtfulness is representative, I confess. But there is no problem and I enjoy lobster risotto among other treats. Meanwhile on the same day I have a new niece born out west and all well.

Dulce ridentem Lalagen amabo / Dulce loquentem.

Rhondda Cynon Taf

On the latest leg of the "Road to Recovery" tour the microbus tootles into Aberaman to share her message in the valleys heartland of Rhondda Cynon Taf. Hafal Practice Leader John Davies promises: “We’re going to have a fun and informative day which will have a surfing theme in more ways than one: as well as sampling the surfer vibe or our microbus, visitors will also be able to visit a computer room where they can surf the net. The main aim of the day is to explore mental health in all its facets through the web, music and photography and woodwork displays. Our displays will get people talking and sharing ideas”.

John's expectations are fulfilled and he also points to local needs, specifically for easier access to out-of-hours emergency help and for a dedicated support service for women.

The campaign continues apace with just 6 out of 22 counties still to go. So how are we doing at the macro level with the national campaign themes? Well, not bad even if the jury is definitely still out...

On the Measure (Welsh Law) the signs are good. The draft interim guidance on care planning, which we hope will translate into regulations and formal guidance under the Measure, does prescribe the holistic care plan we need to achieve as the legal right of all patients in secondary mental health services. However, we need to press hard to provide the maximum legal certainty without loopholes. We are still fighting the cause of timescales, but would hope to see these established at least in a secondary, flexible way in either regulations or formal guidance.

On the restructuring of mental health services to serve individual care plans we have some way to go to reform the present mainly top-down approach. We need to campaign further to ensure that all secondary mental health services are commissioned through analysis of individual care plans; more than that we need to empower patients in future to purchase their choice of care and treatment using individual budgets or direct payments.

On the protection and enhancement of resources for mental health services we have in place the declared ring fence on NHS mental health funding, but we will need to ensure that this is a watertight commitment (see this post for some concerns).

That feels like we are at least three miles along a ten mile road to success?

500 Year Recorde

Evan..........and...........Recorde

It is the 500th birthday of Welshman Dr Robert Recorde, inventor of the "equals" sign: you can see the story here. It is only about 7 years since Dr Recorde was miraculously reincarnated by Hafal to celebrate the birth of the charity ("Hafal" means "equal" or should I say "= = =") with the assistance of longstanding and revered Hafal manager Evan Thomas who has since retired but bore an uncanny resemblance to the high-flying Tudor sage and mathematician.

On the Town

My spies spot (clockwise from top) Hafal Deputy Chief Exec Alun Thomas, Regional Manager Sharon Thomas, and Deputy Regional Manager Jackie James letting their hair down at colleague Gavin Williams' wedding this weekend...

Season of Mists and Mellow Fruitfulness

Well, not quite Keats' autumn yet but the lush later crops are spilling from the garden cornucopia. It has not been a great horticultural year but the slugs and bugs have not been too bad (that cold winter) and the best ever purple sprouting is on the way to stave off the scurvy early next spring. Family stuff earlier this weekend with a visit from my mum and nephew en route to see a new nephew or niece expected imminently further west.

I am also compelled to break my "no DIY at weekends" rule to replace the lavatory seat which has broken just as the rellies turn up. Everybody asserts that this is a simple task but of course they are wrong and I wrestle for hours with incomprehensible instructions in cramped and not entirely savoury working conditions. I suppose I should be grateful that this does not involve the actual plumbing (what a thought).

More family stuff today when I visit an elderly cousin in Carmarthen who gives me a picture he painted in the 1970s of a house which my family used to own in North Pembs. He knows the place has happy memories for me of swimming, collecting mussels, and similar summer fun.

Measure for Measure

Dr Dai Lloyd's visit to Hafal Neath-Port Talbot reminds us that the deadline for getting amendments organised for the Mental Health Measure (Welsh law) looms (Dai chairs the Legislation Committee responsible for the Measure at this stage though we can't usefully lobby him on this one because as Chair he has to remain neutral). You can see some of Hafal's thoughts on amendments in this post but I wanted to support another point being put forward by the Mental Health Foundation - shouldn't there be a requirement in preparing care and treatment plans (under Part 2 of the Measure) for advance directives and similar expressions of wish to be properly taken into account?

(Advance directives - sort of living wills - are written documents which describe what patients want to happen if at some time in the future they are judged to be suffering from a mental disorder in such a way that they are deemed unable to decide for themselves or to communicate effectively. They can inform others about what treatment they want or don't want from psychiatrists or other mental health professionals, and they can identify a person to whom they have given the authority to make decisions on their behalf).

This sounds right to me and the suggestion should not scare the Assembly Government as it is wholly reasonable and does not have significant cost implications. Advance directives do not just provide a practical way to plan for crisis or relapse; they can also provide an important means for the patient to feel in control of their lives even if the directive is not required; and interestingly directives can actually authorise more assertive action where otherwise professionals and carers might have held back - if that is what the patient wants. I have met several patients who report regaining insight following a bad episode, making sense of what has gone on, and wishing their supporters had "gone in harder": they can set that out in a directive.

The idea that people with a mental illness may be better placed to work things out is not new. In Measure for Measure (geddit?) Duke Vincentio reminds us Many that are not mad / Have, sure, more lack of reason.

If we can only get this Measure right it could really make a difference...

Imitating the Inimitable

An all-star cast do a business-like job (Victor Spinetti plays Victor Spinetti as usual) of this funny enough but corny piece. I may be wrong but I think the author was trying to imitate Joe Orton's satirical take on theatre and life in general but nobody can do ortonesque quite like Orton.

Legalisation?

There are both obvious and also disputed connections between the use of “recreational” drugs and serious mental illness.

Alcohol can cause psychosis and permanent, severe mental illness though this is normally associated with extreme abuse. More insidiously alcohol can exacerbate a serious mental illness and inhibit recovery – a very common experience.

Class A drugs like heroine and cocaine can also cause severe mental illness - permanently in some cases - and certainly these drugs can also exacerbate a serious mental illness and inhibit recovery.

In recent years cannabis has increasingly been identified as a potential cause of schizophrenia, though there is dispute over this with views ranging from (i) a direct causal effect, through (ii) a trigger for the illness among those already vulnerable, to (iii) scepticism about any link. Hafal’s view is that it is commonsense to avoid mind–altering recreational drugs if you already have a mental illness and other people should judge the evidence for themselves – cannabis has certainly not been proved to be safe.

I rehearse all this because of the news today (link here) that the outgoing President of the Royal College of Physicians, Sir Ian Gilmore, has called for decriminalisation of drugs and controlled legal supply. He points to the organised and petty crime associated with illegal supply and use as well as the health hazards arising from contaminated drugs, needles, etc.

Most reasonable people can see that prosecuting users of Class A drugs is something of a distraction from helping people to recover. In practice most users are not prosecuted anyway and if they are it does nothing to prevent their continuing use of drugs. However, not prosecuting users will not remove the uncontrolled criminal supply of drugs. The only plausible way to do this is for the government to permit supply of Class A drugs in a regulated but relatively free way – because if users can’t get what they want from an over–controlled legal supply then the illegal trade will continue to flourish alongside.

The respectable legalisation lobby (as distinct from the ghouls who celebrate drug use) points to the widely acknowledged failure of the law-enforcement approach and indeed nobody can pretend the law has made great progress in suppressing the supply and use of drugs.

But, consider, there are less that 0.5% of people in the U.K addicted to Class A drugs. Does anybody seriously believe that the percentage would not rise dramatically if such drugs were available legally? In common with most of my contemporaries when I was a student I smoked cannabis occasionally but never really found out where to buy it and so did not form a habit. I do not doubt that if Class A drugs had been available legally I and most of my friends would have at least experimented with them and no doubt some of us would have developed problems. I am pretty sure I would not do that now but that's because as the years go by you can better calculate the poor return for the risks taken.

A libertarian might argue that this is a matter for individual choice but in fact there is an established tradition of the state protecting citizens from dangerous choices; and society is entitled to make decisions based on the wider good and to protect the vulnerable, not least people with a mental illness. I like to think myself liberal and open to new ways of thinking but all I see in legalisation is misery for many more vulnerable people and a marked deterioration in the quality of life for all society.

So, hard though it may be, success lies not in freeing up the supply but in giving excellent support to those who have been overwhelmed by drugs. Most addicts have insight into their predicament either most of the time or sporadically. If they knew that there was a humane source of practical and personal support then they would be likely to seek out that help – this of course is not just speculation because good quality support arrangements have a track record of getting people clean. On the supply side I do not claim any great understanding of the policing problems but I feel sympathy with those citizens who want to challenge the fatalistic attitude of some law-enforcement agencies in respect of drug-dealing in their neighbourhood. How indeed can it be right that many people in a community know who is supplying drugs but no action is taken?

If you've got a problem talk to your GP or take a look here.

Pantisocracy

Hafal's chair Elin Jones points out John Cabot's Welsh connection Richard ap Meurig who bankrolled the Matthew's voyage to America (see last post) and, according to one tradition, gave his name to the continent (ap Meurig was anglicised to "Amerike"). Of course ap Meurig was only making doubly sure of Wales' claim to America since his fellow-countryman Prince Madog had founded a colony there in 1170 as evidenced by Welsh-speaking Indians in the Mid West whom 18th century European explorers stumbled across (did they offer their visitors tea and Welsh cakes?).

I have been to Fort Mountain, Georgia, where a plaque attributes curious stone fortifications to mediaeval Welsh castle-builders. Incidentally I also encountered a vast bear.

Conventional historians have poured scorn on the story of Madog but I have discovered unassailable proof: French explorer Pierre Gaultier de Varennes observed of the Indian tribe supposed to be descended from Madog's colony that their womenfolk were of "magnificent beauty". I defy anybody to gainsay this clear evidence and advise them to stay away from Wales if they do.

There is a Bristol connection to Madog too. Bristolian Robert Southey (another rare example of an English admirer of Welsh culture) wrote a lumbering Homeric poem about the Prince entitled Madoc in furtherance of his plan to establish an ideal, democratic society which he called a Pantisocracy (no, seriously, even if it sounds like your smalls drawer). Southey and his chum Samuel Taylor Coleridge (who probably had bipolar disorder - so there's the mental health excuse for this post) couldn't decide whether to set up this Utopia in America or Wales (not a bad shortlist, mind you) so it came to nothing. Southey also wrote the original Goldilocks story - more bears.

In The Summertime

A micro-triathlon this morning - 8k in the gym, cycle around Swansea Bay, and a dip in the sea off County Hall (a great spot at high tide). Swansea's sea festival is in full swing so the Matthew (replica of John Cabot's ship) is on a visit from its usual berth across the channel in Bristol (or "Brizzle" as I have learned to say on many happy visits to that excellent city. Bristol women also indiscriminately call men "my lover" - I'm surprised Cabot could find a crew to leave with him).

In the gym the TV options for those running on the spot are cricket (aaaargh), rolling music videos, or children's cartoons. SpongeBob it is then (what is he on?) until a break from tales of Bikini Bottom and I switch to see Shaggy and Rayvon performing "In The Summertime" (1995 - link here) which I haven't seen before but captures the mood of these Dog Days rather well. Its mild political incorrectness is really the same thing as the innocent prefeminism of the Mungo Jerry original (1970 - here) which of course everybody over 45 knows well.

Your Toothbrush, Sir?

Last night to Llandovery for a delightful meal with friends including a good discussion on alternative or complementary medicine. I can't be shaken from a position that all treatments, traditional or modern, herbal or chemical (if that distinction means anything), should be assessed against the same evidential standards for both efficacy and risk. It is the government's and its agencies' job to ensure that there is fair play in such assessment, taking care to see through the vested interests of the pharmaceutical industry and the retailers of herbal remedies alike; they should also not be swayed by the privileged media-exposure of high-profile amateurs like Prince Charles - there is no more reason to give weight to his view of homoeopathy (for example) than that of the valet who puts the toothpaste on HRH's brush.

Of course it's a free country and people should be able to take what they want to treat themselves so long as (i) the supplier does not make claims which are not substantiated by the evidence and (ii) the substance or treatment supplied does not pose risks at a threshold where it should be on prescription or banned altogether.

Consumer choice and opinion are often advanced as arguments to qualify the test of effectiveness but there are surely limits to this. I recollect a recent TV programme which demonstrated that big brand pain-killers were "more effective" because people believed in them more than the identical supermarket brand products. That may be so but you won't convince me that the NHS should pay £3 for a fancy-packaged version of something which is 16p in Asda (and indeed they don't). Rather we need to educate people not to be gulled by advertisements showing headaches dissolving diagrammatically before the grateful consumer joins their friends at the disco.

Hafal rightly promotes choice in both medical and non-medical treatments for mental illness (interestingly most of the popular alternative treatments are medical) but with a firm eye on the evidence. See our treatment guide here, including information on alternative or complementary options, and our recently-updated specialist guide on anti-psychotics here. We also facilitate where possible alternative or complementary treatments which our clients want. I recollect sampling aromatherapy in one of our services and can bear witness to the therapeutic value to my mental well-being (and this is supported by evidence) of getting a gentle massage from an engaging practitioner with a pleasing fragrance in the air. However, there is no compelling evidence of the effectiveness of aromatherapy per se.

Say "Cheese"

Some of the large crowd in Caerphilly yesterday smile for the camera at one of the most successful "Road to Recovery" events held so far this summer. Over 100 signed the post-card supporting the campaign and there was excellent public support and media coverage - congratulations to Nyree George and her team of volunteers and staff.

The national goals of the campaign are:

(1) Wales has recently been given the power to create new mental health legislation and the Assembly Government has introduced a draft "Measure" (Welsh law). Hafal Members would like the new law and accompanying regulations to give all people with a serious mental illness a legal right to a holistic care plan, and to set out all the areas the care plan should cover. We believe that care plans should include all the areas specified by the Welsh Code of Practice for the Mental Health Act, as follows: medical treatment; other forms of treatment including psychological therapies; personal care and physical well-being; accommodation; work and occupation; training and education; finance and money; social, cultural and spiritual aspects; parenting or caring relationships.

(2) We believe that in future all mental health services should be developed and delivered in response to individuals' care plans. This would mean giving each person a 'menu' of services to choose from so that they can exercise choice as much as possible in their recovery.

(3) Given the pressure on public spending, we want resources for mental health and social services to be fully protected – and for new resources to bring mental health services up to scratch.

In Caerphilly one of the local concerns added to this agenda was the need for better information on services. This a useful point. We know that services throughout Wales fall short of what is needed but many patients and families also lose out unnecessarily because they do not know - and are inadvertently not informed about - what is available to them. Hafal doesn't have the answer to the problem but this is a good moment to point people to our local networks (try the interactive map here) who will have a good overview of what's available in their county. Carers and families may want to follow the contact list here.

I like the "Hitchhiker's Guide to Recovery" theme in Caerphilly. Hafal has always used a lot of road transport imagery (even before the arrival of the microbus) precisely because it is often used by our clients to describe their progress. I was quite an accomplished hitch-hiker, once reaching the Mediterranean in the South of France in just a day with eight lifts from St Malo in spite of getting stuck in a local bus strike trying to get out of Nantes circa 1979. These days I'm more comfortable with my own wheels but would not rule out hitching again. My technique was: unaggressive, clean-looking clothes; a ruck-sack which suggests you might be walking some of the way; and relentless eye-contact. I suppose I should also say that it is quite high risk to give or take lifts and widely held not to be recommended, especially for young women: that seems unfair but in truth so few women hitch-hike alone that you might raise the risk by standing out. Actually I believe the greatest risk is from accidents since you don't know the competence of your driver and in my experience some drivers like to show off their driving "skills" or the performance of their vehicle. Around 1976 I and the son of the Lord Chief Justice of Hong Kong were hitching in a lorry which crushed a little Opel car just outside Bwlch - on that occasion it was the car-driver's fault. We didn't have seat-belts but were unhurt because the lorry didn't even slow down when we collided...

Tart

My previous posts on the summer rep in Swansea have been lukewarm or worse which might beg the question "why bother?". The truth is that I am a tart for live theatre and will put up with stuff that you would switch off on the telly. That's not out of loyalty but because live theatre is so exhilarating - even therapeutic - because you engage with and are part of the performance and bond with the performers and the rest of the audience. Most people don't go but they have forgotten or never experienced how different it is to the (literally) two-dimensional, detached viewing of film or TV.

Unsubsidised, populist theatre has to fight hard to find an audience between on the one hand the great mass of people who think theatre is not for them or even elitist and on the other hand the cultural snobs who look down on it and pretend to enjoy Ibsen. But for those in the know theatre, low, middle, or high brow, is a great tonic providing numerous highs like mini-holidays punctuating the dull passage of the year.

Last night's farce was dated and predictable, relying on the usual physical tomfoolery, flashes of ladies' underwear, improbable confusions of identity, and most of all that camp theatrical convention (so unlike real life) that the male characters are appalled at the prospect of sexual contact with very attractive female characters. Brilliant.

Time Limits

Further discussion with stakeholders confirms the view that the key to achieving an effective Mental Health Measure (Welsh law) now lies principally in ensuring that the subsidiary regulations and guidance have strong, prescriptive content giving real rights to patients to get their needs met. That's why the current consultation on the draft guidance on the Care Programme Approach is so important because it will form the basis of the Measure's regulations and guidance (see this post).

Nevertheless the impending opportunity to amend the Measure itself is important and three key priorities are emerging relating to Part 2 of the Measure covering people receiving secondary mental health services...

Patients would like to find a compromise on the question of time limits. They are concerned to see time limits for the periods both from referral by a GP for assessment for secondary mental health services to that assessment being carried out, and from recognition as a "relevant patient” (receiving secondary mental health services) to the completion of the required care plan. Our suggestion is to put on the face of the Measure a requirement for subsidiary guidance to provide timescales for different levels of urgency (for example, it could prescribe a very urgent timescale for those who have quite evident psychotic symptoms) on the basis that the timescales in the guidance would not be absolute but could be challenged in law if unreasonably not adhered to (actually we understand that this requirement to provide guidance on timescales might best fit under Part 5 of the Measure though the effect is to strengthen the substance of Part 2).

It would be reassuring to see in the Measure itself a requirement that the regulations in relation to the required care plan under Part 2 of the Measure should cover the nine "life areas" already prescribed in the Mental Health Act 1983 Code of Practice for Wales, as follows: Finance and Money; Accommodation; Personal care and physical wellbeing; Training and education; Work and occupation; Parenting or caring relationships; Social cultural and spiritual; Medical treatment; Other forms of treatment including psychological interventions.

On the face of the Measure we would also like to see the option for the Minister to prescribe a format for care plans become a requirement. It seems inconceivable that several different formats for care plans should be developed across Wales and our experience with local CPA plan formats is that they have tended to become lengthy and bureaucratic. This was born out by the Government's own study of CPA in Wales. The problem is not one of local services trying to make formats easy for themselves but, on the contrary, vast documents were produced with the best intentions but in practice making life difficult for both patients and practitioners.

We have shared our thoughts with key AMs and third sector colleagues and I will let you know how things proceed. Meanwhile everywhere I go I encounter active interest and practical suggestions from patients and families who have high expectations of the Measure as a platform for a new era in mental health services. If you have a view please don't hesitate to contact us (details here).

My gratuitous time-related picture features the incomparable star of the silent era Harold Lloyd (yes, you've guessed it, his great grandparents came from here). See the nerve-jangling stunts of this Welsh-American immortal from "Safety Last" (1923) here.

Llareggub

A bracing swim early morning at Pendine before the crowds arrive. The tide is already half way out so a long walk to the sea and on the way back I find the RNLI "Bay Watch" team setting up for the day with fancy yellow caps and boards to skim out and rescue you with. I bet there is competition for this job as it must give them an edge in the resort's apres-swim scene.

I now know why I have had blackberry mousse for pudding twice in the last few days. They are last year's from the bottom of the freezer and are making way for this year's, the first of which are encountered in Laugharne later in the morning walking round the headland. A picnic by the castle at low tide offers the spectacle of the muddy creek at the centre of the estuary staked out by herons and local fishermen (at a respectful distance) presumably both after flounder (muddy flavour but that won't worry the herons).

After lunch I walk alone this time up the estuary past Dylan Thomas' Boathouse and back through the town via Corran's second hand bookshop, much shrunk from the time when it filled various dilapidated buildings to the rear but I find a copy of poet Robert Nye's novel "Falstaff" (1976) which looks fun. I think that Nye, like Thomas Hardy, wrote novels to support his (less lucrative) poetry-writing? Nye has a Welsh connection having lived in North Wales until the 1970s and written on Celtic themes.

Brown's Hotel is closed and forlorn. The Thomas trail seems to be going cold. Maybe the Americans aren't coming as they used to, though it's always beaten me how anybody could romanticise the life of this selfish and feckless sponger even if his poetry deserves its fame. I enjoyed the recent film about him "The Edge of Love". It was hard not to sympathise with the poet's mistress's soldier husband when he machine-gunned the house in New Quay where Dylan is carrying on with his wife.

We must line up more treats before the summer runs out of time - you can already feel the autumnal air at night...

Here Be Dragons

The "Men of Gwent" appear at the Eisteddfod to show solidarity with the "Road to Recovery". Their youthful enthusiasm reminds me to reference here Hafal's recent work with young people. But first, and still on the Maes, Hafal Chair Elin Jones attended Children in Wales' Forum on Children and asked the panel (loose translations again):

You have all referred to those most vulnerable children as being in need of support, but in Hafal we are concerned for the most vulnerable of all, those at risk of developing a serious mental illness. At our recent Seminar attended by professionals from all relevant services as well as young people, the need for mainstream services to provide proper support for these children was identified as a priority. Do you agree, and if so, how should this be done at a time of cuts in finance?

Helen Mary Jones AM, Chair of the National Assembly’s Children and Young People Committee, accepted the need but felt that the plans to provide a nurse in every secondary school in Wales would be a positive step in this direction, together with the role of the school council in developing an understanding among both pupils and staff of the nature of mental illness. She thought that one teacher should have training in this field as well, and be responsible for knowing the details of the pupil’s circumstances and supporting them. She also felt that early identification of problems should help to prevent them from becoming worse, and that an important aspect of supporting children with mental health problems would be greater understanding by everyone that recovery from a serious mental illness is possible – it shouldn’t be seen as a life sentence.

Gwenda Thomas AM, Deputy Minister for Social Services, praised Hafal’s work in campaigning on behalf of this section of society, and agreed with Helen Mary. She also argued that the greater integration of services, being introduced next month, would help to improve the situation.

Dr Iolo Doull, speaking from the doctor’s standpoint, said the sooner the patient was seen, the less likely it was that serious problems would develop.

Siân Wyn Siencyn, Trinity University College, said the greater openness in education, the opportunities to learn and express feelings through play, and the greater willingness to listen to children and respect what they say can only help children to make their voices heard.

Hafal's report on our Seminar can be seen here and you can contact Gavin Williams, Hafal's Young People Lead, and John Gilheany, responsible for creating our Lottery-sponsored information for young people, at Hafal's Head Office (see this link).

Yeah but no but yeah but no but yeah...

I get out my wellies again for the Eisteddfod in Ebbw Vale where the microbus gleams in spite of a dust-bath only relieved by intermittent heavy showers. There is much interest in the “Road to Recovery” message along with increasing concern expressed by visitors about the looming funding difficulties for health and social care. The realisation is dawning fast among civic society and the public at large that great change is imminent. With this in mind Hafal’s Chair Elin Jones and staffer Jessica Wearing-Evans attend the “Yes” Referendum campaign meeting on the Maes and Elin bowls a googly at First Minister Carwyn Jones along these lines (very loose translation):

One argument for more powers to be devolved would be that the Mental Health Measure (Welsh law) could have been introduced two years earlier had it not required the palaver of an LCO processing through the UK Parliament first; but what people with a serious mental illness need to know is, whether or not powers are devolved, will you guarantee the ring-fence on NHS mental health spending fully – including the Continuing Healthcare funding used for the most seriously ill?

Elin’s question gets the biggest applause incidentally.



Carwyn responds positively that the Welsh Government’s good record as he sees it on mental health will be sustained. He also makes a general statement widely reported in the media today that a Yes vote will actually ensure a better financial deal for Wales as a whole – his argument seems to be that the UK Government won’t feel inclined to reform the Barnett formula if the Assembly can’t muster public support on the question of powers. The issues are not strictly connected at all (as Carwyn would no doubt acknowledge) and over night the UK Government has swiftly denied that the Referendum would affect their view on funding. However, he has a point about how respectful the UK Government might be of a Welsh Government which can't gain public support for more powers. I expect Hafal like Vicky Pollard will not form a definitive view on the Referendum but we will want to set out the arguments and encourage our stakeholders to get involved and vote.

Back to Elin’s question. It wouldn’t be fair to expect a detailed response from the First Minister at this meeting on the ring-fence issue but we need to pursue this. There is a strong suspicion that one area of NHS mental health spending is not being included inside the fence, that is the Continuing Healthcare funding used to purchase treatment and care for many people with more serious mental illnesses. I am meeting Welsh NHS bosses soon and hope to press this matter.

The Maes this year is a bit of a dog's breakfast surrounded by and even including islands of fenced-off industrial wreckage – I wonder if the organisers expected to find the site in this state when they booked it many months ago?

Implausible

Brian Clemens, writer of this week's repertory season play at the Swansea Grand, also wrote or produced the TV scripts for "The Avengers" and indulged the widespread taste for alluring and physical gamines by casting Honor Blackman, Diana Rigg, and the recently-canonised Joanna Lumley in the female role. Like the Avengers stories this play stretches the bounds of credibility to breaking point with bombs, shootings, feigned deaths, and contorted plot twists to the extent that you can only really take it as an absurd burlesque on the thriller/whodunnit genre. On that basis it was okay.

PIG Brings Home the Bacon

No peace for the wicked. While our virtuous Assembly Members head off for a long summer break in sunnier climes we miserable sinners are left in the drizzle with much to do in their absence. Two connected bits of work this August: first, the consultation on interim guidance on the Care Programme Approach, especially important because the presumption must be that this will form the basis of regulations or guidance on Part 2 of the Mental Health Measure which accords rights to a care plan for people in receipt of secondary mental health services; second, we should be considering possible amendments to the Measure which will continue its passage through the legislative process immediately on the return of the aforementioned relaxed and tanned AMs.

Actually the first matter may be more important, even if it sounds rather technical, because the Measure stands or falls on the extent to which it can create a platform for a consistent, methodical, and holistic pathway to recovery for people with a serious mental illness. At present only a minority of people who experience a serious mental illness are helped - or help themselves - to stabilise quickly following crisis and then take prompt action to reestablish their life plans. All too many instead endure years of stasis or, worse, deterioration, before finally finding the way ahead typically through a coincidence of their own determination and encountering professional or family help with unusual ambition for progress in place of the more usual fatalism. Unsurprisingly and sadly many do not ever find that way ahead because it is much too dependent on good luck.

The signs are good. All credit to the officials who have drafted the interim Policy Implementation Guidance (delightfully these documents are commonly referred to as "pigs"), incorporating clear principles about recovery and concrete requirements for holistic care and treatment plans. Many Hafal members are attending the consultation events later this month and will no doubt seek to reinforce the practical focus of the guidance and resist dilution or unnecessary complication. There are places still left at the consultation events and I would encourage users and carers to attend: if you contact us we can give you the details.

Love Apples

Contrary to what pedants will tell you (i) whales are big fish, (ii) Majorca's "j" is pronounced as the English "j" not "y", and (iii) tomatoes are vegetables not fruit. Hafal's Housing Manager Tracy Lee tells me that her greenhouse tomatoes have still not turned red and, to reassure her, I can report that several friends complain of the same problem. But never one to resist the opportunity to boast in horticultural matters please see evidence of Mrs Blog's success in overcoming the lack of sunshine (the green ones are for chutney). She says the clue is an early start with slow but solid growth in the Spring.