Poleaxed

The secret of a good walk is not to make the mistake of using it to consider matters back at home or work (it doesn't help much, does it?) but instead to observe and contemplate what you see, hear, etc out on your walk.

Like last week I head for a castle, this time nearby Dinefwr with its fantastic view from the I8th c. gothic look-out stuck on top of the original keep. This is the stamping ground of local capo Rhys ap Thomas who, by throwing in his lot with Henry Tudor when his rebellion still looked pretty hopeless, thereby arguably drew a line under the whole Mediaeval era by assisting him to win at Bosworth. Rhys is believed to have personally dispatched Richard III with a poleaxe when he couldn't get any takers for his kingdom in return for a horse (should have tried e-Bay). After Bosworth the new Henry VII used Rhys as his enforcer to put down the remaining Yorkist rebellions while Henry himself transformed government irreversibly by oppressing his rivals fiscally - before Henry there was death, after Henry (and to this day) death and taxes. It is often said that it was Scots who made the British Empire but before that it was Welshmen who forged the modern British state.

I recall seeing an eccentric outdoor production of Richard III in Dinefwr Park where the king was played by a woman who, while soliloquising, would wander into the audience and pinch food and wine from our picnics. Nobody complained as she was quite imperious but there was some relief when she got the chop in Act v. It must also be the only production where the report that "Rice ap Thomas with a valiant crew" had joined the Lancastrian project got considerable applause from the parochially-minded (and evidently well-read) audience. I feel fairly neutral about the Wars of the Roses though I did once write "Harri am byth!" in very large letters in a "book of remembrance" placed in Bosworth Church by the ludicrous Richard the Third Society (I'm sorry - he did kill the Princes in the Tower as any fule kno).

Back home I see the annual debate on telly about the meaning of Hallowe'en between assorted hand-wringing bishops, cockney neo-pagan priests with cod-Celtic druidical titles, and the predictable whingers about "commercialisation" (big pumpkins 50p each in Lidl last week - if that's commercialisation bring it on). I'm surprised not to see Prof Dawkins weighing in to claim it for the atheists.

My picture shows the now roofless folly seen on top of the castle in the print above.

Law in Action

We are sending a briefing today to all Assembly Members urging them to go the extra mile to ensure that the Mental Health Measure (Welsh law) has teeth when they take it through the final plenary stage next Tuesday - see the briefing here.

There is a lot at stake. If, either through amendment and regulations or through the regulations alone (either way can work), we can prescribe unambigously what must be covered in all the individual care plans to which people with a serious mental illness will have a legal right, then we could be on the brink of establishing a unique, unprecedented legal platform for mental health services unequalled in the UK or (so far as I can see) anywhere in the world. The key life areas which will certainly appear in the regulations can be seen in the diagram I have posted - but there is a world of difference between requiring these 9 areas to be considered in drawing up care plans and requiring them to be addressed in writing: on this apparently slight distinction lies the difference between a helpful but unambitious law and a truly revolutionary and transforming one. I am not exaggerating!

We also need some clear but flexible guidance on timescales because a legal right to something at an unspecified time in the future isn't much of a legal right (actually it's not quite as bad as it sounds because delay could be challenged and a court could rule that delay as "unreasonable" - but how much better to be clear about what is expected!).

Final decisions on these crucial matters will not be made on Tuesday - we have to wait to see the draft regulations which follow - but this will be a key opportunity for Assembly Members to seek assurances about the Government's intentions for the regulations.

Next Tuesday will be an early outing for our new National Assembly lead Junaid Iqbal whom we have recently assigned to liaise with Assembly Members on two days a week. He and our National Service-User Champion Sue Barnes will be on hand to speak for patients and families and answer AMs' questions.

I should be so lucky - lucky lucky lucky!

Guess what? I've got tickets to see diminutive Welsh chanteuse Kylie next April at the O2 (what used to be the Millennium Dome, the object of all right-minded citizens' scorn, contempt, and rage). I am pretending that I am going under duress in order to maximise brownie points but really I am looking forward to it. The seats come with a warning that they are unsuitable for people without a head for heights so I will have to take care not to bop too vigorously and fall on top of others in the 20,000-strong mainly adolescent or gay crowd who my friends tell me make up Kylie's loyal following. Everybody has their own reasons for admiring La Minogue and I know mine (see picture).

Sound Advice

A long time ago I promised to set out the implications of the new UK government’s policies for people with a serious mental illness. The delay is not due to my indolence but because it has taken a long time to get a fix on what will really change and in fact the full implications are still not clear.

The Assembly Government’s overall budget has been set but we await details of how they will prioritise. In practice I suspect that they will in any case not prescribe priorities in enough detail so that we will still have to await the decisions of the NHS Local Health Boards and local authorities about priorities and funding for mental health services.

But we are getting more details on benefits and can begin to see the changes which will be experienced by individuals with a serious mental illness. For a simple summary of the proposals with links to more detail follow this link.

For all that there will be pressure on mental health services (and for some individual users of services this may be the most important matter) it is now clear that for most people with a serious mental illness the key concern must be changes to the benefits system. Even before the recent announcements Hafal has had contact with many individuals who have fallen foul of the substantial changes both to the rules and practice relating to Employment Support Allowance. In particular we have witnessed what amounts to oppression of some individuals with serious mental illness who are simply unable to work but have had their delicately-balanced lives disrupted by repeated reviews which fuel anxiety and paranoia in a wholly counter-productive way.

The announcements last week, not least the restrictions on housing benefits for people under 35, add to an anxiety that the principle of assuring a reasonable standard of living for all people with a serious mental illness may be under threat. However, the main issues seem to me still to lie in the rules, culture and interpretation of the system and the jury is still out on whether Iain Duncan Smith can find an approach which genuinely still provides for people with serious problems while meeting his ambitions both for cost-cutting and incentives to get people into work.

I’m not optimistic about this. The trouble is that there is a consensus about wanting rules which will not victimise people with a serious mental illness but nobody has found a way to ensure that the proper concern to expose inappropriate claims of disability and need does not lead to injustice and oppression. And the consequence of mistakes, even if cleared up later, are much greater for people with a mental illness because of the terrible irony that applying pressure to get people back into work can actually make them more ill, and therefore less likely to go to work.

In campaigning terms I cannot see common cause with a position which seeks to protect all present practice in relation to benefits. To do so is to invite the government to ignore what we have to say. An example of this is the Western Mail’s leading article following Iain Duncan Smith’s suggestion to unemployed people in Merthyr that they travel to Cardiff for work. The paper seemed to suggest that it was unreasonable to expect people to catch a bus at 7.55 am to go to work. I will not pass judgement on this but surely such an expectation stands no comparison with applying pressure and threats to the income of vulnerable and lonely people with florid schizophrenia, for example: we need to open the government’s eyes to those people’s needs – and to open the eyes of the likes of Atos Origin, the contractor which is reviewing ESA clients for the government and making a dog’s breakfast of far too many cases.

Hafal will certainly take up the challenge and we are already engaging with DWP to try to establish good practice in reviewing cases. We have also assisted hundreds of our clients this summer through our “Ease the Squeeze” campaign which included advice on ESA.

Patients may feel disempowered and frightened by the changes but I would strongly encourage them to take some control by seeking to establish where they personally stand, even if they have not so far experienced any change. You could do worse than visit your Citizens Advice Bureau or other advisor to check out how you might be affected and consider how you will respond to review and change. I’ve said before that the vital advice is to get help before responding to review processes. The clue to getting the right results is to engage both with a benefits specialist such as the Citizens Advice Bureau and also with a mental health organisation which understands your illness – and you need to involve your care coordinator, doctor or psychiatrist, making sure they understand the implications of what they may write or say on your behalf.

Postscript: nearly thirty years ago I worked for the CAB broadcasting snippets of advice on Swansea Sound. It was my first proper job after university and we had a lot of fun as well as benefiting from the CAB's matchless training. For shame I also recollect that there was a competition among us to see how much anxiety we could cause for the rather self-important disc jockeys who were super-sensitive about not upsetting their mainly female and middle-aged audience. I won by graphically describing on air certain grounds for divorce then still in statute which wouldn't raise an eyebrow today but sent the poor jock into apoplexy, gurning and gesticulating silently at me to stop, which I didn't of course. Happy days.

McDonalds

Q: What do Llansteffan Castle and the Barcelona branch of McDonalds have in common?

A: Both have repeatedly been attacked and occupied by the locals at times of political upheaval.

On an early Sunday morning walk in warm sunshine around the castle I contemplate that for the Norman General Infantryman a posting to Llansteffan meant drawing the short straw; and the extreme apprehension they must have experienced may be evidenced by the unusually large number of garderobes (toilets) still evident in the ruins. For the record the castle was captured by the Welsh in:-

1146 by Rhys ap Gruffydd
1189 by Rhys again
1215 by Llywelyn ab Iorwerth (the "Great")
1257 by Llywelyn ap Gruffydd (the "Last")
1403 by Owain Glyndwr (yes, him again)

My American friend Mike who lived in Barcelona says approvingly that the local McDonalds is systematically trashed during protests about anything including global capitalism, American imperialism, the environment, animal welfare, healthy eating, low pay, the Madrid government (?), etc. Not that McDonalds can be blamed in any way for any thing being an ethical business operating with scrupulous probity - and being an aggressive litigant in defence of its good name...

Welsh patriots may be heartened by their ancestors' successes in Llansteffan but I'm afraid the record does rather show a failure to consolidate, to put it mildly. I can't help thinking that these Welsh tough guys needed some sage advice from a mediaeval Peter Mandelson along the lines of:

1. Adopt your opponents' family policies (primogeniture in particular to avoid all that fratricidal faction)

2. Develop a rounded and credible defence policy (don't just rely on your doughty guerrilla longbowmen but build some warships and stop being outflanked by sea)

3. Deliver on your pledges to coalition partners (i.e. turn up on time for the Battle of Shrewsbury - see this post)

Eating our picnic on the beach below the castle (carrot soup, savoury muffins) I reflect that the Welsh did finally get the castle back (from the Ministry of Works) and it is presently free entry - but Cadw should consider the fate of previous occupiers before ever trying to charge.

Rhydaman

An easy drive to help launch our transformed Centre in Ammanford. I had briefly seen it since refurbishment work was completed but was still amazed and delighted, as was everyone else I'm sure, at the quality of the building and new furnishings. It was always a good building but that had been obscured by neglect until we bought it and got Bob the Builder in. The result is a light and airy space quite like an artist's studio with a very generous number of windows.

There is also evident enthusiasm to match our activities to the building, providing a range of training and recreational opportunities aimed at helping people to recover mental health and become more active members of the community. More on Hafal Carmarthenshire here.

I chat to Swansea City FC's Chairman Huw Jenkins who has joined the festivities, carefully not letting on that the only knowledge of the Club I have are the exploits of their mascot Cyril the Swan (see this post). The last time I attended a soccer game was 1979 in a sleepy hamlet in East Anglia. There was a total crowd of nine but under FA rules we still could not get a pint from the bar after the game started, presumably in case we rioted, attacked the opposing fans (an elderly couple with a dog), or went on the rampage in Downham Market. Mr Jenkins is pleased to hear that Hafal Deputy Chief Exec Alun Thomas has a season ticket and I was able to reassure him that he goes for the sport not in order to brawl with the Cardiff fans at their infamous derbies (or so Alun tells me).

Hafal Chair Elin Jones, who is here to launch the restored Centre, tells me she was involved in the St Teilo's church project which I was a little rude about (whoops, small world!) in this post. But so far from being annoyed Elin fills me in on the whole story and also expands my reference to Dafydd William who it seems nearly drowned while crossing the Loughor next to the church during a storm and was inspired by this experience to write the hymn in question. Personally I wouldn't have tried to cross this muddy, steep-banked and treacherous river at low tide and in calm conditions: fervent Methodist William must I feel have trusted to the Almighty rather than to any 18th c. risk assessment.

Mog Rule

I like cats and have one called Dusty (picture) who shares the house and garden accepting the food on offer in a "well, if it's here I'll eat it" kind of way which doesn't compromise her independence.

Like many pet owners I imagine Dusty having views on matters (a delusion known as the "pathetic fallacy") and in recent days I have believed she might agree with me that the prosecution of a lady called Mary Bale for popping a cat into a wheelie bin in a moment of madness was disproportionate and actually cruel, bringing shame on the authorities for their lack of compassion and slavery to mob rule (the internet was alive with death threats and other vile commentary). The cat was unharmed; the lady was in a bad place with her father seriously ill - he has died since; she had suffered terribly already from the heartless press maelstrom; and, little wonder, she is now suffering from depression.

Of course she did wrong but a wigging from the police would have sufficed surely. I couldn't help but feel distaste hearing on the radio the sanctimonious expression of "satisfaction" with the verdict and sentence from the RSPCA man, presumably wearing that special uniform they have (what's that all about?).

PIG in a poke?

Let me try to get you excited about something which sounds on the face of it humdrum and technical, namely the snappily-titled "Delivering the Care Programme Approach in Wales: Interim Policy Implementation Guidance" (or "PIG"). Now don't run away - I promise it will get more interesting.

This guidance is interim because it will be overtaken by the Mental Health Measure and accompanying regulations and Code of Practice. So doesn't that make it even less significant and yet more boring, Bill? Well, no, because in this stodgy-sounding publication hidden away in a distant corner of the vast WAG web-site you can...

SEE INTO THE FUTURE!

How so? Well it is my cynical guess that many patients will not notice much difference following publication of the Guidance (I hope I'm wrong but there you are) because it doesn't have the force of law and I suspect insufficient energy will be put into getting the Guidance out to care coordinators. There are also unpromising precedents: care plans prescribed under the Mental Health Act have not taken on board the requirements of the Code of Practice; further, WAG's now longstanding instruction that the Code (in particular chapter 14) should be used for all enhanced CPA plans has not been implemented.

However, the Guidance will form the basis of regulations under the Measure and therefore you can glimpse fairly accurately what the future holds for all patients receiving secondary mental health services. But will the Measure be implemented? Though there will surely be glitches and defaults I believe it will for two reasons: (i) the regulations will have the force of law; and (ii) the regulations will prescibe a format for care plans which will make it hard not to comply (though lip service will remain an enemy of course).

So what can patients expect? Assuming that the regulations don't get watered down then patients can look forward to a comprehensive, holistic care and treatment plan conforming to a national standard including prescribed content. It is worth quoting from the Guidance...

In all cases, care and treatment plans should be proportionate to the level of clinical need and input. The outcomes which mental health services are aiming to achieve should be set out, and the care and treatment plan should proportionately address each of the areas in the table set out below.

Service users with relatively straightforward needs may be able to take any necessary action alone in relation to several of the areas but it is important that this is still recorded: for example, if a service user has rented accommodation that is satisfactory and well managed by them, then it is sufficient simply to state that they will continue to maintain their tenancy. By contrast a service user with complex needs may need more detailed action recorded against several or indeed all of the areas. This methodical approach is important in order to maintain a holistic focus on recovery.

(click chart to enlarge)

You can begin to see the transformatory potential of the Measure. The care plans will not of course of themselves change the world but for the first time there would be a solid, high-quality platform on which to build. You can't sadly say that the Measure marks the end of the long journey towards a Wales with first class mental health services but at least it marks the start of that journey. This is no cat but a proper PIG in the poke - but we must ensure nobody tries to switch it for a cat.


Pedants' Corner...

The expression "to buy a pig in a poke" (meaning to be conned into buying what you think is a tasty suckling pig in a sack but then find it is a worthless cat) is common to many languages but usually, and perhaps more logically, the expression translates as "to buy a cat in a sack" ie what you actually get rather than what you think you are getting: for example the French is "acheter un chat dans un sac" and Welsh "prynu cath mewn cwd" (nice and compact that one). What do the Greeks have in common with the English that they too exceptionally use "pig" not "cat" ("αγοράζω γουρούνι στο σακκί")? And can it really be that across the world wily peasants were in the habit of trying to dupe buyers in this way? And were the buyers so universally gullible that they didn't look in the bag - or was there a conjuring trick to exchange bags? And does anybody care?

Marsh Mellow

A Sunday morning autumnal walk down the boggy Loughor estuary from Pontarddulais brings us to the ancient churchyard of St Teilo's, a place many of you will know and recognise but without realising it. It is the walled yard you can see over to the right from the M4 as you pass Swansea and hurtle across the river into Carmarthenshire.


The church itself was dismantled a few years ago and reappeared in the National History Museum, St Fagan's, leaving this magical place bereft and looking like one of those Mexican grave-yards with a white wall and arched entrance but not much inside.

Were they right to move it? Well, better than letting it fall
to pieces but far better to have restored it in situ. But that wasn't going to happen because its most attractive feature, its inaccessibility, meant visitor numbers would not justify repair. And its least attractive feature, the intrusive view and noise from the motorway, also condemned it.

I haven't seen it in its new location but to judge by the pictures the reconstruction (look here) of its alleged 16th c. appearance (which doesn't ring true to me but I'm no expert) does not have much soul.

I wonder what Dafydd William, 18c. Methodist hymn-writer who lived hard by the church, would have thought? There is an interesting topical echo here as it was William's hymn "Yn y dyfroedd mawr a’r tonnau" which the miners trapped below ground in the Tynewydd mining disaster sang in 1877 - and which their rescuers heard as they approached their desperate air-pocket. I wonder what the Chilean miners sang?

Civil Rights

To the Senedd for the launch of our new publication 12 Lives, a groundbreaking set of personal stories exposing the challenges faced by people with a serious mental illness, and our new Young Peoples' Information Hub including the "Road to Recovery" guide (follow Hub link for the on-line version), a distillation of Hafal's recovery methodology aimed at a younger audience and using the VW microbus extensively in its styling.

There is a fantastic buzz in the large crowd, especially from several of the "12-Lifers" who are present and clearly excited at the publication which has had an amazing reception already in the press and other media as well as from the movers and shakers.

Jonathan Morgan AM, author of the LCO which brought powers to the Assembly to legislate on mental health, launches “12 Lives” enthusiastically and praises the courage of the participants. Helen-Mary Jones AM, Chair of the Assembly's Children and Young People Committee, eloquently describes the need to engage effectively with young people in distress. Quite rightly there is emotion in the air.

Having indicated that they just want to talk to the AMs at the last minute the BBC’s Mark Hannaby interviews me too on their daily political show – see the result here (go to the 1 hr 8 minute point unless you want to hear Prime Minister’s Questions as well).

Dai Lloyd AM listens attentively as we brief him on our concern to ensure that care plans prescribed under the Measure are truly holistic. Sweeping the corridors I guide David Melding AM in our direction and briefly greet Health and Social Services Minister Edwina Hart AM.

From the Assembly Government, Phil Chick talks to Hafal Vice-Chair Chris Eastwood (also a 12-Lifer) about supporting people with a serious mental illness who have parenting responsibilities and Peter Meredith-Smith attends to network and check out the launch. I also meet Christine Jackson and Ian Mcgonagle from Lincoln University commissioned to create training materials on care planning in the light of the new Measure. Hafal staff include National Service User Champion Sue Barnes and Junaid Iqbal, recently tasked with taking forward our liaison with the National Assembly on two days a week. Jane Wycherley from the Mental Health Foundation, who assisted with 12 Lives as did MDF the Bipolar Organisation, lends support to the event alongside 12-Lifers Barry Dix and Tracey Saunders. Together with Jo Roberts, Jason Norris, John Hardy, and Leanne Kelly that makes 8 of the 12 present and they all get into animated discussion with the AMs and other visitors.

The mood is lightened when Helen-Mary Jones describes Jonathan Morgan as proof that “our Tories are nicer that their (she means the English) Tories” – there is of course no more dangerous thing than a compliment from your political opponents, especially combined with a swipe at your colleagues!

More pictures at Hafal's Facebook (not yet formally launched so get an early look now).

Let's give Helen-Mary Jones the last word in drawing the lessons about dealing with discrimination, too long seen as the business of spin-doctors or professional activists, however well-meaning:

"We’ve talked a lot over the last ten years about tackling stigma, but the truth is if we look at any successful civil rights movement, whether it’s black people in the USA, the women’s movement, or the disabled movement more widely, it is always the people themselves who set themselves free; and I see "12 Lives" as being absolutely in that tradition of people speaking out about the truth of their experience because that is what will change other people’s hearts and minds. I want to pay a tremendous amount of respect to the people who have had the courage to do that."

Magic

Following a long but successful day at the Senedd (post to follow) I'm not sure I wanted to sit through an opera but the tickets are already bought and I fortify myself in Wetherspoons with steak and kidney pudding, chips and peas along with other better-dressed but equally frugal Mozart aficionados.

When the curtain opens on WNO's Magic Flute we smile at the usual minimalist set (it seems the Arts Council grant - I mean our taxes - all goes on the talent). It is a skyscape with doors floating in the ether - very Magritte - but moments later a 40ft long, entirely
realistic, Daliesque lobster invades the stage in pursuit of the hero Tamino.

Later we learn from cast-members in the bar that Magritte was indeed in mind - it gets more obvious as the chorus all wear bowler-hats, though maybe that also refers to the freemasonry long thought to be a barely-concealed theme of this absurd but delightful comedy.

The styling is all good fun but Mozart properly prevails in a faithful and absolutely professional production. It is a democratic piece with no one part dominating but the Swansea crowd takes cowardly and lustful Papageno, a Christopher Biggins lookalike (actually Neal Davies), to their heart, though the gorgeous Pamina (Elizabeth Watts) gets my vote.

Rural Idyll?

Last night I saw the National Theatre production of "Lark Rise to Candleford" at the New Theatre, Cardiff. I only saw 5 minutes of the TV version because Dawn French hamming it up as an Oxfordshire yokel was actually more awful even than the Vicar of Dibley horror (no, really). This production predates the telly one - though its reappearance obviously cashes in on it - and it's a bit truer to the Flora Thompson books.

It was a slick and well-made production but I didn't like it much (as I knew I wouldn't - not my turn to pick a show) because for all its efforts not to present an idyllic rural world it nevertheless suggests a kind of heroism in adversity for late 19th c. farm labourers which is completely unbelievable. This morning on the box I see Claire Rayner has died and there is a clip of her illustrating her concern for the oppressed saying "Poverty is HORRIBLE!" and she could have added that poverty and injustice is at least as likely to make people embittered, selfish, and uninteresting as it is to make them thoughtful and idealistic.

If you want to understand rural poverty read R S Thomas, especially his Iago Prytherch poems which make you shudder at the repetition and near-pointlessness of labouring on a farm - and that was the 1940s! The fictional Iago does have a certain dignity in his timeless unity with the land but he wouldn't have appreciated anybody saying so as he shivers and spits in the fields. Even better try D J Williams' (picture) autobiographical Hen Dŷ Ffarm (1953) or Waldo Williams' translation of the same The Old Farmhouse (1961) (both out of print but you can find copies on Amazon - at least of the English version). This gives a completely truthful and unromantised (and therefore more moving) insight into rural life in Wales almost as long ago as "Lark Rise". My father pointed out the frail DJW to me doing his shopping at Fishguard market circa 1968, quite a link to the past.

I don't regret going out as we sample the eat-all-you-want for £13.99 menu at Zushi. After an effective charm offensive by Mrs B cooing at the expert knife-work the chef sportingly just passes the raw fish slices straight to us to save it the journey round on the conveyor belt (with attendant risk that some of the other mainly Japanese diners might grab it). Yum.

Mental Health Services and the "Big Society"

I had been contemplating the future of mental health services when I bumped into Peter Hain MP who knows Hafal well (our HQ is in his constituency). He seems reasonably chipper after losing the election for the shadow cabinet then getting back in anyway (still as shadow Secretary of State for Wales) on one of the wild-cards available to new leader Ed Miliband. He asks how things are and I say it's still mainly business as usual until the squeeze starts in earnest in April (as would have happened in some manner whoever was in power). We discuss the Tories' Big Society idea and I agree that it better not just mean the likes of Hafal delivering required services without the necessary resources.

Driving home I hear a torrid Question Time on Radio 4 with in-your-face historian David Starkey backing the Big Society concept, contrasting the Edmund Burke-style, bottom-up, self-help, "British" approach to social development with the "French Revolutionary", top-down, tax-driven model. Put like that the "Big Society" sounds like a good thing but Burke and his friends saw a much lesser role for the state than would be the consensus today (see Rowlandson's Burkian cartoon above which includes equality as an undesirable goal). The QT panel also identifies the problem of the voluntary sector having in large part become the vassals of the state, relying on statutory commissioning (guilty as charged to a significant extent, I'm afraid).

Interestingly there are varying noises from the Third Sector. NCVO complains about depressing times ahead while the Association of Chief Executives of Voluntary Organisations (of which I am a passive member) has been engaging enthusiastically though not unconditionally with the Big Society idea under the leadership of Stephen Bubb, a controversial but effective figure. Stephen's excellent paper on the function of the voluntary sector in the context of the Big Society can be seen here - required reading for anybody concerned with this issue.

President Kennedy is remembered for his own take on the Big Society, advising "Ask not what your country can do for you; ask what you can do for your country". But isn't it paradoxical for the government to ask us to take up certain responsibilities outside the government's agenda? That is a matter for us and there is a risk that we might be less responsive or even bloody-minded if cajoled by politicians to do our bit. Would JFK's words have been forgotten if he had served his time and American citizens had carried on doing just as much voluntary work as they felt like doing?

And what of mental health services? There has been a consensus since before Burke's time that there is a duty for the state to assist people with a serious mental illness (even if that used to mean the Poor Law, primitive asylums or the Workhouse - and, much earlier, Welsh "post-tribal" law codified by Hywel Dda exempted people with a mental illness from contributing to compensation). In more recent times (arguably only in the last 40 years) it has been accepted that people with lower level mental health problems should also be assisted, mainly through Primary Care. We certainly need to insist that the government continues to discharge its responsibilities for citizens experiencing problems at these levels, though they would do well to consider further commissioning of the voluntary and private sectors to deliver services on a test of best quality and value.

But what about the mental well-being of all citizens? We all at least occasionally have significantly troubled thoughts (and I don't just mean unhappiness brought on proportionately by life events). Arguably only about 20% of us (not including me!) are relatively untroubled by at least mild neuroses. Does the state have a role in addressing these matters? Those who manage mental health services increasingly believe so and I agree just to the extent that (i) the state needs to consider the effect of those policies and services for which it has responsibility on citizens' mental well-being and (ii) there is a case to be made to educate citizens about how to protect their own mental health and to help those around them who have problems. However, overwhelmingly these are matters not for government but for individuals, families and society at large.

Citizens should anyway be sceptical about the ability of the mental health establishment (and I include the Third Sector in this) to advise them on how to lead their lives. Such advice is often inappropriate because it finds unnecessary and unhelpful new language for issues which people could address more effectively on their own terms; alternatively the advice can be risibly patronising and obvious, for example letting people know that a walk in the countryside can promote a "sense of well-being" (indeed, and bears sh*t there too, I understand).

Nobel Cause

Good to see the Nobel Peace Prize going to imprisoned Chinese dissident Liu Xiaobo (see here). Predictably the thugs who run the dictatorship laughably called the "People's Republic" have reacted badly, calling in the Norwegian ambassador who patiently pointed out that the decision had nothing to do with his government - but of course these brutes are unable to comprehend any action not sanctioned by the state.

I have never taken much interest in human rights issues in China (and all credit to those who do in the teeth of the indifference of western governments which say little while sniffing for economic advantage) but I did once spontaneously take direct action on the matter. Back in the lead-up to the Beijing Olympics you may recall the human rights and pro-Tibet protests around the world as the Olympic Torch was paraded around. Furious at this affront the Chinese government orchestrated counter-demonstrations of loyal (ie terrified and compliant) overseas Chinese students, one of which I stumbled on in Queen Street, Cardiff, while shopping.

The assembled students were being choreographed by sinister marshals in suits and had placards saying "Hands off China" and suchlike nonsense suggesting it was unfair to complain about the Chinese government's contempt for democracy and the rule of law and their goons' routine use of imprisonment, beating, and torture on anybody who dares raise questions. I stopped and stared, finding it unbearable that this travesty should go unchallenged, and so I started to remonstrate "Shame on you! Shame on your police state!". I suppose I expected them to counter with their own arguments and was prepared to engage in a discussion but in fact their reaction was to go silent and reel back en masse at this verbal assault by what to them must have seemed like an irate giant armed with two Primark bags. I felt instantly guilty at upsetting these innocents and also noticed some stirring by the handful of bobbies keeping an eye. Sensing a possible "Breach of the Peace" situation I ducked back into the crowd and made my way to Zushi (great Japanese restaurant right at the eastern end of Queen Street).

Between mouthfuls of noodles and sashimi Mrs Blog, not impressed, thought I should have stood my ground, got arrested, and made an ironic point in court about their right to protest (and mine) in a free country, blah blah. I did ask my then boss (Hafal's previous Chair Peter Davey) how much trouble I would have been in but was reassured to find that he would happily have been on the barricade himself.

All fun and games which won't make any difference and a million miles from Liu Xiaobo languishing for 11 years in prison. Make a real difference by helping Amnesty International or similar.

The Scottish Play

I have had mainly bad experiences of Waterstone's "three for two" book offer. I end up with one or even two books I don't really want (Amazon is much better: since they made virtually all deliveries free you can buy paperbacks one at a time). But the offer can occasionally have the effect of making you read something you would not otherwise have looked at. This is the case with the book I am currently reading, Gyles Brandreth's Something Sensational to Read in the Train: The Diary of a Lifetime which was a third book hurriedly chosen.

Now I am reluctant to admit enjoying this book. I had thought Johnny Rotten spoke for the nation when, introduced at a party, he told Brandreth "F**k off, f**k-face". Rotten, evidently a man of good taste, must have had in mind the silly jumpers, teddy bear fetishism, breakfast telly lowest common denominator, and assorted trivial self-publicising stunts with which we associate the erstwhile Tory whip.

However, this memoir captures public life over the last 50 years brilliantly with a cast of characters ranging from Lord Longford (surely the only person in history who could hug a stark naked pole-dancer in a seedy club as an act of Christian piety without anybody doubting his motives) to Jeffrey Archer (say no more). Brandreth also hints not for the first time that he has the low-down on the private life of his friend Prince Philip - he's obviously aching to tell all when the old boy (and the Queen I guess) have passed into history. I admit it, it's all good fun. In fairness Brandreth also has a record of assisting prisoners and, on at least one occasion which he describes, people in mental hospitals.

I was interested in Brandreth's account of seeing Nicol Williamson playing Macbeth in Stratford in 1974. Enraged by schoolboys in the audience shuffling and gossiping Williamson hurled a stool across the stage and launched a self-righteous tirade at the offenders.

Well, as a schoolboy I saw this very production and can report that the characters all ludicrously spoke in dainty and "refined" Scottish accents ("Is this a dagger I see before me, Dr Finlay?", "Screw your courage to the sticking place, Miss Jean Brodie" etc). God knows what the director was thinking. Williamson should have realised that his audience had a point to make but maybe his mind was on Helen Mirren (gratuitous picture above) playing Lady M with whom he was then having a fling - we schoolboys might have been more interested if we had known this at the time (certainly the now famous Mirren sexual magnetism failed to draw us - that must have been the accent because it didn't take much at that age). For the record Williamson is a good actor, if notorious for his temper, and I saw him play Lear very movingly many years later in Cardiff.

I too have suffered the curse of the "Scottish Play". I played the lead in an avant-garde production where we recorded the script on a tape-recorder complete with sound-effects then played it back for the performance while miming the action in silhouette using a back-light and translucent sheeting. Sounds good doesn't it? We thought so too and were only disabused when, from the moment the curtain went up, the audience were convulsed with laughter and continued to weep with mirth for the duration. It was never spoken of again.

Come what come may, / Time and the hour runs through the roughest day.

Pearls of Wisdom

Everybody gets excited about the "positive symptoms" of serious mental illness, especially those associated with schizophrenia like loss of insight, delusions, and hallucinations. The risk-managers are worried about these symptoms; the public is intrigued by them and often afraid of them; the media define mental illness by reference to them; the "comedians" make fun of them; the pharmaceutical companies strive to suppress them; the psychiatrists are most interested in them; and families, understandably, are most distressed by them.

Patients too are obviously concerned with positive symptoms which can be deeply distressing and sometimes risky. However, long acquaintance with patients experiencing the range of positive and negative symptoms suggests to me that actually most of them are more concerned with negative symptoms because they affect their lives more damagingly. It is time to put the spotlight on looking for direct therapies and daily life strategies to address them more effectively.

To remind us what "negative symptoms" are here's a short list which covers the ground...

•Under-activity
•Slurred speech
•Low motivation
•Social withdrawal
•Emotional flattening
•Self-neglect

In practice this "passivity" can range from what a lay person might call "total shut-down" through to more familiar experiences like not being able to motivate oneself to get out of bed in the morning.

The problem is these symptoms don't excite or worry the professionals enough. Indeed it is still tacitly "acceptable" to increase passivity through use of medication if it suppresses positive symptoms. In other words it's a "result" to get the patient calmed down to the point where they don't do anything much - they can then be discharged and do nothing much in the community except grow lonely and depressed.

Little wonder that patients resist this approach. Patients tell us that much "non-compliance" with treatment regimes is not due to lack of insight but rather to rebellion against the well-meaning but unambitious goal of reducing positive symptoms at any cost.

This is definitely a case where it will fall to patients and families - not least Members of Hafal - to fight the cause for a better balance in treatment of symptoms, working with enlightened professionals who listen to what patients want and are prepared to manage risk and patient benefit in a proportionate way.

Look here for a simple explanation of the symptoms of schizophrenia; here for a treatments guide; and here for a guide to recovery.

Even if you do not share the Albanian people's reverence for Sir Norman Wisdom (who died yesterday) the opening sequence of "The Early Bird" (1965) may bring comfort in shared adversity to those who struggle to get up in the morning. See it here.

Swansea Swansong

The microbus rolled into Swansea to be welcomed by Lord Mayor Richard Lewis and Lady Mayoress Mrs Angela Lewis on the last of its 22 "official" county visits (actually it has got more freshly-scheduled events in October owing to popular demand). The reception in Swansea is fantastic, especially in view of the bad weather. Unlike the Ryder Cup the event is not disrupted by rain and 365 people sign up to the key campaigning messages...

• 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 wellbeing; accommodation; work and occupation; training and education; finance and money; social, cultural and spiritual aspects; and parenting or caring relationships.

• 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.

• 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.

Richard Timm, Chair of Swansea’s Hafal Partnership, added a local spin: “The event is promoting health and wellbeing and also highlighting the importance of self-management and recovery. Healthy food and drink alternatives are on offer throughout the day to show that healthy eating can be delicious. We’ve also organised a Tai Chi session, a bike ride and a carers’ walk".

Richard and colleagues supported by Practice Leader Steve Reynish have identified local issues concerning mental health service users in Swansea:

• Long waiting lists for talking therapies.

• The lack of sufficient supported housing for those with serious and enduring mental illness.

There will be many people to give credit to when the "Road to Recovery" tour finishes at Hafal's Autumn Conference on 11 November but I take this opportunity to extend our thanks especially to Morgan Williams and David Curtis, both volunteers at Hafal Bridgend, who have performed much of the behind-the-scenes work to prepare and set up the microbus displays alongside Andrew Macintosh as well as attending the events and greeting visitors.

Hafal's volunteers like Morgan and David, many of them also Members of Hafal and therefore in charge of the organisation's policy and governance, make all the difference in enabling Hafal not only to deliver its own local services but also to improve the lives of everybody who is affected by mental illness in Wales through our campaigning work.

Non Appearance

I have stretched the meaning of a "staycation" a little by spending three days fishing and walking on the St David's peninsula. I take a closer look at the familiar landmark of St Non's Well and Chapel a mile south of the City, marking the spot where St David was born to Non in a thunderstorm.

There isn't much there aside from some modern mariolatrous kitsch presumably erected by the RC retreat nearby along with a modern chapel now incongruously littered with New Age trash. The only ancient object apart from the ruinous walls of the old chapel is a stone with a simple cross in a circle. This is widely copied in descriptions of the site, which typically show a descending line below the circle - the bottom end of the crucifix as it were. But closer inspection suggests to me that this line is a cruder, later addition following a natural fault in the rock: you can see what I mean from my photo. This is significant as the simple cross confined within the circle strongly suggests a very early date in Celtic Christianity echoing similar imagery on the maritime highway from mainland Europe through the Irish sea up to the Scottish isles, plausibly a link to the early saints commemorated by tradition on this spot.

No luck with the fishing - I should have thrown a coin in Non's Well before I tackled up.

Postscript: checking my facts after writing this I note that the Pope on his recent visit used some water from Non's Well to bless a new mosaic of St David in Westminster Cathedral. For no good reason this reminds me of the job I had for a few days many years ago as a cleaner in the Cardinal Archbishop's palace at Westminster. Sadly no Da Vinci Code-style revelations to disclose but I did learn that toilets cannot be kept clean by simply giving them a visible dusting of Vim, a lesson pointedly conveyed by the housekeeper when the smell became unbearable. Perhaps water from the holy Well would have helped?

My second photo shows the view west from Caerfai towards Ramsey at dusk, with Grassholm just visible on the horizon to the left