Milk, Polo Mints and Dunhill International

Last night I saw Submarine, the much-admired coming-of-age film set in 1980s Swansea. The plot concerns Oliver (Craig Roberts) trying to lose his virginity with Jordana (Yasmin Paige) before he turns 16 and preventing his mum leaving dad, a failed Open University ichthyologist, and running off with a ghastly New Age therapist.

The grimy estuarine beauty of bombed-out, shabbily-rebuilt, and kleptocratically-governed 20th century Swansea is captured well by first-time director Richard Ayoade, an added bonus for those of us who have an improbable affection for Wales' poor old second city. But the film is anyway very funny and moving so make sure you get there. Oliver describes his first kiss with Jordana as tasting of "milk, polo mints and Dunhill International" - don't we all remember the taste of a first kiss? - but blows the relationship by turning his focus towards his parents' problems.

The film is not about mental illness but this blog must of course highlight the references of which there are several...

Dad is taking medication for depression and exhibits middling-serious symptoms of passivity and self-neglect.

Jordana is tormented by eczema and has slightly alarming pyromaniacal tendencies but the former turns out to be caused by her dog rather than by psychological pressures and the latter looked to me like growing-up stuff which she'd probably get through.

Oliver discovers that his worried mum has bought a book on psychosis in children. He plays up to this by describing improbable delusions to her as a way (I assume) of keeping her away from his real issues which he correctly judges she wouldn't be able to help with. At the end of the film Oliver launches a criminal assault on the therapist's house which might easily have earned him a psychiatric assessment had the authorities been notified - though a fair-minded professional might have agreed with me that his actions formed a grounded and proportionate response to his vile antagonist's behaviour.

Mum is the one to worry about but she has no insight so hard to see the way forward there, though what appears to be a genuine reconciliation with dad may ease the way.

Will Oliver get his girl back at the end? You will have to go see. Plenty of seats at Vue Swansea where the ticket lady tells me "They don't like indie films round here".

Manifestly Sensible

A sneak preview of our Manifesto which will come out later this week. This is based squarely on the realistic and constructive suggestions of our Members who do not demand the earth but do believe that the lives of people with serious mental illness could be transformed if their ideas were taken up. And these ideas would not require investment of huge new resources, though they do need existing resources to be protected.

Here are the three things which patients say they are looking for from candidates and the political parties...


1. Protect funding for mental health

We need candidates’ assurance that they will fully protect resources for mental health, both NHS funding and funding provided to local authorities for mental health social care. We are calling on all candidates and all political parties to ensure that Health Boards and Local Authorities are held to account for their spending on mental health services, that any efficiency savings are re-invested back into mental health and that there is clear and transparent financial reporting of this.

2. Deliver on new mental health law and regulations

The Mental Health (Wales) Measure (the new mental health law) was passed last year with cross-party support. We need candidates’ assurance that the Measure will be delivered in full and that the Regulations and Code of Practice are developed with our rights in mind, ensuring that every person with a serious mental illness has an holistic care plan covering all areas of life.


3. Put patients in the driving seat

Service users and carers know that positive change is only possible if we roll up our sleeves and take charge both of our own circumstances and of wider services. We need candidates’ assurance that they will empower us to choose the services we personally receive and also to have a full say in developing policy and commissioning mental health services.


I will publish links to all our election stuff shortly.

Town and Country Mouse

This sunny and warm weather makes life both in town and country enjoyable and accordingly I have done a bit of both.

Yesterday I visited my tailor in Swansea (Messrs Primark in St Mary's Square - no appointment necessary) to buy some tee-shirts. I settle for plain colours and eschew the ones with messages. Now you tell me: if you wear a tee-shirt which says "Babe Magnet" or similar on it are you actually expecting it to attract women or is it an ironic joke for ugly blokes to amuse their mates with? No, really, I don't know.

After this I enjoy the ambient fruity perfume while buying stuff in Lush and then treat myself to a bacon and egg roll with tea in the sunshine overlooking the Marina.

Today by contrast I am in the countryside enjoying the evidence of spring - the early flowers are much advanced after these few warm days (see my two pics - no bluebells yet but give it a week) and the silence is broken by the ratatat of two woodpeckers.









The hour change is very welcome as now there are options for getting out after work which makes so much difference. For early birds like me it means getting up in the dark but it'll be light enough at 6 a.m. in about another two weeks.


Postscript:

Many will recognise the Town Mouse and Country Mouse as one of Aesop's tales. The idea is that the urban rodent scoffs at the frugal, uncosmopolitan hospitality of his peasant cousin but the latter finds the city unwelcoming and thoroughly dangerous. This strikes me as unfair to both milieus and surely the best option for mice and men is to make use of both town and country exploiting what they are each good for ("Mice and men" may ring a bell too but I'm stopping here as I don't want to go either to Rabbie Burns' silly poem or to Steinbeck's depressing novella).

Nervous Rex

Frenetic activity this week as we work simultaneously on the forthcoming election campaign, the consultation on the draft Mental Health Measure Regulations, and the advance publicity for our summer campaign "Taking the Wheel", the subject of this post.

We are really pleased to have joined forces with our friends in MDF the Bipolar Organisation and the Mental Health Foundation to support people with experience of serious mental illness to run this campaign which will take off in earnest immediately following the election in May and carry on with events and rallies every week until the end of September.

The campaign will engage people receiving secondary mental health services or who have serious mental illnesses such as schizophrenia, bipolar disorder and other diagnoses which typically require high levels of care.



As service-user led organisations Hafal and MDF the Bipolar Organisation Cymru will work in partnership with the Mental Health Foundation to support the campaign which will empower people with serious mental illness to:

• Take the driving seat in managing their own recovery from serious mental illness.

• Make use of their new rights under the Mental Health (Wales) Measure.

• Make choices about the care and treatment they receive - and who provides it.

• Develop and manage services themselves.

• Engage with the providers of mental health services so that they can get involved in planning and commissioning mental health services.

"Taking the Wheel" will feature a rally around Wales in our classic VW microbus with a number of regional and national events. 22 weekly events will take place from May to September, one in each county, and major displays will take place at the National Eisteddfod and Royal Welsh Show. At each event people will be able literally to ‘take the wheel' as they race in a camper van rally simulator which promises excitement and fun.

Now I've had a go on the simulator and was a bit sceptical beforehand but can report that the experience is utterly memorable and I staggered away giddy and, to be honest, a bit shell-shocked. You may sneer at my feeble impression of Nervous Rex but I dare you to have a go when it comes to your town! We will publish the dates and venues soon.

The Seminar launch of the campaign will explore ways in which service users can be empowered to take control of their own recovery and have their say on the services they receive.

"Taking the Wheel" will be launched just after the National Assembly Elections providing an excellent opportunity for service users and carers to engage in current mental health campaigning issues, challenging the new Government to ensure that:

● The Mental Health (Wales) Measure has a robust Code of Practice and Regulations.

● The Assembly Government's Annual Quality Framework target for full compliance by the NHS with the Care Programme Approach is fully implemented.

● There are sufficient resources for mental health services, and the mental health budget is protected.



Postscript:
For the less literary among you Nervous Rex is the timid and easily-scared friend of arch softie Walter, Dennis the Menace's routine target for mean tricks and general contempt. Dennis turned 60 last week and he is still rebelling weekly in the Beano. However, a few years ago he became less mean to Walter as the publishers worried that it looked a bit homophobic.
Unsure that this had cleared the matter up they then gave Walter a girl-friend which should have meant that Dennis could again beat him up without fear of opprobrium. But more recently and in a further wave of political correctness Dennis has ceased the fisticuffs and no longer carries offensive weapons. Dennis has even shown feelings for Minnie the Minx but the world would surely come to an end if that relationship took a serious turn.

Sue's View Queue

There has been a great response to Sue's View - our rolling campaign on the dry-and-dusty-sounding but actually very important matter of the draft Regulations for the Mental Health Measure. Over 100 people have already queued up to register their support and we will be sending on all the responses to the Assembly Government.

If you are going to make a detailed response to the consultation then don't forget to say that you support Sue's View; if you simply want to back up what Sue is saying then just write to us, or, if you are a group, you might like to collect signatures on Sue's new Response Form. The latest edition of Sue's View plus all the details about how to respond can be found on this Link.

Ballots and Bullets

Following extensive consultation Hafal will shortly be publishing its Assembly Election Manifesto in anticipation of the poll on 5 May 2011. Final details are being settled but let me rehearse some of the issues here.

Of course we need to quiz candidates and parties on the extent to which they are prepared to protect resources for mental health services (both NHS and local authority) and especially the funds needed for the most vulnerable, those using secondary mental health services, which presently require about 80% of mental-health-specific resources and will continue to need this level of support.

But resources aren’t everything. We are overdue for a new vision for mental health services and Hafal has been arguing for a long time that the best approach is to build a vision alongside the Mental Health Measure (which of course had cross-party support), in particular recognising the centrality of individual care planning for secondary mental health services and the use of such plans to promote a recovery-based approach.

It is probably too much to hope that political parties will set out a clear vision on mental health issues but we need to test their – and individual candidates’ – approach and specifically whether they are prepared to take on board the views of mental health patients and their families and to respect their choices.

Watch this space for more details – I will draw attention to the Manifesto when it comes out at the end of the month. Incidentally, if that seems quite late in the day then let me explain that all experience indicates that nobody is remotely interested in such things until just a few weeks before the election itself – so timing is everything!

Meanwhile, two more key questions ...

(1) Are there votes in mental health?

Quite apart from the detail of what we want from our politicians we need to flag up the political significance of mental health in these elections for both voters and candidates. Hafal has rightly made as much noise about this at previous elections as about the policy matters because we need to convince everybody involved that mental health can influence the outcome of elections, especially in Wales where the devolution settlement places a particular emphasis on health and social care in National Assembly elections.

Traditionally, it seems to me, mental health was discounted by politicians because they didn’t hear about it on the doorstep and at the hustings. Little wonder because of the stigma which would prevent people talking about mental health to their own families let alone at a public meeting. But this is changing, not least owing to Hafal’s efforts, and indeed we have seen much more about mental health in party manifestos in recent years as a result.

But we need to drive home this point and show that, in fact, mental health carries a heavy electoral punch if voters choose to exercise it. Consider: about one in thirty of us experience a serious mental illness in our lifetimes and it is not implausible to think that those people – and their close families and friends – would use their vote to support candidates who had an exceptional policy which would assist people with a serious mental illness.

(2) Does the Assembly election cover all the key issues for people with a serious mental illness?

The short answer is “no”.

The greatest concern of people with a serious mental illness and their families today is welfare benefits which are not a devolved area. We need to be sure that we are not deflected by the election from the challenge of influencing the current reform of both disability and general benefits. To this end Hafal has recently joined forces with other UK mental health campaigners to submit a response on reform to DLA and will do the same shortly on the Welfare Bill.

Criminal Justice is the other key non-devolved area and Hafal will be watching how the UK Government moves forward following consultation on its Green Paper "Breaking the Cycle". More about this in due course.


Postscript:

This year sees the 180th anniversary of the 1831 general election which saw riots and mayhem in the streets of Carmarthen. Tory candidate John Jones of Ystrad was injured in the violence and the election had to be postponed until August.

Carmarthen traditionally takes its elections very seriously, in the past not trusting simply to the boring ballot box but employing bribery, corruption and intimidation to give the whole business a zest quite absent from today's contests. The rioting was so customary that to this day the two main streets leading to the town centre are known as Red Street and Blue Street where supporters of the Whigs and Tories respectively would congregate on election day to exchange abuse and, not unusually, gunfire.

I suspect that amid this vigorous form of electioneering there was little attention paid to the attitudes of the candidates to improving mental health services but I am happy to be put right on that if you know better.

My own experience of Carmarthen's democratic traditions came during the 1983 election when I attended a brutal and combative hustings in the Civic Hall and fell over Labour leader Michael Foot during the cheese and wine afterwards. I would like to be able to report that this was due to a riot situation but in fact Footie was, like many politicians when you see them in the flesh, very short and I simply didn't see him - but he apologised to me which was generous in the circumstances.

5,000 Volts

I have received a few tuts from blog-readers about my apparent indolence at weekends, to which the only possible plea is a resounding "guilty". I take no credit in admitting a deep-seated horror of domestic chores of any kind and especially DIY projects. I'm not sure that I am necessarily bad at these jobs but I simply cannot muster the necessary Zen-like patience and application; in fact quite the reverse and I have been known to abandon small tasks for over a decade when some irritating obstacle wrecks the plan. For example there is a sawn plank sitting accusatorily in my shed which should have graced my "study" (a.k.a. second bedroom) as a neat bookshelf but fell foul of a rawl plug-related incident in 1997. One day I may get over it and try again.

However, sometimes needs must or, more specifically, Mrs Blog requires something to be done. In the safety of mid-winter I agreed to check out on Google how we might thwart Mrs B's arch-antagonist - the badger and his family who over the last three years have devastated our root vegetables (a row of carrots in particular attracts these nocturnal nuisances like a line of Bolivian attracts Charlie Sheen).

My preferred option was to borrow the neighbour's Russian 4-10 and stake out the veg patch at dusk fortified by a thermos of sweet tea. But, you've guessed it, it's illegal to blow away cuddly Mr Badger who appears to have cleverly got himself covered under the European Human Rights Act - not necessarily an insuperable hurdle but it is in this case as there are undoubtedly people in the street of the urban, animal-hugging tendency who would summon Dyfed-Powys' best as soon as they heard the surprisingly loud report of the light-weight Baikal pop-gun.

A long shot was to invite the Assembly Government's Minister of Agriculture Elin Jones to choose my garden for her notorious cull which was revived this week (see the story here) but she says she has her eye on Pembrokeshire.

So, the answer gleaned from the Internet is a 5,000 volt electric fence which I spend the day erecting. I avoid major expense by borrowing the fence materials from my brother and adapting an old set of car jump-leads to connect it up. The physicists among you may be interested to know that the fence only works if you literally earth the return connection in the soil (in my case using an old poker) and the current, being of such a vast voltage, can travel for a mile or more through the ground to complete the circuit and scare the sh*t out of the marauding mammal as he targets your precious crops. At least that's the theory.

For now at any rate the fence has done the trick: Mrs B gratefully shakes a mean Margarita which I enjoy while watching Wales whip the Irish against the odds as the sun goes down on an unusually industrious Saturday.


Postscript:
The least useful link which I found on Welsh badgers may be seen here.

Capital Result

The first WAG consultation event on the draft Regulations for the Mental Health (Wales) Measure took place in Cardiff on Monday. Gavin Williams, Hafal’s Young People’s Lead, attended and reports back:

“We put across our interest in the care planning aspects of the Measure. At present the Measure’s draft Regulations state that at least one holistic life area needs to be completed in a Care and Treatment Plan. The view from our service users and carers, which I put forward at the event, is that there needs to be a box to record eight life areas (accommodation, education and training, finance and money, medical and other forms of treatment including psychological interventions, parenting or caring relationships, personal care and physical well-being, social, cultural and spiritual, work and occupation) rather than a minimum of one and that all areas should be recorded for each individual.

This point was backed up by delegates who attended the event (there were about 50 in total) and put forward to the facilitators. Hopefully these events will lead to more effective care plans which will help service users to progress with their recovery.”

See more about this, including the rapidly growing "Sue's View" campaign, here.

Sue's View

Sue Barnes makes a useful suggestion in her article this month in the Western Mail. She invites readers to try out the 8 life areas specified by the new Mental Health Measure against their own experience...

The Measure says all patients receiving secondary mental health services have the right to a care plan and that the planned outcomes must relate to one or more of the following areas: accommodation; education and training; finance and money; medical and other forms of treatment, including psychological interventions; parenting or caring relationships; personal care and physical well being; social, cultural and spiritual and work and occupation.

It’s clear to see why care plans are so important.

Think how the areas above relate to you. Whether you have a mental illness or not, planning ahead in terms of your accommodation, your finance or your occupation is important.

Of course, for someone with a mental illness these considerations become more important still, as all of these areas have a considerable impact on our mental health.

For anyone, the biggest step to recovery of mental health may be finding a great place to live, getting a job, establishing a good relationship with their family, meeting new friends or identifying a professional who can help them work through their problems.

Read Sue's column in full here and visit the dedicated Sue's View pages on the Measure Regulations consultation here.

Celtic Arcadia

In the continuous and warm sunshine this weekend I make my way to Pwllgwaelod, the best beach below Dinas on the north Pembs coast, to play ducks and drakes in the still water lapping at low tide and walk up the steep Coast Path to view Fishguard to the west and the Preseli mountains south east. Then to the Sailors Safety, the famous ramshackle inn nestling right up against the shingle. I refuse to call it by its ugly and prosaic new name the "Old Sailors" and you just have to hope that in the fullness of time a new owner will revert to the correct title.

The pub is quite respectable now (with a fancy little restaurant section - roast dinner not great but I'm told the fish and chips is good) but used to have a bit of a reputation. Dylan Thomas inevitably visited and after his time I can remember different phases in its history including when it was a haunt for biker gangs (keep your back to the wall and don't catch any one's eye, still less talk to their girls!) and a long spell as the favourite local place for late drinking (in return for a monthly crate of bottled Bass a resident at the top of the long hill down to the beach would ring the landlord if the police were on the way).

On hot summer days you can lie languidly with your pint on the grass outside the pub, sheltered by Dinas Island to the north, and find yourself in a Celtic Arcadia very distant from the cares of modern Wales. In this weekend's weather that prospect seems a little nearer, reinforced by the early signs of spring - young leaves in those grassy stone walls unique to the far west presaging abundant colour from early May.

Twit

It is hardly surprising that drugs which dramatically affect the mind - in particular alcohol and other recreational drugs including cannabis, cocaine, and heroin - might "tip over" vulnerable people into mental illness for the first time or, if they have previous experience, into relapse. The research published this week (see our report with links here) certainly indicates this in relation to cannabis. Equally, the research indicates very clearly that the vast majority of cannabis users are not affected in this way; put another way you are very unlikely indeed to get a mental illness by using cannabis but it does appear to carry a very low but statistically validated risk.

So how should we respond? I suggest that there is a powerful argument for people with experience of mental illness (especially psychosis) to steer clear of mind-altering drugs, including alcohol in other than very moderate quantities, not so much because of this and other research but on the commonsense grounds that you want to give yourself the maximum chance to get well and stay well and there is bound to be some risk attached to taking drugs which artificially and unnaturally bend, alter, expand (call it what you will) your mind.

For those who have no significant experience of mental illness I don't think the new research changes anything much either. Anybody who thinks that taking recreational drugs, including alcohol, carries no risk of mental illness is a fool and they were before this and similar research was published. Most people won't be affected but of course some will and nobody knows in advance if they are one of the vulnerable people who will be affected, possibly in a devastating way. I've just given a quote to Wales on Sunday about that twit Charlie Sheen who has defiantly celebrated his addictions: now there is an example of somebody who has found out the hard way how these drugs can hurt you.

Is that an argument for total abstention? Of course not, any more than the significant and mortal risks of driving a car are a decisive reason not to drive cars. But you have to add up the risk and make an informed choice which may be a different choice from (for example) your choice to take the risk of driving cars around.

I don't think my choices about this are any more valid than yours but I'm happy to share my views which I suspect are very conventional. I don't think the possible rewards of taking cocaine or heroin are worth the risks so I won't be sampling those. I think alcohol remains obviously more risky than cannabis both for one's physical and mental health but, based on habit and the conventions of our society, I will remain one of the 90% plus of us who use this powerful drug.

I probably won't be taking cannabis much though, not because of the real but low risks but because its illegal status makes it inconvenient and undignified to source and I don't like the idea of enriching the nasty and often violent people who control supply. Also my own experience of using it is that, though it all seems very clever at the time, actually the drug tends to turn the user, while under its affect, into a crashing bore and it leaves no lasting memories of interest; by contrast alcohol, edgier, more unpredictable and potentially more dangerous in its affect, can stimulate interesting thought and interaction (as well as boring and circular nonsense of course!).

I would add though that as I get older it looks rather sad that we culturally depend so much on drugs - conventionally alcohol - as a necessary component of having a good time. I discussed this with a conservative, abstaining Muslim. He was very reluctant to pass any judgement, wanting to respect people's choice, but following a bit of pressure he admitted to wide-eyed disbelief and great sadness as he observes what most of us would see as the conventional recreational habits of our society especially at the weekend. To him it just looks like thoughtless mass hysteria. It does make you think...

...but, enough from me, have a good weekend whether you choose to do that "conventionally" or in your own way.

Vote for (Your) Mental Health

There has been worryingly little excitement about today's Referendum. This may well be because the constitutional change on which we are being consulted is not straightforward. It's not about whether devolution is a good idea or even whether we should move to the Scottish model (for example) but something in-between.

However, if you are reading this in time, do get out and vote not just because the issue matters or even to keep democracy alive and well but for the sake of your own mental health. How's that? Well, forgive me quoting myself from April last year...

Voting is good for the voter's own mental health. It’s not too much of a stretch to say that the scant majority of us who vote in elections are doing ourselves some good by feeling empowered in making the collective choice of those who govern us, perhaps thereby seeing them as our servants rather than our masters. By contrast those who cannot make a choice (in the many undemocratic countries of the world) can be unsettled psychologically by the sense of having limited control over their livelihoods and by repressed rage at that injustice. So do yourself a favour and cast your vote.

Though this was not exactly prophetic I think there has been ample evidence of the truth of what I said in the recent news from north Africa and the Middle East, both in the immense bravery of citizens taking on their repressors and in their ecstatic partying when they win the day - surely a huge catharsis of that repressed rage.

We should remember that this all started when a young street vendor called Mohamed Bouazizi (picture) set fire to himself because corrupt municipal jobsworths in Tunis were hindering him from earning a living because they knew that he couldn't do a damn thing to stop them. This kind of desperate response to disempowerment, turning his rage on the only thing over which he had some control (his own life), illustrates the inhumanity of political repression and, by contrast, the importance to our mental health of exercising political rights in countries where we are free to do so. It also echoes the importance of empowerment for specific groups within otherwise relatively free societies such as ours - patients of mental health services in particular come to mind.

The Welsh Referendum may seem a bit trivial compared with the struggles of our friends in Arabia but at least we are being asked and, I repeat, we should do ourselves the favour of responding.