Irritable Bullocks

Ever since Mrs Blog alighted at Wrexham station on Friday afternoon I have been in a frenetic whirlwind of weekend activities leaving me looking forward to the relative ease of the working week. In summary I have...

• Found a modest oasis in the gastronomic desert that is Wrexham (sorry, but I have been looking in vain for somewhere nice to eat here since the 1980s). The Eastern Sheraton restaurant in the town centre offers good Chinese food without heart-stressing levels of monosodium glutamate.

• Walked north of the Travelodge at Rhostyllen to discover the whereabouts of the Eisteddfod's Maes and explore the old iron-works on the Clywedog river.

• Visited Chester for the first time on Saturday, circumambulating its ancient walls and wondering at its unique split-level mediaeval shops (the "Chester Rows"). And it takes only a little imagination to conjure the Roman legionary fortress which still defines the lay-out of this extraordinary place.

• Wisely chose Italian chain Carluccio's for a fine lunch including an unusual penne pasta with cured sausage sauce.


• Spent a pleasurable three hours admiring RSC veteran Natalie Grady playing the sexiest ever Rosalind in "As You Like It" (which is saying something as Rosalind is Shakespeare's sexiest character) in Chester's Grosvenor Park. I don't know if she was as good - or as sexy - when she was in Coronation Street but I might have changed the habit of a life-time to find out. See the Guardian's review here.

• On Sunday crossed the Mersey by ferry from Birkenhead to Liverpool (my first visit) - thanks to Hafal's North Wales employment lead Janet Randles for suggesting this stylish means of transport.

• Admired some great works including a few first division (or in this city should I say "Premier League"?) impressionists in the Walker Gallery and raced past the usual corn you find in museums including a huge gallery full of rubbish "classical" Victorian sculpture. I also liked a Lucian Freud portrait from 1951 (topical as he died this month). His sitter apparently complained that his legs were too short, to which Freud tersely replied that his legs were indeed too short...




• Lunched agreeably at the Bistro Franc in Hanover Street. £8.95 for three courses including sea-bass, chicken chasseur, crème brûlée...Wow.

• Met the entire population of the city visiting the new Museum of Liverpool which opened this week. Interesting stuff but just a little self-congratulatory? Good to see the local crowd not taking some of the more sentimental bits too seriously. Also a section on Liverpool's Welsh community...




• Back in Wrexham scrambled up Bersham Colliery slag-heap - dusty, a little dangerous and, technically, a criminal offence but necessary as the Coal Board (or whatever its successor body is called) has failed to maintain the adjacent footpath which I was attempting to follow. On top of the tip there is a panoramic view over the fields where the sunny weather has prompted frantic haymaking. Finally chased out of a field (while on a legitimate footpath) by a herd of irritable bullocks.

...in fact everything except actually attend the Eisteddfod happening on my temporary doorstep - that treat is for tomorrow.

Safeguarding

To the launch of the excellent training film on safeguarding created by service-users in Wrexham supported by Hafal (see my post of 22 July below). The film was created in partnership with Wrexham Council and the Social Services Improvement Agency (SSIA)and will be used to train practitioners across Wales and beyond on the crucial issue of protecting vulnerable people from exploitation and abuse.

Health and Social Services Minister Lesley Griffiths, also of course the local Assembly Member here, commended the film fulsomely drawing attention to the professionalism of Hafal's Expert Patient Trainers who had made it. In my spot I tried to draw out the wider contribution which service-users could make in Wales, in particular to (i) making better use of the limited resources available for secondary mental health services and (ii) implementation of Part 2 of the Mental Health Measure next year - the only show in town at the moment. We will keep working on Lesley when she visits our stand at the Eisteddfod!

Tug-of-War

170 service users, carers and their families turned out yesterday to support the "Taking the Wheel" campaign at Hafal’s annual North Wales event held in the glorious setting of Eirias Park, Colwyn Bay. I am proud to report that my team won the tug-of-war competition which required four consecutive back-breaking contests: I am not sure whom to contact first - my doctor or my solicitor.

The campaign (see the details here) is empowering people with a serious mental illness in Wales to take control of their lives and the services they receive. It's been a big hit across Wales this summer not least at the Royal Welsh Show which took place last week. Following yesterday's event our intrepid team set off to put together our stand at the Eisteddfod starting this Saturday in Wrexham. By the end of the summer we will have held events in all 22 counties.

Thomas, a service user attending the annual North Wales Event for the second year running, told us: "I’m really interested in this idea of taking control of resources so I can purchase my own care package. This sounds really good to me because it not only means I would get a choice, but it would also keep services on their toes because they would have to convince me to choose what they have on offer. This could make all the difference because at the moment services often have a take-it-or-leave-it approach and they aren’t really incentivised to provide what we want." Quite so - only real consumer power will make services truly responsive.

The event has saw service users and carers from across North Wales take the opportunity to compete in a number of activities including Tai Chi, boules, kite-making, five-a-side football, a treasure hunt and of course the infamous tug-of-war.

Hafal's Janet Randles, who must take much credit for organising the event along with many colleagues and volunteers, said: "It's been a fun day out for clients, carers and staff as there’s been so much to do."

A Difficult Subject

The Norwegian Church in Cardiff this week

This morning on Radio 4 John Humphrys chaired a short debate about whether Anders Breivik, the self-confessed Norwegian homicide, was suffering from mental illness or acting rationally from extreme political convictions.

Of course this makes for uncomfortable listening but I do think it is important to consider what is undoubtedly being discussed informally across the world. People with a serious mental illness and those who support them need to join in the discussion carefully in order to avoid misunderstanding and the risk of increasing stigma.

Nobody knows whether Breivik is mentally ill at this stage (as I write his lawyer has just claimed that he "probably" is) but that will not stop the discussion nor will it diminish the confusion which affects many people about the different reasons why people act violently.

My contribution to this discussion is to challenge the widely-expressed view of pundits, politicians, and the public that it is “impossible to understand” why people act in this way. In fact, if people stop to think about it, it is possible to analyse rationally why people act violently.

Most people believe that there are circumstances which justify homicide – for example in just wars, under severe political oppression, or in self-defence. There are few true pacifists among us.

We know that political extremists who commit homicides typically feel justified by reference to some extreme peril which they believe faces “their people”, country, religion, or culture. This is usually unjustifiable but not incomprehensible because we can readily point to political homicides which we would justify. For example, many of the public would justify the actions of underground political cells (some enjoying little public support at the time) which violently attacked occupying Axis personnel in war-time Europe or the minority political establishment in pre-liberation South Africa. What we have to do is to differentiate the causes espoused by the French Resistance and the ANC from those of al Qaeda and those expressed in Breivik’s website. That is something we are all capable of doing; it is not mysterious and we do understand the difference.

I would argue that the motivations behind most of the small numbers of homicides committed by people with serious mental illness are also comprehensible.

A very few people by reason of psychosis have delusions which many of the public would, if they experienced them, agree might appear as a justification for homicide. Examples would be: paranoid delusions leading a person to believe that somebody else was about to kill them, leading to a homicide "justified" through self-defence; or delusions leading a person to believe that another person or persons had violent and evil intentions for all humankind and therefore, again, that homicide would be “justified” for the greater good. These and similar delusions are quite common in the very uncommon circumstances of homicides by people with a serious mental illness.

So how does understanding the reasons for these different sorts of homicide affect how we should respond to them?

In the case of political extremism society is entitled to pursue, convict, and punish humanely those who commit unjustifiable homicides even if the perpetrators believe they were right in what they did. Their wrong political judgement is not a reason for clemency.

In cases where people are led by their psychotic delusions to believe that a homicide is justified society is fully entitled to protect itself and so restrict the freedom of those people as long as they pose a real threat. However, logically there should also surely be a significant degree of compassion on the basis of “There but for the grace of God”. Severe mental illness can affect any of us – or our nearest and dearest – and none of us can be sure how we would act in extreme psychosis.

In reality the "impossible to understand" line is defensive because deep down we fear comparison of those who act violently with our own experience of anger, delusion, disproportionate responses to events, etc. But we would do better to acknowledge that we all have the potential for violence and so we can often understand very well (not necessarily the same thing as "sympathise with") those who act violently. Through that acknowledgement we could distinguish more clearly between those who act violently for political reasons and those who do so by reason of their mental illness - and thereby we could respond more appropriately and effectively to both.

Heroic

Up the Black Mountain this weekend to explore the derelict lime quarries and kilns accessible east off the scenic pass between Llangadog and Brynaman. The large number of inns in the tiny village of Llangadog is explained historically by the necessity for the waggoners collecting lime to stay two nights as it took a whole day to ascend the mountain, load the lime, and then descend back to the village.

The wagons were long gone but in the 1970s I joined in the heroic efforts of this still distinctive and self-contained community to keep all the pubs open through our determined custom. But that battle has been lost as the Plough Inn and, further up the mountain, the Three Horseshoes, Pont Aber, and New Inn are all gone - but not the memories of youthful adventures in all of them (not least in the Plough where I met for the first time a raven-haired local beauty who is now Mrs Blog but was then a welder in a satanic chain factory - also long gone - on the banks of the Sawdde).

Back up the mountain you can tell it must have been hard to work the quarries at such a great height though you can imagine some small comfort which the heat from the kilns would have given in winter. Dangerous work, too, as this memorial indicates:



I've soon had enough of this bleak industrial landscape. Halfway down an enterprising trailer in the car-park enables me to add to my "Five a Day" tally (or have I misunderstood this public health message?)...

Hafal Telly

I'm looking forward to meeting the new Health and Social Services Minister Lesley Griffiths AM next Friday when she will launch "Safeguarding for the protection of vulnerable adults", an educational DVD made by Hafal mental health service users and carers in conjunction with Wrexham Council and the Social Services Improvement Agency (SSIA). See more on this here.

The aim of the DVD is to provide information on safeguarding and to examine what the barriers to reporting abuse are. The film's message is: "Talk to somebody. Don't put up with it. Don't keep it to yourself. It's not OK."

I've had a sneak preview and it really works well, demonstrating that the best people to convey otherwise dusty and technical-sounding messages about protecting vulnerable adults are the people who are directly affected. Keep an eye on this brilliant group of service users who are making a reputation as excellent communicators as well as working really effectively with our colleagues in Wrexham to improve local mental health services.

Hafal's Wrexham Community Link Worker, Denise Charles, who was involved with the production of the DVD, tells me that the Minister is a good friend to Hafal in her constituency: "I'm delighted that Lesley is launching the DVD because she has been very supportive of Hafal in Wrexham. For example, last year she was interviewed by service users from our project for our newsletter, ‘Voice'. She later invited them to the Senedd on St David's Day this year where she treated them to a tour of the building and gave them VIP treatment."

Meanwhile our Royal Welsh stand has been a runaway success, even attracting its own choir (follow this link).

Barbarella

It's high summer (somebody please tell the Almighty) so it's time for the Swansea Grand's repertory season. The first offering is a nearly successful two-man thriller about an actor-producer who entraps, lectures at length, and then murders a drama critic who has dogged and wrecked his career. The critic suggests to his tormentor that he is suffering from serious mental illness and this is cheerfully acknowledged. However, this "madness" is just another example of lazy dramatic convention necessary to support the unlikely plot - so no mental health insights intended or delivered.

The play is full of bitter, excoriating criticism of critics in general which must surely be a personal matter for the (real) playwright, Tudor Gates (1930 - 2007), who had a very modest career as a telly and stage writer, failed as a Parliamentary candidate for the Liberals, but played a more successful role as a trade unionist in the creative field.

Gates' most prestigious billing was as one of several writers who stitched together the plot of science fiction pseudery "Barbarella" (1968), one of the silliest films ever made (the criticism of it may therefore have inspired Gates' play) but still well known for propelling a youthful Jane Fonda into stardom.

21 Windows, 22 Counties

Hafal Chair Elin Jones and Ceredigion manager Julian John (acting up as lead mechanic)

Our client-led campaign "Taking the Wheel", which is empowering people with a serious mental illness in Wales to take control of their lives and the services they receive, is storming the Royal Welsh Show this week.

The campaign features a rally around Wales in a classic VW microbus with 22 weekly events taking place from May to September, one in each of the 22 counties. We have already had a fantastic turnout at our stops in places such as Cardiff, Aberystwyth, Carmarthen and Caernarfon. It has really captured the public's imagination.

Visitors to the Royal Welsh are literally taking the wheel as they race in a camper van rally simulator. The campaign camper itself - a 1964, 21-window Samba sourced from Colorado and fully reconditioned with authentic parts - has already gained a huge amount of attention on its travels and is a terrific draw for the tens of thousands attending Wales' premier show.

The campaign, which runs until September, is engaging 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. Service-user led organisations Hafal and MDF the Bipolar Organisation Cymru are working 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 them

- 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

A word from our partners...

Sue Wigmore, Manager, MDF The Bipolar Organisation Cymru says: "MDF Bipolar is very excited to join forces on this user-led campaign which brings together the two mass membership organisations for patients with a serious mental illness in Wales, Hafal and MDF The Bipolar Organisation Cymru, along with our friends in the Foundation."

David Crepaz-Keay, Mental Health Foundation, says: "We are very pleased to be involved because we recognise how important it is that people with a serious mental illness take action to help themselves. We are delighted to support the campaign along with Hafal and MDF The Bipolar Organisation Cymru."

Constantinople?

My PC went on strike early last week (the chips got "chippy") but industrial relations have now been reestablished so I can catch up...

The "Taking the Wheel" campaign reached Gwynedd last week as the microbus and simulator van rolled up to lay siege to Caernarfon Castle. Hafal's Practice Leader Lesley Jones said: "We've had a good discussion on how people with a serious mental illness can take control of their lives." Some comments from clients who attended:-

"The most important factor in my recovery has been gaining independent housing. It has meant that I have been able to leave my parents' house and have more time for myself. I moved in just before Christmas. It's the first time I‘ve lived on my own since I was in college. I've learnt new housekeeping skills and I'm really enjoying it"

"The most empowering thing for me has been the friendship I have gained at Hafal's service. The feeling of community has saved my life a few times. Stigma and isolation have been a problem for me. Listening to and talking to the staff and meeting service users have helped me a lot"

"Learning IT and photography has helped me believe that I have the ability to do things I never thought I'd be able to do again"



Postscript:

Everybody is familiar with Edward I's most formidable castle in Wales. Its design - in particular the hexagonal walls and sandwiched layers of coloured stone - made a clear nod towards the legendary walls of Constantinople (previously Byzantium, latterly Istanbul). Respect is implied to the locals that keeping them in order required defences similar to those employed to defend the greatest city of the Middle Ages and the final flourishing of the Roman Empire whose walls were only finally breached in 1453 by the Ottomans - over 100 years after the Welsh castle was completed.

Elegiac

After a vigorous session on the running machine plus a less punishing swim in the unexpected sunshine I walk stiffly up to the ruins of Dryslwyn Castle.

There isn't much left of what was the most complex native-built castle in Wales. It was lost to the English in 1287 as a result of an unwise uprising by Rhys ap Maredudd which brought 11,000 of Edward I's troops down on him, though like many others the castle was taken by Glyndŵr over 100 years later and became a centre of his operations in South Wales for a while.

Today in warm sun the setting is lush and picturesque with stunning views east and west along the Towy Valley. I have also frequently climbed up here in winter when this is a gloomy and windswept spot, its crumbling remains an elegy to the ancient princedom of Deheubarth.



Standing on top of the ruins I also contemplate elegiacally the demise of the fairly ancient "News of the World", surely a great shame and completely out of proportion to the recent intrusions into people's lives (did anybody seriously imagine this didn't go on?).

We are moving into a period of oppression of press freedom to the delight of the rich and powerful and apparently with our acquiescence if not support. We should be careful. Press freedom should be preserved even at the risk of some distasteful activities by journalists. In fact the phone-hacking and alleged bribery of the police are already crimes - you don't need changes in regulations to deal with these matters.

We have recently found ourselves in the extraordinary position, as a consequence of rich and sometimes most unsavoury people using injunctions based on "rights to privacy" under European law, where it can be unlawful to tell the truth even though your information has been acquired legally. It isn't a defence to point out that the information might concern, for example, a powerful person routinely using prostitutes - people who are often seriously vulnerable owing to addiction to drugs, mental illness, control by violent pimps, or even people-trafficking (don't believe all that salacious bunk about posh tarts in control like "Belle de Jour").

With that sort of scandalous suppression of truth already going on are we seriously contemplating further protection of the "privacy" of politicians, rich celebrities and tycoons? Well, regardless of what we think, they are.



Postscript:

Lest you think me a tad prudish be assured that I'm not much bothered by less reprehensible, routine naughtiness, though I still don't think you need laws against publishing it. The late Alan Clark knew that the press couldn't hurt you (unless you'd done something really wicked) if you just laughed it off. He breezily survived this startling but entirely true revelation, for example...

Fearsome

The microbus continues the North Wales leg of its mighty 22 county odyssey, rolling up today at the Deeside Leisure Centre, Flintshire, along with our VW camper racing simulator which is so fearsome that it requires the Fire Brigade to stand by in case of emergency...



Hafal’s Family Liaison Co-ordinator Janet Fletcher reports that there was a good discussion on how carers can take control of their lives.

One carer who attended the event said: “Being a carer is extremely stressful and lonely at times. Having the opportunity to meet other carers at Hafal projects has enabled me to pursue different interests and develop new skills. It has given me the confidence to complete educational courses which broaden my horizons.

“Because of the training I have received, I now have the confidence to be fully involved with planning future services. I am now more aware of the influence my opinions have on service planners; one way I feel empowered is when I voice my views at carers’ strategy meetings.”

Janet added: “Carers are key supporters of the people they care for, people with a serious mental illness, as they work towards recovery.

“Hafal helped 1,400 mental health carers in Wales last year."

See Hafal's advice for carers here.

Great to see the Rt Hon David Hanson MP, a good friend of Hafal in North Wales, engaging enthusiastically with the simulator...

Defiance

Now an established fixture Hafal's Physical Health Awareness Day (universally known as "The Sports Day") has been an outstanding success with 250 attending the event at Neath Sports Centre today compared to last year's record-breaking 150. Once again we were especially delighted to welcome a large contingent of participants from three hospitals who enjoyed their active day out.

This partly reflects Hafal's recent spurt of growth in services but also the growing optimism of our clients who increasingly challenge the stereotyping of people with a serious mental illness as passive and sedentary.

You can still find people who should know better - including mental health professionals - saying things like "There's no point in trying to persuade people with schizophrenia to stop smoking - it's the least of their worries!" etc. It's that stereotyping which leads to people with a serious mental illness having a life expectancy 10 or 20 years below the average.

Fortunately many patients know that it is in their power to defy those glum statistics and enjoy life more in their defiance through anything from gentle walking through to five-a-side soccer.

You have nothing to lose except perhaps a little of your dignity as Hafal Chair Elin Jones sportingly illustrates...

Could Do Better

No great surprises in the Wales Audit Office's "school report" on mental health services in Wales released today (see here for the full report). "Could do better" is the predictable message.

The recommendations in the report are fair enough as far as they go but they don't recognise sufficiently that the "only show in town" for making decisive progress in mental health services is the Mental Health Measure. This has the potential to give much better focus not only on individuals' pathways to recovery but also on the planning and commissioning of mental health services generally.

In a nutshell around 80% of mental health resources are presently spent - and will continue to need to be spent - on secondary mental health services. The Measure means that all the patients receiving secondary services will have a standard-format Care and Treament Plan setting out their goals and the services required to achieve them, whether those services are a £300,000 a year high secure bed or a £3,000 a year, light-touch, community-based or peripatetic service.

Now if I was an LHB Director of Finance (or local authority equivalent) I'd be demanding that all spending on secondary mental health services must in future be justified squarely - and exclusively - on delivering those Care and Treatment Plans. On what other basis could any spending be justified? In saying this the DoF would have the support of patients who are fed up with being told "These are the services we provide - we must see how we fit you into them". The money should follow patients' Plans not the other way round.

My impression is that services have so far not sufficiently grasped the legal duty coming their way next year to negotiate the new Plans with individual patients. Still less have senior planners worked out the great opportunity which the Measure offers for them to focus secondary services efficiently and systematically where they are needed.

The Measure can truly be "win-win" for patients, their families, practitioners and senior planners but that will require getting on the front foot, not waiting for the legal duties to roll over them and then whinging about "additional workloads".

For our part Hafal means to help patients and their families to get on the front foot, embrace the Measure, and help the people helping them to make the most of the great opportunities which the Measure presents. The Welsh Government needs to awaken the NHS and social services not just to their new duties but also to those wider opportunities.

The other clear message from the report is that the evidence for protection of mental health resources through the "ring fence" isn't really there. We badly need consistent and transparent audit of NHS spending - too much discretion and opportunities for obfuscation are accorded to the LHBs' finance departments: now that's an area where the Directors of Finance won't have the support and confidence of patients until they clean up their act!

Let's hope mental health services pay attention to the report...

Slippery Freudian

It is very hot but I have enjoyed my week's holiday. Walking, fishing, and cycling have been the pattern, though today my plan to do the British Heart Foundation bike ride in Swansea is thwarted as the event is axed owing to the tyre fire which is still burning in Fforestfach after three weeks. I suppose this cancellation was absolutely necessary.

So instead I wander up the Towy, slowly as the afternoon sun is quite oppressive, noting the familiar pair of swans who patrol the mouth of the Breinant tributary and, for the first time, a large number of eels (Anguilla anguilla), some 2 ft long, evidently on their way back to the Sargasso sea to spawn.

Actually nobody is quite sure what eels get up to over their life-cycle. Aristotle decided they must be a mutation of earthworms which themselves must have just sprung from the mud. Nobody seriously challenged the Greek polymath until two hundred years ago but there are still lots of unanswered questions about these curious fish (including "Why do people eat jellied eels?" - even Aristotle would have struggled with that one).

But there is no doubt that the common eel played an important - no, vital - role in the development of psychiatry. Sigmund Freud's very first project as a student was to dissect hundreds of eels in a search for their sexual organs. He never found them and so, in disgust, turned his attention to other matters, namely the treatment of neurosis, the study of the unconscious mind, etc. The rest is history.

You have to wonder if Freud's painstaking but fruitless search for the eels' private parts might have caused him to focus obsessively on these matters when he changed over to psychiatry - I mean as a sort of transference or compensation for his earlier failure? Consider this: if his early project had instead involved him looking for the eel's nose then we might today believe that smell rather than sex was the driver at the root of our unconscious mind (forgive the simplistic if not parodic exegesis of the great man's theories). Not a wholly outlandish possibility as the aroma of roast chicken stuffed with whole cloves of garlic wafts up from the kitchen. I'm on my way, unable to restrain my nasal urges.