Stuck In The 1960s

Between social activities I have been reading the final volume of A N Wilson's history of modern Britain Our Times, which covers the coronation of the present Queen up to Gordon Brown's government. Deeply depressing stuff. Wilson skewers what he sees as a succession of charlatans and half-wits who have dominated the UK's political and social establishment in our times.

I don't agree with all that he says and there are some spectacular inaccuracies. His two pages on Welsh devolution are hopelessly wrong. He says that following his success in the 1966 by-election Gwynfor Evans lost to the Tories in the following election (he lost to Labour); more egregiously he suggests that Rhodri Morgan was Blair's placeman to be the first First Minister - it was of course Alun Michael and Rhodri, whom Blair couldn't abide, had to fight to supplant him.

However, much of what Wilson says is all too accurate. There is an especially good chapter on mental health which describes the familiar story of how Enoch Powell as Health Minister (and his successors of both government parties), keen to invest in a range of modern general hospitals, latched on to some trends in psychiatry in order to demolish traditional mental health institutions (to save money) then failed to replace them with modern, community-based services.

Those trends were substantially influenced, as we know, by the repellent patient-abuser R D Laing, the psychiatrist who turned all common sense about mental health on its head - and dealt with the inconvenience of opposition from families and carers by blaming them for causing the problems in the first place.

The extraordinary thing is the extent to which Laing's influence survives to this day where unreconstructed proponents of anti-psychiatry, still stuck in the 1960s, shun the word "illness" to describe such conditions as schizophrenia and continue to refuse to listen to the witness of carers and families.

The problem is that "traditional" psychiatry has also failed to listen to patients and families and so doesn't have the moral authority to challenge all this nonsense. There are excellent psychiatrists about these days - we in Hafal know several - but I do wish they would rigorously redefine their profession's function and their philosophical position on mental illness.

The latest trend among professionals in mental health is at least benign in intent but side-steps the difficult questions about mental illness to concentrate on a wider agenda about the whole population's "well-being". Now, I've no quarrel with a concern for everybody's happiness (though I hope we can all agree that mental health services should not take the lead on that agenda) but the challenge of assisting people with a mental illness remains - and so, therefore, does the need for the mental health charity Hafal.

Wilson usefully contrasts the baleful influence of the opinionated exploiter and "guru" Laing and his gullible followers with his exponentially more humble contemporary Rev Chad Varah who established the Samaritans after presiding at the funeral of a girl who committed suicide. The Samaritans have saved countless lives since.

And what distinguishes the Samaritans? (1) They were not set up by - or even influenced by - mental health services, and (2) Their entire approach is based on listening to people. Work it out - the two points are connected.

Theatre Monkey

I have enjoyed a "two-centre" Christmas holiday in Bristol (see me above admiring the giddy view from the Suspension Bridge) and Surrey, incorporating a visit to London...

At the National Portrait Gallery I take a look at Queen Anne and other luminaries from her time having recently read Anne Somerset's biography Queen Anne - the Politics of Passion. It is quite startling to see intimate, colourful and fresh images of these people from so long ago.

Incidentally, who else spotted the portrait lurking in the background when the Queen visited the Cabinet a few days ago? It was actually Anne's half-brother the "Old Pretender" who, if the Jacobites had had their way, would have stopped the Germans taking over the British royal family including the present monarch - is somebody trying to make a point?



On to the Aldwych Theatre to see the musical extravaganza Top Hat which is a great hoot. Best known as the Fred Astaire and Ginger Rogers film of 1935 this is frenetic escapism at its best - an appropriate tonic today as it was in the economic gloom of the 1930s. The set reminds me of something ... then I recall it is Guildford Cathedral also designed in 1935 with those familiar geometric lines - see this post.

Our seats are fantastic but only £14 (slip seats in the Grand Circle) in contrast to cramped £85 stalls. If you are at all interested in West End shows allow me to let you into a secret which is the brilliant web-site Theatre Monkey. This doesn't sell cheap tickets - look elswhere for those - but gives you the low-down on every seat in every theatre, including tips on unlikely ones which are often bargains.

The show has little serious to offer but Irving Berlin has clear advice on achieving "mental well-being", superior to any humourless NHS pamphlet and which works for me...

Heaven, I'm in Heaven,
And the cares that hang around me thro' the week
Seem to vanish like a gambler's lucky streak
When we're out together dancing, cheek to cheek.

Oh! I love to climb a mountain,
And to reach the highest peak,
But it doesn't thrill me half as much
As dancing cheek to cheek.

Quite right - you can get through the troubles of working Monday to Friday by climbing up Snowdon (or similar physical activity) and, above all, through exciting personal contact.

I snapped this picture looking west from Waterloo Bridge on the way home (click on the picture to expand)...

Sparrow-Sized Turkey

Not so much a New Testament Nativity as an Old Testament Flood as my picture of the Towy Valley shows. I'm sorry for those who are actually disrupted by the rain but I find apocalyptic weather oddly soothing as it puts one's personal daily challenges into a spectacular perspective, more so than news of dramatic human events (such as the long lost war in Afghanistan) because by contrast these examples of human folly seem close to home (though not literally so) and, I suppose, matters for which we are disturbingly responsible.

But enough of these musings. I'm up at 6 a.m. this morning for a croissant stuffed with ham and cheese and to open a present from Mrs Blog - a 225g tub of "Prince" shaving cream from Lush, with the strapline "Because no girl wants to be prickled by her prince". This is very welcome and it's in addition to a subscription to a scurrilous magazine which I already knew about. Mrs B is pleased with her presents too, the highlight being a blue scarf with a nautical motif and a pair of pliers for removing bones from fish.

And before I forget - Happy Christmas! And a special Happy Christmas to all Hafal's clients and their families and to Hafal's excellent staff, not least those working today.

A sparrow-sized turkey will be roasted later today but yesterday we had native oysters (this means the flat, meaty ones rather than the flimsier Portuguese-style ones which are equally good and better for beginners) followed by lobster risotto (using a frozen lobster from Lidl - £5.99 - see picture below). The recipe is originally from Bill Granger, the ever-smiling Australian chef, and I've refound it on this link - you can halve his ingredients to make two generous portions or four good starters using one Lidl lobster. It is worth taking the trouble to make the stock using the lobster shell - Mrs B does this but using a base of light, white fish stock. This a really delicate dish (no Parmesan please!) and you do need a nice clean starter to complement it - hence the oysters.

Sandy Hook

I have pointed out before that the United States has almost exactly 100 times the population of Wales (just over 300 million to Wales' just over 3 million) which makes the arithmetic relatively easy when comparing statistics.

There are probably many Welsh people who would not be surprised if they were told that there were two homicides involving firearms each week in Wales. This would be a small number in terms of personal risk. In other words it would scarcely constitute a reason to change behaviour or to buy life insurance; nor, being such a remote possibility, would it logically be a reason for living in fear, though of course fear isn't always logical.

In fact two homicides involving firearms a week emphatically do not occur in Wales - that is the number we would see if we had the same rate as the USA. In reality the numbers in Wales are so tiny that no one year is typical but, based on UK figures, we might average about 3 each year.

So homicides involving firearms are rare in the USA and over 30 times less likely in Wales, not a reason for panic in either country although, all other factors being equal, if the USA had the same gun controls as Wales then they might save nearly all the lives of people killed by guns each year - that's around 10,000 people.

I have always tried not to scoff at the (to us) eye-popping libertarian tendency of US citizens which finds its most improbable manifestation in the right to bear arms. Many US citizens consider UK subjects (a word they think apposite!) to be abjectly passive and feeble in preserving our liberties and they have a point - look at the apparent popularity of the Leveson Report's recommendation to reintroduce state controls on the UK press for the first time in 300 years.

So I listened carefully to what the USA's National Rifle Association had to say in today's press conference following the Sandy Hook tragedy. But they have nothing useful to say, predictably suggesting armed guards in schools so that they can "fight back".

Of course some of the homicides involving firearms in the USA are committed by people with a mental illness, including some of the most prominent and memorable tragedies. It may prove the case this time too - we'll see. It is just common sense that there will be far more homicides where firearms are readily available because there will always be people momentarily ungrounded by extreme anger, panic in the course of committing a crime, or indeed mental illness, for whom the availability of a firearm turns what would otherwise have been an ugly but unmemorable moment into a shocking tragedy which destroys the lives of both victims and perpetrators.

Incidentally 20,000 people take their own lives with firearms each year in the USA but I guess the wretched NRA is at ease about that too.

Spaghettini Alle Vongole

Some links for people with a mental illness and their families who want to have a good Christmas but may have some anxieties...

• For the NHS Choices advice on keeping healthy at Christmas go here

• And for their specific advice on keeping your cool during the festivities go here

• And for their advice for people alone at Christmas go here

• Some great tips from our friend Andrew McCulloch at the Mental Health Foundation can be seen posted on their Facebook site yesterday here

My view is that it is the pressure of expectations - one's own, other people's, and the media's - which lead to difficulty. Problems can then range from the trivial, such as disappointment that the big meal doesn't live up to Nigella's seemingly effortless version, through to the very serious, such as those who feel sad feeling even sadder and left out because "everybody" says you have to be jolly at Christmas.

In truth we are the same people at Christmas as we are the rest of the year. We don't become celebrity chefs magically and nor do we suddenly acquire contentment and happiness if we didn't have them in November.

So the clue is to be yourself - and true to yourself - rather than put on an act which will put you under strain and won't in the end please other people if they really care for you.

My final tip is ... sea-food. Traditional Christmas fare is very heavy and best confined to a small number of special meals. If you want to have other special meals over the holiday then why not invest in some cockles, prawns (regular or Dublin Bay), mussels, crab, lobster (quite affordable frozen ones in Lidl), or more exotic stuff like razor clams - not expensive on Swansea market. All these make lovely meals which contrast with the traditional stuff and can be a lot healthier. Take a look at your fishmonger or check out the fresh and frozen stuff in the supermarkets.


Try this Welsh Italian delight:-

Cook 8oz/200 grams spaghettini (thin spaghetti - available in supermarkets - you could use ordinary spaghetti but go with me on this one) according to the instructions on the packet in very salty water - don't overcook (spaghettini cooks very quickly) and so keep "al dente".

Meanwhile heat two tablespoons of olive oil in a frying pan, add finely chopped garlic to your taste and cook lightly, add a very tiny amount of chilli (the heat should only just be discernable in the final dish), add a splash of white wine if you've got it and boil off quickly, stir in up to 4 oz/100 grams cooked Welsh cockles and heat through for a few seconds, stir in the cooked, drained spaghettini and some chopped parsley, adjust seasoning (a grind of pepper perhaps) and serve.

This does two hearty meals or four substantial starters. Don't add parmesan as this would be a crime under Italian law (or should be). If you want to make it look good add a few cooked cockles in their shells to the mix. An inauthentic but very pleasant variation is to add some chopped bacon (fry in the oil before you add the garlic) and/or, if you need the comfort, stir in a blob of crème fraîche (but again don't tell the Italian food police). Yum.

Stinking Billy

Queen Anne and William, Duke of Gloucester - by Sir Godfrey Kneller

An active weekend - 12,000 steps on the pedometer on Saturday and 15,000 on Sunday - but I still found time on these long nights to finish reading Anne Somerset's biography of Queen Anne: The Politics of Passion .

I confess I didn't know much about the last of the Stuarts but this filled the gap. It was a hard slog because the politics is complex, not just the comings and goings of Whigs and Tories but the added problem of James II's son the "King over the Water" (Catholic/Jacobite version) otherwise known as the "Old Pretender" (Protestant/Hanoverian version) - so called because allegedly not a royal at all but a "supposititious" infant smuggled into the queen's bedroom in a bed-pan - and the inexplicable and ultimately pointless War of the Spanish Succession (Blenheim, Ramillies, Oudenarde, Malplaquet - all those battles won by the Duke of Marlborough). I said it was hard.

I suspect that this complexity is why students stick to the Tudors - much easier to understand! Also Anne was the first British monarch never to execute anybody for treason - noble on her part (especially in view of the provocation) but not so much fun for "Horrible Historians".

Somerset tries to make Anne seem her own woman but failed to convince me that she was more than a limited personality who mainly influenced policy through delays and obstruction rather than proactively. She was arguably therefore the first truly constitutional monarch whose ministers really ran the country. We've never looked back.

Not that her family was much better. I already knew that her father the deposed James II was a clot with tyrannical tendencies but I hadn't fully appreciated what a boorish and prickly character was his usurper (and Anne's brother-in-law) William II - also known as William of Orange or "Sweet William" (to Protestants/Hanoverians) or "Stinking Billy" (to Catholics/Jacobites).

But nobody comes out worse than the appalling Sarah, Duchess of Marlborough, who patronised and exploited Anne mercilessly and then betrayed her confidence and put it about that she was gay - a cruel "outing" in those days even if it had been true but it almost certainly wasn't.

Poor old Anne went through 17 pregnancies but was predeceased by all her children including William, Duke of Gloucester, who died aged 11 (you can see the signs of hydrocephalus which killed him in the picture above). Had he survived they wouldn't have had to import those Germans who still squat like cuckoos in the privileged nest of British monarchy.



Postscript:

20 years ago my Catholic friend Nick dragged me across Paris to Saint-Germain-en-Laye to look at the palace and memorials of the Jacobite court in exile which struggled on to launch the 1715 and 1745 rebellions and then slowly became objects of romanticism for Sir Walter Scott, Queen Victoria (oddly enough, given that she was their usurper's descendant), and latterly Hollywood (eg Errol Flynn in The Master of Ballantrae - 1953).

Interesting, but I wasn't moved. In truth they were a snooty and despotic lot without a care for ordinary citizens. The ones we ended up with instead may not be much better but they soon relinquished any major function in running the country so that today their successors' personal qualities and views of the world can be matters of indifference to us.


Postscript 2:

My Mum tells me that my story about the bigamous marriage (see this link) is incomplete: the mayor who inadvertently witnessed the illegal ceremony was also the daughter of the Archbishop of Canterbury. You couldn't make this up.

Downing Street "Domestic"

The drugs legalisation debate has started up again and overnight I read that this has turned into a "domestic" between the PM and Deputy PM who are scowling at each other across the Downing Street breakfast table - see the story here.

I am sceptical of some claims of a direct correlation between drug use and specific mental illnesses but I am in no doubt that drug use is a major contributor to mental health problems and a major obstacle preventing many people with a mental illness from recovering. However, I may be missing something but I cannot work out how legalisation could assist in diminishing drug use - which is surely everybody's objective aside from a few ghouls who celebrate intoxication and addiction.

Of course not legalising drugs doesn't mean authorities can't act proportionately. So, for example, most people agree that there is rarely any point in prosecuting individual users - and that is indeed the usual practice of the police. But the illegal status of drugs does give the authorities some leverage to push those who are at risk from their addiction towards treatment and recovery.

The illegal nature of supply obviously creates its own problems and risks and, yes, you could put a lot of criminals out of business and ensure some quality and safety standards if you permitted drugs to be freely and cheaply available - but who believes that would reduce drug use and addiction?

There appears to have been a small drop in drug use in recent years and that is to be welcomed. Nobody can claim that the decrease is because of hugely effective law enforcement but equally who doubts it would have gone up if drugs had been legalised?

The majority of people steer well clear of illegal drugs because (1) drugs are a bad idea, (2) they wouldn't readily know where to get hold of them, (3) they don't want to do business with criminals, and (4) they don't want to get into trouble with the law. Legalisation would cast doubt on reason (1) and wholly remove reasons (2), (3), and (4).

Drugs should remain illegal but we should recognise that law enforcement only keeps an unstable lid on the problem. Education for those not yet using drugs and for those who have started using, plus assertive treatment for addiction are the way ahead but nobody said it was going to be easy.

Register Office

St Cadog's Church, Llangadog

My father married hundreds of people. No, this is not a tale of wayward parenting and childhood woe - he had a Saturday job (in addition to his Monday to Friday one running a local authority) as a Superintendent Registrar which involved checking out couples' paperwork then marrying them at the Register Office (sic - it's not a "Registry Office").

He had some good stories including the occasion when a couple turned up without a witness: my dad suggested they pop out into the street and find a passer-by which they did and by chance it was the Mayor who sportingly came in and duly acted as a witness. Some time later it was discovered that the marriage was illegal because one of them was already married - cue small town embarrassment all round.

Perhaps it is memories of this that make me ponder the institution, especially in these times of debate about gay marriage. Personally I have no problems with gay marriage but I do have an unusual proposal which might assist the Prime Minister as he grapples with the antis. Why not just pull the state right out of marriage? There is very little legal meaning to marriage these days because the law quite rightly concentrates on the welfare of children and fairness between couples who separate whether or not there is a marriage.

Without state involvement churches or anybody else could "marry" people and give them any certificate they fancy - but none of it would have any state endorsement. What's to lose? Who wants or needs the state to validate their private decisions about who they want to live with and what ceremony or form of agreement they want to use? And there is a lot to gain - no need for Registrars, Register Offices and the state could give up all that pointless paperwork and concentrate on the issues of children's welfare and fairness on separation. And of course there would be no role for the state in considering who can and can't marry - that sounds right.

Just an idea.



Postscript:

I got married in church for reasons of form and tradition rather than faith, something which involved some economy with the truth when the future Mrs Blog and I were quizzed over tea and rich tea biscuits by a Trollopean Rural Dean who probably didn't believe our protestations of religious fervour (he'd never seen us before) but couldn't do much about it.

Of course English heterosexual sweethearts can force their Established Church parson to marry them even if they are paid-up Jedi Knights - the seventh most popular religion in the UK according to the 2011 census although worryingly at 176,000 adherents it has halved in 10 years. O tempora o mores!

Jerusalem

Imagine a time and a place in the future where people with a mental illness can choose which psychiatrist they go to and choose where they go for treatment and care - and where that choice isn't confined to the NHS but includes private and third sector provision too.

Quite a thought, eh? It could really shake things up not just because patients could get the help they want but mental health practitioners and services would be compelled to take notice of patients' wishes instead of just saying "here it is - take it or leave it" (or, if the patient is subject to the Mental Health Act, "take it whether you like it or not"). Patients could vote with their feet and services would have to work really hard to provide courteous, respectful, and effective services - because if they didn't they would go out of business.

"And what is the point of this day-dreaming about building Jerusalem, Bill?" I hear you ask. But it isn't a dream. That place is called England and the time when it happens is April 2014: see the story here.

Come on, Welsh Government, don't get left behind. You've done a good job with the Mental Health Measure but - read my lips - YOU WILL NEVER ACHIEVE EXCELLENT MENTAL HEALTH SERVICES IF YOU DON'T GIVE PATIENTS CHOICE AND CONTROL OVER THEIR TREATMENT AND CARE.



Postscript:

England's unofficial anthem "Jerusalem" is of course by William Blake who had some symptoms of schizophrenia, in particular vivid visions which he ascribed to God. Many of his contemporaries thought he was mad but the conventional wisdom these days is that he was just a genuine free thinker ahead of his time. I think he was probably both...

The music to which Blake's poem is set is by Sir Hubert Parry. I would like to be able to tell you that Parry was Welsh - and indeed many people think he was because of the name and because there are so many famous Welsh composers of hymns - but he wasn't.

I will not cease from mental fight,
Nor shall my sword sleep in my hand,
Till we have built Jerusalem
In England's green and pleasant land

What's In A Name?

Lots of interesting stuff coming out of the Inquiry into the Schizophrenia Label - see this link.

I don't inhabit the wilder shores of antipsychiatry but I do think there is quite a lot of hocus and dodgy science in psychiatric diagnosis - and schizophrenia is a case in point. It sounds (because it's Greek?) like a definitive diagnosis but in reality it depends on some rather arbitrary scoring of disparate symptoms which don't add up convincingly to a single, specific illness.

And yet... many of those who experience schizophrenia, their families, and those of us who work to support people with a serious mental illness know very well what schizophrenia is and it's obviously an illness even if we can't pin it down scientifically.

So I'm not sure I can agree with the Inquiry's view that "it is time to move away from psychiatric diagnoses and support people as fellow human beings rather than as people with a medical illness". This is in any case tendentious because of course you can give somebody a psychiatric diagnosis and also support them as a fellow human being. The serious question remains whether diagnosis makes sense and, on balance, I do think you have to give illnesses a name and indeed many patients draw comfort and understanding from knowing their illness is recognised, not unique to them, and that there are tried and tested treatments (however imperfect) and pathways to recovery. Of course the diagnosis of schizophrenia is very difficult to bear but calling it something else or nothing at all isn't going to make things better sadly.

What is needed is much greater honesty about the vagueness of the diagnosis and I certainly agree that attention needs to be placed on recognising and treating the specific symptoms of individual patients rather than focusing on the schizophrenia label - good psychiatrists do just that in our experience but there isn't consistent practice.

For an honest decription of the illness see Hafal's leaflet on schizophrenia here.



Postscript:

Many people will recognise this post's title from Romeo and Juliet (Act II Scene 2) -

What's in a name? that which we call a rose
By any other name would smell as sweet

Less well known is the immediately preceding half line -

O, be some other name!

So says Juliet wishing Romeo wasn't a Montague and some people would say the same about the schizophrenia label. But, as with the rose, name changes don't alter the reality.

Crime-Fighting Dentist

People with a serious mental illness are frequently victims of crime on the streets of Wales for a host of reasons:-

• Bullies who know about their illness may pick on them as easy targets

• Thieves may similarly mark them down as targets

• The stigma of mental illness can lead to hostility based on irrational fears

• Odd behaviour - talking to oneself, involuntary movements and facial expressions (often the result of medication) - can draw unwelcome attention

• If patients are "ungrounded" or over-confident (for example when on a "high") they may make poor judgements when communicating with strangers

• Genuine misunderstandings can occur if somebody is suffering illusions - not that this excuses a criminal response

• Homeless people - many of whom have a mental illness - are disproportionately exposed to crime

Sadly a high proportion of patients and their carers have stories about low level assaults and occasionally about much nastier events. For this reason we should take a lively interest in schemes to reduce violence on our streets and in that spirit we should celebrate the work of Professor Jonathan Shepherd of Cardiff University who is making a name for himself in this field. Today it is widely reported that the authorities in Amsterdam have beaten a path to his door to find out how to reduce the effects of violence in the Dutch capital.

So is Prof Shepherd a criminologist or high-tech security expert? Indeed not - he is actually a dentist. But we shouldn't be so surprised as it is dentists who see the results of all too many violent assaults where teeth, jaws and mouths are so often damaged. The professor's brain-wave was to suggest looking into where his patients got hurt in the first instance (these assaults are often not reported) and share that with the police and others so that the problem can be addressed in an intelligent, targeted way. This approach has already been taken up across England and Wales.

The results are impressive. See the story here and the professor's web page here: note that he has got the psychiatrists and psychologists aboard his team too.

Welsh Blamed For World War

I recently commended A N Wilson's brilliant history The Elizabethans - see this post - and this led me to log onto Amazon (I know, I shouldn't because they aren't paying enough tax) to buy and read his substantial history of the first 50 years of the 20th century After The Victorians: The World Our Parents Knew .

Wilson famously annoys many people and he certainly enjoys being a bit naughty about iconic if not saintly people and institutions. Wilson doesn't ignore Wales and he must be the first historian to suggest that the Welsh Disestablishment movement was one cause of the First World War - in as much as the British Government saw it as one of a number of threats to the British Empire which might usefully be placed to one side if war was enjoined, notwithstanding the fact that Disestablishment was achieved under the Welsh Church Act in 1914.

My family is entirely innocent in this, I should say, as my grandfather was a leading proponent of Antidisestablishmentarianism. I had wondered uncharitably if he might have been motivated in part by the £800 a year plus elegant house which he enjoyed as vicar of Ammanford but it is good to know that he was actually attempting to prevent the satanic forces of Welsh Nonconformism from precipitating a holocaust on the fields of Northern France.

Conversely one might note (Wilson doesn't) that the only serious popular opposition in Britain to the war in 1914 came not from international labour solidarity (as some expected but in reality all those ties between workers evaporated instantaneously) but from...Welsh Nonconformism, the pacifist instincts of which were only with difficulty overwhelmed by the old goat Lloyd George himself.

Wilson also doesn't shy from mentioning the anti-Jewish riots in the Valleys in 1911, something not much discussed today because they upset the saccharine and false memory of an idyllic solidarity in those communities in the industrial age, a mythic fantasy according to which the only conflict was with capitalists. Sadly poverty and oppression don't necessarily make people nice to one another.


My picture shows a detail from Guildford Cathedral (1936) which I visited last weekend having read about it in Wilson's book.

Beau Geste

Last week I attended the annual conference of my "trade union", that is the Association of Chief Executives of Voluntary Organisations. You might expect this to be a gathering of progressive, bleeding-heart liberals but actually they are quite business-like - and literally look and sound like business people as I suppose we are. ACEVO's eccentric but effective Chief Exec Stephen Bubb was knighted a year ago adding to the Establishment feel of the organisation.

It is valuable to catch up with colleagues as you can learn from the successful ones and discreetly take selfish comfort from listening to the ones who have come a cropper - and take note how to avoid the same pitfalls.

My Mum had been talking to me the night before about the recently-published Counting One's Blessings: Selected Letters of Queen Elizabeth the Queen Mother edited by William Shawcross (I think my Mum thinks I have been a bit rude about the late Queen Mum - see this post - whereas the letters apparently show she had some sense and sensitivity).

Anyway, at the conference the same William Shawcross shows up because he's the new Chairman of the Charity Commission. In his speech he suggests that the Commission is going to desist from taking a look at whether certain religious groups actually do society any good. I don't agree at all as I think the Commission should indeed take a long, hard look. I'm not thinking of the poor old embattled C. of E., Catholics, Muslims, etc but those disturbing cults you can't name because they sue on the least provocation.

He also indicates he wants to reestablish the principle that charity is essentially about private philanthropy. When he takes questions I challenge this because he ignores the modern phenomenon of charities using statutory funding to deliver services when they are the best people to do this, especially if led by their beneficiary group (like the exemplary Welsh mental health charity Hafal). He replies reassuringly about "just taking a look" but we must keep an eye on this. Of course there are great charities which depend on private donations but also suspect ones which spend too much on seeking those donations. Charities are not morally superior because privately funded. Good to see Sir Stephen agrees with me - see this link.

We also hear an amusing speech on "Leadership Under Pressure" from Corporal Johnson Beharry VC. I'm not sure if his compelling story of derring-do will help me much practically when I come under pressure in my job but I now have some tips about what to do if I ever find myself driving an armoured car into a Taliban ambush in Afghanistan - unlikely in terms of risk management but it's as well to be prepared.



Beharry's story is not the stuff of classic, one-dimensional Beau Geste nonsense but truly a tale of redemption following a startlingly misspent youth. He has also spoken out frankly about his mental health problems and the need for better mental health care for soldiers and veterans.

The conference is next to the Tower of London, enabling me to take this picture with the Shard behind...

Star Chamber

Is the Welsh NHS in serious financial trouble? I don't mean in terms of not having as much money as it would like (that would not be news!) but rather is it living within its means?

I'm not a health economist but I think there is cause to worry. Today the head of the Welsh NHS David Sissling has sought to reassure us by letting us know he's stuffed a big wad of fivers (£50 million) under the mattress in case things get sticky - see the story here. But the Wales Audit Office has said there could be as much as a £130 million deficit by the end of this financial year. Meanwhile only a few days ago the Assembly's Finance Committee expressed extreme scepticism about the Local Health Boards' ability to stay within budget this year.

I suppose we should be reassured by Mr Sissling's prudence in setting money aside but the trouble is that the LHBs know about it and will find it difficult to resist spending it even before it has been allocated. This runs the risk of resulting in that perennial unfairness where a well-run LHB can end up getting less money overall than a badly-run one - talk about perverse incentives!

It is reassuring that the Minister is talking about three year strategic budgets which could make for better planning but there is no substitute for rigorous control and holding LHBs - and their Chiefs and Directors of Finance in particular - to the fire when it comes to financial management.

I trust Mr Sissling will grill senior NHS execs mercilessly in his Star Chamber to ensure compliance with budgets. It just isn't acceptable for NHS organisations to overspend - by so doing they don't enhance health care but damage it, skew priorities, and make more work and waste more resources in sorting it out.

All this reinforces my view that the ring-fence around NHS funding for mental health services is vital and we need to see transparency and consistent adherence to the ring-fence across Wales. This will take time but meanwhile if anybody notes any reduction or withdrawal of NHS funding from any mental health service (however much that may be justified) they should immediately challenge the LHB concerned to explain what other mental health service (enhanced or new) will be the beneficiary of that saving. Don't accept any argument that "mental health has to contribute its share of the savings we have to make" - the ring-fence makes it clear that the funding for mental health cannot be reduced.

For clarity the ring-fence does not (and should not) protect all existing services - some of which may need to give way to new priorities in mental health - but it does protect the funding - hence my point that the LHB must have answers to the questions which I suggest you ask.

Oh, and let us know if you hear about withdrawal of funding so we can also raise those questions...



See below this Blog's favourite monarch, canny Welshman Henry VII, presiding in his Star Chamber which he used to shake down the English aristocracy in order to enhance public expenditure (well, his expenditure really but then he would have said that's the same thing)

Shameful Injustice

An independent inquiry commissioned by our friends Rethink Mental Illness into the state of care for people with schizophrenia and psychosis in England is calling for a widespread overhaul of the system. See our story plus links to the report here.

It says too much is being spent on the most expensive form of care, secure care, and more should be invested in prevention and community support.

The Schizophrenia Commission says care of people with schizophrenia and psychosis in England is falling "catastrophically short". It says improvements in the understanding and treatment of the condition mean it should no longer be considered a "diagnosis of despair".

Their report, "An Abandoned Illness", describes "shameful" standards of care on some acute mental health wards, which can "make patients worse rather than better". It calls for every ward in England to be brought to a standard where people would recommend them to a friend or relative: spot on - that is exactly the standard which Hafal invites people to apply in assessing services.

The report also highlights the disparity between the money spent on people with physical illness and those with mental illness; only 13% of the English NHS budget goes towards treating mental ill health, even though 23% of conditions dealt with by the NHS are mental rather than physical. It also expresses concerns that highly effective early intervention treatment teams are being cut in some areas; these are estimated to save the NHS £16,000 per person over the first three years of their illness.

My opposite number Paul Jenkins, CEO of Rethink Mental Illness, who sat on the Commission (though he found time too to join us climbing Snowdon in September!), tells us: "It's been over 100 years since the term "schizophrenia" was first coined, but care and treatment are still nowhere near good enough. It is a scandal that in 2012 people with schizophrenia are dying 15-20 years earlier than the general population and that only 7% are able to get a job. Too many people are falling through the gaps in the system and ending up in prison or homeless."

Sadly there's no reason to suppose that the experiences of people with schizophrenia and psychosis in Wales are any better than the experiences of those in England. Indeed in some respects the redevelopment of the in-patient estate in Wales lags behind England. This excellent report is a reality check.

We now have good legislation in Wales and a new mental health Strategy but the truth is that there remains a huge amount of work to do to put right the shameful injustice of how people with a serious mental illness have been treated. Above all this report tells us that the priority is to devote additional resources and effort into providing a decent service to people with the very highest needs.

Uncle Joe

I got up to go to the gym on Saturday morning and almost immediately abandoned the idea. It had been a long, if enjoyable and successful week and so I spend most of the day on the sofa.

On Sunday I do a brisk walk early morning and manage to climb above the mist into bright warm sunshine. After that I enjoy reading (vaguely appropriate for Remembrance Sunday) about the gangsters, con-artists, spongers, tarts, foreign royalty and toffs who hung out in the grandest hotels of London during WW2 in Matthew Sweet's light-weight but amusing The West End Front.

My favourite story is of the 40 members of the Communist Party led by Max Levitas who demanded access to the Savoy's very posh shelter during a bombing raid in September 1940. The police wanted to evict them but the hotel manager wisely let them in and the waiters served them tea for which the occupiers paid at Lyons Corner House rates. The whole affair was politely conducted on both sides - and hushed up in the press (apart from the Daily Worker).

The CP was at that time in a strange position as their ideological masters in Moscow were still allied with Hitler, an embarrassment which was only removed in June 1941 when 4 million Germans marched into the Soviet Union and everybody had to start loving Uncle Joe.

The Communist Party lays a claim to helping Londoners during the blitz by campaigning for deep shelters and this may have assisted in getting the London Underground opened up for this purpose although this is usually ascribed to ordinary Londoners anarchically forcing access and even breaking down the gates - not unreasonably you have to say.

More Fish In The Sea

The Wall of Death experience:-
Stage (1) Starting out. Fear factor 5/10; dignity intact...


Stage (2) On the way up. Fear factor 8/10; dignity still intact...


Stage (3) Reaching the top. Fear factor 10/10; dignity still intact and momentary signs of respect from the audience...


Stage (4) Rapid descent. Fear factor 0/10; dignity shattered by inelegant landing; all signs of respect dissolve in audience laughter...


The "Summit" event yesterday was moving, celebratory, informative and great fun with over 200 attending and massive enthusiasm for all the activities ranging from the frivolous all the way to earnest workshops on medication, psychotherapy, benefits and criminal justice plus rallies for patient and carer activists respectively.

This was a great way to celebrate the culmination of our hugely successful Movin' On Up campaign which brought Hafal together with our partners Bipolar UK and the Mental Health Foundation to fight for a good deal for people with a mental illness and their families.

A fantastic job done by Emma and other stalwarts who heroically still kept their sense of humour long after the show had ended as the vast collection of display matériel was carefully dismantled and loaded onto various vans and trucks. I'm notoriously unhelpful at this stage of proceedings but tried to assist the incredibly painful winching by hand of the VW campervan onto its trailer (you didn't think we drove it around, did you?) only to find that media-man John Gilheany who was steering it up the ramp had left it in gear!

More pics today and next week here.


Postcript:

John is quickly forgiven, not least because he had earlier sung a ballad of his own composition as part of the event's closing session, also including the "Voice of Hafal" Rikki Withers and, a new discovery, Andrew Macintosh - better known as our IT guru and guardian of the sacred VW (few staff in Hafal get away with doing just one job).

I'm surprised to find that John's song is a poean to Hafal's corporate progress with the refrain "There's more efficiency" until I realise that I have misheard what is actually a rather classy piece about unrequited love - the refrain is in fact "There are more fish in the sea".

The "Voice of Hafal" plus John G. (see above)

High Heels

We are gearing up for tomorrow's conference to mark the culmination of our Movin' On Up Campaign - inevitably the event is styled as a "Summit" (geddit?).

Hafal Events Coordinator Emma Billings tells us: "Two hundred delegates, most of them people with a serious mental illness and their families, have already booked to attend the Summit. They'll have a unique opportunity to share experiences with people from other areas and to celebrate the success of this year's campaign which has been praised by Health and Social Services Minister Lesley Griffiths AM."

Activities at the Summit include:

• Workshops on welfare reform, psychological therapies, medication, and care and treatment planning

• A Carers' Forum and Users' Rally

• Updates on Hafal's Learning Centre and Criminal Justice services.

More worryingly there is also...

• Scaling a mobile climbing wall

• Zumba and Tai Chi workouts

The trick if you want to avoid these physical activities is to wear impractical clothes (perhaps a ball-gown or top hat and tails?) and then plead that sadly you have forgotten to bring suitable attire.

Although, now I think about it, Emma was observed (at the Seminar back in May which launched the campaign) climbing to the dizzy summit of our massive "wall of death" in high heels, an impressive achievement the more so because it was done elegantly and without loss of dignity. Sadly no pictures can be found (where have you put them, Emma?) so we'll have to make do with a repeat picture (above) of our Mental Health Foundation partner David Crepaz-Keay climbing the same wall - but without high heels...so big deal!

Moustache

I'm pleased to announce a new secret weapon in the battle for resources: step forward GP and academic Simon Braybrook who has offered out of the blue to grow his moustache in support of Hafal. Now don't hesitate - get your credit card out, dust off the cobwebs, go to his Justgiving page on this link, and max out your limit with a generous payment which befits Simon's noble effort and (of course) the even nobler cause.


Postscript:

Following my suggestions for a budget-but-quality Christmas last week, including mention of the Aldi Christmas pudding at £7.99, former Hafal Chair Peter Davey contacts me to draw attention to rival purveyor of fancy goods Lidl's Snowy Lodge Luxury Christmas Pudding which he describes as "rich, packed with vine fruits, glacé cherries, and with a hint of sherry, brandy, and whisky". It's a whopping 750 grams for (wait for it) £2.99. Thanks to Peter for his canny advice (could there be a Davey ancestor from Cardiganshire who migrated to Merseyside? We may even be distant cousins) and I would add to his tip that while you are in Lidl you can pick up a keenly-priced bottle of brandy with which to set fire to this irresistible delicacy.

P C World

I have frequently used this Blog to urge everybody to use your vote in various elections both so that you can influence the result one way or another but also as a bit of self-therapy - it does you good to know you are ultimately in charge and can hire or fire the politicians.

I suppose I do again urge you to use your vote in the elections for Police and Crime Commissioners on 15 November but I can't say I do so with unqualified enthusiasm. My lack of excitement about this isn't because I don't support the principle of democratic accountability for policing. On the contrary I have long thought that many senior managers in the police have had a tendency to run their forces with an eye to public relations considerations, the classic resort for organisations which are not sufficiently accountable.

Note that this is not a criticism of the police or of their Chief Constables - indeed I speak as a solid supporter of the police whom Hafal's members consistently see as the most reliable agency among those tasked with helping people with a mental illness and their families. No, it's the politicians who are responsible for getting the lines of accountability right.

My view is that the new system might be nearly right for England although it has got off to a bad start and turn-out in the elections may be very low. However, in Wales it makes no sense. It is glaringly obvious that Wales should have just one police force - you may recall that there was previously a plan for this (former Home Secretary Charles Clarke said a single force for Wales was the "only acceptable option") but it crashed and burned because of a lot of flak about "localism" mainly fired in England; further, it is also glaringly obvious that we should make use of the existing Welsh democratic structures, namely the National Assembly, to hold policing accountable. I mean the National Assembly and not the Welsh Government: the Assembly is not the Government but holds the Government to account and that's right for policing too.

Oddly enough you would not necessarily need to devolve policing to Wales at least in the short term - the National Assembly could serve as a Police Authority under the present arrangements with the (London) Home Office still holding overall authority for police matters, although if it worked the argument for devolution could be made.

An important advantage of a single force is that it would be able to perform specialist functions more effectively and efficiently. Mental health liaison naturally comes to mind: an all-Wales force could afford a specialist team led by a more senior officer which could work effectively with mental health services and the courts.

While we waste time voting for multiple Police Commissioners in tiny Wales the Scottish Government is setting up a single force (in a country twice the size of Wales!) and those with expertise in these matters see no reason why it shouldn't work well and save money.





Postcript:

What would you call an all-Wales police force? This was discussed back in 2006 when the idea was still alive and I recollect that "Heddlu Cymru - Wales Police" was suggested but my favourite was just "Heddlu". Everybody in Wales except perhaps a hermit living in a deep cave in remotest Snowdonia knows what "heddlu" means and no other country is likely to copy it - unless there is a devolved force in Patagonia? And "Heddlu" (the root of which is of course "hedd" meaning "peace" so happily "heddlu" means something like "peace-corps") would be superior to the Irish "Garda Síochána na hÉireann" ("Guard of the peace of Ireland") which is a bit pompous and militaristic - not to say extravagant in sign-painting costs.

PPS:

During the recent riots Welsh police vans were observed with alarm on the streets of London (see picture above) as the local twittersphere wondered what the letters HEDDLU stood for, presumably a sinister Stasi-like instrument of state oppression?

Elizabethan Taffia

A weekend of exercise - two gruelling hours in the gym on Saturday and 12,000 steps recorded on the pedometer while walking in the Towy valley on Sunday morning (see above) - after which on Sunday afternoon I settle down as the rain and wind take hold outside to finish reading A.N.Wilson's The Elizabethans undisturbed by the cats who are to hand but entirely supine.

Wilson's book is great. I've read a lot of stuff on the Tudors but this explores some surprising sources (new to me) and overall has a refreshing and slightly provocative approach which is sometimes very amusing, a contrast to the work of, for example, David Starkey who is owed our thanks for invigorating history after years of Marxist tedium but is still rather self-important - he is condescending to his subjects and leaves you in no doubt that if he had been them he would have made better decisions.

By contrast Wilson respects the key players, not least Elizabeth herself, and gives a convincing analysis of their strengths and weaknesses. One intriguing theme in the book is the notion that a Welsh Taffia (Wilson uses the term) was quietly running the kingdom.

Wilson is evidently one of those rare English people who respects the Welsh and their place in history (whereas Starkey has said that Welsh history is just English history if you start from any date that matters!). Wilson points out that the Queen was very Welsh herself, not that she had a lot of Welsh blood but that's not the point of course - she was like her grandfather Henry vii who was cunning, far from headstrong, indeed slow to make decisions except when forced to (as at Bosworth; Elizabeth's equivalent was the Armada), cautious in the extreme with his resources, prepared to play the long game, but in the end courageous. This is mostly the opposite of the stereotypical English character but the underlying point which Wilson makes is that the approach actually worked for both monarchs.

At the heart of the Taffia were the Queen herself and (each side of the "work-life balance") the Cecils (father and son) who were essentially her prime ministers plus Blanche Parry (the Cecils' cousin) her Chief Gentlewoman of the Privy Chamber who was a Welsh-speaker and an influential confidante on matters well beyond the household.

Of course the Queen had other influences, not least her tutors appointed from fellows of St John's College, Cambridge, who helped her to become an accomplished classicist who could hold her own easily with the leading academics of her day; and she learnt a little Welsh too - so I'd call that a good all-round education. It is a happy and entirely plausible thought to imagine the Queen cracking discreet jokes in Welsh with Blanche during formal audiences.

Willy-Nilly

Excellent interview with the Government's mental health Strategy lead Sian Richards here, including a useful answer on the critical issue of the ring-fence...

Q: The current economic climate is very harsh. What does the Strategy say about ring-fencing money for mental health services and protecting existing resources?

A: "Together for Mental Health" reaffirms the commitment made by the Minister for Health and Social Services to the mental health ring-fence, ensuring that mental health funding is protected in these challenging financial times. It sets out clear expectations that Local Health Boards’ expenditure on mental health services must be open and transparent and signals a review of the effectiveness of the ring-fence. Spending on mental health remains the largest single area of the health budget.


The great thing about the ring-fence (so long as it's enforced!) is that it can embolden planners of mental health services in the NHS to reform their services without the risk that their Directors of Finance grab savings when redundant or time-served services are exposed.

Without the ring-fence mental health insiders are more likely to protect existing services willy-nilly even if they are out-of-date on the basis that an old-fashioned service is better than none at all. In other words the ring-fence is not just vital in preserving the resources but it's also an agent for change. For clarity the ring-fence quite rightly does not protect resources for existing services but rather requires that if a service is wholly withdrawn, slimmed down, or made more efficient then the savings must be reinvested in other mental health services.

The Minister has acknowledged that it was patients specifically who persuaded her about this matter (and actually I know which ones!) - little wonder as service-users and their families are interested in the practicalities and know that the rest of the Strategy is just so many words if the money isn't protected.


Postscript:

Revered arbiter of food quality Good Housekeeping magazine has tested Christmas turkeys and the Co-op's British Elmwood frozen birds came top (Mrs Blog had already got this very brand and it's in the freezer); meanwhile the best cranberry sauce was Tesco's at £1.49 (worst was Fortnum and Mason at £10.95). It isn't true that "you get what you pay for" and my advice is to ring-fence your Christmas budget and if you make savings by ignoring snobby brands then reinvest those savings in an Aldi Christmas pud - £7.99 and GH says "delicious" and a "real bargain" (Fortnums £24.95 and "a real disappointment").

Swing States

Three Hafal staff are presently guests of the National Alliance on Mental Illness in Pennsylvania where we are exchanging ideas on a range of issues including criminal justice and Wales' Mental Health Measure: see more about this here.

This reminds me of a visit I made to Georgia and Tennessee a few years ago where I took a look at the care and treatment of people with schizophrenia. You might have expected health-care for poor and uninsured citizens, especially in those conservative southern states, to bear invidious comparison with our system but actually the picture was mixed.

A surprise was to find that people on Medicaid (government-funded health-care for the very poor) got the best possible anti-psychotic medications - much less grudgingly than the NHS - but it turned out that this wasn't because of state or federal generosity (both fund Medicaid) but rather because the health-care providers contracted to support these patients had worked out that it was cheaper to give them the best drugs because they recovered quicker and so cost less!

Lessons here for the NHS and others about a smarter approach which can be both better for patients and yet cost less - something which requires a system of individual budgets but does not mean that the principle of universal health-care need be in any way compromised.

On which subject it was chilling to find that uninsured poorer citizens who were not eligible for Medicaid (because not quite poor enough) had no means of getting support except through acts of charity which could not be wholly depended on. In practice the patients I met were getting the treatments because providers struck deals with the pharmaceutical companies to get extra supplies of drugs thrown in with the funded prescriptions, a precarious system indeed.

To his great credit President Obama has gone a long way towards plugging this shameful gap in US health-care with his recent reforms which so far seem to be surviving the furious backlash of his political opponents and a heavyweight legal challenge. I suppose I should maintain a position of political neutrality even concerning elections in other countries (though I note that Boris Johnson is backing Obama so there's no neat cross-over) so I will balance this apparently pro-Obama point by pointing out that Mitt Romney actually introduced near-universal health-care in Massachusetts when he was Governor - although now he's doing his best to play that down! He's also got a Welsh wife but I don't think that will tip the balance for him - whereas if she had been Irish...

Romney seems to have the edge today in the polls but I'm tipping Obama to win by a whisker and possibly with less votes than his opponent under their curious system. He still seems to be clinging on for dear life to Florida, Ohio and Virginia - and if he holds them he's safe. Pennsylvania is also close - if Romney takes it he will probably take Ohio too and there will be everything to play for - so Hafal's delegates are going to have to speak loudly to get heard!

Gastronomic Paradise

Health Minister Anna Soubry (that's the Department of Health in England but this will apply to Wales too) announced today that "consumers will be able to make healthier choices about the food they eat with the introduction of a new, consistent system of front of pack labelling".

Note that she didn't say it would be "simple", however, and indeed she could not have done so as the new system is a complete mess combining three different approaches, namely "guideline daily amounts (GDA)", colour (traffic-light style) coding and "high/medium/low" text. This comes after a three-month consultation with retailers, manufacturers and other interested parties on "what a consistent, clear front of pack label should look like"!

This dog's breakfast of a compromise comes about because of a failure to agree between public health wonks and the food retailers. The public health people have been arguing for years for a simplistic, dumbed down traffic-light system distinguishing "good" (green), "so-so" (amber), and "bad" (red) foods while the retailers have had varying views but tended to want to offer more facts and less arbitrary, simple judgements. No doubt the retailers were jockeying for their best commercial interest but, whatever their motives, they were actually in the right.

The public health people make three fundamental mistakes. The first is to patronise people by suggesting that facts shouldn't clutter their finger-wagging messages. The second is to fail to see the consequences of traffic lights which would inevitably see manufacturers carefully manipulating ingredients by a small fraction in order to get a "healthier" label thereby duping the unwary. The third and far more serious problem is that they are unwittingly reinforcing the very worst attitudes towards nutrition in the UK by suggesting that entirely healthy foods like butter, cheese, bacon, chocolate etc are bad for you, thereby adding to our society's flawed relationship with food which sees many people suffering eating disorders, a high proportion of the population painfully yo-yo dieting, and, yes, a lot of obesity - itself largely a symptom of the national guilt trip about food.

The EU, no doubt because it includes countries with a much more psychologically healthy attitude to food (and less obesity), like many UK retailers supports GDAs because of course this is really all about eating a balanced diet including all sorts of food but in the right proportions (for heaven's sake - who does not know this?).

Most French people love food and are at ease with it. They do not understand why anybody would call cheese unhealthy nor do they suffer guilty self-reproach masked by gallows giggling just because they are eating a cream bun. But there are early signs that some French people are absorbing what they call "anglo-saxon" (actually meaning British and American) guilty attitudes to food and their government should resist this with every fibre in their slim bodies, if necessary turning away British public health officials at the Channel ports to stop them spreading pernicious ideas about food in their gastronomic paradise.

Lots of good information and onward links on physical health including diet here.

Postscript:

I guess I should evidence all this with one example of typical domestic French cooking I am particularly fond of...

Fry one or more pork chops in (per chop) a small knob of butter and an equal amount of vegetable oil; when they're done remove the chops to the (hot) plates which you are going to eat them off; add (per chop) a big serving-spoonful of crème fraîche (on no account the "low-fat" version - in reality a horrible concoction with added industrial gum which won't cook properly!) and two heaped teaspoons of French mustard to the juices in the pan, heat vigorously while stirring for 30 seconds, season - including a good grind of pepper - and pour over the chops. Serve with new or boiled potatoes and a big green salad on the side (you only need dress the salad lightly with vinaigrette because once you've eaten your chop you can copy the French by mixing it a bit with the remaining sauce on your plate - yum); finish the meal with fresh fruit. A good starter for this meal would be sliced big tomatoes with a splash of balsamic vinegar and a drop or two of olive oil. This works well for one person as well as numbers - and no waste necessary.

In this case the suggested light starter and pudding balance the fairly substantial main course - if you have a light main course you can have more substantial other courses. With a decent breakfast (I mean some toast and marmalade, or boiled egg and soldiers, or similar) and other secondary meal (perhaps soup, bread and a little cheese plus fruit) you can eat like this every day and slowly lose weight or maintain a healthy weight (adjusting portion sizes to your size and activity levels). It's not rocket science! So do I practise what I preach? Very imperfectly as far as eating the right amount is concerned - but I don't beat myself up which is the most important message here.

Wiggle Room

Yesterday I attended the launch of the Welsh Government's new mental health Strategy "Together for Mental Health" in Ystrad Mynach - see a summary and links to the document here. There isn't a lot to quarrel with in it. Indeed the Government has commendably listened to what Hafal (meaning patients and families) has said. A year ago I was concerned that the Government might not follow through the logic of the Mental Health Measure in its new Strategy but, in fairness, they have got that mostly right, in particular using the eight holistic "life areas" pioneered by Hafal over the last ten years to set out methodically what different agencies need to do to support patients' recovery.

A new feature of the Strategy is that it spends a lot of time looking at the wider issues of public health and public attitudes. What is said about these issues is fair enough but you could form the impression reading the Strategy that significant resources were to be expended on those wider matters whereas in reality the entire Government expenditure on such things would pay for little more than one specialist in-patient bed. But then the Government has got that right: there isn't any new money and if there was we would be arguing that it should be spent on direct services for those most in need.

The least sexy but most important part of the whole Strategy is the undertaking to continue (and test the functioning of) the ring-fence around NHS mental health spending. Nothing will improve if the "floor not ceiling" (as the Minister described it on the telly) of a minimum level of NHS funding for mental health is not maintained as the squeeze on public expenditure tightens in the next couple of years. But at present there is a suspicion that the significant "discretion" which Directors of Finance in the LHBs have about how they allocate costs may well mean that the ring-fence is not all it's cracked up to be. We urgently need to shed light on the detail of mental health costs in the LHBs so that there is no wiggle room.

Meanwhile there was extensive coverage in the media of Hafal's clients and staff commenting on the launch, including me peering over my £10 Tesco glasses in a manner which drives my younger brother potty with irritation. I thought it looked rather authoritative.


Postscript:

"Wiggle room" is correct, not the increasingly common "wriggle room" (notwithstanding its pleasing alliteration).

Imagine Your Goals

One of the delights of our recent Movin' On Up Snowdon Challenge was bumping into Hafal's former Chair Peter Davey and family at the Basecamp Bash in Llanberis. Anybody who knows Peter will be aware that as well as having a great track record of supporting people with a mental illness in Wales he is a Liverpudlian by origin and a longstanding and stalwart supporter of the Blues.

Peter draws my attention to the excellent work that his club is doing on mental illness through their charitable arm "Everton in the Community". Since 2007 the club has developed a major project "Imagine Your Goals" employing a full-time officer and creation of a mental health football league which regularly supports over 150 people.

Yesterday Everton in the Community was named "Charity of the Year" in the prestigious Charity Times awards, not least for its work on mental health.

See this link for more details of this remarkable initiative which is a credit to Merseyside's leading club (4th in the Premier League while the Reds languish at 14th as former Swans manager Brendan Rogers wonders why he moved there).

A Fine Line

View of Welshpool - Edward Dayes (1763–1804)

Our Facebook editors have linked an interesting story about creativity and mental illness here. This is always a tricky one because of course people with a mental illness can be creative - indeed there is no limit to their potential as evidenced by the success of famous artists and writers with a mental illness through the ages (see one example above and below) - but we need to be careful not to romanticise mental illness. I have previously commented on the "popularisation" of bipolar disorder here and creativity is an aspect of that.

Driving in this morning I hear John Humphrys on Radio 4 talking to the Swedish researcher who published the report and it seems that bipolar in particular is somewhat associated with people who engage in creative activities. The penny drops as I recollect how so many people I have met with bipolar talk about creating books, films, etc - not always, it has to be said, very realistically.

Those who are counselling people with a mental illness who are driven to these creative activities need to balance encouraging them on the one hand with honesty about the limitations of their skill and their prospects of being taken seriously. There is nothing more dispiriting than seeing poor quality art, poetry, music etc celebrated ecstatically in competitions, publications, and performances organised by mental health organisations, presumably on the patronising assumption that it is remarkable that somebody with a mental illness can create anything at all. For clarity I should say that there is nothing wrong with encouraging the use of art, writing, and music for therapeutic purposes - but that shouldn't include extravagant praise of the results if they are honestly not much good.

I like to think that Hafal has mainly got this right and where we have celebrated stuff created by our clients - including things I've put on this Blog - it stands a test of being worthwhile in its own right and without "allowances" being made. But it's a fine line.


The English Bridge, Shrewsbury - Edward Dayes