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

Bonfires

It was a poor summer as far as the weather was concerned and in some ways autumn can be less frustrating as expectations are not high and so good weather is received with delight and gratitude - certainly that was my response this weekend to the cool but sunny weather. My autumnal picture shows the M4 going west past Swansea at 6.48 a.m. on Saturday. In town I bought a stack of pumpkins for both Hallowe'en display and culinary purposes - Mrs Blog only got one medium-sized specimen from her garden, another result of the rubbish summer.

Everybody bangs on about autumn colours - referring to deciduous trees changing appearance - which can indeed be interesting but also a bit dreary. I prefer R.L.Stevenson's poem for children Autumn Fires which ends...

Sing a song of seasons!
Something bright in all!
Flowers in the summer,
Fires in the fall!

I like the idea that autumn's answer to summer colour isn't a dull vista of dead leaves but rather the bright flames of bonfires (actually made up of those dead leaves) from October onwards and of course even brighter fire-works on Guy Fawkes night.

Dodgy

I confess it makes me queasy to see self-righteous celebs with so little to complain about cunningly lining up with severely-wronged members of the public like Milly Dowler’s family in the lobby group "Hacked Off". This powerful group is trying to make the UK government legislate to control the press - as the ill-conceived Leveson Enquiry may indeed recommend. I believe that the people who have most to lose from a controlled media are the weak and vulnerable, including people with a mental illness - and that it is worth the risk of some salacious or intrusive coverage of famous people to keep the media unfettered and able to point out abuses of people without a voice.

And anyway is the media so out of control in the UK? Let's examine the facts...

The criminal law is already available to deal with such things as phone-tapping and bribing police officers; our severe libel laws already go too far in enabling rich people to attack and impoverish journalists and publishers, even to the point of encouraging "libel tourism" where foreign litigants pursue their action in the UK because of the rich pickings to be had here and the burden of proof placed on the defendants; and the "right to privacy" under European law is looking increasingly dodgy, for example protecting from exposure powerful members of the establishment who use prostitutes (frequently vulnerable women and men with drug and mental health problems exploited by brutal pimps) - isn't the public entitled to judge the true worth of powerful people who demand our respect by reference to such reprehensible behaviour? Meanwhile the UK Government wholly controls the funding (and so can always call the shots) of our major broadcaster the BBC with its much-vaunted "unique system of funding" (i.e. you go to prison if you don't pay for it even if you never watch it but prefer other telly providers).

We all know that the media can behave badly, whether it's the old News of the World or indeed the Guardian (which after taking the moral high ground actually got the Dowler hacking story wrong too, illustrating that the truth is an elusive quarry). But do we seriously think that celebrities need more protection from media interest in their activities?

Jimmy Savile must be laughing in his unmarked grave.

Corker

There has long been a tiresome competition between successive UK Governments of different parties to come up with populist criminal justice measures which have tabloid appeal but are not based on evidence. This competition was suspended under the present government while good old uncle Ken (Clarke) kicked off his suede shoes, puffed his cigar benignly in the Ministry of Justice and restrained his colleague Theresa May over at the Home Office (who is also famous for her choice of shoes) from making rash policy suggestions. But with Ken gone it is business as usual.

Mrs May has come up with a corker and you have to pinch yourself to believe you heard her right. She proposes to set back jurisprudence 3,000 years by letting victims choose the punishment of criminals, thereby reintroducing the concepts of vengeance, vindictiveness and vendetta which dogged primitive societies and which law was invented to restrain.

People with a mental illness are often victims of crime and for the life of me I don’t see their interests being served by inviting them to get involved in invidious decisions about what to do with the people who have wronged them – they want the courts to sort that out while they get on with recovering their nerve.

Where people with a mental illness are the perpetrators of crimes it is important that sentences are expertly determined certainly to protect the public but also to advance their recovery and rehabilitation, not matters which a victim is likely to know much about or want to consider.

Everybody agrees that victims need better support but that should not be confused with a fundamental principle of civilised societies that determining punishment is a matter for society as a whole and must be removed from the context of personal conflict.

There were two other proposals. Some chaotic or out-of-control people with a mental illness may face injury - or even death - from the wheeze of allowing householders to use disproportionate violence against intruders. Doesn't "disproportionate" mean "unreasonable" and so this must a priori be wrong? Isn't defining what is proportionate or reasonable the real issue here? And the "Two strikes means life" idea will inevitably lead to injustice as specific cases come to court - such catch-alls (aping similarly simplistic and now discredited measures in the US) always do...

Link to Hafal's criminal justice services here.

Chunky Chips

Off to the Senedd yesterday for the culmination of Movin' On Up, our summer-long national campaign led by mental health service users and carers and supported by Hafal along with Bipolar UK and the Mental Health Foundation. Health and Social Services Minister Lesley Griffiths AM (along with a big turn-out of AMs of all parties and a large contingent of service users and carers from across Wales plus key mental health professionals) welcomed the campaign microbus back from its epic 22 county trip around Wales. More brilliant pics and details on Facebook here.

The event also saw the premiere of a film of the Snowdon Challenge which took place on 28th September when 100 service users, carers and professionals - and me, as if I could forget! - scaled Wales' highest peak. It will be on-line shortly.

The Minister told us: "It is very important we ensure service users and carers have their say on the policies and services which we know impact on their daily lives. Movin' On Up accomplished just that. It has empowered service users, families and their carers and also highlighted the crucial role the third sector plays. Hafal and its partners, Bipolar UK and the Mental Health Foundation, deserve our thanks for making the campaign such a success over the summer.

"I was particularly interested to learn of the recent climb of Snowdon. The climb neatly symbolised the desire of service users to reach new heights and maximise their potential for recovery and to take control of their lives.

"Service users were at the heart of Movin' On Up and their views also informed the Welsh Government. Our philosophy that service users should be involved in the planning and delivery of care can be seen in both the Mental Health (Wales) Measure and the forthcoming Mental Health Strategy for Wales. 'Together for Mental Health' is one of the best Strategies I've seen as Minister and AM since I've been here since 2007. I think the reason for that is because service users have had such a big input in to it."

We and our partners are extremely pleased with the campaign which has been a great success. In particular as Lesley says the Government has indeed listened to us and ensured that the Measure and its Regulations and Code of Practice prescribe a holistic Care and Treatment Plan format and set timescales for producing Plans. We are also optimistic that the forthcoming Mental Health and Wellbeing Strategy and accompanying Delivery Plan will recognise that mental health services should be commissioned in response to the needs identified in Care and Treatment Plans - and that they must address all eight life areas included in those Plans.

By the time I get to the Senedd caterers' sandwiches they are all gone except the veggie ones, not necessarily a disaster but in this instance it is a frugal experience as the filling is a spinach leaf unadorned by any flavoured or calorific sauce. I am relieved on returning home to find that dinner is a substantial chicken breast schnitzel with a crunchy coating, pommes de terre Pont Neuf (aka chunky chips), and a richly-dressed salad. Oh, and cheese. And tiramisu - Mrs B's special recipe with dark rum instead of the traditional Marsala. Equanimity is duly restored.

Belting

World Mental Health Day tomorrow so Movin' On Up will finish its tour of Wales at the Senedd where the Minister of Health Lesley Griffiths AM will greet the campaign campervan plus a large contingent of patients, families, and mental health professionals.

Meanwhile in anticipation of the day Hafal Chair Elin Jones gave a belting interview on S4C's Prynhawn Da magazine programme yesterday. Follow this link (22 mins in) and if you don't speak Welsh try the subtitles which are eccentric but you can get the gist.

With or without subtitles you can in any case see the evidence of Elin's commitment to the cause - in her Hafal blue hair extensions. Am I alone in thinking that this admirable corporate gesture sets a challenging precedent? Hair extensions are probably not for me but there are other possibilities...





Postscript:

"Belting"? Not a word I use normally but our Young People's Hub editor John Gilheany assures me that this is the adjective of choice among young people to denote excellence so I thought I should give it an outing in the spirit of ensuring that this Blog retains its red-hot, contemporary and à la mode status. Apparently "wicked" and "peachy" are old hat which is a shame. In the highly improbable event of Elin giving a poor interview I could deploy the vivid and still popular "pants". And there again I might just keep my own counsel.

On Top Of The World

Wow that was quite a day!

Exceeding all our expectations 100 clients, carers and professional staff climbed Snowdon on Friday in challenging conditions, in particular the familiar but spooky cloud cover that invested the final 800 feet to the summit. Fortunately the rain mainly held off until the final minutes (but drenched the check-point supervisors who of course had to stay up all day and come down last sweeping the slower climbers before them).

Along with representatives of the three Movin' On Up partners we were joined on the day by a big team from the Welsh Government plus contingents from our friends in Mindwise and Rethink, Hafal's sister charities in Northern Ireland and England respectively.

But the day belonged to the service users who defied the stigma which assumes their passivity and marched all the way up and down again in high spirits. Remarkably only four people didn't make it to the top (and no shame in that - they did their best!) and there were no significant injuries, always a possibility with so many people involved however well the risks are assessed.

Meanwhile a further 60 Hafal activists from North Wales turned out to support the climbers and enjoy a day of activities at our "Basecamp Bash" in the intriguingly-named Electric Mountain Centre...



I found the climb enjoyable but harder than the dry run back in July. I think that was because I stopped to talk to people and so didn't proceed methodically at my own pace. Any pause seemed to lead rapidly to aching muscles and stiffness! This was truly a tough challenge and no mere gesture.

Mental Health Foundation service user Terry Davies said: "Twenty years ago the idea that an event like this, which is being led by the people who are most important in the process, would have taken place would not have been believed. People with serious mental illness have many mountains to climb in their journey towards recovery, but when we work together – as we have during the campaign - we can move mountains. We are all capable of achieving great things as we have today. It’s only right that we shout about our achievements from the heights - and there aren’t many places higher than Snowdon!"

And Sue Wigmore, Manager of Wales Bipolar UK, said: "The Movin’ On Up campaign has achieved a lot this summer. It’s brought service users, carers and mental health professionals together to consider the excellent legislation we have in Wales and the best way to take it forward. I’ve attended some of the events which have taken place across the country and I’ve been delighted by the lively debates that have taken place. Friday’s climb capped the campaign in style. I took part in the Pen y Fan climb in May; it wasn’t easy. Today’s climb was an even tougher challenge, but one that service users rose to. The campaign has provided a great springboard for campaigning in future years and how to tackle the next big challenge: how to bridge the implementation gap we have in Wales – the gap between the fine legislation and  patchy service delivery."

A big vote of thanks to Emma Billings and the other staff and volunteers who made the day such a success - I know that this stretched us further than any previous event and yet everything worked like a well-oiled machine - apart from my poor legs.

Next week on World Mental Health Day the campaign microbus will celebrate its journey around all 22 counties of Wales (Snowdon  - in Gwynedd of course - was the final stop) at the Senedd where we will be joined by the Minister of Health Lesley Griffiths AM and other guests including clients from North and South Wales: watch this space.